Nfpa 99 Ed 2021 Standard

NFP�
10-
Health Care Facilities Code

2021
II]
NFPA1
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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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technologies, innovations, and methods as these develop over time and that NFPA Standards reflect
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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
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 Kevin T. Porter, Encore Wire Corporation, TX [Ml
Rep. The Aluminum Association, Inc. Rep. Narional Electrical Manufacturers Association
H. David Chandler, Newcomb & Boyd. GA [SE) Don Rabel, Mid-West Electric Company, TX [IM)
Rep. NFPA Health Care Section Rep. National Electrical Contractors Association
Nancy W. Chilton, Schneider Electric, NC [Ml Vincent M. Rea, TLC Engineering for Architecture, FL [SE]
Dan Chlsholm,Jr., MG! Systems, Inc., FL [IM) Keith Riechers, Hill Rom Company, IN [Ml
Charles Cowles, American Society Of AnesthesiologisLs, TX [Cl Brian E. Rock, Hubbell Incorporated, CT [Ml
David A. Dagenais, Partners/Wentworth-Douglass Hospital, NH [Ul Steve R . Sappington, Caterpillar Inc., GA [M)
Richard L. Day, Michigan State Fire Marshal's Office, Ml [El Kevin A. Scarlett, Washington State Deparm1ent of Health, WA [El
Vincent Della Croce, Siemens, FL [Ml Ronald M. Smidt, Atrium Health, NC [Ul
Chris M. Finen, Eaton Corporation, TN [M] Rep. American Society for Healthcare Engineering
Pamela Gwynn, UL LLC, NC [RT) Joshua Vann, MB Healthcare, NJ [U)
Ja.�on RyanJamil, Cleveland Clinic, OH [U) Walter N. Vernon, IV, Mazzeni, CA [SE ]
GaryJ. Krupa, US Department ofVeterans Affairs. NE [U) Leonard W. White, Stanford White Associates Consulting Engineers,
Stephen M. Lipster, SNAG Consulting, OH [SE] Inc., NC [SE)
Robert Wolff, BRE Engineers, NC [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
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)
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] James K. Lathrop, Koffrl Associates, Inc., CT [SE]
Chad E. Beebe, ASHE · AHA, WA [U] Dale L. Lyman, Greeley Fire Department, CO [El
Rep. American Society for Healthcare Engineering Bret M. Martin, CNA Insurance, NC [I]
JeffN. Besel, Obermiller Nelson Engineering, MN [Ml Michele Mucia,Johnson Controls, IL [M]
Rep. Automatic Fire Alarm A�sociation, Inc. Rep. National Electrical Manufacturers A�sociation
Bruce D. Brooks, Noelker and I-lull Associates. Inc., VA [SE] James S. Peterkin, TLC Engineering, PA [SE]
Rep. American Institute of ArchitecL� Milosh T. Puchovsky, Worcester Polytechnic Institute.. MA [SE]
Gordon D. ButTill, Teegor Consulting Inc., Canada [U] Pamela Reno, Telgian, OH [SE]
Rep. Canadian 1--Jeahhcare Engineering Society
Joe Sdbetta, BuildingRepom, GA [M]
Michael A. Crowley,JENSEN HUGHES, TX [SE]
Robert Sontag, State of Colorado, CO [El
Roger N. Dahozy, US Deparanent of Health & 1-luman Services, AZ
[E] Frank L. Van Overmeiren, Fire Protec Lion & Code Consultants,
LLc., IN [SE]
Richard L. Day, Michigan State Fire Marshal's Olli.ce, Ml [El
Joshua Vann, 1\-18 Healthcare, NJ [U]
CarlJ. Ferlitch, Jr., Chubb (;roup of Insurance Companies. PA [I]
John L. Williams, Wa�hington State Department of Health, WA [El
Henry Kowalenko, Illinois Department of Public Healt.h, IL [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)
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
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) Jack Poole, Poole Fire Protection, Inc., KS [SE]
Pete Brewster, US Department of Veterans Affairs, WV [U) Pamela Reno, Telgian, OH [SE]
David A. Dagenais, Partners/Wentworth-Douglass Hospi1<-i.l, NH [U] Patrick C. Rhinehart, Northside Hospital, GA [U)
NicholasE. Gabriele,.JENSEN HUGHES, CT [SE) Kevin A. Scarlett, Washington State Departn1ent of Health, WA [El
Sharon S. Gilyeat, Koffel Associates, Inc., MD [SE) James P. Simpson, Electrical Training Alliance. MN [L)
KennethJ. Hebert, The.Joint Commission, IL [E] Rep. International Brotherhood of Electrical Workers
Dale L. Lyman, (;reeley Fire Departn1ent. CO [El Jerry Spickler,.Johnson Controls, OH [M)
James L . Paturas, Yale New Haven Heahh System, CT [U) 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] Barry E. N ewton, WH&.. International. Inc., NJ\'i [SE]
Rep. American Society for Healthcare Engineering Dennis Nosldn, Dennis Noskin Architects, NY [SE]
W. Robert Bryant, Perry Baromedical Corporation, TX [Ml Robert B. Sheffield, International ATMO, Inc., TX [U]
Francois Burman, Divers Alert Network, NC [SE] John M. Skinner, Medical Equipment Technology, Inc.. GA [IM]
Mario Caruso, Hyperbaric Consulting LLC, FL [SE] Deepak Talati, Sechrist Industries. Inc., CA [M]
Mark Chlpps, Life Support Technologies Group Inc.. NY [U] Nam To, US Food and Drug Administration, MD [E]
Jolene E. Cormier, Baylor Medical Center. TX [U] John L. Williams, Washington State Department of Health, WA [El
Keith Ferrari, Praxair, Inc., NC [M] Rep. NFPA Health Care Section
Adrian Garay, HYPERBARIC MODULAR SYST EMS, Inc., CA [M]
Derail Garrett, Undersea Hyperbaric Medical Society (UHMS), FL
[U]
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
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
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 Edward A Litvin, US Depar1men1 ofVe1erans Affairs, DC [U)
Grant A. An derson, Bard, Rao & A1hanas Consulting Engineers, Rep. US Depar1me111 of Veterans Affairs
LLC, MA [SE] Anthony Lowe, Allied Hospital Sys1ems, MD [IM]
Chad E. Beebe, ASHE -AHA, WA [UJ James L. Lucas, Tri-Tech Medical Inc., OH [M]
Rep. American Sociecy for Healthcare Engineering Bret M. Martin, CNA Insurance, NC [I)
David Braidich, US Army Corps of Engineers, VA [U) Jeffer y F. McBride, Red Lion Medgas Consultams, Inc., DE [SE]
Dana A. Colombo, PIPE/Na1ional ITC Corporation, L-\ [L) Douglas Miller, Loe al 190, Ml [L)
Charles Cowles, American Sociecy OfAnes1hesiologisls, TX [ CJ David B. Mobile, Medical Engineering Sei,ices, LLC, WV [SE)
Mark Fasel, V iega LLC, IN [M] Dave Preble, American Dental Association, IL [U)
Keith Ferrari, Praxair, Inc., NC [M) Rep. American Demal Associa1ion
Rep. Compressed Gas Association Kevin A. Scarlett, Washing1on Stale Depanmem ofHealth, WA [El
Michael Frankel, Utility Sys1ems Consul tanLs, FL [SE] Sean Schwartzkopf, S1a1e ofColorado, CO [El
Rep. American Society of Plumbing Engineers RonaldJ. Schwipps, WinRock HeahhCare. IN [M)
Andrew Fuchs, Local 137, IL [L)
E. Daniel S hoemaker, Accmron Inc., AZ [�1)
Neil Gagne, ,vm. G. Frank Medical Gas Testing & Consulting, LLC,
Allan D. Volz, OSF HealthCare System, IL [U]
NH [SE]
KevinJ. Walsh, EM Duggan Inc., MA [IM]
Ed Golla, TRI/ Air Testing, TX [RT)
Rep. Mechanical ComracrnrsAssociation ofAmerica, Inc.
John C. Gregory, Henderson Engineers_. AZ [SE)
Jonathan C. Willard, Acute Medical (;as Services. NH [SE)
Scott Hamilton, ASSE Imeruational, IL [U)
Rep. Imernaiional Association ofPlumbing & Mechanical
Officials
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
NFPA99 1.1.3.3 Requirement� fo1· piped gas an<l vacuum systems 111
h)perbaric facilities are covered in Chapter 14.
Health Care Facilities Code 1.1.3.4 Requirement� for piped dental gas an<l vacuum
systems are cove1·ed in Chapte1· 15.
2021 Edition
1.1.4 Electrical Systems.
IMPORTANI' NOTE: This NFPA document is made available for 1.1.4.1 Chapte1· 6 covers the performance, maintenance, and
use subject to imporlant notices and legal disclaimers. These notices testing of electrical systems (hoth normal an<l essential) in
and disclaimers appear in all publications containing this document health care facilities.
and may be found under the heading "Imporlant Notices and
Disclaimers Concerning NFPA Standards. " They can also be viewed 1.1.4.2 The following a1-eas are not ad<lressed in this code, but
at www. njj,a.orgldisclaimers or obtained on requestfrom NFPA. are addressed in other NFPA documents:
UPDATES, ALERTS, AND FUTURE EDITIONS: New editions of (1) Specific 1·equi1·ement5 for wising and installation of elec
NFPA codes, standards, rerommended practices, and guides (i.e., tt·ical systems and component� thereof are covered 111
NFPA Standards) are released on scheduled revision cycles. This NFPA. 70.
edition may be superseded by a later one, or it may be am ended (2) Requirement5 for illumination an<l identification of
outside of its scheduled revision cycle through the issuance of Tenta means of egress in health ca1·e facilities are cove1·ed 111
tive Interim Amendments (TIAs). An oJJicial NFPA Standard at any NFPA 101.
point in time consists of the current edition of the document, together (3) Requirement5 for installation, testing, an<l maintenance
with all TIAs and Errata in effect. To verify that this document is the of fit·e protection signaling systems a1·e covere<l in
current edition or to determine if it has been amended by TIAs or NFPA 72.
En-ata, please consult the National Fire Codes® Subscription Seroire (4) Requi1·ement5 fo1· installation of fire pumps are cove1·ed
or the ''List of NFPA Codes & Standards" at www.nfpa.org/docinfo. in NFPA 20, except that the alternate power source is are
In addition to IIAs and En-ata, the document information pages also pe1·mitted to he the essential electrical system.
include the option to sign up for alerts for individual documents and (5 ) Requi1·ement� fo1· installation of stationaty engines and
to be irroolved in the development of the next edition. gas turbines are covered in NFPA 37.
NOTICE: An asterisk (*) follm\�ng the numher 01- lette1-
designating a paragraph indicates that explanat01y mate1·ial on
1.1.5 Informa tion Technology and Communications Systems.
Chapter 7 covei-s the perfo1·mance, maintenance, an<l testing of
the paragraph can be found in Annex A.
information technology and communications systems in health
A reference in brackets r l following a section or paragraph
care facilities.
indicates material that has been extracted from another NFPA
<locument. Extracted text may be edite<l for consistency an<l 1.1.6 Plumbing. Chapter 8 covers the perforntance, mainte
style and may include the revision of internal paragraph refer nance, and testing of plumhing systems in health care facilities.
ences and other references as appropriate. Requests for inter
pretations 01· revisions of extracte<l text shall be sent to the 1.1.7 HVAC Systems. Chapter 9 cove1·s the perfo1·mance,
technical committee responsihle for the source document. maintenance, and testing of heating, cooling, and ventilating
Information on reference<l an<l extracted publications can in health care facilities.
be found in Chapte1· 2 an<l Annex D.
1.1.8 Electrical Equipment.
Chapter 10 cove1·s the perform
ance, maintenance, and testing of electrical equipment in
Chapter I Adminislration health care facilities.
1.1.9 Gas Equipment. Chapter 11 covers the performance,

I.I Scope. maintenance, and testing of gas equipment in health ca1-e
I.I.I The scope of this code is to establish minimum criteria facilities.
as follows in 1.1.2 through 1.1.14.
LI.IO* Emergency Management. Chapter 12 establishes crite-
1.1.2 FWidamentals. Chapter 4 establishes c1·ite1·ia for levels of 1·ia fo1· emergency management in the development of a
health care sen,ices or systems ba�ed on risk to the patient�. program for effective disa.�ter preparedness, response, mitiga
staff, 01· visito1·s in health care facilities. tion, an<l recovery in health ca1·e facilities.
1.1.3 Gas and Vacuum Systems. 1.1.11 Security Management. Chapter 13 establishes criteria
for security management, including management controls,
1.1.3.1 Chapter 5 covers the performance, maintenance, mitigation practices, staff training, and program evaluation in
installation, and testing of the following: health care facilities.
( 1) Nonflammahle me<lical ga� systems with opei-ating pres
1.1.12* Hyperbaric Facilities. Chapter 14 establishes criteria
sures below a gauge pressure of 2068 kPa ( 300 psi)
for design an<l operation of hype1·baric chambe1·s and facilities.
( 2) Vacuum systems in health ca1·e facilities
Chapter 14 cove1·s electrical, fire, pressm·e, and gas hazards
( 3) ,vaste anesthetic gas disposal (WAGD) systems, also refe1·
a�sociated with hype1·baric facilities that are used. or intended
red to as scavenging
to be use<l, for medical an<l experimental procedures at gauge
(4) Manufactm·e<l assemblies that are intended fo1· connec
p1·essures from O kPa to 690 kPa (0 psi to 100 psi).
tion to the me<lical gas, vacuum, or \VAGD systems (also
1·efen-ed to as scavenging) 1.1.13 Dental Gas and Vacuum System. Chapter 15 covers the
performance, maintenance, and testing of <lental gas and
1.1.3.2 Requirements for po1·table comp1·essed gas systems are
vacuum systems in health care facilities.
covere<l in Chapter 11.
2021 Edition
REFERENCED PUBLICATIONS 99-15
1.1.14 Features of Fire Protection. Chapte1· 16 covers the ( l) Category l spaces

performance, maintenance, anrl testing of fire protection (2) Category 2 spaces
equipment in health ca1-e facilities. (3) Category 3 spaces
(4) Category 4 spaces
1.2 Purpose. The purpose of this code is to provide minimum
requirement� for the installation, inspection, testing, mainte 1.3.4.2 Anesthesia. It shall be the responsibility of the health
nance, pei-formance, and safe practices for facilities, mate1-ial, ca1·e facility's governing body to designate anesthetizing loca
equipment, anrl appliances. tions.
1.3 Application. 1.3.4.3 Wet Procedure Locations. It shall be the responsibility
of the health care facility's governing borly to rlesignate wet
1.3_1 This code shall apply to all health care facilities other procedure locations.
than home care and vete1·ina1·y care, except as requi1·erl by
1.3.1.1. 1.4 Equivalency.
1.3.1.1 Hyperbaric chambers for veterinary care shall be in 1.4.1 Nothing in this code is intenderl to prevent the use of
acc01·rlance with the 1·equi1·ements ofChapte1· 14. systems, methorls. 01- devices of equivalent or superior quality,
strength, fire resistance, effectiveness, durability, anrl safety to
1.3.1.2 This code is intended for use by those pe1·sons involved those prescribed by this corle. Technical rlocumentation shall
in the design, construction, inspection, and operntion of health be submitted to the authm·it:y having ju1·isdiction to rlemon
ca1-e facilities and in the rlesign, manufacture, anrl testing of strate equivalency. The system, method, or rlevice shall be
appliances anrl equipment userl in patient care rooms of health approved for the intended purpose by the authority having
can· facilities. jurisrliction.
1.3.1.3* Facilities that employ systems, equipment, 01· applian 1.4.2 Alternative systems, methorls, or devices approved as
ces that are subject to regulation by this code shall not be equivalent by the authority having jurisdiction shall be recog
1-equirerl to be subject to any other provisions of this corle nized as being in compliance with this code.
unless so rli1·ected by the scope of the indivirlual chapte1·(s) of
this code or as directerl by the authority having jurisdiction's 1.4.3 The authority having jurisdiction shall be permitted to
adoption of this corle. grant exceptions to this code.
1.3.2 Construction anrl equipment 1·equirement� shall be 1.5* Units. Prima1y unit� will be trnde units, and secondaty
applied only to new construction and new equipment, except units will be the conversion.
as modified in inrlividual chapters.
1.6 Code Adoption Requirements.
1.3.2.1 Only the alte1·ed, 1·enovaterl, 01· morlernizerl portion of
an existing system or indivirlual component shall be required 1.6.1 The effective <late of application of any provision of this
to meet the installation and equipment requirements stated in code is not rletermined by the National Fire Protection Associa
this corle. tion. All questions related to applicability shall be di1·ected to
the authority having jurisdiction.
1.3.2.2 If the alteration, renovation, or morlernization
adversely impacts the existing performance requirements of a 1.6.2 Enforcement. This corle shall be administered and
system 01· component, additional upgrnding shall be requi1-erl. en.forcerl by the authority havingjurisrliction. (SPP A.nnPx Cfor a
smnplP wnrdingfor enabling legislatinn.)
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 Chapter 2 Referenced Publications
that such use constitutes a rlistinct hazard to life.
2.1 * General. The document� referencerl in this chapter, or
1.3.2.4 Rerlucing safety features in existing systems shall not portions of such rlocuments, are referenced within this code
be permitted where such is requi1·ed for new construction or anrl shall be conside1·ed part of the 1-equirement� of this code,
equipment. and the following shall also apply:
1.3.3 Polici es. (1) Document� referencerl in this chapter, or portion of such
document�, shall only be applicable to the extent called
1.3.3.1 The health care organization shall ensure that policies for within other chapters of t his code.
are established and maintainerl that permit the attenrling merli (2) Where the requirements of a referenced code or stanrl
cal professional to supersede the requirements of this code in ard dille1· from the requi1·ements of this code, the
01·de1· to satisfy the eme1·gency neerls of any patient. 1·equi1·ements of this code shall govern.
1.3.3.2 Each application of the provisions of 1.3.3.1, where (3) Existing builrlings or installations that do not comply with
this code's requirement� are superserlerl to satisfy the emer the provisions of the codes or standards referenced in
f
gency needs o a patient, shall be clearly documented anrl this chapter shall be permitted to be continued in sen-ice,
1·eviewed with the intent of meeting similar futu1·e neerls within provirlerl that the lack of conformity with these docu
the requirements of this code. ment� rloes not present a serious hazarrl to the occupant�
as rleterminerl by the authority having jurisdiction.
1.3.4 Patient Care Spaces. f J0J:2.1 l
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):
2021 Edition
2.2 NFPA Publications. National Fi1·e Protection A�sociation. NFPA 853, Standard fnr the Installatinn of Statinnar y Fill'l Cell
1 Batterym arch P ark, Quincy, MA 021G9-7471. Pnwer Systems, 2020 edition.
NFPA 1600®, Standard nn Cnntinuity, Emergen,y, and Cri'iis
NFPA 10, Standard for Portable Fire Extinguishns, 2018 edition.
Management, 2019 edition.
NFPA 13, Standard for the lnslallatinn of SprinldM Systl'1m, 2019
edition. NFPA 2001, Standard nn Clean ,4g1>ntFire Extinguishing Systems,
2018 edi tion.
NFPA 14, Standard for the installation of Standpipe and HnsP
-�vstnm, 2019 edition. NFPA 5000®, Building Gmstruction and Safety Coders, 2021
edition.
NFPA 20, Standard for the Installation of Statinnary Pumps for
Hre Pmtertinn, 2019 edition. 2.3 Other Publications.
NFPA 25, Standard for the Inspertinn, ]ps/ing, and Mainte nrm1:e
nf Water-BasNl Fire Pmtfftinn Systnn�. 2020 edition. 2.3.1 AAMI Publications. Associ ation for the Advancement of
Medical Instrnmentation, North Glehe Road, Suite 300, Arling
NFPA 30, Fla11111wble and Cmnbustible Liquids Cnde, 2021
ton. VA 22203.
edition.
NFPA 31, Standard for the Installation nf Oil-Burning 1.'quipment, ANSI/AAMI ESfi0G0l-1, I\,fediml electrii:al equipment - Part 1:
2020 edition. (',eneral requirements for ba1i1.· safety and essmtial f>erformanre, 2012.
NFPA 37, Standard for the Installation and u�e nf Statinnary
2.3.2 ANSI Publications. American National Standards Insti
Cmnlmslinn Engi.rws and (',as Turbine.1, 2018 edition.
tute, Inc., 25 West 43rd S treet, 4th Floor, New York, NY 10036.
NFPA 45, Standard nnFire Pmtfftinn fnr Laboratnril'-1 U�ing Chm1-
iral1, 2019 edition. ANSI B57.l, Cnmpressed (',as Cylinder Valve OutlPI and Inlet
NFPA 54, National Fuel (',as Cnde, 2021 edition. Cnnnertinns, 19G5.
NFPA 55, Cmnpressed (',ases and Cr yngenir Ruid� Cnde, 2020 ANSI Zl3G.3, Ameriran National Standard for Safe U,e nf La1ers
edition. in Health Care, 2018.
NFPA 58, Liquefied Petmlewn (',a_1 Cnde, 2020 edition.
NI-PA 7rP, National E!Pdriral ('nde ®, 2020 edition. 2.3.3 ASHRAEPublications. ASHRAE, 1791 Tullie Circle, NE,
NFPA 7:P, 1\lational Fire 1tlarm and Signaling Cndl", 2019 Atlanta, GA 30329-2305.
edition. ASHR-\E 90.1, EnPrgy Standard for Buildings Exmpt Low-Rise
NFPA 82, Standard nn Inrinemlor.1 and Waste and Linen &.tidential Buildings, 20lG.
Handling Syste111s and 1.'quipmmt, 2019 edition.
NFPA 90A, Standard for the Installation nf ,4ir-Conditinning and ASHRA.E 170, Ventilatinn nf Health Care Fat:ilities, 2017, includ
Vmtilating Systmns, 2021 edition. ing Addenda a.
NFPA 91, Standard for Exhaust Syste111sf"r Air Cnnveying nf 2.3.4 ASME Publications. American Society of Mechanical
Vapors, C11sl'-1, 1'iist1, and Partirulate Snlids, 2020 edition. Engineers. Two Park Avenue. New York. NY l00lG-5990.
NFPA 96, Standard for l1Pntilatinn Cnntml andFire Pmtn:tinn nf
Cmmnerrial Cnnking Operatinns, 2021 edition. ASME Al7.l/CSA B44. Safety Code fnr Elevators and fai:alatnrs.
NFPA IOI ®, Life Saffty Cnde®, 2021 edition. 2016.
NFPA 110, Standardfor fanergenry and Standby Pawer Systnn1, ASME Al7.:>, Safety Cnde fnr Existing Elroators and li.scalatnrs,
2019 edition. 2015.
NFPA 111, Standard on Stnred Elertriml Energy Emergm1y and
Standby Pnwer Systems, 2019 edition. ASME Bl .20.1, Pipe Thrpad,, General Purpose, Inch, 2013.
NFPA 170. Standard for Fire Safety and Eml'lgency Symbol1, 2018 ASME Blfi.22, Wmught CoppPr and Cnpper Alloy Snlder-joint Pm�
edition. sure Fittings, 2013.
NFPA 211, Standard for ('.,himn1ys, Fireplarl'-�, Vent1, and Solid
hll'l-Buming.4pplianas, 2019 edition. ASME Bl G.2G, Cast Cnpper Alloy Fittings for H1md Copper Tubes,
2013.
NFPA 259, Standard Test Aiffhnd for Potmtial Hmt of Building
Material,, 2018 edition. ANSI/ASME Bl6.50, Wrought Cnppn and Copper ,4llny Brm.e-
NFPA 2G0, Standard Methods of1Pst� and ClaHijit:ation System for Joint PrPssureFittings, 2013.
CigarPtte Ignition Resi1tanrP of Cmnponenl1 nf Uphol,tered h1miture,
2019 edition. ASME B31.:>, Pmre.�� Piping, 2016.
NFPA 261, Standard lvlNhnd of ]pst fnr Detmnining Resistance nf ASME B40. l 00, Pre.mtre Gauges and Gaugp Attarhments, 2013.
Mnrk-Up Uphnl1tered Furniture IHaterial Assnnblil'-1 tn Ignition by
SmoldPring Cigamttes, 2018 edition. ASME PVHO-1, Safety Standard for Pressure ie.uel, fnr Human
NFPA 28G, Standard I'>lethnd1 nf Fire ]psts for Evaluating Contri Oi:rnpanry, 2016.
lmtion nf Wall and Ceiling InteriorFinish tn Rnmn Fire Grnwth, 2019 Boiler and PrfssurP Vfssel Code, 2017.
edition.
NFPA 418, Standard for Heliports, 201 G edition. 2.3.5 ASSE Publications. Ame1·ican Society of S anitaty Engi
NFPA 400, Hm.a,dnm Material1 Cnde, 2019 edition. neering, 18927 Hickory Creek Drive, Suite 220, Mokena, IL
60448.
NFPA 495, Expln.tive Material� CodP, 2018 edition.
NFPA 701. Standard Alethnd1 nf Fire ]psts for Flame Propagation AS SE GO 10, PmJe.��innal Qualifii:atinns Standard for I\,fpdiral Gos
nflPxtiles andFilms, 2019 edition. Systmns Installe rs, 2018.
NFPA 750, Standard n n Water Mi,t Fire Prntertinn Systnns, 2019
AS SE 6015, Pmfe.�1innal Qualifiratinns Standard for Bulk Mediral
edition.
Gns Systmns Imtallers, 2018.
2021 Edition
REFERENCED PUBLICATIONS 99-17
ASSE 6020. Professional Qzwlifimtinns Standard fnr Mediml Gas A.�TM E2652. Standard ]psi Methnd for Assessing Cmubustibility
Systnns Inspttor:-;, 2018. nf Matfrial� U.ring a Tube Fumare with a Cnne-shaf1ed Airflow Stabil
iur, at 75D °C, 2018.
ASSE 6030, Pmfessirmal Qualifimtions Standard for Mediral Ga�
Systems V!>rijien, 2018. ASTM E2965, Standard Test Mfthnd for Detmninatinn nf Lnw
L1,vel� nf Heat RPlmse RfLtP fnr Material� and Prndw:t� U�ing an
ASSE 603.">, Professional Qualifiratiom Standard for Bulk Mediral O:-:ygen Cnnrnmptinn Calnrimeter, 2017 .
Gas Systnns \frijim, 2018.
ASTM F438, Standard Spffijiratinn fnr Snr.ket-Type Chlorinated
ASSE 6040, Prnfessional Qualifirations Standard for Medical Ga� Pnly(Vinyl Chloride) (CPl'C) Pla�tir Pip Fittin�, Sr.hedule 40, 2017.
Alaintmanre Pl'rsonnPl, 2018.
ASTM F439, Standard Sperifiratinn for Chlnrinated Pnly (Vinyl
2.3.6 ASTM Publications. ASTM International, 100 Barr Chlnride) (CPVC) Plllstir. Pipe F'ittin�, Srhedule 80, 2013.
Harbor Drive, P.O. Box C700, West Conshohocken, PA
19428-2959. ASTM F441/F441M, Standard Sperifiratinn for Chlorinated
Pn�v(Vinyl Chlnride) (CPVC) Pla�tir Pip, Sr.hedules 40 and 80, 2015.
ASTM A269/A269M, Standard Sperifimtion for Seamless and
VVelded iwstn1itir Stainles� Steel Tubing for (',eneral Servia, 2015a. ASTM F493, Standard Specifiratinn for Sn/vent Cements for Chlmi
nated Poly(Vinyl Chlnride) (CPVC) Plastii: Pipe and Fittings. 2014.
ASTM A.�12/A312M, Standard SpPCifiration for Semnless,
Welded, and Hmvily Cold Worked A.mtmiti,: Stainle.�� Steel Pipes, 2.3. 7 AWS Publications. American Welding Society. 8669 NW
2018a. 3G Street,# 130, Miami, FL 33166-6672.
ASTM B32, Standard Spnijiration for Solder Metal, 2008, 1·eap ANSI/AWS A5.8M/A5.8, Sperifiratinn fnr Filler Metal� for Bra2.
prnved 2014 . ing and Braze Welding, 2011. Addenctum 1, 2014.
ASTM B88, Standard Spedfiratinn for Seamles.� CoppPr Water AWS B2.2/B2.2M, Spfrijiration for Brm.ing Pml.'fdure and
Tube, 2016. Performana Qualifiration, 2010.
ASTM Bl03/B103M, Standard Sperifiration for Phosphor Brnnu 2.3.8 BICSI Publications. BICSI, 8610 Hidcten River Parkway,
Plllte, ShPPt, Stiip, and Rnlled Bar, 2015. Tampa, FL 33637-1000.
ASTM B280, Standard Sprifimtion for Semnles� Copper 111/Je for T he BICSI lnfnrmatinn Transpnrt Systems ( ITS) Dirtinnarv, 31·ct
A.ir Conditioning and RPfrigm1tinn Field Service, 2018. edition.
ASTM B819, Standard Sprifiration for Seamle.�� Copper Tube fnr 2.3.9 CDA Publications. Coppe1· Development Association
Aifdiml Gas Systems,2018. Inc., 260 Madison Avenue, #17, New York, NY 10016.
ASTM B828, Standard Practire for II-laking Capillary jnint.1 by Cnpper Tube Handbnnk, 2010.
Soldering nf Cnpper and Copper Allny Tube and Fittin�, 2016.
2.3.10 CGA Publicalions. Compressed Gas Association, 14501
ASTM D5/D5M, Standard Test 1',Jetlwdfor Penetratinn nf Bitmni Gemge Caner \'\'ay, Suite 103, Chantilly, VA 20151-2923.
nous Alaterial�. 2019.
CGA C,.7, Guide to Cla�sifiratinn and La/Jf'ling of Compre.��ed
ASTM Dl785. Standard Sperifimtinn fnr Pn(v(Vinyl Chlnride) GmP.�. 2014.
(PFC) Plmtir Pi(x', Sr.hedules 40, 80, and 120, 2015el.
CGA G-4. Oxygen, 2015.
ASTM D24(i6, Standard SpN:ifiration fnr Poly(Vinyl Chloride)
(PVC) Plmtir Pi{x' Fitting1, Sdiedule 40. 2017. CGA G-4.1. Cleaning Equipment fnr Oxygen Servire. 2009.
ASTM D2467, Standard Spffijiration fnr Poly(Vinyl Chloride) CGA G-6.1. Standard fnr Inmlated Liquid Carbnn Dinxide Systnm
( PVC) Pla�tir. Pip Fittin�, S,:hedule 80, 2015. at Consumer Sites, 2013.
ASTM D2672, Standard Sper.ijimtinn fnr Jnints fnr JPS PVC Pipe CGA G-6.5, Standard fnr Small Statinnary Inrnlllted Carbnn Dinx
u�ing Snlvent Cement, 2014. ide Supply Systnn�, 2013.
ASTM D2846/D2846M, Standard Sperifiratinn for Chlminated CGA G-8.1, Standard for Nitrous Oxide SystmH at Custmner Sill's,
Pnl}>(Vinyl Chlnride) (CPVC) Plllstir Hnt- and Cnld-Watfr Distributinn 201,\.
Systnns, 2019. CGA M-1, Standard fnr Medical Ga� Supply Systm1s at Health
ASTM D4359, Standard Test 1't1.etlwd for Dftn-mining Whether a Ca re Frll'ilitil's, 2018.
Material I.I a Liquid nr a Snlid, 1990, 1·eapprnved 2019. CGA P-2.5, Tramfilling nf High Press1m Gmenm Oxygen u�ed fnr
ASTM E84, Standard Test Mftlwd for Surfat:P Burning Charar.ter RPspiratinn, 2011.
i�tirs of Building Material�. 2019a. CGA P-2.6, Transfilling of Liquid Oxygm Used for RPspiratinn,
ASTM E136. Standard Test Alethnd for AuP.uing Cnmlmstibility nf 2011.
l'llaterial� llring a Fertiral Tube fornace at 750 °C, 2019. CGA P-18, Standard for Bulk Inert Ga� Syste;ns at Conswner Sitl's,
ASTM El5:l7, Standard Test Method for Hre Testing nf Uphnl�tmd 2013.
Fumitzm, 2016. CGA V-1, Strmdard fnr Cmnpressed Gm C}•lindn Valve Outlet and
ASTM El590, Standard Test Method fnr Fire ]!'sting nf Mattresses, Inlet Cnnnfftinns (ANSI B57.l), 2013.
2017.
2021 Edition
CGA V-5. Diameter Index Safety System (NoninlPffhangrable Low 2.3.19 UL Publications. Underwriters Laborntories Inc.. 333
Press11re Connertions for Medical (',as Applimtionsj, 2008, reaf'. Pfingsten Road, Northbrook, IL 60062-2096.
fit·med 2013.
UL 723, Standard for Tes/ for Surfare Burni ng Cham,:teri,tfrs of
2.3.11 CSA Group Publications. CSA Group, 178 Rexdale Building MatPrial�, 2018.
Bl vd., Toronto, ON M9W 1R3, Cana<la.
UL 1069, Standard for Hospital Signaling and Nurse Call Equifr
CSA C 22.2 No. 0.3, ]psf Metlwd� for E!Prtrir:al Wires and Cables, men/, 2007, re\ise<l 2018.
2009, i·eaffirmed 2014.
UL 1685, Standard for VPrtiml-Tray Firl'-Pmpagation and Smokl'
2.3.12 FGI Publications. Facilitv Guidelines Institute, 1919 &!Pa�e Ttstfor Elerttiral and Optiral-Fiber Cables, 2015.
McKinney Avenue, Dallas, TX 75201.
2.3.20 U.S. G overnment Publications. U.S. Government
Guidelinesfor Desi gn and Construrtion of Hospital�. 2018. Publishing Office, 732 North Capitol Street, NW, Washington,
DC 20401-{)001.
Guidelines for Design and Construrtion of Outpatient Facilities,
2018. DOE-STD-3020, Sperijiration for HEPA. Filten Used by DOE
t..()ntrarton, Department of Energ)', 2005.
Guidelim's for Design and Construttion of &sidential Health, Care,
and Support Facilities, 2018. Title 16, Co<le of Federnl Regulations, Part 1632, "Stann
ard fot· the Flammability of Matu·esses and Mattress Pads (FF
2.3.13 ISA Publications. International Society of Automation, 4-72) ..,
67 TW. Alexander Drive. P.O. Box 122i7. Research Triangle
Pad,, NC 27709. T itle 21, Co<le of Fe<leral Regulations, Part 210, "CutTent
Good Manufactut·ing Practice in Manufacturing, Processing,
ANSI/ISA S-7.0 .01, Quality Standard for lnstrmnent A. ir, 1996. Packing, or Holding of Drugs - General."
2.3.14 MSS Publications. Manufacturn's Standat·dization Title 21, Co<le of Fe<leral Regulations, Part 211, "CutTent
Society (MSS) of the Valve an<l Fittings Industry, 127 Park Good Manufacturing Practice fot· Finished Pharmaceuticals."
Street NE, Vienna, VA 22180-4602.
Title 21, Unite<l States Code, Chapter 9, "Fe<leral Food,
MSS SP-58, Pipe Hangn-s and Support� - lv!aterial�, Design, Drug, and Cosmetic Act."
lv!anzifarture, SPlertion, App!iration, and Installation, 2009.
2.3.21 Other Publications.
2.3.15 State of C alifornia Publicalions. State of California,
Department of Consumer 1�Jfairs, 3485 O1·ange Grove Avenue, Mfrrimn-lYPbster\ Collegiate Dictionary, 11th edition, Merriam
Nmth Highlan<ls, CA 95660-5595. Webste1·, Inc., Sp1-ingfield, MA, 2003.
California Technical Bulletin 117, Requimnent�. 1Pst Proad1m 2.4 References for Extracts in Mandatory Se ctions.
and Apparatus for TPsting the Flmne &tardar11:e of &silimt Filling
I\,faterinl� u�ed in Uplwl�tPredFumiturP, 2000. NFPA 10, Standard for Portabw Fire .Extinguishers, 2018 edition.
NFPA 13, Standard for the installation of SprinklPr Svstnn,, 2019
California Technical Bulletin 129, Flammability Test Pmredure edition.
for I\1.attresse.�for u�e in Publir Building�, 1992. NFPA 30, Flammable and Cmnbmtible Liquid� Code, 2021
edition.
California Technical Bulletin 133, Fl,mmnability Tes/ Proadure
for Seating Fumitim for u�e in Public Ou:upanries, 1991. NFPA 55. Comprmed (',ase.1 and Cryagmi,: Fluid� Code, 2020
edition.
2.3.16 TC Publications. Trnnspon Canada, 330 Spat·b Street, NFPA 70®, National Elertriral Codi", 2020 edition.
Ottawa, ON KlA ON!',, Canada. NFPA 70B, &rmnmmded Pmdir·e for E!Prtrir:al .Equipment Main-
Transportation <ifDangmmt Good� &gulatiom. tenanre, 2019 e<lition.
NFPA 99B, Standard for Hy pobatir Farilities, 2021 edition.
2.3.17 TIA Publications. Telecommunications Industry A�so NFPA 101®, LifPSajfty Code®, 2021 edition.
ciation, 1320 North Courthouse Road, Suite 200, Arlington, VA NFPA 110, Standard for Enmgm,:y and Standby Power Systmns,
22201. 2019 edition.
TL-\/EL'\ 568-B, t..()111mercial Building TPlPmmmunirations NFPA Hi70. Standard on Opemtiom and Training for 1Prhniml
Cabling Standard, 2012. Sean:h and &srue lnrident�, 2017 edition.
NFPA 5000®, BuildingConstrnrtion and SafPty Codl\ 2021
TL-\/EIA 606-B, Administration Standard for Cmnmerrial 1elP edition.
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
DEFINITIONS 99-19
Chapter 3 Definitions 3.3 General Definitions.
3.1 General. The <lefinitions containe<l in this chapte1· shall 3.3.1 Adiabatic Heating. The heating of a gas caused by it5
apply to the tei-ms use<l in this code. Where te1·ms are not comp1·ession. (HYP)
defined in this chapter or within another chapter, they shall be 3.3.2 Aerosol. An intimate mixture of a liquid or a solid in a
<lefined using their ordinarily accepted meanings within the gas; the liqui<l m solid, called the dispe1·se<l pha�e. is uniformly
context in which they are used. Merriam-HWister\ Col!Rgi,ate distt·ibuted in a finely divi<le<l state throughout the gas, which is
Dirtionar_\', 11th e<lition, shall be the source for the or<linarily the continuous phase or dispersing medium. (MED)
accepted meaning.
3.3.3 Alarm System. (PIP)
3.2 NFPA Official Definitions.
3.3.3.1 Area Alarm System. A warning system within an area
3.2.1 * Approved. Acceptable to the authority having jurisdic of use that provides continuous visible and audible surveil
tion. lance of Categ01y l an<l Catego1y 2 medical gas and vacuum
3.2.2* Authority Having Jurisdiction (AHJ). An organization, svstems. (PIP)
office, or individual responsible for enforcing the requirement� 3.3.3.2 Category 3 Alarm System. A warning system within an
of a co<le or stan<lar<l, or for apprming equipment, materials, area of use that provides continuous \isible and audible
an installation, or a pt·ocedure. surveillance of Catego1y 3 medical gas systems. (PIP)
3.2.3* Code. A standar<l that is an extensive compilation of 3.3.3.3 Local Alarm System. A warning system that provides
provisions covering broad subject matter or that is suitable for continuous visible and audible surveillance of medical gas
adoption into law in<lependently of othe1· codes and standatTls. and "-acuum system som·ce equipment at the equipment site.
3.2.4 Guide. A document that is advisory or informative in ( PIP)
nature and that contains only nonmandatory provisions. A 3.3.3.4 Master Alarm System. A wan1ing system that moni
guide may contain mandatory statement� such a� when a guide tors the operntion an<l condition of the source of supply, the
f
can be used, but the document as a whole is not suitable for 1·eserve source (i any), an<l the presstu-e in the main lines of
adoption into law. each me<lical gas an<l vacuum piping system. (PIP)
3.2.5 Labeled. Equipment 01· materials to which has been 3.3.4 Alternate Power Source. One 01· more generator set�, 01·
attached a label, symbol, or othe1· i<lentifying ma1·k of an organ battery systems where permitted, inten<le<l to provide power
ization that is acceptable to the authority ha,ing jurisdiction during the interruption of the normal electrical service; or the
an<l concerned with product evaluation, that maintains pe1·i public utility electrical service intende<l to provide powe1·
o<lic inspection of pro<luction of labele<l equipment 01· mate1·i <luring intetTuption of senice normally provided by the gener
als, and by whose labeling the manufactm·e1· in<licates ating facilities on the premises. (ELS)
compliance ·with appropriate sta.n<lards or performance in a
specified manner. 3.3.5 Ambulatory He alth Care Occupancy. A..11 occupancy
used to provide services or treatment simultaneously to four 01·
3.2.6* Listed. Equipment, mate1·ials, or services inclu<le<l in a more patient� that provides, on an outpatient basis, one or
list published by an organization that is acceptable to the more of the following: (1) treatment for patients that renders
auth01·ity ha,ingjm·isdiction and concerned with evaluation of the patients incapable of taking action for self-pt·eservation
product� or services, that maintains periodic inspection of unde1· emergency con<litions without the assistance of others;
production of listed equipment or materials or periodic e\-alua (2) anesthesia that ren<lers the patient� incapable of taking
f
tion o se1·vices , an<l whose listing states that either the equip action fot· seu:presermtion un<le1· emergency con<litions with
ment, matet-ial, or service meet� appropt-iate <lesignate<l out the assistance of others; (3) tt·eatment for patients who,
stan<lar<ls 01· ha� been teste<l and found suitable for a specified due to the nature of their injuty rn· illness, are incapable of
purpose. taking action for self-preservation under emergency con<litions
3.2.7 Shall. In<licates a mandat01·y requi1·ement. without the assistance of others. f 101, 2021 l (FUN)
3.2.8 Should. Indicates a recommendation or that which is 3.3.6 Ampacity. The maximum current, in amperes, that a
advised but not requi1·e<l. conductor can carry continuously under the conditions of use
without exceeding it� temperature rating. f70, 20201 (EL'I)
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 3.3. 7 Anesthetic. A� use<l in this code, applies to any inhala
in<licate 1·equirements an<l that is in a form gene1·ally suitable tional agent used to produce sedation, analgesia, or general
for mandatoty reference by another standat·d <ff co<le or for anesthesia. (MED)
adoption into law. Nonmandatory provisions are not to be 3.3.8 Appliance. Utilization equipment, generally othe1· than
considered a part of the requirement� of a standard an<l shall industrial, normally built in standardized sizes or types, that is
be \ocate<l in an appendix, annex, footnote, infornrntional installe<l or connected as a unit to perform one or more func
note, or other means a� pennitted in the NFPA Manuals of tions. (MED)
Style. \'\'hen used in a generic sense, such as in the phrase
"standards development process" or "stan<lar<ls <levelopment 3.3.9 Applicable Code. The building co<le, fire co<le, or
activities," the term "standards" includes all NFPA Standards, NFPA 101 adopte<l by the jurisdiction, or NFPA J OJ where no
including Codes, Standards, Recommen<le<l Practices, and such code has been adopted by the jurisdiction. (FUN)
Guides.
2021 Edition
3.3.10* Applicator. A means of applying high-frequency 3.3.19.3* Bulk Oxygen System. A bulk system with a stornge
energy to a patient other than by an electrically comluctive capacity of mon, than :,66 m' (20,000 ft:3) at normal temper
connection. (MED) atm·e and pressur·e of oxygen. (PIP)
3.3.11 Area of Administration. Any point within a room 3.3.20 Category 3 Vacuum System. A Category 3 vacuum
within 4.3 m (15 ft) of oxygen equipment or an enclosure distribution system that can be either a wet system designed to
containing 01- intended to contain an oxygen-e1u-iched atmos 1·emove liquids, air-gas, or solids from the treated area; 01· a dry
phere. (MED) system designed to trnp liquid and solids before the senice
inlet and to accommodate air-gas only through the service
3.3.12* Atmosphere. The pressure exerted by, and gaseous
inlet. (PIP)
composition of, an environment. (HYP)
3.3.21* Central Suppl y System_ The complete source of
3.3.12.1 Atmosphere Absolute (ATA). The pressure of the
supply for a medical ga� or vacuum system or a medical support
earth"s atmosphere, 760.0 mmHg, 101.325 kPa, or 14.7 psia.
gas system. (PIP)
Two ATA = l:\vo atmospheres. (SPe alsn 3.3.12, AtmnsphPrP.)
(HYP) 3.3.22 Clean Agent. Electrically non-conducting, volatile, or
gaseous fire extinguishant that does not leave a residue upon
3.3.12.2* Atmosphere of Increased Burning Rate. Any atmos
evaporation. r10, 20181 (FUN)
phe1·e containing a percentage of oxygen or oxygen and
nitrous oxide greater than the quotient of 23.4:, divided by 3_3.23* Clinical IT Network. An information technology
the squa re root of the total pressure in atmospheres. (HYP) video, voice, and data communication nel:\\/ork that is dedica
ted for shared use by medical devices, nur·se call, clinical info1·
3.3.12.3 Chamber Atmosphere. The emironment inside a
mation systems, patient-<:ritical applications . and clinical
chamber. (HYP)
wireless communication equipment. (ELS)
3.3.13 Automatic. Providing a function without the necessity
3.3.24 Combustible. Capable of unde1·going combustion.
of human inten,ention. (ELS)
(MED)
3.3.14 Bathrooms. An area including a basin with one 01-
3.3.25* Combustible Liquid. Any liquid that was a closed-cup
more of the following: a toilet, a urinal, a tub, a shower, a bidet,
flash point at or above 37.8'C (I0O O F). Combustible liquids ar·e
or similar plumbing fixtures. r10, 20201 (FON)
classified as follows: (a) Class II liquid. A.ny liquid that ha� a
3.3.15 Battery-Powered Lightin g Units. Individual unit equip flash point at or above 37.8 ° C ( lOOOF) and below 60'C (14-0"F);
ment for backup illumination consisting of a rechargeable (b) Class IIL<\ liquid. Any liquid that has a fla�h point at or
battery, battery-<:harging means, provisions fo1· one 01· more above 60'C (140'F) and below 93"C (2000F); (c) Class IIIB
lamps mounted on the equipment, or with te1·minals fo1· liquid. Any liquid that has a flash point at 01· above 93'C
remote lamps, or both, and relaying device arranged to ener (200'F). (FUN)
gize the lamps automatically upon failure of the supply to the
3.3.26* Combustion. A chemical process of oxidation that
unit equipment. r10, 20201 (ELS)
occtlt"s at a rnte fast enough to produce heat and usually light
3.3.16 Bends. Decompression sickness; caisson worker's in the form of either a glow or flame. r5000, 2021 l (HYP)
disea�e. (HYP)
3.3.27 Compact Storage. Stornge on solid sheh·es not exceed
3.3.17 Branch Circuit. The circuit conductors between the ing 0.9 m (36 in.) in total depth, arranged as part of a compact
final overcurrent device protecting the circuit and the storage module, witl1 no more tl1an 0.76 m (30 i n.) bel:\veen
outlet(s). r10, 20201 (ELS) shelves venically and with no inten1al venical flue spaces other
than those between i ndividual shelving sections. [13, 20191
3.3.18 Branch Line. See 3.3.146, Piping. (PIP) (FON)
3.3.19 Bulle System. An assembly of equipment for supplying 3.3.28* Compressed Medical Gases (CMG). Any liquefied or
comp1·essed ga� (consisting of, but not limited to. sto1·age vaporized gas alone or in combination with other· gases that is
containers, pressure 1·egulat01·s, pressm·e relief devices, vaporiz classified as a drug. r55, 20201 (PIP)
f
ers, mani olds, and interconnecting piping) that terminates
where the gas, at service pressure, first enters the main line. 3.3.29 Container. A low-pressure, vacuum-insulated vessel
The stornge containe1·s are either· stationary or movable and containing gases in liquid form. (MED)
include unconnected reserves on hand at the site, and the
3.3.29.1 Liquid Oxygm Base Reservoir Container. A container·
source gas is stored as a compressed gas or cryogenic fluid.
used for liquid oxygen not exceeding 60 L (15.8 gal) specifi
(PIP)
cally designed for use as a medical device as defined by 21
3.3.19.1 Bulk Inert Gas System. A bulk system with a stornge OSC 9, "Federal Food, Drug and Cosmetic Act," that is
capacity of more t11an 566 m� r20,ooo ft� (sd) l of inert gas. intended to deliver gaseous oxygen for therapeutic use.
(PIP) transfilling, or both. (MED)
3.3.19.2 Bulk Nitrous Oxide System. A bulk system with a 3.3.29.2 Liquid Oxygen Portable Container. A container· used
stornge capacity of more than 1452 kg (3200 lb) rapproxi fot· liquid oxygen not exceeding 1.5 L (0.396 gal) specifi
mately 793 m3 (28,000 ft') at normal tempernture and pres cally designed for use as a medical device as defined by 21
sure.I of nitrous oxide (PIP). 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)
2021 Edition
DEFINITIONS 99-21
3.3.30 Critical Branch. A system of feeciers and branch 3.3.42* Disaster. \Vithin the context of this code. any unusual
circuits supplying power for task illumination, fixed equip occurrence or unforeseen situation that seriously overtaxes or
ment, select receptacles, and select powe1· ci1·cuit� sening areas threatens to se1·iously overtax the routine capabilities of a
and fi.mctions related to patient care that a1·e automatically health care facility. (HES)
connected to alternate power sources by one or more transfer
switches during interruption of the normal power source. 3.3.43 D .I.S.S. Connector. A system of noninterchangeable
(ELS) medical gas and vacuum connect01·s complying with CGA V-5,
Dimn�tn Indrx Safety System (Noninterrhangral1le Low Pre.uure
3.3.31 Critical Equipment. That equipment essential to the Connfftinm for Medii:al Gas A.pplii:atinm). (PIP)
safety of the occupanl� of the facility. (HYP)
3.3.44* Double-Insulated Appliances. Appliances whe1·e the
3.3.32 Cryogenic Fluid Central Supply System. An assembly primaty means of prntection against electrical shock is not
of equipment for suppl)'ing compressed ga�. incluciing. but not grounding. The primary means is by the use of combinations of
limited to, a stationa1·y tank(s) that is permanently installed insulation anci separation spacings in accordance with an
thrnugh anchoring to a foundation, pressure regulators, p1-es apprnveci stanciard. (MED)
s111·e relief cievices, vaporizers, manifolds, anci interconnecting
piping that is designed to be filled at the health care facility 3.3.45 Electrical Life Support Equipment. Electrically
with a cryogenic fluid and that terminates at the source valve. powered equipment whose continuous operation is necessa1y
(PIP) to maintain a patient's life. (ELS)
3.3.32.l Bulk Nitrous Oxide Central Supply System. A central 3.3.46 Electrical Preventive Maintenance (EPM). A manageci
supply system with a stornge capacity of more than 1452 kg program of inspecting, testing, analyzing, and servicing electri
cal systems and equipment with the put·pose of maintaining
(3200 lb) fi.e., apprnximately 793 m3 (28,000 ft�) at normal
safe operations anci production by 1·educing or eliminating
tern perature and pressure l of nitrous oxide. (PIP)
system interruptions anci equipment breakdowns. f70B, 20191
3.3.33 Cylinder. A supply tank containing high-p1·ess111·e gases (ELS)
01· gas mixtures at p1·essu1·es that can be in excess of 13.8 kPa
3.3.47 Electrode. An electt·ically conductive connection to a
gauge (2000 psi gauge). (MED)
patient. (MED)
3.3.34 Decompression Sickness. A syndrome due to evolved
3.3.48 Emergency Management. The act of developing proce
gas in the tissues 1·esulting from a 1-eduction in ambient pt·es
ciures anci plans to create effective preparedness, mitigation,
sure. (HYP)
response, and recovery during a disaster aflecting a health care
3.3.35* Defend in Place. The operntional response to an facility. (HES)
emergency in a builrling. in which the initial action does not
3.3.49 Emerge ncy Oxygen Supply Connection (EOSC). An
involve evacuation of the building occupant�. (FUN) f
assembly o equipment that permits a gas supplier to make a
3.3.36 Demand Check. A pai1·ed set of fittings that pe1·mit ga� temp01·a1y connection to supply oxygen to a building that has
flow when correctly mateci hut interrupt flow when separateci. had iL� mffmal smu-ce of oxygen inte1n1pted. (PIP)
(PIP)
3.3.50 Equipment Branch. A system of feeders and branch
3.3.37 Dental Air. Comp1·esseci gas to drive dental cievices, cit-cuit� arrangeci fo1· delayed, automatic, or manual connection
supplied by compressed air systems, pressurized cylinde1·s of air, to the alternate power source and that serves prima1·ily 3-phase
or nitrogen. (PIP) power equipment. (ELS)
3.3.38 Dental Office. A building or part thereof in which the 3.3.51 Equipment Grounding Bus. A grounding te1·minal bus
following occtu-: (I) examinations anci minor t1-eatment�/ in the feede1- ci1·cuit of the branch circuit distribution panel
procedures performed under the continuous supervision of a that sen;es a particular area. (MED)
ciental professional; (2) use of limited to minimal sedation and
3.3.52* Es.sential Electrical System. A system comp1·ised of
treatment 01· p1·oceci111·es that do not 1·ender the patient incapa
alternate powe1· sou1·ces anci all connected distribution systems
ble of self-preservation under emergency conditions; and (3)
and ancillary equipment, designed to ensure continuity of elec
no overnight stays for patient� or 24-hour operations. (PIP)
trical power to designated areas anci functions of a health care
3.3.39 Dental Vacuum/Scavenging. A system used in dentistry facility during disruption of nonnal power smu-ces, anci also to
for oral evacuation anci nitrous oxicie/oxygen scavenging. minimize ciisruption within the inten1al v.�ring system. (ELS)
(PIP)
3.3.53 Evacuation - Waste Gas. See 3.3.185, Wa�te Anes
3.3.40 Detonation. An exothe1·mic 1·eaction whe1·ein the 1·eac thetic Gas Disposal. (PIP)
tion propagates through the unreacted material at a rate
3.3.54 Exposed Con ductive Surfaces_ T hose surfaces that are
exceeding the velocity of sound, hence the explosive noise.
capable of carq,ing electric current and that are unprotected,
(MED)
uninsulated, unenclosed, or unguarded, permitting pe1·sonal
3.3.41* Direct Electrical Pathway to the Heart_ An external contact. (ELS)
izeci conciuctive pathway, insulated except at it� encis, one end
3.3.55* Facility Fire Plan. A plan developed by the health
of which is in direct contact with heart muscle while the other
ca1·e facility to ciesc1·ibe the actions to be taken dut·ing a fire
is outside the body and is accessible for inacivertent or inten
emergency. (FUN)
tional contact with groundeci objects or energized, grounci-
1·eferenced sou1·ces. (MED) 3.3.56 Fault Current. A current in an accidental connection
between an energized anci a g1·ouncieci or other conductive
2021 Edition
element 1·esulting from a failure of insulation. spacing. or ventilation may be inadeguate. Ca1·diovascula1· function 1s
containment of conrluctors. (ELS) usually maintai ned. (PIP)
3.3.57 Feeder. All circuit conrluctors betw·een the service 3.3.68.3 Moderaie Sedation/Analgesia (ConscioUII Sedation). A
eguipment. the som-ce of a separately rle1·ived system, m· othe1· rlrug-induced depression of consciousness rlu1·ing which
power supply source anrl the final branch-circuit overcurrent patients respond purposefully to verbal commanrls, either
rlevice. (ELS) alone or accompanied by light tactile stimulation. No inte1·
ventions are regui 1·ed to maintain a patient airway, and
3.3.58* FGI Guidelines. A collection of rlocuments that spontaneous ventilation is arleguate. Cardiovascula r func
includes the following: (1) Guidtlines for Design and Comtrurtion tion is usually maintainerl. (PIP)
of Hospital�; (2) GuidPlinPs for Design and Comtrurtion of Outpa
tient Farilitifs; anrl (3) GuidPlims for Dtsign and Comtrnrtion of 3.3.68.4 Minimal Sedation (Aru:iolyns). A rlrug-inrlucerl state
&sidential Hmlth, Cart, and Support FadlitiPs. during which patient� respond normally to verbal
commands. AJthough cognitive function and coordination
3.3.59* Flammable. A combustible that is capable of easily may be impai1·ed, ventilat01·y and ca1·diovascular fi.mctions
being igniterl anrl rapidly consumerl by fire. (FUN) are unaffecterl. (PIP)
3.3.60 Flammable Gas. Any substance that exist� in the 3.3.69* Growid-Fault Circuit Interrupter (GFCI). A rlevice
gaseous state at normal atmosphe1·ic tempernture and pressure intended for the protection of per·sonnel that functions to de
anrl is capable of being ignited anrl burned when mixed with ene1·gize a circuit 01· portion the1·eof wi.tl1in an established
proper proportion of air, oxygen, or other oxirlizers. (HYP) period of time when a current to ground exceeds the values
3.3.61 Flammable Liquid. A liguid that has a closed-cup flash established for a Cla�s A device. r10, 20201 (ELS)
point that is below 37.8'C (I0OO F) and a maximum vapor pres 3.3.70 Grounding. See �.3.71, Grounding Sys tem. (ELS)
sure of 2068 mmHg (40 psi absolute) at 37.S"C (I0OOF). (FUN)
3.3.71 * Growiding System. A sys tem of conrluctors that
3.3.62* Flash Point. The minimum temperatm·e at which a prnvirles a low-impedance return path fo1· leakage and fault
liquid m· a solid emits vapor sufficient to fonn an ignitable currents. (ELS)
mixture with air near the surface of the liguid or the solid.
(FUN) 3.3. 72 Hazard Current. For a given set of connections in an
isolaterl power system, the total cm-rent that would flow
3.3.63 Flow-Control Valve. A valve, usually a needle valve, that through a low imperlance if it we1·e connecterl between either
precisely controls flow of ga�. (MED) isolaterl conductor anrl ground . (ELS)
3.3.64* Flowmeter. A device fo1· measuring volumetric flow 3.3. 72.1 Fault Hazard Current. The hazard cmTent of a
rates of ga�es and liquids. (MED) given isolated power system with all rlevices connected
3.3.65* Frequency_ The number of oscillations, per unit time, except the line isolation monitor. (ELS)
of a panicular cutTent m· voltage waveform. 1l1e unit of 3.3. 72.2 Monitor Hazard Current. The hazard cmTent of the
freguencv is the henz. (MED) line isolation monit01· alone. (ELS)
3.3.66* Fume Hood_ An enclosure designed to rlraw air 3.3.72.3 Total Hazard Current. The hazarrl current of a
f
inwatTI by means o mechanical ventilation. (EL�) given isolated system with all rlevices. including the line
3.3.67 Gas-Powered Sy..tem. A Level 3 gas rlistribution system isolation monitor, connected. (ELS)
comprised of component part� including but not limited to 3.3. 73* Health Care Facilities. Buildings, portions of build
cylinders. manifolds. air compressor. motor. 1·eceivers. controls. ings, or mobile enclostu-es in which human merlical, dental,
filters, dryers, valves, and piping that rlelive1·s compresserl air m· psychiatric, nursing, obstetrical, 01· sm·gical care is provided.
nitrogen at pressures less than 1100 kPa (less than 160 psi) (FUN)
gauge to power rlevices (e.g., hanrl pieces, syringes, cleaning
rlevices) as a powe1· sou1·ce. (PIP) 3.3_74* Health Care Facility's G overning Body. The person 01·
persons who have the overnll legal responsibility for the opera
3.3.68* G eneral Anesthesia and Levels of Sedation/Analgesia. tion of a health care facility. (FUN)
3.3.68.1 General Anesthena. A drug-induced loss of 3.3.75* Health Care Microgrid. A group of interconnected
consciousness during which patient� are not arousable, even loarls anrl rlistributed energy resources within cleady defined
by painful stimulation. The ability to inrlependently main boundaries that act� a� a single controllable entity with respect
tain ventilatory function is often impaired. Patients often to the utility. (ELS)
1·eguire assistance in maintaining a patent airway. and posi
tive pressm·e ventilation may be regui1·ed because of 3.3.76 Health Care Microgrid Control System. A system
rlepressed spontaneous ventilation or drug-induced depres including health care microgrid control functions that can
sion of neuromuscular function. Carrliovascular function manage it�elf; ope1·ate autonomously, arni. connect to and
may be impai1·ed. (PIP) disconnect from the utility for the exchange of power and the
supply of ancillary services. (ELS)
3.3.68. 2 Deep Sedation/Analgena. A drug-induced depres
sion of consciousness rlm·ing which patient� cannot be easily 3.3.77* Home Care. Medical se1·vices or equipment prnvided
aroused but responrl pm-posefully following repeated 01- in residential settings that pm-posely facilitate the provision of
painful stimulation. The ability to independently maintain merlical or custodial care; excludes commercial facilities.
ventilatory fimction may be impairerl. Patient� may reguire (FUN)
assistance in maintaining a patent ainvay, anrl spontaneous
2021 Edition
DEFINITIONS 99-23
3.3.78 Hospital. A building or portion the1·eof used on a 24- the lead to grounrl, or to either conductor of the power line,
hour basis for the merlical, psychiatric, obstetrical, or surgical result� in current flow below a hazardous limit in the lead.
ca1·e of four or mme inpatient�. f IOI, 20211 (FUN) (MED)
3.3.79 Humidifier. A rle,ice userl fo1· adding water vapor to 3.3.93* Isolated Power System. A system comprising an isola
inspirerl gas. (MED) tion transformer or its equivalent, a line isolation monitor, anrl
its ungrounrled cit-cuit conductors. (ELS)
3.3.80 Hyp erbaric Facility. Building, structure, or space used
to house hype1·ba1·ic chambers anrl auxiliary service equipment 3.3.94 Isolation Transformer. A transfm·mer of the multiple
for medical applications and procedures at pressures above winding type, with the prima1y and secondary windings physi
normal atmospheric pressm·e. (HYP) cally separated, that inrluctively couples it� ungrounded
secondary winding to the grounded feeder system that ene1·gi
3.3.81* Hyp erbaric Operations. Procedures conrlucterl on zes its primary winding. (ELS)
the patient receiving hyperbaric treatment. (HYP)
3.3.95* Laboratory. A building, space, room, or group of
3.3.82 Hyp erbaric Stand-Alone Oxygen S ystem. The oxvgen rooms intended to serve activities involving procedures fot·
system is entirely separate from the hospital's Category l investigation, diagnosis, or treatment in which flammable,
Oxygen System or is a freestanding hyperbaric facility. (HYP) combustible, or oxidizing materials are to be userl. (FUN)
3.3_83 Hyp obaric Facility. Builrling, structm·e, 01· space used 3.3.96 Leak Detectant. For purposes of this standard, a
to house hypobaric chambe1·s and auxiliary service equipment reagent, a solution, or an electronic or mechanical device suita
for medical applications anrl procerlures at pressures below ble for the detection or visualization of escaping gas. (PIP)
atmospheric pressu1·e. (HYP)
3.3.97 Life Safety Branch. A system of feeders and branch
3.3.84 Hyp oxia. A state of inadequate oxygenation of the circuit� supplying power for lighting, receptacles, and equip
f
blood and tissue su ficient to cause impairment of function. ment essential for life safety that is automatically connected to
f99B, 2021 l (HYP) alternate power sout·ces by one or m01·e transfer switches
3.3.85 Immediate Restoration of Service. Automatic restora during interrnption of the nm·mal powe1· source. (ELS)
tion of operation with an interruption of not more than 3.3.98* Limited-Combustible (Material). See 4.4.2. (FUN)
10 seconrls. (ELS)
3.3.99 Line Isolation Monitor. A test instrument rlesigned to
3.3.86* Impedance. Impedance is the ratio of the voltage continually check the balancerl and unbalanced impedance
rlrop across a circuit element to the current flowing through from each line of an isolaterl circuit to ground anrl equipperl
the same circuit element. The unit of impedance is the ohm. with a built-in test ci1·cuit to exet-cise the ala1·m without adrling
(MED) to the leakage current hazard. (ELS)
3.3.87 Incident Command System (ICS). The combination of 3.3.100* Liquid. Any material that ( 1) has a fluidity greater
facilities, equipment, personnel, procedures, and communica than that of 300 penetration asphalt when tested in acco1·rlance
tions operating within a common 01·ganizational structu1·e that with ASTM D5, Standard ]"'pst A1Ptlwd f(jr PPnPfratinn of Bituminom
ha� responsibility for the management of assigned resources to I\,fatfrial�. or (2) is a \iscous substance for which a specific melt
effectively accomplish staterl objectives pertaining to an inci ing point cannot be determinerl but that is dete1·mined to be a
rlent or trnining exercise. fl 670, 20171 (HES) liquid in accmdance with ASTM D43:,9, Standard Test for Deter
3.3.88* Instrument Air. A merlical support gas that falls unrler mining H'liethl'T" a Afatnial is a Liquid ora Solid. f30, 2021 I (FUN)
the general requirement� for medical gases. Merlical air and 3.3.101* Local Signal. A visible inrlication of the operating
instrument air are distinct systems for mutually exclusive appli status of equipment. (PIP)
cations. (PIP)
3.3.102 mA. Milliampere. (FUN)
3.3.89 Intermittent Positive-Pressure Breathing (IPPB). Venti
lation of the lungs by application of intermittent positive pt·es 3.3.103 Manifold. A device for connecting the outlets of one
sure to the ainvay. (MED) or more gas cylinde1·s to the central piping system for that
specific gas. (PIP)
3.3.90* Intrin sically Safe. A� applied to equipment and
wiring, equipment and wiring that are incapable of releasing 3.3.104* Manufactured Assembly. A factory-assembled prorl
sufficient electt·ical energy under n01·mal or abnormal condi uct rlesignerl fot· aesthetics or convenience that contains medi
tions to cause ignition of a specific hazardous atmospheric cal gas or vacuum outlets, piping, or other rlevices related to
mixture. (HYP) medical gases. (PIP)
3.3.91 Invasive Procedure. Any procedu1·e that penetrntes the 3.3.105 Mask. A device that fits over the mouth and nose
protective surfaces of a patient's body (i.e., skin, mucous (oronasal) or nose (nasal) used to administer gases to a
membrane, cornea) anrl that is pedormed with an aseptic field patient. (MED)
(procedural site). fNot included in this category· are placement
of peripheral intravenous needles or catheters used to adminis 3.3.106* Medical Air. For purposes of this code, merlical ai1· is
ter fluids anrl/or merlications, gastrointestinal endoscopies air supplied from cylinders, hulk containers, or merlical air
(i.e., sigmoidoscopies), insertion of m·ethrnl cathete1·s, anrl comp1·esso1·s or reconstituted from oxygen USP and oil-free,
other similar procedures.] (ELS) dry· nitrogen NF. (PIP)
3.3.92 Isolated Patient Lead. A patient lead whose impedance 3.3.106.l Proportinning System for Medical Air USP. A central
to ground or to a powe1· line is sufficiently high that connecting supply that produces medical air (USP) reconstituted from
2021 Edition
m,')'gen USP and nitrngen NF by means of a mixer or blen 3,3-120 Nitrogen Narcosis. A conrlition 1·esembling alcoholic
der. (PIP) inebriation, which resull� from breathing nitrogen in the air
under significant pt·essure. (HYP)
3.3.107 Medical Air Compressor. A comp1·essor that is
designed to exclude oil from the air stream and comp1-ession 3.3.121 Nitrous Oxide. An inorganic compounrl, one of the
chamber and that does not under normal operating conrlitions oxirles of nitrogen. It exisl5 as a gas at atmospheric pressure
or any single fault adrl any toxic 01· flammable contaminants to and temperatm·e , possesses a sweetish smell, and is used for
the compresserl air. (PIP) inducing anesthesia when inhalerl. The oxygen in the
compound will he releaserl under conditions of combustion,
3.3.108 Medical Gas. A patient medical gas or medical creating an oxygen-enriched atmosphere. (MED)
support gas. (Spe alrn 3.3.144, Patient i\,1.fdii:al C',a.1, and 3.3.111,
Mediral Suppart (',as.) (PIP) 3.3.122 Noncombustible (Ma terial). See 4.4.1. (FUN)
3.3.109 Medical Gas System. An assembly of equipment anrl 3.3.123 Nonflammable. Not rearlily capable of burning with a
piping for the distribution of nonflammable medical gases flame and not liable to ignite and burn when exposed to flame.
such as oll.·ygen, nitrous oxirle, comp1·esserl ai1·, carbon dioxirle, (FUN)
and helium. (PIP)
3.3.124 Nonflammable Anesthetic Agent. Refers to those
3.3.110* Medical Office. A building 01· part thereof in which inhalation agenl� that, because of thei1· vap01· pressure at 37'C
the following occu1·: (1) examinations and min01· treatmenl�/ (98.6'F) anrl at atmospheric pt·essure, cannot attain flammable
procedures performed under the continuous supervision of a concentrations when mixerl with air, oxygen, or mixtures of
medical professional; (2) the use of limited to minimal seda oxygen and nitrous oxide. (MED)
tion anrl treatment or procedu1·es that do not 1·ender the
patient incapable of self�preservation unde1· emergency conrli 3_3_125* Nonflammable Medical Gas System_ See 3.3.109,
tions; anrl (3) no overnight stays for patients or 24-hour opera Merlical Gas System, and Chapter 5. (PIP)
tions. (FUN) 3.3.126 Nonmedical Compressed Air. A...ir that is used for
3.3.111 Medical Support Gas. Niu·ogen or instrnment ai1· put-poses other than patient care 01· merlical rlevices that
used for any medical support purpose (e.g., to remove excess provirle direct patient care. (MEC)
moisture from instrnmenl� before furthe1· processing, or to 3.3.127 Nursing Home. A building 01· portion of a building
opernte medical-surgical tools, ai1--driven booms, pendanl�, 01- used on a 24-hour basis fot· the housing and nu1·sing care of
similar applications) and, if approp1·iate to the procedures, four or more persons who, because of menlal or physical inca
used in laboratories and are not respirerl as part of any treat pacity, might he unable to prmiirle fo1· their own needs and
ment. Medical support gas falls under the general require safety without the assistance of another pe1·son. r IOI, 2021 l
menl� for merlical gases. (PIP) (FUN)
3.3.112 Medical-Surgical Vacuum. A method used to provide 3.3.128 Opportunity for hnprovement. An identified gap or
a source of drninage, aspiration, and suction in 01·der to shortfall with the potential to raise something to a more desira
remove body fluirls from patienl�. (PIP) ble or oul�tanding quality or condition. (HES)
3.3.113 Medical-Surgical Vacuum System. An assembly of 3.3.129* Oxidizing Gas. A gas that supports combustion.
central vacuum-producing equipment anrl a netw01·k of piping (HYP)
for patient suction in medical, medical-surgical, anrl waste
anesthetic gas disposal (WAGD) applications. (PIP) 3,3-130* Oxygen. A chemical element that, at normal atmos
pheric tempe1·atures and pressu1·es, exists as a colorless, orlm·
3.3.114 Multiple Treatment Facility- A diagnostic or treatment less, and tasteless ga� and comp1·ises about 21 pet-cent by
complex unde1· a single management comprising a number of volume of the earth's atmosphe1·e. (MED)
single treatment facilities, which can be accesserl one from the
othe1- without exiting the facility (i.e., rloes not involve widely 3.3.130.1 Gaseous Oxygen. A colorless, odorless, tasteless,
separaterl locations 01· separate rlistinct practices). (FUN) anrl nontoxic gas, comprising about 21 percent of n01·mal
air by volume, that is about 10 percent heavier than air; also
3.3.115 mV. Millivolt. (FUN) the physical state of the element at atmospheric tempera
3.3.116 Nasal Cannula . Device consisting of two short tubes to ture anrl pressm·e. (MED)
he inserted into the nostrils to arlminister oxygen or other the1· 3.3.130-2* Liquid Oxygen. Exisl� at cryogenic temperatme,
apeutic ga�es. (MED) approximately -184.4 °C (-300'F) at atmospheric pressure.
3.3.117 Nebulizer. A de,ice used for prorlucing an aerosol of It retains all of the properties of gaseous oxygen, but, in
water and/or medication within inspi1-ed gas supply. (MED) addition, when allowed to warm to 1·oom temperature at
atmospheric pt·essure, it will evaporate anrl expanrl to fill a
3.3.118 Nega tive Pressure. Pressure less than atmospheric. volume 860 times it� liquirl volume. (MED)
(MED)
3,3-131 Oxygen Concentrator Unit. A...11 enginee1·ed assembly
f
3.3.119 Nitrogen. An element that, at atmosphe1·ic tempera o components that operate to raise the concentration of
tures and pressures, exisl� a� a clear, colorless, anrl ta�teless gas; oxygen, providing oxygen as a drug product. (PIP)
it comprises approximately fotll'-fifths of the earth's atmos
phere. (MED) 3.3.132" Oxygen Delivery Equipment. A.ny rlevice used to
transport and deliver an oxygen-enricherl atmosphere to a
3.3.119.1 Nitrogen NF. Nitrogen compl)'ing as a minimum patient. (MED)
with nitrogen NF. (PIP)
2021 Edition
DEFINITIONS 99-25
3.3.133* Oxygen Hood. A device encapsulating a patient's 3.3.145 Piped Distribution System. A pipeline network assem
hearl anrl used for a purpose similar to that of a mask. (Sfe alrn bly of equipment that starts at anrl inclurles the source valve,
3.3.105, Mask..) (HYP) warning systems (ma�te1·. a1·ea, local ala1·ms), bulk gas system
signal actuating switch wi1·ing, inte1·c01111ecting piping. anrl all
3.3.134 Oxygen 93 USP. Oxygen complying with Oxygen USP other component� up to and including the station outlet�/
93 Monograph. (PIP) inlets. (PIP)
3.3.135* Oxygen Toxicity (Hyperbaric). Physical impairment 3.3.146 Piping. The tubing or conduit of the system. The
1·esulting from bt·eathing ga�eous mixtu1·es containing oxygen three general classes of piping are main lines, risers, and
enriched atmospheres at elevated partial pressures for exten branch (lateral) lines. (PIP)
rlerl pet-io<ls of time. (HYP)
3.3.146.1 Branch (Lateral) Lines. Those sections or portions
3.3.136 Oxygen USP. Oxygen complying with Oxygen USP of the piping system that serve a room or group of rooms on
Monograph. (PIP) the same story of the facility. (PIP)
3.3.137 Oxygen-Enriched Atmosphere (OEA). For the purpo 3.3.146.2 Main Lines. The piping that connect� the source
ses of this code, an atmosphere in which the concentrntion of (pumps, receivers, etc.) to the risers or branches, or both.
oxygen exceerls 23.5 percent by volume. (HYP) (PIP)
3.3.138 Patient Bed Location. The location of a patient sleep 3.3.146.3 Risers. The vertical pipes connecting the system
ing bed, 01· the bed or procerlure table of a Category 1 space. main line (s) with the branch lines on the various levels of
(ELS) the facility. (PIP)
3.3.139 Patient Care-Related Electrical Equipment. Electrical 3.3.147 Plug (Attachment Plug, Cap). A device that, by inset··
equipment appliance that is intenrlerl to be used for diagnostic, tion in a receptacle, establishes connection bet\veen the
therapeutic, or monitoring purposes in a patient care vicinity. conductors of the attacherl flexible cord anrl the conductors
(MED) connected permanently to the 1·eceptacle. (MED)
3.3.140* Patient Care Space. Any space of a health ca1·e 3.3.148 Plume (Medical). The smoke by-product consisting of
facility wherein patient� are intenrlerl to be examined or trea vapors, smoke, and particulate debris prn<lucerl <luring the
ted. (FUN) thermal rlestruction of tissue by energy-baserl devices such as
3.3.140.1* Category 1 Space. Space in which failure of lasers, elecu·osut·gical generators, and broa<lbanrl light sou1·ces.
equipment or a system is likely to cause major i1tjury or (MEC)
f
death of patients, staf , or visitors. (FUN) 3.3.149 Pressure.
3.3.140.2* Category 2 Space. Space in which failure of 3.3.149.1 Absolute Pressure. The total pressure in a system
equipment or a system is likely to cause minor injuty to with reference to zero pressure. (HYP)
patients, staff, or visitors. (FUN)
3.3.149.2 Ambient Pressure. Refers to total pressure of the
3.3.140.3* Category 3 Spare. Space in which the failure of environment referenced. (HYP)
equipment or a system is not likely to cause injury to
patient�, staff, or visitorn but can cause discomfort. (FUN) 3.3.149.3 Gauge Pressure. Refe1·s to total p1·essure above (01·
below) atmospheric. (HYP)
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 3.3.149.4 High Pressure. A pressure exceeding 1.:-18 kPa
on patient care. (FUN) (200 psi) gauge (215 psia). (MED)
3.3.141 Patient Care Vicinity. A space. within a location inten 3.3.149.5* operating Pressure. The press11l'e that a particu
rlerl for the examination and treatment of patient�, extending lar piping system is set to operate at. (PIP)
1.8 m (6 ft) beyond the n01·mal location of the bed, cha.it·,
table, treadmill, 01· other device that support� the patient 3.3.149.6* Partial Pressure. The pressut·e, in absolute unit�,
<luring examination and treatment anrl extending vertically to exerted by a particula r gas in a ga� mixtme. (HYP)
2.3 m (7 ft 6 in.) above the floor. (MED) 3.3.149.7 Positive Pressure. Pressure g1·eater than ambient
3.3.142 Patient Equipment Grounding Point. A jack or termi atmospheric. (MED)
nal that serves as the collection point for redundant grounding 3.3.149.8 Working Pressure (Rated). The maximum raterl
of electric appliances serving a patient care vicinitv or for operating p1·essure for a pipe, tube, 01· vessel based on it�
grounding othe1· items in or<le1· to eliminate elecu·omagnetic material, its allowable stress in tension, its outside diamete1·
intede1·ence problems. (MED) and wall thickness, the operating tempernture, the joining
3.3.143* Patient Lead. Anv deliberate electrical connection method, anrl industry safety factors. (PIP)
that can carq; cmTent bet\�een an appliance and a patient. 3.3.150* Pres.sure-Reducing Regulator. A device that automat
(MED) ically rerluces ga� un<le1· high pressure to a usable lower work
3.3.144 Patient Medical Gas. Piperl ga�es such as oxygen, ing pressure. (MED)
nitrous oxirle, helium, carbon rlioxi<le, anrl medical air that a1·e 3.3.151 Procedure Room. \Vl1e1·e the procerluralist is using
userl in the application of human respirntion and the calibrn instrumentation that requires constant observation anrl
tion of merlical devices userl for human respiration. (PIP) control. (MED)
2021 Edition
3.3.152* Producer. The machine(s) or device(s) that gene1· 3.3.165 Self-Extinguishing. A characteristic of a mate1·ial such
ate the flow and suction required for vacuum, \,v'AGD, anrl that, once the source of ignition is removed, the flame is
plume evacuation systems to opernte. (PIP) quickly extinguished without the fuel 01· oxidizer being exhaus
ted. (HYP)
3.3.153 psia. Pounds per square inch absolute, a unit of pres
sure measurement with zero pressure as the base or reference 3.3.166 Semipermanent Connection. A noninterchangeable
pressure. (HYP) 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
3.3.154* psig. Pounrls pet· square inch gauge, a unit of pres for sen•ice. It is not the point at which the user makes connec
sure measurement with atmospheric pressure as the base or tions or disconnections. (PIP)
reference pressure. (HYP)
3.3.167 Service Inlet. l11e pneumatic terminus of a Level 3
3.3.155 Qualified Person. A person who, by possession of a piped vacuum system. (PIP)
recognizerl degree, certificate, professional standing, or skill,
and who. by knowledge. training, and experience, has demon 3.3.168 Service Outlet. The pneumatic te1-minus of a piped
strated the ability to pedorm the wmk. (HYP) gas system fot· other than critical, continuous duty, nonflamma
ble medical life support-type gases such as oxygen, nitrous
3.3.156 Reactance. The component of impedance contrib oxirle, or medical air. (PIP)
uted by inductance or capacitance. The unit of 1·eactance is the
ohm. (MED) 3.3.169* Single lreatment Facility. A diagnostic or t1·eatment
complex unrler a single management comprising a number of
3.3.157 Receptacle. A receptacle is a contact device installerl use points, but confined to a single contiguous group of use
at the outlet fot· the connection of an attachment plug. A single point� (i.e., does not involve wirlely separaterl locations 01· sepa
receptacle is a single contact device with no othe1· contact rate distinct practices). (PIP)
device on the same yoke. A multiple receptacle is two or more
contact rlevices on the same yoke. [70, 20201 (ELS) 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
3.3.158 Reference Grounding Point. The grounrl bus of the intentionally venterl to the atmosphe1·e. (MED)
panelboard or isolated power system panel supplying the
patient care room. (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
3.3.159 Relocatable Power Tap (RPT). A device for indo01· purpose. (FUN)
use consisting of an attachment plug on one enrl of a flexible
corrl and tlu-ee or more receptacles on the opposite enrl. (SPP 3.3.172 Standard Cubic Feet per Minute (SCFM). Volumetric
W2.3.6.) (MED) flow rate of gas in units of standa1·rl cubic feet per minute.
(PIP)
3.3.160* Remote. A Level 3 source of supply that is accesserl
by exiting the single or multiple treatment facility. (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
3.3.161 Reserve Supply. Where existing, that portion of the tions and disconnections. (PIP)
supply equipment that automatically supplies the system in the
event of failure of the operating supply. The reserve supply 3.3.174 Station Outlet. An outlet point in a piped medical gas
only functions in an eme1·gency and not a� a normal opernting distribution system at which the user makes connections and
procerlure. (PIP) disconnections. (PIP)
3.3.162 Risk Categories. (FUN) 3.3.175 Supply Source. Those portions of the central supply
system that act a� a self:contained supply. (PIP)
3.3.162.1 Category I. Activities, systems, or equipment
whose failure is likely to cause major ittjury or death to 3.3.175.1 operating Suppl.y. The portion of the central
f
patient�, staf , or "isitors. (FUN) supplv svstem that is supplying the piping system at the time
f
o obsen•ation. (PIP)
3.3.162.2 Category 2. Activities, systems, or equipment
whose failure is likely to cause minor injury to patients, staff, 3.3.175_2 Primary Supply. l11e portion of the central supply
or visitors. (FUN) system that is the default supply for the piping system. (PIP)
3.3.162.3 Category 3. Activities, systems, or equipment 3.3.175.3 Reseroe Supply. Where provided, the portion of
whose failure is not likely to cause injuty to patient�, staff, or the central supply system that will supply the piping system
visitors but can cause rliscomfon. (FUN) when the primary and secondary supplies are exhausterl or
are not operative. (PIP)
3.3.162.4 Category 4. Activities, systems, or equipment
whose failure would have no impact on patient care. (FUN) 3.3.175.4 Serondary Supply. Where provirlerl. the portion of
the central supply system that will supply the piping system
3.3.163 Scavenging. Evacuation of exhaled mixtures of when the primaty supply is exhausterl or is not operative.
oxygen and niu·ous oxirle. (PIP) (PIP)
3.3.164 Selected Receptacles. A minimal number of recepta 3.3.176* Surface-Mounted Medical Gas Rail Systems. A
cles selecterl by the health care facility's governing borly as surface-mounted gas delivery system intended to provide 1·eady
necessary to provirle essential patient ca1·e and facility senices access fot· two or m01·e gases through a common delivery·
during loss of normal power. (ELS) system to provide multiple gas station outlet locations within a
single patient room or Categoq' l Space. (PIP)
2021 Edition
FUNDAMENTALS 99-27
3.3.177 Task Illumination. Provisions for the minimum light campus 01· utility se1vice and building interim· distribution of
ing required to cany out necessary tasks in the area� described communications systems. (ELS)
in Chapter 6. including safe access to supplies and equipment
and access to exits. (ELS) 3.4.2 Telecommunications Equipment Room (TER). An envi
ronmentally controlled centralized space for telecommunica
3.3.178 Terminal. The enrl of a flexible hose or tubing used tions equipment, typically including main or intermediate
in a manufactured assembly whe1·e the use1· is intended to cross-connect equipment and cabling. (ELS)
make connection anrl disconnection. (PIP)
3.4.3 Telecommunications Room (TR). An enclosed a1-chitec
3.3.179 Touch Current. Leakage current flowing from the tural space for housing telecommunications equipment, cable
enclosu1·e 01· from part� thereof, excluding patient connec terminations, anrl c1·oss-connect cabling, serving a floor 01· an
tions, accessible to any operntor or patient in normal use, area of a flom. (ELS)
through an external path other than the protective grounding
(earth) conductor to earth or to another part of the enclosure.
(MED) 01.apter 4 FW1damentals
3.3.180 Transfilling. The process of transferring a medical ga� 4.1 * Risk Categories. All activities, as well as sy stems or equip
in gaseous or liquid state from one container or cylinder to ment that are new or altered, shall be designerl to meet Cate
anothe1· container or cylinder. (MED) go1y 1 through Category 4 requi1·ements, a� detailed in this
code.
3.3.181 Tube.
4.1.1* Category I. Activities, systems, or equipment whose
3.3.181.1 * Endutracheal Tube. A tube for insertion through failure is likely to cause majm· i1�ury or death of patients, staff,
the mouth or nose into the upper portion of the trachea or visitors shall be designed to meet Categmy I 1·equi1·ements,
(windpipe). (MED) a� detailed in this code.
3.3.182 Use Point. A location with any number of station 4. 1.2* Category 2. Activities. systems. 01· equipment whose
outlets anrl inlets arranged for access by a practitioner <luring failure is likely to cause minm· injm·y of patients, staff, 01· visi
treatment of a patient. (PIP) tors shall he designed to meet Category 2 requirements, as
3.3.183 Vaporizer. A heat exchange unit designed to convert detailed in this code.
cryogenic liquid into the gaseous state. (PIP) 4.1.3 Category 3. Activities, systems, or equipment whose fail
3.3.184 Ventilation. The mechanical or natural movement of ure is not likely to cause i1�ury to patient�, staff, or visitors, but
air. (MEC) can cause discomfort, shall be designed to meet Categm·y 3
requi1·ement�, as detailed in this code.
3.3.185 Waste Anesthetic Gas Disposal (WAGD). The process
of capturing anrl canying away gases vented from the patient 4.1.4 Category 4. Activities, systems, or equipment whose fail
b1·eathing circuit during the nm·mal operation of gas anesthe ure woulrl have no impact on patient care shall be designed to
sia or analgesia equipment. (PIP) meet Category 4 1·equirements. as detailed in this code.
3.3.186 Waste Water. fMEC) 4.1.5* Acti\ities, systems, and equipment shall be permitted to
be rlesignerl to a highe1· 1·isk category.
3.3.186.1 Black Waste Water. Grossly contaminated and
contain pathogenic, toxigenic, or other harmful agents. 4.2* Risk Assessment.
(MEC) 4.2.1 The health care facility's governing borly shall establish
3.3.186.2 Clear Waste Water. Originates from a sanitary the processes anrl operations that are planned fo1· the health
water source and rloes not pose substantial risk from care facility.
dermal, ingestion, or inhalation exposure. (MEC) 4.2.1.1 The governing borly shall conduct risk assessment� anrl
3.3.186.3 Gmy Waste Water. Contains significant contami shall determine risk catego1·ies baserl on the characte1· of the
nation and has the potential to cause rliscomfon or sickness processes and operations conducted in the health care facility.
if contacted or consumed by humans. Can contain poten 4.2.2* Risk categories shall be classifierl by the health care
tially unsafe levels of microm·ganisms 01· nutt·ient5 for micro facility's goven1ing body by following and documenting a
org-anisms, as well as other m·ganic 01· inorganic matter rlefinerl 1·isk. assessment procedure.
(chemical or biological). (MEC)
4.2.2.1 Where requirerl by the authority having jurisdiction,
3.3.187* Wet Procedure Locations. The area in a patient ca1·e the risk assessment shall be provided to the authm·ity having
space whe1·e a procedure is perfo1·med that is normallv subject jurisdiction for review based on the characte1· of the processes
to wet conditions while patients are present, including standing and operations conducted in the health care facility.
fluids on the floor or drenching of the work area, either of
which condition is intimate to the patient 01· staff. (FUN) 4.2.3 A documented 1·isk assessment shall not be required
where Catego1y 1 is selected.
3.4 BICSI Definitions. These terms are defined in Tltf BJCSI
Infarmation Transport Systems (ITS) Dictionary. 4.3 Application. The Category definitions in Chapter 4 shall
apply to Chapters 5 through 11, 14, and 15, except as modified
3.4.1 Telecommunications Entrance Facility (EF). An in those chapters.
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
2021 Edition
4.4 Materials_ 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
4.4.1* Noncombustible Material.
4.4.1.I A material that complies with any of the following shall Chapter 5 Gas and Vacuum Systems
be consirlererl a noncombustible material:
(1) A mate1·ial that, in the fot·m in which it is used and unde1· 5.1 Category 1 Piped Gas and Vacuum Systems.
the conditions anticipated, will not ignite, burn, support
combustion, or release flammable vapors when subjected 5_Ll * Applicability.
to fire or heat 5.1.1.1 These requi1·ement� shall apply to health care facilities
(2) A material that is reported as passing ASTM El 36, Stand that require Category 1 systems as 1·eferenced in Chapter 4.
ard Test Methnd fnr Behavior nf Matm:aL� in a Vfrtiral T11/Je
Furnace at 750° C 5.1.1.2 Category 1 piped gas or piperl vacuum system require
(3) A material that is 1·epmted as complying with the pass/fail ment� shall be applierl where any of the following crite1·ia is
critet-ia of ASTM El36 when tested in acc01·dance with met:
the test method and procedure in ASTM E2652, Standard ( 1) General anesthesia, a� definerl in 3.3.68.1, or deep seda
Test l\iethnd fnr Behavior nf Material� in a Tube I-i1maa with a tion, as defined in 3.3.68.2, is performerl.
Cnne-shaped liirjlnw Stabilizer, at 75WC (2) The loss of the piperl gas m piperl vacuum systems is
4.4.1.2 Where the term limited-rmnlmstible is userl in this code, likely to cause major i1tjury or death of patients, staff, or
it shall also include the term nnncmnbmtible. r5000:7.l.4.1.2l visitors.
4.4.2* Limited-Combustible Material. A material shall be 5.1.1.3* Whe1·e the te1·ms mediral gns or mediral suppart gm
considered a limited-combustible material where one of the occut·, the provisions shall apply to all piped systems for
following is met: oxygen, nitrous oxide, medical air, carbon dioxide, helium,
nitrogen, instrument ai1·, and mixtures thereof. \Vherever the
(1) The conditions of 4.4.2.1 and 4.4.2.2, and the conditions name of a specific ga� service occurs, the prmision shall apply
of eithe1· 4.4.2.3 m 4.4.2.4, shall be met. only to that gas.
f
(2) The conrlitions o 4.4.2.6 shall be met.
5.1.1.4* An existing system that is not in strict compliance
4.4.2.1 The material shall not comply with the requirement� v,':ith the provisions of this code shall be permitterl to be contin
for noncombustible mate1·ia l in accor·rlance with 4.4.1. ued in use, unless the au1h01·itv having jurisdiction has dete1·
4.4.2.2 The material, in the f01·m in which it is used, shall minerl that such use constitutes a rlistinct hazard to life.
exhibit a potential heat value not exceerling 3500 Btu/lb (8141 5.1.1.5 The following sections of this chapter shall apply to
kJ/kg) where testerl in accordance with NFP,i\. 259. the operntion, management, and maintenance of Category
4.4.2.3 The material shall have the structu1·al base of a 1 medical gas and vacuum systems in both new and existing
noncombustible material with a surfacing not exceerling a facilities:
thickness of ¼ in. (3.2 mm) where Lhe surfacing exhibit� a (1) 5.1.2
flame sp1·earl inrlex not greate1· than 50 when tested in acco1·d (2) 5.1.3.1
ance with ASTM E84, Standard Test Metlwd fnr Surfaa Burning (3) 5.1.3.2
Chamcteri�tirs nf Building Material�. or UL 723, Standard fnr Test (4) 5.1.3.3.4
Jar Surfaa Burning Characteristics nf Building Material�. (5) 5.1.3.6.2
(6) 5.1.3.6.3.lO(A) (2)
4.4.2.4 The material shall be composed of materials that, in (7) 5.1.3.7.6(A) (2)
the form and thickness used, exhibit neither a flame sprearl (8) fU .3.8.4.1 (2)
index greate1· than 25 nor evirlence of continuerl prng1·essive (9) 5.1.14
combustion when tested in accordance with ASTM E84, Stand
ard 1;,s1 Metlwd for Surfare Burning Chami:teristii:s nf Building Mate 5_1.J.6 Category 1 systems shall be pe1·mitted to se1·ve spaces
rial�. or UL 723, Standard fnr Test Jar SurfaCP Burning i den tifi erl as Category 1, Categoq; 2, or Category 3.
Chararteristirs nf Building Material�. anrl shall be of such composi
tion that all surfaces that would be exposed by cutting through
5.1.2 Nature of Hazards of Gas and Vacuum Systems. Poten
tial fire and explosion hazards associated with positive p1·essut·e
the material on any plane would exhibit neither a flame sprearl
gas central piping systems anrl medical-sm·gical vacuum
index greate1· than 25 1101· exhibit evidence of continuerl
systems shall be considered in the design, installation, testing,
progressive combustion when testerl in accordance with ASTM
ope1·ation, and maintenance of these systems.
E84 or UL i23.
4.4.2.5 Mate1·ials shall be considered limited-combustible 5.1.3* Category I Sources.
materials whe1·e tested in accordance with ASTM E2965, Stand 5.1.3.1 Central Supply System Identification and Labeling.
ard ]�st Methnd far Determinatinn nf L nw Level� nf Heat &!Pase Rnte
fnr Material� and Pmdw:t� U�ing an Oxygen Cnnsumptinn Calarime 5.1.3.1.1* Cylinde1·s, containers, and tanks shall be designed,
fPT, at an incident heat flux of 75 k\V/m� for a 20-minute expo fabricated, testerl, anrl marked (stamped) in accordance with
sure anrl both of the follov,':ing conditions are met: 1·egulations of DOT, Transport Canada (TC) Tmnspnrtatinn nf
Dangnnus (',ands &gulatinm, or the ASME Bnilfr and Prl's.mre
(1) The peak heat release rate shall not exceed 150 HV/m 2 VP.�vl CndP, "Rules fot· the Construction of Unfirerl Pressure
for \onge1· than 10 seconds. Vessels," Section VIII. r55:7.l.5.l l
(2) The total heat 1·eleased shall not exceed 8 MJ/ m2 .
2021 Edition
c;As AND VACUUM SYSTEMS 99-29
5.1.3.1.2* Cylinde1· contents shall be identified by attached 5.1.3.2.5* If cylinde1·s at·e \Happen when received, the wrap
labels or stencils naming the content5 in accordance with the pers shall be removerl prior to storage.
manrlatory 1·equi1·ement� of CGA C-7, Guide tn Classifimtion and
La/Jfling nf CmnfrrPssPd GrLSPS. 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.
5.1.3.1.3 Liquid containers shall have additional prorluct irlen
tification visible from all directions with a minimum of 51 mm 5.1.3.2.7 C1yogenic liquid storage uniL� intended to supply gas
(2 in.) high letters such as a 360-degree wraparound tape for to the facility shall not be used to transfill other liquirl storage
medical liquirl containers. vessels.
5.1.3.1.4 Cqugenic liquirl containe1·s shall be provirlerl with 5.1.3.2.8 Ca1·e shall be exercised when handlin g cylinder·s that
ga�-specific outlet connections in accm·dance with the manrla have been exposed to freezing temperatut·es or containe1·s that
tory requirements of CGA V-5, Diameter Index Sajfty Systnn contain cryogenic liquids to p1·event injury to the skin.
(Nnninterrhangmble Lnw Pre.mtre Connertinns fm- .Mediral (',as A.ppli 5.1.3.2.9 Cylinde1·s containing compresserl gases and contain
r:atinns ), or CGA V-1, Standard Jm- CnmpressPd (',as Cylinder Valve e1·s fot· volatile liquids shall be kept away from radiators, steam
Outlft and Inlft Cnnnectinns. piping, and like sources of heat.
5.1.3.1.5 Cylinder anrl cryogenic liquirl container outlet 5.1.3.2.10 When cylinrler valve protection caps ar·e supplied,
connections shall be affixed in such a manner· as to be integral they shall be securerl tightly in place unless the cylinde1· i s
to the ,,ilve(s), unremovable with ordinaty tools, or so connecterl for use.
rlesigned a� to render the attachment point unusable when
1·emoverl. 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).
5.1.3.1.6 The content� of cylindei-s and ct"Vogenic liquirl
containers shall be verified prior to use. 5.1.3.2.12 Central supply systems for nitrous oxide and carbon
dioxirle using cylinders or portable containe1·s shall be p1·even
5.1.3.1.7 Labels shall not be defaced, alte1·ed, or removerl, and ted from 1·eaching temperatures lower than the recommenda
connecting fittings shall not be modified. tions of the central supply system's manufacturer, but shall
5.1.3.1.8 Source locations containing positive pressure gases never be lower than -7'C (20'F) or greater than 52'C ( 125'F).
other than oxygen anrl medical air shall have thei1· doors 5.1.3.3* Central Supply System Locations.
labeled as follows:
5.1.3.3.1 General. Central supply systems shall be located to
Positive Pressure Gases meet the criteria in 5.1.3.3. l through 5.1.3.3.1.10.
NO Smoking or Open Flame
Room May Have Insufficient Oxyge n 5.1.3.3.1.1 Any of the following central supply systems shall be
Open Door and Allow Room to Ventilate Before Entering permitted to be located together in the same outdoor enclo
sure:
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 ( l) Manifolds fix g-as cylinde1·s (sPP 5.1.3.5.10)
uerl in use as long as the authority having jurisrliction has ( 2) Manifolrls for ctyogenic liquirl containers (seP 5.1.3. 5.11)
rletermined that such use does not constitute a rlistinct hazard (3) C ryogenic fluid central supply (SPP 5.1.3.5.12)
to life. (4)* Individual components on the oxygen sirle of concentra
tor sources (sPe 5.1.3. 9)
5.1.3.1.9 Source locations containing only oxygen or medical
air shall have thei1· rloors labeled as follows: 5.1.3.3.1.2 A.ny of the following systems shall be permitterl to
be located togethe1· in the same indoor enclosure:
Medical Gases (1) Manifolds for g-as cylinde1·s (sPP 5.1.3.5.10)
NO Smoking or Open Flame (2) Manifolrls for ctyogenic liquirl containers (sPP 5.1.3. 5.11)
5.1.3.1.9.1 Existing signage that is not in strict compliance (3) In-building eme1·gency reserves (see 5.1.3.5.14)
with the provisions of this code shall be permitted to be contin (4) Instrument air stanrlby headei-s (.w 5.1.13.3.7.6)
uerl in use as long as the authority having jurisrliction has (5 )* Individual components on the oxygen side of concentra-
dete1·mined that such use does not constitute a rlistinct hazarrl tor sources (see 5.1.3.9)
to life. 5.1.3.3.1.3 Any of the following central supply systems shall be
5.1.3.2 Central Supply System Operations. permitted to be locaterl together in the same room:
5.1.3.2.1 The use of arlapters 01· conversion fittings to adapt (1) Medical air central supply compressor supply sources (sPP
one gas-specific fitting to another shall be prohibited. 5.1. 3.6.3)
(2) Medical-surgical vacuum central supply sources (SfP
5.1.3.2.2 Cylinrlers anrl containers shall be handled in strict 5.1.3.7)
acco1·dance with 11.6.2. (3) VVaste anesthetic ga� disposal ('VAGD) central supply
sout-ces (stt 5.1.3.8)
5.1.3.2.3 Only gas cylinders, reusable shipping containers, anrl ( 4) Instrument air compressor central supply sources (see
their accessories shall be permitted to be storerl in rooms 5.1.13.3.7)
containing central supply systems or gas cylinde1·s. (5 ) 1\ny othe1· com p1·ess01·, vacuum pump, or electrically
5.1.3.2.4 No flammable materials , cylinders containing flam powererl machinery
mable gases, or containers containing flammable liquids shall (6)* Compressors, dryers, and air receivers used to supply
be storerl in rooms with gas cylindern. oxygen concentrators (sPe 5.1. 3. 9)
2021 Edition
(7) Concentrator unit� with ai1· an<l oxygen sides in an inte- buil<ling by walls and f1001·s having a 1-hour fit·e resist
gral unit (m5.1.3.9) ance rating with doors an<l other opening protectives
having a ?\-hour fire protection rating.
5.1.3.3.1.4 Any central supply system listed uncier 5.1.3.3.1.3 (7)* They shall comply with NIP.A. 70 for or<linar y locations.
shall not be located in the same room with any central supply (8)* Fuel-fired equipment shall not he located in the room.
system listed under 5.1.3.3.l. l or 5.1.3.3.1.2, except instrument (9) If they require heat, the maximum allowable tempera-
ai1· 1·eserve headers complying with 5.1.3.2.11 an<l 5.1.1 3.3. 7.6 tu1·e of the in-room heating element shall be 130'C
shall be permitted to be in the same room as an instrument ai1· (266'F).
compressor. (10) They shall be provi<led \,nth racks, chains, or other
5.1.3.3.1.5 In<loo1· locations fot· oxygen, nitrous oxide, and fastenings to secure all cylin<lers from falling, whether
mixtu1·es of these gases shall not communicate with the follow connecte<l, unconnected, full, 01· empty.
ing: (11 )* They shall he supplied with elect1·ical powe1· compliant
with the requirement� for essential electrical systems as
( l) Areas involve<l in critical patient ca1·e describe<l in Chapte1· 6.
(2) Anesthetizing locations whe1·e mo<lerate sedation, deep (12) They shall have racks, shelves, and support�, whe1-e
sedation, or genei-al anesthesi a is administered provi<le<l, constructed of noncombustible materials or
(3) Locations storing flammables limited-combustible materials.
(4) Rooms containing open electrical contacts 01· transform- (13) 1l1ey shall protect elect1-ical <levices from phys ical
e1·s damage.
(5) Storage tanks for flammable or combustible liquids (14)* They shall allow access by delivery vehicles an<l manage
(6) Engines ment of cylinders.
(7) Kitchens (15) 1l1ey shall be designed to meet the operational requi1·e-
(8) Areas with open flames f
ment� o 5.1.3.2 with regard to room temperature.
5.1.3.3.1.6 Cryogenic fluid central supply s ystems for oxygen 5.1.3.3.2.2 Design an<l construction of locations fot· ct"yogenic
shall comply with NFPA 55. fluid central supplv S\'litems shall comply \\lith 5.1.3.5.12.
5.1.3.3.I.7 Bulk nitrous oxi<le central supply systems shall 5.1.3.3.3 Ventilation.
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. 5.1.3.3.3.1 Ventilation for Indoor Locations. Central supply
system locations, medical gas storage rooms, and transfilling
5.1.3.3.1.8 Central supply systems for carbon dioxi<le using room ventilation shall comply with 9.3.6.
pe1·manently installed containers with product capacities
g1·eater than 454 kg (1000 lb) shall comply with NFPA 55 an<l 5.1.3.3.3.2 Venting of Relief Valves. In<loor supply systems
with the man<lat01·y 1·equirement� of CGA G-6.1, Standard for shall have all relief valves vented pet· 5.1.3.5.6. l(4) through
Inmlated Liquid CarlJon Dioxide Systems at Gmsiwter Sites. 5.1.3.5.6.1(9).
5.1.3.3.1.9 Central supply systems fot· carbon dioxide using 5.1.3.3.3.3 Ventilation for Motor-Driven Equipment. The
pe1·manently installed containers with product capacities of following soui-ce locations shall be ventilate<l to prevent accu
454 kg (1000 lb) or less shall comply with NFPA 55 and with mulation of heat:
the man<latory 1·equi1·ement� of CGA G-6.5, Standard for Small (1) Medical air central supply systems sources (sep 5.1.3.6)
Stationan• Insulated Car/Jon Dioxide Supp�,• Systems. (2) Me <lical-surgical vacuum central supply systems sou1·ces
5.1.3.3.1.10* C ry ogenic fluid central supply systems for inert (Sl'i' 5.1.3. 7j
gases shall comply \\�th NFPA 55 and with the mandat01·y (3) Waste anesthetic gas disposal (''\'AGD) centt·al supply
requirements of CGA P-18, Standard for Bulk Inert Gas Systnm al systems sources (s!'I' 5.1.3.8.1)
Consumer Sites. (4) Instrument air central supply systems som·ces (.�l'I'
5.1.13.3.7)
5.1.3.3.2* Design and Conslruction.
5.1.3.3.3.4 Ventilation for Outdoor Locations.
5.1.3.3.2.1 Locations for central supply systems, excluding
cryogenic fluid central supply systems, and for the storage of (1) Outdoor locations surrounded by impermeable walls,
positive-pressure gases shall meet the following 1·equirements: except fit·e ba1Tie1· walls, shall have protected ventilation
openings locate<l at the base of each \\"all to allow free
(l) They shall be constructed with access to move cylinders, circulation of air within the enclosure.
equipment, and so forth in and out of the location on (2) Walls that are shared with other enclosures or with build
hand trucks complying with 11.4.3.l.l . ings shall be pe1·mitted to not have openings.
(2) They shall he provided with lockable doors or gates 01· (3) 1l1e fit·e barrie1· wall shall not have openings or peneti-a
othetwise able to be secure<l. tions, except conduit or piping shall be permitted, provi
(3) If outdoors, they shall be well drained and provi<led with <led that the penetration is protecte<l with a firestop
an enclosure (e.g., wall or fencing) constructed of system in accor<lance with the building code.
noncombustible matet-ials.
(4) If out<loors, cylinders an<l containers shall be protecte<l 5.1.3.3.4 Storage.
from prolonged contact with soil. 5.1.3.3.4.1 Full or empty me<lical gas cylindei-s, when not
(5) If in<lo01·s, they shall have inte1·i01· finishes of noncom connected, shall be st01·ed in locations com plying with 5.1.3.3.2
bustible 01· limited-combustible materials. through 5.1.3.3.3 and shall he permitted to he in the same
(6)* If indoors, rooms containing oxygen, nitrous oxi<le, or rooms 01· enclosures as their respective central supply systems.
other oxidize1-s shall be separated from the 1·est of the
2021 Edition
c;As AND VACUUM SYSTEMS 99--31
Apprnved existing installations shall be permitte<l to be contin 5.1.3.5.3 Medical Support Gases. Centt·al supply systems for
uect in ser,.,ice. medical support gases shall not be piped to, or used for, any
purpose except medical suppon application.
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 5.1.3.5.4* Materials. Materials use<l in central supply systems
the exception of cylin<lers intended for instrument air reserve shall meet the following reguirements:
hea<lers complying with 5.1.13.3. 7.G, which shall be permitted In those ponions of systems intended to han<lle oxygen at
(1)
to be placed in the same location containing an instrument air gauge pressures greater tha11 2 413 kPa (350 psi), inte1·
compressor when it is the only motor-driven machinery located connecting hose shall contain no polymeric materials.
\\1thin the room. Only cylinders intended for instrument air In those portions of systems intended to handle oxygen
(2)
1-eserve headers complying \\1th 5.1.13.3.7.6 shall be permitted or nitrous oxi<le matet-ial, construction shall be compati
to be store<l in enclosures containing instrument air comp1·es ble with oxygen unde1· the temperatm·es and pressu1·es to
sors. which the component� can be exposed in the contain
5.1.3.4 Control Equipmen t. Fo1· control eguipment, as speci ment and use of oxygen, nit1·ous oxide, mixtures of these
fied in 5.1.3.5.5, 5.1.3.5.G, anct 5.1.3.5.7, that is physically gases, 01· mixttl!'es containing more than 23.5 percent
remote from the supply system, the control eguipment shall be oxygen.
installed \\1thin a secure enclosure to prevent unautho1·ized (3) If potentially exposed to cryogenic tempe1·atures, materi
access in accor<lance with 5.1.3.3.2. l (2). als shall be designe<l for low temperatut·e service.
(4) If intended for outdo01· installation, materials shall be
5.1.3.4.1 The enclosure shall prmicte enough space to installed per the manufacturer's reguiremenK
perfo1·m maintenance and 1·epair.
5. 1.3.5.5 Controls for Line Pressure.
5.1.3.4.2 The location of the enclosure for contrnl eguipment
other than for medical air shall not communicate with combus 5.1.3.5.5.1* All positive-pressure supply systems shall be prmi
tible 01· flammable mate1·ials. ded with means to control the final line pressm·e at the source
with all the following charncteristics:
5.1.3.5* Central Supply Sys tems. Centrnl supply systems shall
be permi tte<l to consist of the following: (1) Able to maintain stable pressures within the limit� of
Table 5.1.11
(l ) Cylinder manifolds for gas cylinders pet· 5.1.3.5.10 (2) Each control mechanism able to flow 100 percent of the
(2) Manifolds for Cl'yogenic liguid containet's per 5.1.3.5.11 peak calculate<l demanct
(3) Cryogenic fluict central supply systems per 5.1.35.12 (3) Rectundant, such that each component of the control
( 4) Medical air comp1·essor systems per 5.1.3.6 mechanism can be isolated for senice or replacement
(5) Medical-surgical vacuum producers pet· 5.1.3.7 while maintaining normal operntion
(G) WAGD pro<lucers pet· 5.1.3.8 (4) Protected against overpressure (.�PP 5.1.3.5.6)
(7) Instrument air compressor systems per 5.1. l :\.3.7 (5) Be constructed of materials deemed suitable by the
(8) Proportioning systems for medical air USP per m.an ufac tut·er
5.1.3. 6.3.14
(9) Oxygen central supply systems using concentrators per 5.1.3.5.5.2 The line pressure 1·egulat01·s reguire<l un<le1·
5.1.3.9 5.1.3.5.5.1, where used for cryogenic fluict central supply
systems, shall be of a balancect design.
5.1.3.5.1 General. Ce11tt·al supply systems shall be ohtaine<l
from a supplier or manufacturer familiai· with their proper 5.1.3.5.6 Relief Valves.
construction a11d use and installect in accordance with the 5.1.3.5.6.1 All pressure relief valves shall meet the following
manufactu1·e1·'s instructions. 1-egui1·ement�:
5.1.3.5.2 Permitted Locations for Medical Gases. Central (l ) They shall be of brass, bronze, or stainless steel construc
supply svstems for o>..-ygen, me<lical air, nitrous oxide, carbon tion.
dioxide, and all other patient medical gases shall he piped only (2 ) They shall be designe<l fo1· the specific gas service.
to medical g-ds ouLlets complying with 5.1.5, into areas whe1·e (3) They shall have a 1·elief pt·essure setting not higher tha11
the gases will be used under the direction of licensed me<lical the maximum allowable working pressure (MAWP) of the
professionals for put·poses congruent with the following: component \,�th the lowest working pressure 1·ating in the
(l ) Direct respiration hy patient� portion of the system being protected.
f
(2) Clinical application of the ga� to a patient, such as the use ( 4) They shall be vented to the out�ide o the building,
of an insufflat01- to i1-uect carbon dioxide into patient except that relief valves for compressed air systems having
bocty cavities ctm·ing laparoscopic surgery a11d carbon less than 84,950 L (3000 ft'l ) at STP shall be permitted to
dioxide use<l to prn·ge hean-lung machine blood flow be diffused locally by means that will not restt·ict the flow.
ways (5) They shall have a vent ctischai·ge line that is not smaller
(3) Medical de,ice applications di1·ectly 1·elated to respiration than the size of the relief valve outlet or 20 mm (1/,NPS),
( 4) Powe1· fo1· medical devices usect directly on patient� whicheve1· is la1-ger.
(5) Calibration of me<lical <levices intended for 5.1.3.5.2(1) (6) Where two or more relief valves discharge into a common
through 5.1.3.5.2( 4) vent line, the internal cross-sectional area of the common
(6) Simulation centers for the education, training, and a�sess line shall be not less than the aggregate cross-sectional
ment of health cai·e professionals ai·ea of all relief valve vent discha1·ge lines served.
(7) They shall not discharge into locations creating potential
haza1·ds.
2021 Edition
(8) They shall have the rlischarge terminal turned down and (5) Pressure indicator indicating the pressure of header
screened to prevent the entry ofrain, snow, or vermin. content�
( 9) They shall be <lesigne<l in accor<lance with ASME B31.3, (6) Check valve to prevent backflow into the header and to
Pmuss Piping. allow service to the heade1·
(7) Ifintended for gas cylinder service, a check valve at each
5.1.3.5.6.2 Pressure relief valves for cryogenic flui<l central connection for the cylin<ler lead in 5.1.3.5.9(2) to
supply systems shall be in accor<lance with 5.1.3.10.10. prevent loss ofga� in the event of damage to the cylinder
5.1.3.5.6.3 \'\'hen vented to out<lom·s, materials an<l constrnc lead or operation of an individual cvlinder 1·eliefvalve
tion for relief \'alve discharge lines shall be the same as (8) If intended for gas cylin<ler senice, a pressure regulator
required for positive presstll'e gas <listt·ibution. (See 5.1.10.1.) to 1·educe the cylinder p1·essu1·e to an intermediate pres
sure to allow the proper operation of the pt·imary and
5.1.3.5.6.4 C.entrnl supply systems fot· positive pt·essure gases secon<la1·y headern
shall inclu<le one or more relief valves, all meeting the follow (9) If intended for service with cryogenic liquid containers,
ing 1·equirements: a pressure relief valve
(1) They shall be located between each final line regulato1· (10) Vent valves, if fitted on a heade1·, vented outside of the
and the source valve. building per 5.1.3.5.6. l (5) through 5.1.35.6. l (9) and
(2) They shall have a relief setting that is 50 pe1·cent above 5.1.3.5.6.3
the nm·mal system operating p1·essure, as indicated in 5.1.3.5.10* Manifolds for Gas Cylinders.
Table 5.1.11.
5.1.3.5.10.1 The manifolds in this category shall be located in
5.1.3.5.6.5 v\-'hen vented out�i<le, 1·eliefvalve vent lines shall be acco1·dance with 5.1.3.3.1 an<l shall meet the following:
labeled in accordance with 5.1.11.1 in any manner that will
distinguish them from the medical gas pipeline. (1) Iflocate<l outdom·s, they shall be installed in an enclostu-e
used only for this purpose and sited to comply with mini
5.1.3.5.7 Multiple Pressures. \'\'here a single centt·al supply mum <listance 1·equirements in Table 5.1.3.5.11.1.
system supplies separate pipe<l <listribution networks operating (2) If located in<loors, they shall be installed within a room
at different presstlt"es, each pipe<l <listribution network shall use<l only for enclosure of such manifol<ls.
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 5.1.3.5.10.2 The manifold locations for this categoq• shall be
master ala rm. con strncte<l in accordance with 5.1.3.3.2.
5.1.3.5.8 Local Signals. 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.
5.1.3.5.8.1 The follo"�ng centrnl supply systems shall have
local signals located at the source equipment: 5.1.3.5.10.4 The manifol<ls in this category shall consist of the
following:
(1) Manifolds for ga� cylinders without resenre supply (.w
5.1.3.5.10) (1 ) Two equal headers in acco1·<lance with 5.1.3.5.9, each with
(2) Manifolds for gas cylinde1·s with reserve supply a su fficient numbe1· of gas cylinder connections for one
(3) Manifolds for cryogenic liquid containers (.w 5.1.3.5.11) average day"s supply, but not fewer than two connections.
(4) Cryogenic flui<l central supply systems (.fff 5. 1.3.5.12) and with the headers connected to the final line pt·esstlt'e
(5) In-buil<ling eme1·gency 1·esen,es (sef 5.1.3.5.14) 1·egulat01· assembly in such a manner that either header
( 6) Instrument air headers (.w 5.1.13.3. 7.6) can supply the system
(2) Vent valves, if fitted on a hea<ler, vented out�ide of the
5.1.3.5.8.2 The local signals shall meet the following require building per 5.1.3.5.6. l (5) through 5.1.3.5.6. l (9) and
ment�: 5.1.3.5.6.3
(1) Provision of visual in<lication only (3) Interme<liate relief valve(s), piped to the out�i<le in
(2) Labeling for the service and condition being monitore<l accordance \\1th 5.1.3.5.6.1( 5) through 5.1.3.:>.6.1(9).
(3) If intended for outdom· installation, be installe<l pet· that protects the piping between the heade1· pt·essure
manufacturer's requirement� 1·egulat01· an<l the line pressure regulator a�sembly. and
protect� the line pressure regulators from overpressure in
5.1.3.5.9* Headers. In central supply systems using cylindei-s the event of a hea<ler regulator failu1·e
containing either gas or liquid. each hea<ler shall include the
following: 5.1.3.5.10.5 The manifolds in this category shall include an
automatic means of alternating the two headers to accomplish
( l)* C.ylinde1· connections in the number required fot· the the following in normal operation:
hea<le1·'s application
(2) C.ylinde1· lead for each cylinde1· constrncte<l of mate1·ials (1) One heade1· is the prima1·y and the other is the secondary.
compl�ng with 5.1.3.5.4 and provided with end fittings "1th either being capable of either role.
pe1·manently attached to the cylin<ler lead complying (2) When the pt·imarv header is supplying the system, the
with the mandatm·y 1·equi1·ements of C.GA V-1, Standard secon<lary header is prevented from supplying the system.
for Cmnpm��ed C',rl� Cylinder lizlve Outli!t and Inlet Connn: (3) \'\'hen the pt·imary hea<ler is depleted, the secondary·
tions (ANSI B57.1) hea<ler automatically begins to supply the system.
(3) Filter of a material complying with 5.1.3.5.4 to prevent 5.1.3.5.10.6 The manifol<ls in this category shall have a local
the intrnsion of deb1·is into the manifold controls signal that visibly indicates the operating status of the equip
(4) Hea<ler shutoff valve <lownstream of the nearest cylin<ler ment and shall activate an indicator at all master alarm panels
connection, but upstt·eam of the point at which the when or at a p1·edetermined set point befo1·e the secondary
hea<le1· connect� to the central supply system
2021 Edition
header begins to supply the system. indicating changeove1· has cylinde1- supply having equal capacity to meet the
occurrerl or is about to occur. required peak flow rate of the primary hearler, and a
rese1·ve gas cylinde1· hearler in acc01·dance \\'ith 5.1.3.5. 9
5.1.3.5.10. 7 If manifolrls are located out of doors, they shall be having sufficient number of gas cylinrler connections fot·
installed pet· the manufacture1·'s requirements. one average day's supply, but not fewer than three
5.1.3.5.11 Manifolds for Cryogenic Liquid Containers. connections
5.1.3.5.11.1 Manifolds fm cryogenic liquirl containers shall be 5.1.3.5.11.5 The manifolds in this categ01·y shall include an
located in accordance ,-.nth 5.Ul.3.1 anrl shall meet the follow automatic means of controlling the three headers to accom
ing: plish the following during normal operation:
( 1) If located outdoors, they shall be installerl in an enclosut·e (1) If provirlerl ,vith two liquid containe1· hearle1·s, one cry�
used only for the enclosure of such containers and sited genie liquirl header shall be the prima1·y anrl the othe1·
to comply \\'ith minimum distance requirement� in Table shall he the secondary, \\'ith either being capable of either
.'d.3.5.11.1. role .
(2) If located inrloors, they shall he installed within a room (2) If provided ,vith one liquirl containe1· header and one gas
used only for the enclosure of such containers . cylinder header (a hybrid arrangement), the liquirl
containe1· header is the pt·imary anrl the gas cylinrle1-
heade1· is the secondary.
Table 5.1.3.5.11.1 Minimum Separation Distance Between
(3) When the primary heade1· is supplying the system, the
Portable Cryogenic Containers and Exposures
secondary hearler is prevented from supplying the system.
( 4) When the primary heade1· is depleted, the secondary
Mirumum Distance heade1· automatically begins to supply the system.
Exposure ft m 5.1.3.5.11.6 The manifolds in this category shall be equipped
( 1) Building exits 1() 3.1 with a means to conserve the gas produced by evaporation of
(2) \'\'all openings 1 0.3 the cryogenic liquid in the secondary header (when so prmi
(3) Air intakes 10 3.1 detl). This mechanism shall rlischarge the conserved gas into
the system upst1·eam of the final line regulator a�sembly.
(4) Property lines 5 1.5
(5) Room or a1·ea exit� 3 0.9 5.1.3.5.1 I. 7 The manifolds in this category shall include a
(6) Combustible mate1-ials, manual or automatic means to place either header into the
(e.g., paper, leaves, weeds, role of primary header and the other into the role of seconrlary
dry grass, debris) 15 4.5 header, except where a liquirl/gas hyb1·irl manifold ts
(7) Incompatible hazarrlous employed.
materials 20 6.1
5.1.3.5.11.8 The manifolds in this category shall include a
[55:Tahle H.7.'.I] means to automatically activate the rese1·ve hearle1· if fot· any
reason the prima1·y anrl secondary heade1·s cannot supply the
5.1.3.5.11.2 The manifolds in this category shall have their system.
pt·imary anrl seconrla1·y heade1·s locaterl in the same enclosure.
5.1.3.5.11.9 The manifolds in this categmy shall have a local
5.1.3.5.11.3 The reserve header shall he permitterl to he loca signal that visibly indicates the operating status of the equip
ted in the same enclosure as the primary and secondary hearl ment and activates an indicator at all ma�ter alarms under the
ers or in another enclosure compliant with 5.1.3.5.11.1. follmving conditions:
5.1.3.5.11.4 The manifolds in this category shall consist of the (1) When or at a p1·edetermined set point befo1·e the secon
following: rlary header begins to supply the system, indicating
changeover
(1) Two equal heade1·s in accordance ,-.nth 5.1.3.5.9, each (2) Whe1·e a hyb1·id arrangement is employerl, when or at a
having sufficient internal or external vaporization pt·edeterminerl set point before the secondary (cylindet')
capacity to meet the requirerl peak flow rate and each hearler contents fall to one average rlay's supply, inrlicat
having sufficient number of liquid container connections ing secondary low
fot· one average day's supply, and \\'ith the headers (3) When or at a predete1·mined set point befo1·e the reserve
connected to the final line pressure regulator assembly in hearler begins to supply the system, indicating reserve is
such a manner that either header can supply the system in use
(2) Rese1·ve heade1· in accorrlance ,vith 5.1.3.5.9 having suffi (4) When or at a prerletern1inetl set point befo1-e the reserve
cient numhe1· of gas cylinrler connections for one average heade1· content� fall to one average day's supply, inrlicat
day's supply, hut not fewer than three connections, anrl ing reserve low
connected downst1·eam of the primary/seconrlar y hearl
ers and upstream of the final line pressure regulators 5.1.3.5.12 Cryogenic Fluid Central Supply Systems. The stor
(3) Pressure relief installed downstream of the connection of age, use, anrl hanrlling of cryogenic fluid centrnl supplv systems
the rese1-ve header and upstream of the final line p1·es that deliver compresserl medical gases (CMGs) to health care
sure regulating a�semblv and set at !",O percent above the facilities shall be in accorrlance with 5.1.3.10.
nominal inlet pressure
5.1.3.5.13* Emer gency Oxygen Supply Connection (EOSC).
(4) If provided with one liquid container header (primary),
Emergency oxygen supply connections (EOSCs) shall be in
one gas cylinrler heade1· (secondary), and a 1·eserve ga�
stallerl to allow connection of a tern pot·ary auxiliary source of
cvlinrler heade1· (a hybrid arrnngement). a seconrlary gas
2021 Edition
supply for emergency or maintenance situations w here either 5.1.3.5.14.5 IBER� shall have a local signal that visibly imli
of the following con<litions exist: cates the operating status of the equipment and an alarm at all
The bulk liquid S)llltem or cryogenic fluid central supply maste1· ala1·ms when or just befo1·e the reserve begins to serve
(1)
system is outside of and remote from the building that the system.
the oxygen supply serves, and there is no connected in 5.1.3.6* C ategory I Medical Air Central Supply S ys tems.
building oxygen 1·eserve sufficient fot· one ave1·age day's
supply. (SI'!' 5.1. 3.5.14 for rNJUirnnmtsfor sw:h resPrvPs.) 5.1.3.6.1" Quality of Medical Air. Medical alt" shall be
(2) Multiple freestan<ling buil<lings are served from a single required to have the following characte1·istics:
oxygen source such that damage to the interconnecting ( 1) It shall be supplied from cylinders, bulk containers, or
o>-ygen line could result in one or more buildings losing medical air comp1·essor som·ces, or it shall be reconstitu
oxygen supply, in which ca�e each building is requin�d to ted from oxygen USP an<l oil-free, <lry nitrogen NF.
be provided with a sepa rate emergency connection. (2) It shall meet the requirement� of medical air USP.
5.1.3.5.13.1 EOSCs shall be located as follows: (3) It shall have no detectable liquid hydrocarbons.
(4) It shall have less than 25 ppm gaseous hydrocarbons.
( 1) Located on the exterim· of the buil<ling being serve<l in a ( 5) It shall have equal tom less than 1 mg/m� (6.85 x 10-;
location accessible by emergency supply vehicles at all lb/y<l 3) of permanent particulates sized 1 micron or
times in all weather conditions la1·ger in the air at no1·mal atmosphe1·ic pt·essure.
(2) Connected to the main supply line immediately clown-
f
stream of the main shutof valve 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
5.1.3.5.13.2 EOSCs shall consist of the following: be used only for ai1· in the application of human respiration
( 1) Ph)lllical protection to prevent unauthorize<l tampe1·ing and calibration of me<lical devices for respiratoty application.
(2) Female DN (NPS) inlet for connection of the emergency 5.1.3.6.3* Medi cal Air Compressor Supply Sources.
oxygen source that is size<l for 100 pet-cent of the system
demand at the eme1·gency source gas pt·essure 5.1.3.6.3.1 Location. Medical ai1· comp1·essor S)llltems shall he
(3) Manual shutoff valve to isolate the EOSC when not in use located per 5.1.3.3 as follows:
( 4) Two check valves, one downstream of the EOSC and one (1) Indoors in a <le<licated mechanical equipment area,
downstream of the main line shutoff valve, with both adequately ventilated an<l with any 1·equired utilities ( e.g.,
upstt·eam from the tee connection for the two pipelines electricity, <lrains, lighting)
( 5) Relief valve sized to protect the downstream piping (2) In a room ventilated per 5.1.3.3.3.:1
system an<l related equipment from exposure to p1·essures For ai1°coole<l equipment, in a room designe<l to main
(3)
in excess of 50 percent highe1· than normal line pt·essure tain the ambient tempernture range as recommended by
(6) Any valves necessary to allow connection of an eme1·gency the manufacturer
supply of oxygen an<l isolation of the piping to the
no1·mal source of supply 5.1.3.6.3.2 Required Components. Medical air compressor
(7) Minimum of 1 m (3 h:) of clearnnce around Lhe EOSC fot· S)llltems shall consist of the following:
connection of temporaty auxiliaty source
(1) Component� complying with 5.1.3.G.3.4 through
(8)* Four alarm connection point� installed to both master 5.1.3.6.3.8, atTange<l pet· 5.1.3.G.3.9
alarm panels to allow the tempornry supply to be moni Automatic means to pt·event backflow from all on-cycle
(2)
tored while in use comp1·essors through all oH�cycle compressm·s
f
5.I .3.5. I 4 In-Building Emergency Reserves ( IBERs). (:I) Manual shutof valve to isolate each compressor from the
centrally piped system and from othe1· compressors for
5.1.3.5.14.1 IBERs shall not be used a� substitutes for the bulk maintenance or repai1· without loss of pressure in the
gas reserve system that is require<l in 5.1.3.10.3.4. S)llltem
5.1.3.5.14.2 When an IBER is provi<le<l insi<le the building as a (4) Intake filter-muffler(s) of the dq• type
substitute for the EOSC or for othe1· put·poses, it shall be loca ( 5) Pressure 1·elief valve(s) set at 50 percent above line pres
ted in accordance with 5.1.3.3 as follows: sure
(G) Piping an<l components between the compressor and the
f
( 1) In a room 01· enclostffe constructe<l pet· 5.1.3.3.2 source shutof valve that do not contt·ibute to contami
(2) In a mom 01· enclostu-e ventilate<l per 5.1.3.3.3 nant levels
5.1.3.5.14.3 IBER� shall consist of either of the following: (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
( 1) Ga� cylin<ler heade1· per 5.1.35.9 with sufficient cylinde1· medical air source valve that are of any design or
connections to pt·ovide fot· at least one average day"s construction appropriate for the service as <letermined by
supply with the appropriate number of connections being the manufacturer
determine<l afte1· consideration of the <lelivery sche<lule,
the proximity of the facility to alternate supplies, and the 5.1.3.6.3.3 Air Drying Equipment. Medical air compressor
facility's emergency plan systems shall pt·eclude the condensation of wate1· vapm· in the
(2) Manifold for gas cylinders complying with 5.1.3.5.10 piping distt·ihution system by air drying equipment.
5.1.3.5.14.4 IBERs shall include a check valve in the main line 5.1.3.6.3.4 Compres.sors for Medical Air.
placed on the distribution system side of the ordinaty source's (A)* Compressors for medical air shall be designed to prevent
main line valve to prevent flow of gas from the emergency the introduction of contaminants or liquid into the pipeline by
reserve to the or<lina ry source. any of the following metho<ls:
2021 Edition
(1) Elimination of oil anywhere in the compressor (e.g., (D) Antivibration mountings shall be installed for afte1·coolers
liqui <l ring and permanently sealed bearing compressors) a� required by equipment dynamics or location and in accord
(2) Reciprocating compt·essors provi<le<l with a separation of ance with the manufacturer's 1·ecommendations.
the oil-<:ontaining section from the comp1·ession chamber
hy at least two seals creating an a rea open to atmosphere 5.1.3.6.3.6 Medical Air Receivers. Receivers for me<lical ait·
that allows the following: shall meet the following requirement5:
(a) Direct an<l unobstructed visual inspection of the (l ) They shall he made of corrosion-resistant materials 01-
interconnecting shaft through vent and inspection othenvise be made coITosion resistant.
openings no smaller than 15 shaft diameters in size (2) They shall comply with Section VIII. "Unfired Pressure
(b) Confit-mation hy the facility operatot·s of prope1· seal Vessels," ofthe ASME Bniler and PrPss1;rf VP.��fl CndP.
operation by di1·ect \isual inspection through the (3) They shall be equipped with a p1·essure 1·eliefvalve, aut�
above-shaft opening, without disassembly of the matic drain, manual drain, sight glass, an<l pt·essure indi
compt·essor (e.g., extended hea<l compresso1·s with cator.
an atmospheric vent between the compression (4) They shall be of a capacity sufficient to pt·event the
chambe1· and the crankcase) compressors from short-cycling.
(3) Rotating element compressors provided with a compres 5.1.3.6.3.7 Medical Air Dryers. Medical air dryers, where
sion chamber free of oil that provide the following: t·equi1·ed, shall meet the following requi1·ements:
(a) Separation of each oil-containing section from the (1) Be designed to prnvide a.it· at a maximum dew point that
compression chamber by at lea5t one seal having is helow the frost point f O"C (32 ° F) l at 345 kPa to
atmosphet·ic vent5 on each sine with the vent closest 380 kPa ( 50 psi to 55 psi) at any level of demand
to the oil-containing section supplied ,vith a gravity (2) Be sized for 100 pet·cent of the system peak calculated
drain to atmosphere deman<l at <lesign conditions
(h) Unobstructed visualization of the atmospheric (3) Be constructed of materials deeme<l suitable by the
vent(s), closest to each oil-<:ontaining section, that is manufactu1·er
accessible fot- inspection without disa�sembling the (4) Be provi<le<l ,vith antivihration mountings installed as
compressor required by equi pment dynamics or location an<l in
(c) Entry of the rotating shaft into each compression accot·dance with the manufacturer's 1·ecommendations
chambet· at a point that is above atmospheric pt·es
sut·e 5.1.3.6.3.8 Medical Air Filters. Medical air filtet·s shall meet
(d) Confirmation by the facility operators of proper seal the following requirement5:
operation by direct visual inspection of the atmos (1) Be apprnpt·iate for the intake ait· conditions
pheric vents (2) Be located upstrean1 (source sine) of the final line regula
(B) For liquid ring compressors, service water and seal water tors
shall be treate<l to control waterborne pathogens and chlorine (3) Be size<l for 100 pet-cent of the system peak calculate<l
from hyperchlorination from entering the medical a.it·. deman<l at design conditions and be rated for a mini
mum of98 pel'Cent efficiency at l micron or gt·eatet·
(C) Liquid ring compressors shall comply with the following: (4) Be equipped with a continuous visual indicator showing
Service watet· and seal water of a quality t·ecommen<le<l by the status of the filter element life
(l )
the compressor manufacturer shall be used. (5) Be constructed of materials deeme<l suitable by the
manufacturer
(2) Reserve me<lical air standby hea<lers or a backup
compresso1· shall be installed. 5.1.3.6.3.9 Piping Arrangement and Redundancies.
(3) When installed, the headet· shall comply with 5.1.3.5.9.
(4) \'\'hen installed, the number of attached cylinders shall be (A) Component arrangement shall be as follows:
sufficient for l hour normal operation. ( l) Components shall he arrange<l to allow senice an<l a
(D) Compt·ess01-s shall he constructed of matet·ials deemed continuous supply of medical air in the event of a single
suitable by the manufactut·el'. fault failure.
(2) Component arrangement shall be permitted to vary· as
(E) Antivibt·ation mountin� shall be installed ftx compressors t·equire<l by the technology(ies) employed, prnvided that
as t·equired by equipment <lynamics 01· location and in accord an equal level of operating re<lun<lancy and medical ait
ance ,vith the manufacturer's t·ecommendations. quality is maintaine<l.
(F) Flexible connectors shall connect the air compt·essot·s ,vith (B) Medical ait· compt·essot·s shall be sufficient to serve the
thei1· intake and outlet piping. peak calculated demand ,vith the lat·gest single compressor out
of service. In no case shall there he fewer than t\vo compres
5.1.3.6.3.5 Aftercoolers. sors.
(A) Aftercoolers, whet-e 1·equired. shall he prmide<l ,vith indi (C) When aftercoolers at·e provided, they shall he arranged to
vidual condensate traps. meet eithet· one of the following:
(B) The receiver shall not he used as an aftercooler or al"ter (1) A1Tanged as a duplex or multiplex set, sized to serve the
cooler trap. peak calculate<l deman<l with the largest single aftet·
(C) Aftercoolers shall be constructed of materials deemed
cooler out of service. an<l prmide<l ,vith valves a<leguate,
suitable by the manufacturer. to isolate any single aftercooler from the system without
shutting down supply of medical air
2021 Edition
(2) ,\!Tanged one per comp1·ess01·. size<l to handle the output (1) \\'he1·e me<lical air source systems having two 01· m01·e
of that compressor, an<l valve<l as appropriate to allow compressors employ any electrical circuit device that
1·epair or replacement with that comp1·essor out of service upon failure coul<l prevent supply of medical ai1·, the
but without shutting down supply of medical air controls shall be provided with an automatically activated
alternative method for ensuring supply (e.g., redundant
(D)* A medical air receiver(s) shall be prmi<le<l with proper component(s), an alternate electrical supply path, or
valves to allow the flow of compr·essed air to enter and exit out other equivalent method).
of separate receiver ports during normal operntion and allow (2) Control circuit� shall be aLTanged in such a manner that
the receiver to be bypasse<l <luring service without shutting isolation of one compressor or component from the
down the supply of me<lical air. system (e.g., for maintenance 01· 1·epair) does not inte1·
(E) Dryers, filtei-s, an<l 1·eb•1..ilat01·s shall be at least duplexed, rupt the operation of othe1· comp1·ess01·(s) or compo
with each component sized to serve the peak calculated nent(s).
demand with the la1·gest of each component out of service. (3) Automatic restart function shall be included, such that
the supply of me<lical ai1· will resume n01·mally after
(F)* Dryers, filtei-s, and 1·egulat01·s shall be provided with power inten-uption without manual intervention.
manual valves upstream and manual valves or check valves
<lownstream to allow service to the component� without shut (C) Each compressor motor shall be provided with electrical
ting down the system in either one of the following ways: component� including, but not limited to, the following:
( 1) They shall be installed for each component, upstt·eam ( 1) Dedicated disconnect S\\�tch installed in the electrical
and downstream of each component, allowing each to be circuit ahead of each motor starter
individually isolate<l. (2) Motor starting device
(2) They shall be installed upstt·eam (sout-ce si<le) an<l down (3) Overload protection
stream of component� in series so as to create re<lun<lant (D) Me<lical air compressor system conu·ols shall be provided
pa1·allel branches of components. with electrical systems including, at a minimum:
(G) A tlu·ee-way valve (tlu-ee-port), indexed to flow, full port (1) Built-in disconnect means shall be inclu<le<l to allow
shall be permitted to be used to isolate one branch or compo appropriate operation of multiple compressor systems
nent fo1· the purposes of 5. l.3.6.3.9(C), 5. l.3.6.3.9(D), an<l protect senice personnel from exposut·e to live
5.1.3.6.3. 9(E), an<l 5. l.3.6.3.9(F). voltages.
(H) Under normal operation, only one aftercooler shall be (2) Control ci1·cuits shall be an-anged so that failure of any
open to ait-flow with the othe1· afi:e1·cooler valved off. component of the control circuit, or shutdown of one
comp1·esso1· (e.g., for service), <loes not interrupt auto
(I) Un<ler normal operation, only one <l1·ye1·-filter(s)-regula matic operntion of the standby comp1·essoi-.
tor sequence shall be open to airflow with the other sequence (3) An automatic restart function shall be included, such that
valve<l off. the comp1·esso1·(s) will restart al'ter power interrnption
without manual inte1·vention.
(J) If the relief valve require<l 111 5.1.3.6.3.2(5) an<l (4) \Vhere components are common to more than one
5. U\.6.3.6(3) can be isolate<l from the system by the valve control circuit (e.g., autodrains) t he common device shall
aLTangement used to comply with 5. l.3.6.3.9(F), then a 1·e<lun be provi<le<l with electrical protection to prevent loss of
da11t 1·elief valve(s) shall be installed in the parallel sequence. the control ci1·cuit�(s) in the event of shon ci1n1it in the
(K) A DN8 (NPS 1/,) valve<l sample port shall be provided device.
downstream of the final line pressure regulatm·s, dew point (E) Electt·ical installation and wi1·ing shall conform to the
monitor, and carbon monoxi<le monitor and upstream of the requirement� of NFPA 70.
source shutoff valve to allow fot· sampiing of the me<lical air.
(F) Emergency electrical service for the compressors shall
(L) Medical ai1· source systems shall be provi<le<l with a source confo1·m to the requi1·ement� of the essential electrical system
valve per :,.1.4.2. a� <lesct"ibed in Chapter 6.
(M) Whe1·e medical air piping systems at diffe1·ent opernting 5.1.3.6.3.11 Compressor Intake.
pressu1·es are required, the piping shall separate after the filters
but shall be provided witl1 separate line regulators, dew point (A) The me<lical air comp1·ess01·s shall draw their ai1· from a
f
monitors, relief valves, and source shutof valves. sout-ce of clean ai1·.
5.1.3.6.3.10* Electrical Power and Control. (B) The medical air intake shall be located a m1111mum of
7.6 m (25 ft) from ventilating system exhausts, fuel storage
(A) Medical air· source systems shall be controlled to ensure vent�, combustion vent�, plumbing vent�, vacuum and WAGD
continuous supply of me<lical air at pressures consistent with discharges, or area, that can collect vehicular exhausts or other
Table 5.1.11 under all conditions of system use as follows: noxious fomes.
(1) Automatic activation of comp1·essoi-(s) as necessary to
(C) The medical air intake shall be located a minimum of 6 m
supply the <lemand.
Managing the operation to equalize wear on all compres (20 ft) above ground level.
(2)
sors. \'\'here this equalization is achieved manually, the (D) The medical air intake shall be located a minimum of
facility staff shall arrange a schedule for manual alterna 3.0 m (10 ft) from any <loor, \\�ndow, or other opening in the
tion. buil<ling.
(B) Controls shall provi<le the following functions:
2021 Edition
(E) If an air source equal to or bette1· than out�ide ai1· (e.g., air temperature sens01· that shut� down that compressor and
already filtered for use in operating room ventilating systems) activates a local alarm indicator (.�Pe 5.1. 9.5.4 ), the temper
is available, it shall be pern1itted to be used for the medical air atm·e setting shall be as 1·ecommended by the comp1·ess01·
compressors with the following prmisions: manufactu1·er.
(l ) This alternate source of supply air shall he available on a (2) Coalescing filters with element change indicator shall be
continuous 24hout'-pet'-day, 7-<lay-pet'-week basis. provided.
(2) Ventilating systems having fans with mot01·s or drive belt� (3) Cha1·coal absorber shall he provided.
located in the airstt·eam shall not be used as a source of ( 4) Gaseous hydrocarbons shall be monitored on a quartedy
medical air intake. basis.
(F) Compressor intake piping shall he permitted to be made (F) When the capacity of the medical ai1· system not in use is
of materials and use a joining technique as permitted umler less than the equivalent capacity of one compressor, a local
5.1.l 0.2 and 5.1.l 0.3. ala rm shall activate [�Pf 5.1. 9.5. 4( ])}. This signal shall require
manual reset.
(G) Air intakes for separate compressors shall be permitted to
be joined together to one common intake where the following 5. 1.3.6.3.13 Medical Air Quality Monitoring. Medical air qual
conditions are met: ity shall be monitored downstream of the medical air regula
t01·s and upstream of the piping system a.� follows:
(l) The common intake is sized t o minimize back p1·ess1u-e in
accordance v.ith the manufactu1·e1·'s recommendations. (1) Dew point shall be monitm·ed and shall activate a local
(2) Each compressor can be isolated by manual or check alarm and all master alarms when the dew point at system
valve, blind flange , 01· tube cap to prevent open inlet <lelive1·y p1·essure excee<ls +2'C (+3 5 ° F).
piping when the compressor(s) is removed for service (2) CadJon monoxide shall be monitored and shall activate a
from the consequent backflow of room air into the other local alarm when the CO level exceeds 10 ppm. [Sep
compressor(s). 5.1.9.5.4(2).}
(3) Dew point and carbon monoxide monitors shall activate
(H) The end of the intake shall be turned down and sct"eened their individual monitor's signal at the alarm panels
or otherwise be protected against the entry of vermin, debris, where their signals are required when their power is lost.
or precipitation by screening fabricated or composed of a
noncon-oding material. 5. 1.3.6.3.14 Category I Medical Air Proportioning Supply
Sources.
(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 (A) General.
air intake. ( l )* Medical air 1·econstituted from oxygen USP and nitro
gen NF, produced using a proportioning system(s) , shall
5.1.3.6.3.12 Operating Alarms and Local Signals. Medical air be required to meet the follov.ing:
systems shall be monitored fo1· conditions that can affect air
quality during use or in the event of failure, based on the type (a) The quality of medical ai1· shall be in acc01·dance
of compressor(s) used in the system. v.ith 5.1.3.6.1.
(b) l11e system shall be capable of supplying this qual
(A) A local alarm complving with 5.1.9.5 shall be provided for ity of medical air, in accot·dance with 5.1.3.6.1, ove1-
the medical air comp1·ess01· sout·ce. the entire range of flow.
(B) i' Vhere liquid ring air compressors, compressors having (c) The system shall produce medical ai1· with an
watet-cooled
f
heads, or watet'-cooled a tercoolers are used, air oxygen content of 19.5 percent to 23.5 percent.
' (2) The medical air proportioning system shall operate auto
1·eceive1·s shall he equipped with a high water level sensor that
shuts down the compressor system and activates a local ala1·m matically.
indicator. [.'ieP 5.1.9.5.4(8j.J ( 3) The mixture shall he analyzed continuously, and a
recording capability shall be provided (e.g., via data
(C) i' \, 'he1·e liquid ring comp1·essors are used, each compressor port).
shall have a liquid level sensor in each air-water separator that, (4) l11e analyzing system specified in 5.l .3.6.3.1 4(A)(3)
when the liquid level is above the design level, shut� down it� shall be a dedicated and independent analyzer used to
compressor and activates a local ala1·m indicat01·. [See control the medical air proportioning system.
5.1. 9.5.4(9).} ( 5) If the mixture goes out of specification, an alarm shall
be activated automatically, the prima1·y medical ai1·
(D) Where nonliquid ring compressors compliant \\1th proportioning system shall he disconnected, and the
5.l .3.6.3.4(A) ( l ) are used, the ai1· temperattu-e at the immedi 1·ese1·ve supply shall he activated.
ate outlet of each comp1·essor cylinder shall be monitored by a ( 6) l11e system shall be arrnnged such that manual interven
high-temperature sens01· that shuts down that compressor and tion is necessary to correct the composition of the
activates a local alarm indicator {�Pe 5.1. 9.5.4(10)}. The temper mixtm·e before reconnecting the medical ai1· proportion
ature setting shall be as recommended by the compressor ing svstem to the health care facility pipeline system.
man ufacttu-e 1·. (7) If dedicated sout-ces of oi.-ygen USP and nitt·ogen NF
(E) Where compressors compliant with 5.l .3.6.3.4(A) (2) and supply the medical air proportioning system, reserve
5.l.3.6.3.4(A)(3) are used, the following requirement� shall sources fot· the oxygen and nitrogen shall not he
apply: 1·equi1·ed.
(8) If dedicated sources of oxygen USP and niu·ogen NF
( 1) The air temperature at the immediate outlet of each supply the medical air proportioning system, they shall
comp1·ess01· chambe1· shall be monitored by a high- not be used as the 1·eserves for oxygen and nitt·ogen
2021 Edition
systems supplying the pipelines of the health care (3) Minimum of one recorder for recording the medical air
facility. proportioning system performance anci air quality for a
(9)* If the sources of oxygen USP and nitrogen NF that period of not less than 24 hours
supply the meciical ai1· proportioning svstem a1·e the ( 4) Continuous analvsis of the mixtm·e and a recording
same sources that supply the health care facility, engi capability provicieci (e.g., via a data port)
neering controls shall be provided to pt·event cross (5) Mechanism for isolating the prima ry medical ait· prop01·
contamination of oxygen and nitrogen supply lines, as tioning system from the t·ese1-ve supply and the meciical
prnvided in 5.1.3.5.7. ait· piping distribution system by employing sequential
(10) A risk analysis anci approval from the authority having valves for redundancy
jmisdiction shall be requit·ed. (6) Capability of the t·eserve supply to automatically activate
if the primat·y supply is isolateci
(B) Location. The medical air proportioning system shall be (7) Reserve supply of medical ait· USP sizeci, at minimum,
located per 5.1.3.3 as follows: for one average day·s supply and consisting of one of the
(1) The meciical air proportioning system's supply of m..-ygen following:
USP and nitrogen NF shall he locateci pet· 5.1.3.3 and Additional medical ait· proportioning unit with a
(a)
NFPA 55, as applicable. dedicated supply of oxygen USP and nitrogen NF
(2) The mixing device anci contrnls, analyz ers. and t·eceivers (b) Medical air compressor system per 5.1.3.6.3, with
shall be located indo01·s within a room or at·ea pet· the exception of the allowance of a simplex mecii
5.1.3.3.1. cal air compressor system
(3) The indoor location shall include atmospheric monitor (c) Medical air cvlinder manifold per 5.1.3.5.10
ing fot· oxygen concentrntion. (8) Receivet· fitted with a pressu1·e t- elief valve and p1·esslu-e
(4) The incioot· location shall be constructed with all gauge as follows:
required utilities (e.g., electricity, cirains, lighting) per
NFPA 5000. (a) The receiver shall he constructed of corrosion
(5) The indoor location shall be ventilateci and heated pet resistant materials.
Chapter 9 and the manufacturer's recommendations. (b) The receivet-, relief valves, and pressure gauges
shall comply with ASME Boi.ll'r and Pre.�mre le.ufl
(C) Required Components. The medical air prnportioning Code and manufactm·er's t·ecommendations.
system shall consist of the following: (9)* Warning systems pet· 5.1.9, including a local signal and
(1) Supply of oxygen USP and supply of nitrngen NF a� mastet· alat·m that inciicates nonconfo1·ming oxygen
follows: concentration per manufacturer's recommendations
(10) Final line pressure regulators complying with 5.1.3.5.5
(a) The supply lines shall be filte1·eci to t·emove partic (11) Pressure relief complying with 5.1.3.5.6
ulate entering the prnportioning system. (12) Local signals complying with 5.1.3.5.8.2
(h) The minimum safe supply gas temperature anci
t·ecommended local signal shall be specified hy the 5.1.3.7* Medical-Surgical Vacuum Central Supply Syste:ms.
medical air proponioning system manufacturer.
(2) Mixing device with analyz ers and engineering controls 5.1.3.7.1 Medical-Surgical Vacuum Central Sources. Medical
per manufacturer's recommendations to include, as a surgical vacuum central supply systems shall be located per
minimum. the following: 5.1.3.3 a� follows:
(a) At lea�t nvo oxygen analyzers capable of independ (1) Indoors in a cieciicateci mechanical equipment area,
ently monitoring oxygen concentration adequately ventilated and with any required utilities
(b) Mechanism where each analyz e•· based upon ( 2) In a room ventilated per 5.1.3.,\.3.3
nonconforming oxygen concentrntion is capable, (3) For air-cooleci equipment, in a mom designed to main
directly or via other medical air proportioning tain the ambient tempernture range as recommended by
system contrnls. of automatically shutting off the the equipment manufacturer
supply from the medical ait· proportioning system 5.1.3.7.1.1 Medical-sm·gical vacuum central supply systems
to the medical air pipeci ciistt·ibution system anci shall consist of the following:
activating the reserve supply
(c) Mechanism where each analyzer, ba5ed upon (1) Two 01· m01·e vacuum pumps sufficient to serve the peak
nonconforming oxygen concentrntion, is capable, calculateci demanci with the largest single vacuum pump
directly or via other proportioning system controls, out of senice
of automatically shutting off the supply of m..-ygen (2) Automatic means to prevent backflow from any 01Hycle
and nitrngen to the proportioning system and acti vacuum pumps through any ofl:.Cycle vacuum pumps
vating the reserve supply (:I) Shutoff valve 01· othe1· isolation means to isolate each
(d) Provision for manual resetting of the proportion vacuum pump from the centrally piped system and other
ing system aftet· detection of nonconforming vacuum pumps for maintenance or repair without loss of
oxygen concentrntion and subsequent shutciown vacuum in the system
once conforming m..-ygen concentrntion is estab (4) Vacuum receiver
lisheci, in orcier to re-establish flow to the medical (5) Piping between the vacuum pump(s), ciischarge(s),
f
ai1· piping system receiver(s), and Vdcuum sout·ce shutof valve in acc01·d
(e) Means of verifying the pedormance of the a11ce with 5.1.10.2, except bra�s. galvanizeci, 01· black steel
analyzers by reference to an air standarci, with pipe, which is permitteci to be used a, recommendeci by
known tt·aceable oxygen content the manufacturer
2021 Edition
(6) Except as define<l in 5.1.3.7.1.1(1) through 5.1.3.7.1.1(5), 5.1.3.7 .5 Piping Arrangement and Redundancies.
materials and de�ices used between the medical vacuum
exhaust and the medical vacuum som·ce that are permit 5.1.3.7.5.1 Piping an-angement shall be as follows:
ted to be of any design or consu·uction appropt-iate for (1) Piping shall be a rrange<l to allow service an<l a continu
the service as determine<l by the manufacturer ous supply of medical-surgical vacuum in the event of a
(7) Vacuum filtration per 5.1.3.°7.4 single fault failure.
(2) Piping arrangement shall be permitte<l to vary based on
5.1.3.7.2 Vacuum Pumps. the technology(ies) employed, provi<le<l that an equal
5.1.3.7.2.1 Vacuum pumps shall be consu·ucted of materials level of operating redundancy is maintaine<l.
<leemed suitable by the manufacttll'er. (3) Whe1·e only one set of vacuum pumps is available for a
combined medical-sm·gical vacuum system an<l an analy
5.1.3.7.2.2 Antivibration mountings shall be installed for sis, a resea1·ch, or a teaching laboratory vacuum system,
vacuum pumps as required by equipment <lynamics or location such laboratories shall be connected separately from the
an<l in acco1·dance with the manufacturer's recommen<lations. me<lical-surgical system di1·ectly to the 1·eceive1· tank
5.1.3.7.2.3 Flexible connectors shall connect the vacuum through its own isolation valve an<l fluid trap located at
pumps with their intake an<l outlet piping. the receiver, an<l between the isolation valve an<l flui<l
trap. a scrubber shall be pe1·mitted to be installed.
5.1.3.7.2.4 Fm· liquid ring vacuum pumps, seal water shall be
of a quality recommen<led by the vacuum pump manufactut·er. 5.1.3.7.5.2 The medical-surgical vacuum 1·eceive1·(s) shall be
serviceable without shutting down the medical-surgical
5.1.3.7.3 Vacuum Receivers. Receivers fo1· vacuum shall meet vacuum system by any method to ensm·e continuation of se1·v
the follov,,jng requirements: ice to the facility's me<lical-surgical pipeline <listt·ibution
( 1)They shall be ma<le of materials deeme<l suitable by the system.
manufacturer. 5.1.3.7.5.3 Medical-surgical vacuum central supply systems
f
(2) They shall comply with Section VIII. "Unfi1·ed P1·essme shall be provided \\,jth a som·ce shutof valve per 5.1.4.2.
Vessels," of the ASME BnilPr and PrPs.mre \1,,ssel CodP.
(3) They shall be capable of withstanding a gauge pressure of 5. 1.3. 7.6 Electrical Power and Control.
415 kPa (60 psi) an<l 760 mm (;\O in.) gauge HgV. (A) Medical vacuum source systems shall be controlled to
(4) They shall be equipped with a manual drain. enslu-e continuous supply of suction at pressures consistent
(5) They shall be of a capacity ba�ed on the technology of the with Table 5.1.11 under all con<litions of system use as follows:
pumps.
(1) Automatic activation of pump(s) as necessary to supply
5.1.3.7.4 Vacuum Filtration. Central supply systems for the deman<l.
vacuum other than liquid ring pumps shall be provided \\,jth (2) Managing the operation to equalize wear on all pumps.
inlet filtration \\,jth the following characteristics: \Vhere this equalization is achieved manually, the facility
f
(1) Filtration shall be at least <luplex to allow one filter to be staf shall arrange a sche<lule for manual alternation.
exchanged without impai1·ing the vacuum system. (B) Controls shall provide the following functions:
(2) Filtration shall be locate<l on the patient side of the
vacuum p1·o<luce1·. ( 1) Whe1·e medical vacuum sou1·ce systems having two 01·
(3) Filte1·s shall be efficient to 0.3 µ and 99.97 pe1·cent HEPA mm·e pumps employ any electt·ical circuit device that
or better, per DOE-STD-3020, SpPrijiwtirmfnr HEPA FiltPl':'i upon failure coul<l prevent supply of me<lical vacuum, the
U�ed l,y Dot.· Cnntmrtors. controls shall be provided with an automatically activate<l
(4) Filtration shall be size<l fo1· 100 percent of the peak alternative method for ensuring supply (e.g., redundant
calculated deman<l while one filte1· or filte1· bundle is component(s), an alternate electt·ical supply path, 01·
isolated. other equivalent method).
(5) It shall be pe1·mitted to group multiple filters into (2) Control ci1·cuits shall be atTange<l in such a manner that
bun<lles to achieve the 1·equired capacities. isolation of one pump or component from the system
(6) The system shall be prmide<l with isolation valves on the (e.g. for maintenance 01· 1·epair) does not interrupt the
source side of each filter or filter bun<lle an<l isolation operation of other pump(s) or component(s).
valves on the patient side of each filte1· or filte1· bundle, (3) An automatic restart function shall be included, such that
permitting the filters to be isolate<l without shutting off the supply of medical vacuum will 1·esume n,ffmally afte1·
flow to the central supply system. power interruption without manual intervention.
(7) A means shall be available to allow the use1· to observe (C) Each pump motor shall be provi<le<l with electt·ical
any accumulations of liquids. components including, but not limite<l to:
(8) A vacuum relief petcock shall he provided to allow
vacuum to be relieve<l in the filter canister during filter (1) Dedicated disconnect switch installed in the electrical
replacement. ci1-cuit ahea<l of each mot01· staner
(9) Filte1· element� an<l caniste1·s shall be pe1·mitte<l to be (2) Mot01· staning <levice
constructed of materials a� <leemed suitable by the (3) Overload protection
manufacturer. (D) Vacuum som·ce system controls shall be provided with
(10) In normal operation, one filte1· 01· filte1· bundle shall be electrical systems inclu<ling, at a minimum:
isolate<l from the system to be available for service
should a blockage in the operating filter occur or rota (1) Control circuit5 shall be arrange<l so that failure of any
tion of the filters be <lesi1·ed after filter element component of the control circuit, or shut<lown of one
exchange.
2021 Edition
pump (e.g.. fot· service). <loes not intet-n1pt automatic capacity of one pump. a local alat·m shall activate [�Pe
operation of the standby pump. 5.1.9.5.4(4j]. This signal shall require manual reset.
(2) Controls shall be provi<le<l v.1th built-in disconnect means
to allow appropt·iate operation of multiple pump systems 5.1.3.8"' Waste Anesthe tic Gas Disposal (WAGD) Central
and protect service personnel from exposure to live Supply Systems.
voltages. 5.1.3.8.1"' Supply Sources. WAGD supply somces shall be
f
(3) ,\!here component� are common to more than one chosen in consultation with the medical staf ha\ing knowledge
control circuit, the common device shall be provided \\1th of the requirement� to determine the type of system, number
electrical protection to prevent loss of the control and placement of terminals, an<l other required safety and
circuits(s) in the event ofshon circuit in the device. opernting devices.
(4 ) An automatic restan function shall be included, such that
the pump(s) will restart after power interruption without 5.1.3.8.1.1 WAGD shall be permitted to be produced through
manual intervention. the medical-surgical vacuum source, by a dedicated producer,
or by venturi.
(E) Electt·ical installation and wiring shall confot·m to the
requirements of NI-PA 70. 5.1.3.8.1.2 If WAGD is produced by the medical-surgical
vacuum source, the following shall apply:
(F) Emergency electrical service for the pumps shall conform
to the requit·emenl� of the essential electt·ical system as de (1) lhe medical-surgical vacuum sout-ce shall comply with
scribed in Chapter 6. 5.1.3.7.
(2) The total concentration of oxygen shall be maintained
5.1.3.7.7 Medical-Surgical Vacuum Exhaust. below 23.6 pet-cent, or the vacuum pump shall comply
with 5.1.3.8.2.1.
5.1.3.7.7.1 The medical-sut·gical vacuum pumps shall exhaust (3) ll1e medical-su1·gical vacuum source shall be sized to
in a manner and location that minimizes the hazards of noise accommodate the additional volume.
an<l contamination to the facility and it� environment.
5.1.3.8.1.3 If WAGD is pro<luce<l by a de<licate<l WAGD
5.1.3.7.7.2 The exhaust shall be located as follows: producet· with a total powet· equal to 01· greater than l horse
( 1) Outdoors power in total (both producers), the following shall apply:
(2) At least 7.5 m (25 ft) from any <loot·, winnow, air intake, (l ) The WAGD source shall be located in accordance with
01· other openings in buildings or places of public assem 5.1.3.3.
bly (2) 1l1e WAGD source shall be located indoors in a <le<licated
(3) At a level different from air intakes mechanical equipment area with any requit·ed utilities.
(4 ) Where pt·evailing winds, adjacent buildings, topogrnphy, (3) 1l1e WAGD source shall be ventilated pet· 5.1.3.3.3.,l.
01· other influences will not <liven the exhaust into occu (4) For air-<:.ooled equipment, the WAGD source shall be
pied areas or prevent dispersion of the exhaust located to maintain the ambient temperature range as
5.1.3.7.7.3 The end of the exhaust shall be turned down an<l t·ecommended by the manufactm·et·.
screened or otherwise be protected against the entry of vermin, (5) The WAGD producers shall comply with 5.1.3.8.2.
debris, or precipitation by screening fabricated or composed of 5.1.3.8.1.4 If WAGD is pro<luce<l by a de<licate<l WAGD
a noncorroding mate1·ial. pro<lucet· with a total power less than l horsepower in total
5.1.3.7.7.4 Vacuum exhaust shall be labeled in acc01·<la.nce (both producers), the following shall apply:
with 5.1.11.1 with anv method that woul<l distinguish it as a (1) 1l1e WAGD source shall be permitted to be located near
vacuum exhaust. the inlet(s) served.
5.1.3.7.7.5 The exhaust shall be free of dips an<l loops that (2) For ait·-<:ooled equipment, the WAGD sou1·ce shall be
might u·ap condensate or oil or provi<le<l with a <lrip leg an<l located to maintain the ambient temperature range as
valved drnin at the bottom of the low point. recommended by the manufact111·et·.
5.1.3.7.7.6 Vacuum exhausts from multi ple pumps shall be 5.1.3.8.1.5 For liquid t·ing pumps in WAGD service. seal water
permitted to be joined together to one common exhaust where shall be of a quality as recommended by the pump manufac
the following conditions are met: tm·er.
( 1) The common exhaust is sized to minimize back pressure 5.1.3.8.1.6 The WAGD somce shall consist of the following:
in accordance with the pump manufacturer's recommen (l ) Two or more WAGD producers sufficient to serve the
dations. peak calculated demand with the largest single WAGD
(2) Each pump can be isolated by manual or check valve, producer out of service
blind flange, or tube cap to prevent open exhaust piping (2) Automatic means to prevent b ackflow from any on-<:yde
when the pump(s) is removed for service from conse WAGD producers through any ofl:cyde WAGD producers
f
quent flow of exhaust ai1· into the room. (3) Shutof valve to isolate each WAGD producet· from the
5.1.3.7.7.7 Vacuum exhaust piping shall be permitted to be centrnlly piped system and othe1· WAGD pro<lucern for
made of materials an<l use a joining technique as permitted maintenance or repair without loss of ,-vAGD in the
under 5.1.10.2 and 5.1.10.3. system
(4) Piping between the ,-vAGD producet"s an<l the som·ce
f
5.1.3.7.8 Operating Alann.s. When the capacity ofthe medical shutof valve compliant with 5.1.10.2, a� t·ecommended by
vacuum supply system not in use is less than the equivalent the manufacturer
2021 Edition
(5) Antivibration mountings installed for \\'ACD producers as m·e could stop the WAGD. the controls shall be provided
required by equipment dynamics or location and in ,,1th an automatically activated alternative method for
accordance v.�th the manufactu1·e1·'s recommendations ensuring supply (i.e.. redundant component(s), an alter
(6) Flexible connectm·s interconnecting the producers with nate electrical supply path 01· othe1· equivalent method).
their intake and outlet piping as required by equipment (2) Control circuit� shall be arranged in such a manner that
dynamics or location and in accordance with the \VAGD isolation of one producer 01· component from the system
producer manufacttu-e1·'s recommendations (e.g., for maintenance or repair) does not inten-upt the
operntion of othe1· pump(s) 01· com ponent(s).
5.1.3.8.1.7 If WAGD is produced by a venturi, the following (3) An automatic restart fimction shall be included, such that
shall apply: the supply of WAGD ,viii resume no1·mally after powe1·
( l) The ventut·i shall not be use1·-adjustable (i.e., requi1·e the intetTuption without manual intervention.
use of special tools).
(2) The venturi shall be driven using water, inert gas, instru- 5.1.3.8.4.3 Each producer motor shall be prmided with elec
ment air, or other dedicated air source. trical components including, but not limited to, the following:
(3) Medical air shall not be used to powe1· the venturi. (1) Dedicated disconnect s,,1tch installed in the electrical
circuit ahead of each motor starter
5.1.3.8.2 WAGD Producers. (2) Motor sta1·ting device
5.1.3.8.2.1 Vacuum pumps dedicated for WAGD service shall (3) Ovedoad protection
be a� follows: 5.1.3.8.4.4 WAGD source system controls shall be provided
(1) Compliant with 5.1.3.i.2 with electt·ical systems including at least:
(2) Designed of mate1·ials and using lubricants and sealant� (1) Control circuit� shall be arranged so that failure of any
that are inen in the presence of oxygen, nitrous oxide, component of the control circuit, or shutdown of one
and halogenated anesthetics producer (e.g. for se1vice) does not interrupt automatic
5.1.3.8.2.2 Vacuum produce1·s (e.g., fans or blowers) designed operation of the standby producer.
fot· operation at vacuums below 130 mm (5 in.) HgV shall be as (2) Controls shall be provided ,vith built in disconnect means
follows: to allow appropriate operation of multiple producer
systems and protect senice personnel from exposure to
( l) Permitted to be made of any mate1·ials dete1·mined by the live voltages.
manufacturer as suitable fot· the senice (3) Whe1·e component� are common to more than one
(2) Provided with anti'l,ibration mountings as required by control circuit, the common device shall be provided with
equipment dynamics or location and in accordance ,vith electt·ical protection to prevent loss of the control
the manufactu1·e1·'s 1·ecommendation circuiL�(s) in the event of short ci1·cuit in the device.
(3) Connected ,,1th their intake and outlet piping through (4) Au automatic restart function shall be included, such that
flexible connections the pump(s) \viii resta rt after power interruption \vithout
( 4) Used only for WAGD se1·vice and not employed fot· other manual intervention.
services
(5) Interconnected via piping, ducnvork, and so forth, made 5.1.3.8.4.5 Electrical installation and v.fring shall conform to
of materials dete1-mined by the manufacturer as suitable the 1-equirement� of NFP./1 70.
to the service
5.1.3.8.4.6 Emergency electrical senice for the produce1-s
5.1.3.8.3 WAGD Alarms. shall conform to the requirement� of the essential electrical
system as described in Chapter 6.
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 5.1.3.8.5 WAGD Exhaust. The WAGD pumps shall exhaust in
ded for the WAGD source. compliance with 5.1.�.7.7.
5.1.3.8.3.2 i'Vl1e1·e WAGD som·ce systems have two or mm·e 5.1.3.9* Oxyge n Central Supply Systems Using Con centrators.
produce1·s. and the capacity of the iVAGD system not in use is A.ny oxygen central supply system that includes one 01· more
less than the equivalent capacity of one producer, a local alarm oxygen concentrator supply systems shall comply with 5.1.3.9. l
shall activate {�ff 5.1. 9.5.4( 5)}. This signal shall require manual through 5.1.3.9.:,.
1·eset.
5.1.3.9.1* Oxygen Concentrator Supply Units.
5.1.3.8.4 Electrical Power and Control.
5.1.3.9.1.1 Oxygen concentrator supply unit� for use ,vith
5.1.3.8.4.1 i'\'AGD som·ce systems shall be controlled to ensu1·e medical gas pipelines shall produce oxygen meeting the
continuous flow under all conditions of system use as follows: requi1·ement� of Oxygen 93 USP 01- Oxygen USP.
(1) Automatic activation of producer(s) as necessat)' to 5.1.3.9.1.2 O utput shall have less than or equal to l mg/m3
supply the demand. (1.685 x 10-G lb/yd3 ) of permanent particulates sized l micron
(2) Managing the operation to equalize wear on all produc or large1· at normal atmospheric pressu1·e.
ers. Where this equalization is achieved manually, the
facility stalf shall arrange a schedule for manual alterna 5.1.3.9.1.3 Materials of construction on the ai1· sirle of the
tion. oxygen concentrato1- unit shall be suitable fo1· the se1vice as
dete1·mined by the manufacture1·.
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 5.1.3.9.1.4 Materials of construction on the oxygen side of the
ers employ any electrical ci1·cuit device which upon fail- oxygen concentrato1· unit shall comply with 5.1.3.5.4.
2021 Edition
5.1.3.9.1.5 The component� that make up the oxygen concen (5) Closing the isolating valve, whether automatically or
trator unit shall be as follows: manually, shall activate an alarm signal at the master
(1) The manufactu1-e1· of the concentrnt01· unit shall be alarms (.�ef 5.1.9.2) indicating that the oxygen concentra
permitted to use such components and atTangement of t01· supply unit is disconnected.
such component� a� needed to produce oxygen comply 5.1.3.9.1.13 The oxygen concentrator supply unit shall be
ing with 5.1.3.9.1.1 in the quantity as required by the provided with an oxygen concentration monito1· with the
facility, except whe1·e otherwise specifically defined in this following characteristics:
code.
(2) Air receivers and oxygen accumulators, where used, shall (1) 1l1 e monitor shall be capable of monitoring 99 percent
comply v.1th Section VIII, "Unfi1·ed P1·essm·e Vessels," of oxygen concentration v.1th 1 percent accm·acy.
the ASME Bnil,,r and PrPs.rnre l'es�fl� Cndf and be provided (2) The monitor shall continuously display the oxygen
with overpressure relief valves. conce11tt·ation and shall activate local alarm and ma�ter
alarms in accordance with 5.1.3.9.5 when a concentration
5.1.3.9.1.6 The supply air to the concentratol"(s) shall be of a lower than 91 pe1·cent is observed.
quality to ensure the oxygen concentrnto1· unit can produce (3) The monit01· shall continuously display the oxygen
m..-ygen complying \\1th 5.1.:1.9.1.1 and shall not be subject to conce ntrati on.
normally anticipated contamination (e.g., vehicle or othe1- (4) It shall be permitted to inse1·t the monitor into the pipe-
exhausts, gas leakage, discharge from vents, flooding). line without a demand check.
5.1.3.9.I.7 The oxygen concentrator supply unit and any asso 5.1.3.9.2 Location. An oxygen central supply system using a
ciated electrical equipment shall be provided with, at a mini concentrato1·(s) shall be locaterl in acc01·dance with 5.1.3.3 and
mum, the following electrical components: as follows:
(1) Either a disconnect switch for each major electrical (I) Indoors in a dedicated mechanical equipment area, venti
component or a single disconnect that deactivates all lated, anrl with any required utilities (e.g., electricity,
elecu-ical component� in the concentt·at01· unit drains, lighting).
(2) Mot01·-..tarting de,ices with ovedoad protection fix any (2)* In a room ventilated in accordance ,,1th 5.1.3.3.3.:1.
component with an electrical motor over 2 hp (3) For air cooled equipment, in a room designed to main
tain the ambient tempe1·ature range as recommended by
5.1.3.9.1.8 A vent valve shall be provided as follow11: the manufactu1·e1-.
(1) Located on the source side of the concentt·ator outlet ( 4) A room containing an oxygen central supply system using
isolation valve to permit the operation of the oxygen a concentrator(s) that does not have the concentrator
concentrator unit for validation, calibrntion, and testing purge gas vented to the out�ide shall be equipped with
while the unit is isolated from the pipeline system oxygen depletion monit01·s with alarm indicat01·s at the
(2) Sized to allow for at least 25 percent of the oxygen entrance(s) that will indicate ambient oxygen levels in
concentrator unit flow the room below 19.5 percent.
(3) Vented to a location compliant with 5.1.3.3.3.2 (5)* Individual elements of the o},.-ygen central supply system
using a concentrntor(s) shall be pe1·mitted to be located
5.1.3.9.1.9 A DN8 (NPS 1/,) valved sample pmt shall be provi in separate rooms or enclosures a� necessar y to meet
ded near the oxygen concentt·ation monitor sensor connection 5.1.3.9.2(1) through 5.1.3.9.2(4).
for sampling of the gas from the oxygen concentrator unit.
5.1.3.9.3 Arrangement and Redundancies. An oxygen centrnl
5.1.3.9.1.10 At least one 0.1 micron filter suitable for oxygen supply system using a concentrator(s) shall be permitted to
service shall be provided at the outlet of the oxygen concentra consist of tw-o or tlu·ee supply sources, as follows:
tor supply unit.
(1) If tw-o supply sources are provided, one shall be an
5.1.3.9.1.11 A check valve shall be prmided at the outlet of oxygen concentrator supply unit and the second shall be
the oxygen concentrat01· supply unit to prevent backflow into a cylindei- header complying with 5.1.:1.5.9 with suffi
the oxygen concentrator supply unit and to allow service to the cient cylinder connections fo1· one average day's supply.
unit. Containers shall not be used as a supply smu-ce.
(2) If three supply sources are provided, each shall be capa
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 ble of independently supplying the full system demand
in the event of the unavailability of one or both of the
the following charncteristics:
other sources. The three sources shall be permitted to
(1) The valve shall have both manual and automatic actua be eithe1· of the following:
tion with "isual indication of open or closed.
(a) An oxygen concentrnt01· supplv system complying
(2) The valve shall close automatically whenever the oxygen
with 5.1.:1.9.1.
concentrator unit is not producing oxygen of a concen
(b) A cylinder header complying with 5.1.3.5.9 with
tration equal to that in 5.1.3.9.1.1.
sufficient cylinder connections for one average
(:I) Continuing operation of the oxygen concentrator supply
day's supply. Containers shall not be used as a
unit through the vent mode shall be pe1·mitted with the
supply source.
isolating valve closed.
(:I) Use of oxygen concentt·ator supply systems as all three
( 4) The isolating valve, when automatically closed due to low
sources shall only be permitted after a documented risk
concentration, shall requi1·e manual reset to ensure the
oxygen concentrat01· supply unit is examined p1·ior to analysis by the governing auth01·ity of the health care
facility indicating understanding of the inherent risks
1·eturn to service.
and defining how those 1·isks shall be mitigated.
2021 Edition
(4) An isolation valve and automatic check valve shall be (3) Automatic activation of the reserve supply source shall be
provided to isolate each of the three sources from the available if the primaty and secondaty supply source are
othe1·s and from the pipeline. The valves in 5.1.35.9(4), not able to maintain supply pressu1·e or concentration of
5.1.3.5.9(6), 5.1.3.9.1.11, and 5.1.3.9.1.12 shall be oxygen.
permitted to be used for this purpose. (4) Where t\vo or more concentrator supply sources are
(5) Each of the three supply sources shall be provided with a included in the system, the oxygen concentrator supply
pressure relief valve complying with 5.1.35.6 on the som·ces shall be pe1·mitted to rotate as the primary supply
source side of it� respective isolating valve. SOlU-Ce.
(6) The three supply sources shall join to the pipeline (5) Automatic operation such that the supply of gas will
systems through control aITangement� with at least the continue through intern1ption of the main electt·ical
following characteristics: sou1·ce.
(a) Able to maintain stable pressures within the limit� (6) The oxygen concentrator supply sou1·ce(s) in the system
of Table 5.1.11 shall be capable of automatically returning to normal
(b) Able to flow 100 pe1·cent of the peak calculated ope.-ation following a power intetTuption. If required by
demand the technology, it shall be permitted to isolate the
(c) Redundant, such that each component of the concentrator supply sonrce(s) using the automatic
conu·ol mechanism can be isolated for service or valve (s) to restore normal oxygen concent1-ation prior to
replacement while maintaining nm·mal operation 1·econnecting the oxygen concentrat01· supply sout·ce to
(d) The cascade of sources described in 5.1.3.9.4 the system by opening the automatic valve. The valve can
(e) Protected against overp1·essure (.w 5.1.3.5.6) be actuated automatically for this purpose as an excep
(7) A p1·essure 1·elief valve shall be provided in the common tion to 5.1.3.9.1.1 2(4).
line bet\veen the so1u-ces and the line pressure contt·ols. 5.1.3.9.5 Operating Alarms and Local Signals.
(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. 5.1.3.9.5.1 For each oxygen concentrato1- supply source in the
(9) A gauge and switch or sensor shall be located bet\veen system, the supply som·ce's concentration monitor (.�Pf
the three sou1·ces and the line p1·essure controls to moni 5.1. 3. 9.1.13) s hall be able to pedo1-m the following:
tor the pressure feeding the line pressure controls. (1) Indicate low oxygen concentration when a concentration
( 10) An oxygen concentration monitor, sampling the gas on lowe1· than 91 percent is observed
the patient side of the line pressu1·e controls and on the (2) Activate a local alarm (see 5.1. 9.5)
source side of the source valve, shall be provided with (3) Activate an alarm signal at the master alarm (sw 5.1.9.2)
the following cha1·acte1·istics: indicating that the oxygen concenu·ation from that
(a) The monito1· shall be capable of monitoring supply source is low
99 percent oxygen concentration with :tl.O percent (4) Activate the automatic isolating valve for that oxygen
accuracy. concentrator supply source (sw 5.1.3.9.1.12) to prevent
(b) The monitor shall be attached to the pipeline supply from that oxygen concentrator supply source
through a demand check in accm·dance with (5) Close the automatic isolating valve for that oxygen
5.1.8.2.3. concentrator supply source (sff 5.1.3.9.1.12), which acti
(c) The monitor shall continuously display the oxygen vates an alarm signal at the master alarm (.�PP 5.1.9.2) indi
concentration and shall activate local ala1·m and cating that the oxygen concentrator supply source is
maste1· alarms when an oxygen concentration disconnected
lower than 91 percent is obse1ved. 5.1.3.9.5.2 For the entire oxygen central supply system, the
( 11) A DN8 (NPS Yi) Vdlved sample pon shall be provided on system concentration monit01· [�ee 5.1.3.9.3( 10)] shall be able to
the patient side of the line p1·essu1·e controls and source pedorm the following:
side of the source valve for sampling the oxygen.
( 12) An auxilia r y sou1·ce connection shall be provided (1) Indicate low oxygen concentration when a concentration
complying with 5.1.4.10. lowe1· than 91 percent is obse1·ved
( 13) Electrical installation and wi1·ing shall conform to the (2) Activate a local alarm (see 5.1. 9.5)
requirement� of NFPA. 70. (3) Activate an alarm signal at the master ala rm (see 5.1.9.2)
(14) Emergency electt·ical senice for all components of the indicating the m,-ygen concentration is low
oxygen supply system shall conform to the 1·equirement� 5.1.3.9.5.3 For each heade1· source (s1¥i 5.1.3.5.9) in the supply
of the essential electrical system as described in Chap system, local signals and alarms shall be provided as follows:
ter 6.
(1) A p1·essure gauge fot· delive1·y p1·essure
5.1.3.9-4 Operating Controls. i\.J1
oxygen central supply (2) A means to activate an alarm signal at the ma�ter alarm
system using a concentrator(s) shall include means to provide (.�PP 5.1.9.2) indicating the oxygen cylinders are in use
the following functions: (3) A means to activdte an ala rm signal at the ma�ter alarm
( l) Selection of an appropriate prima r y supply source. \'\'hen (s1¥i 5.1.9.2) indicating the content of the oxygen cylinde1·
the primary supply Sotffce is in operation and oxygen heade1· is reduced below one average day's supply
quality is suitable, the secondary and rese1ve supply sour 5.1.3.9.5.4 An O}..ygen central supply system using a concentt·a
ces shall be prevented from supplying the system. t01·(s) shall be provided with operating alarms as follows:
(2) Automatic activation of the secondary supply som·ce shall
be available if the prima r y supply source is not able to (1) Owngr of Source. An operating alarm shall be provided as
maintain p1·essm·e or concentration of oxygen. follows:
2021 Edition
(a) If the supply source in use fails to supply the system 5.1.3.10.2.7 Carbon dioxide 1·efrigerated liquid central supply
and is changed in accordance with 5.1.3.9.4(2) or systems shall be sited in accordance w · ith Chapter 13 of
5.1.3.9.4(3), a local alarm and a signal at the maste1· NFPA :,5 and CGA G-6.1, Standard far lnmlnted Liquid Carbon
ala1·m shall be activated, indicating an oxygen D£m:ide SystP111s at Con.mm.Pr Sites. f55:17.2.7l
supply change has occurred.
(b) The signal in 5.l .3.9.5.4( l )(a) shall not be activated 5.1.3.10.2.8 Nitrous oxide refrigerated liquid central supply
if the system has rotated sotu-ces in accordance with systems shall be sited in accordance with Chapter 16 of
5.1.3.9.4(6). NFPA 55 and CGA G-8.1, S tandard far Nitmm O:xidP Systnns at
(2) Internal Prl'ssurP Low. A local ala.rm and a signal at the Customer Sites. f55:17.2.81
maste1· ala1·m shall be activated when or just before the 5.1.3.10.3 Cryogenic Fluid Central Supply Systems Operation.
pt·essure falls below the pressu1·e 1·equired to drive the
calculated requi1·ed flow rate through the line pressure 5.1.3.10.3.1 The following components of the ct"yogenic fluid
controls indicating the oxygen supply internal pressure is central supply system shall be accessible and visible to delivery
low {.w 5.1.3.9.3(9) for snisar location]. personnel during filling operntions:
5.1.3.10* C ryogenic Fluid Central Supply Systems. (1) Fill connection

(2) Top and bottom fill valves
5.1.3.10.1 General. (3) Hose purge valve
(4) Vent valve
5.1.3.10.1.1* The storage, use, and handling of cryogenic (5) Full trycock valve
fluid central supply systems that deliver compressed medical (6) Liquid level indicator
gases (CMGs) to health care facilities shall be in accm·dance (7) Tank pressut·e indicato1·
with the requi1·ements of this section. f55:l 7. l . !"I
f55: l 7.3. ll
5.1.3.10.1.2 Applicability.
5.1.3.10.3.2 Cryogenic fluid central supply systems shall
(A) The so111·ce valve shall be the line separnting the applica
consist of the following:
bility between NFPA 55 and this code. f55: l 7. l.2. l l
(1) One or more main supply vessel, with capacitv deter
(B) C ryogenic fluid central supply system installations up to, mined after conside1·ation of the customer usage requi1·e
but not including, the source valve shall be covered by ment�, delive ry schedules, proximity of the facilitv to
NFPA 55. f55:l 7. l .2.2l alternative supplies, and the emergency plan
(C) The source valve and all downstream piping and compo (2) A content� gauge on evety main vessel
nents , including wiring to storage system alarms, shall be (3) A 1·ese1·ve supply sized for g1·eater than an avernge day's
covered by this code. f55:l 7. l .2.3l supply, with the size of \·essel or numbe1· of cylinders
determined after consideration of delivery schedules,
5.1.3.10.2 Cryogenic Fluid Central Supply Systems Installation. proximity of the facility to alternative supplies, and the
emergency plan
5.1.3.10.2.1 Ctyogenic fluid central supply systems shall be (4) At least tW'O main vessel 1·elief valves and rnptu1·e discs
installed by personnel qualified in accordance with C GA M-1, installed downstream of a three-way (i.e., three-port) valve
Standard far Medical Gas Supply Systmis at Hmlth Carp Farilitil's, or (5) A check valve located in the p1·imary supply piping
ASSE 6015, Projl'ssional Qualifications Standard for Bulk A1Pdiral upstream of the intersection \\�th a seconda ry supply or
{',as Systnm lnstallm. f55:17.2.1l reserve supply
5.1.3.10.2.2 C1yogenic fluid central supply systems shall be f55: l 7.3.2l
installed in compliance with the Food and Drug Administra
tion (FDA) CutTent Good Manufactu1·ing Practices pet· 21 CFR 5.1.3.10.3.3 Reserve CMG supply systems consisting of eithe1· a
210 and 21 CFR 211. f55:17.2.21 second cryogenic fluid source or a compressed gas source shall
include the following:
5.1.3.10.2.3 Cryogenic fluid central supply systems shall be
anchored with foundations in accordance with CGA M-1, Stand (1) \Vhe1·e the rese1·ve source is a compressed gas sou1·ce, the
ard far Mediml Gas Supply Systl'ms at Hmlth Care Facilities. reserve shall be equipped with the following:
f55:17.2.3l (a) A cylinder manifold having not less than three gas
cvlinde1· connections 01· as otherwise required for
5.1.3.10.2.4 Cryogenic fluid cenu·al supply systems shall have a f
an average o one day's gas supply
minimum wm·k space clearance of 3 ft (1 m) around three
sides of the storage container, three sides of the vaporizer(s), (b) A pressm·e switch to monitor the pressure in the
cylinde1· manifold
and the cabinet opening or front side of the pressure
regulating manifold for system maintenance and operation. (2) ,vhere the 1·ese1·ve sou1·ce is a second ct"yogenic fluid
vessel, the reserve tank shall be equipped with the follow
5.1.3.10.2.5 Inert oyogenic fluid central supply systems shall ing:
be sited in accordance with Chapter 8 of NFPA 55 and CGA (a) An actuating s,,�tch or sens01· to monitm· the inter
P-18, Standard for Bulk lnPrt {',as Systl"lns at ConsumPr Sites. nal tank pressure
f55:17.2.51 (b) A contents gauge to monitor the liquid level
5.1.3.10.2.6 Oxygen cryogenic fluid central supply systems (3) ',,\'he1·e the 1·esen:e sout·ce is either a ctyogenic fluid or
shall be sited in accm·dance with Chapters 8 and 9 of NFPA 55, comp1·essed gas source, a check valve shall be provided to
as applicable, and C GA M-1, Standard far Medical {',as Suf1ply prevent backflow into the reserve system.
Systnn� at Hmlth Carp Farilities. f55:17.2.6l f55:I 7.3.3l
2021 Edition
5.1.3.10.3.4 Bulk ct"yogenic liquict sources shall include auto (4) It shall have a check valve at each connection on the
matic means to provide the following functions: cylinder heacter to minimize loss of gas from the rese1ve
system.
(l ) When the main supply is supplying the system, the
reserve supply shall be prevented from supplying the [55:17.5.31
system until the main supply is rectucect to a level at or
below the rese1·ve activation p1·essure. 5.1.3.10.6 Cryogenic Fill System. C1yogenic flui<l central
(2) When the main supply cannot supply the system, the supply systems shall include a fill mechanism consisting of the
reserve supply shall automatically begin to supply the following components:
system. (1) A nonremovable product-specific fill connection in
(3) \'\'he1·e there is more than one main supply vessel, the compliance with CGA V-6. Standard Bulk RPfrigfratPd Liquid
system shall operate as follows for prima ry, secon<lary, and 1'ranspr Cnnnertirms
reserve operation: (2) A means to cap and secure the fill connection inlet
(a) If ptu,icted with tw-o liquict containe1· heade1·s, one (3) A check ,,alve to pt·event product backflow from the fill
cryogenic liquict hea<ler shall be the primary and inlet
the other shall be the secon<lary, with either being (4) A fill hose purge valve
f
capable of either role. (5) Support� that hold the fill piping of the grounct
f
(b) f provided with one liquid container heade1· and (6 ) A secure connection bet\veen the bulk tank and the fill
one ga� cylinde1· header (i.e., a hyb1·id arrange p1p111g
ment ), the liquict container header shall be the (7) Support�, as necessary, to hold the fill line in position
p1·imary and the gas cylinde1· header shall be the <lm-ing all operations associated with the filling procedure
secondary.
[55:17.61
(c) When the prima1y header is supplying the system,
the secondary heacter shall be prevente<l from 5.1.3.10.7 Vaporizers.
supplying the system.
5.1.3.10.7.1 Vaporizers used to convei-t nyogenic CMG to a
(d) \Vhen the primary heade1· is depleted, the secon
gaseous state shall meet the follm,�ng requirements:
daty header shall automatically begin to supply the
system. ( 1) Vapo1·ize1·s shall be pern1itted to ope1·ate by either ambi
( 4) \'\'l1e1·e the1·e are two or more ctyogenic vessels, thev shall ent heat transfr1· or external the1·mal smu-ce (e.g., electric
be permitted to alternate (e.g., on a timed basis) in the heater, hot water, steam).
f
roles o primary, seconda1y, and reserve, provided that an (2) Vaporizers using a heat source other than ambient air
opernting ca�cade (i.e., primary-secon<la1·y-reserve) is shall he protected in the event of a loss of the ene1·w,
maintained at all times. SOUi-Ce.
(:,) Where a cryogenic vessel is use<l a� the rese1ve, the
rese1ve vessel shall include a means to conserve the gas [55:17.7.ll
produced by evaporntion of the ct"yogenic liquid in the 5.1.3.10.7.2 Vaporizers shall be <lesigned to pro\ide capacity
reserve vessel and to discha1·ge the gas into the line fot· the customer's use under the following conditions:
upstream of the final line regulator assembly.
(1) Customer's ave1·age and peak flows
[55:17.3.41 (2) Local conditions (e.g .. structures that obstrnct air ci1·cula
tion or sunlight)
5.1.3.10.4 Main Supply System. 1l1e main supply vessel for a Seasonal con<litions ( e.g.. freeze periods)
(3)
cryogenic flui<l central supply system shall be a etyogenic stor
age tank. [55:17.41 [55:17.7. 21
5.1.3.10.5 Reserve Supply System. 5.1.3.10.7.3 A system design that uses switching vaporizers
shall meet a.II of the following requirement�:
5.1.3.10.5.1 A CMG resetve supply system shall consist of
either of the following: ( 1) Valves shall be pe1·mitte<l to be manual 01· automatic.
(2) Valves and piping shall allow an operating vaporizer 01· an
(l ) A secondar y cryogenic vessel
operating section of a vaporizer to be s,�tched to a
(2) A high-pt·essure comp1·essed gas source
nonoperating condition for deicing.
[55:17.5.ll (3) The system design shall provide continuous flow of CMG
to the health care facility during vaporizer s,�tchover.
5.1.3.10.5.2 A crvogenic source reserve supply shall have a (4) The system design shall provide continuous flow of CMG
switch or senso1· to monitor the tank pt·essure. f55: 17.5.21 to the health ca.re facility ifvaporize1· switchove1· fails.
5.1.3.10.5.3 A compressed ga� reserve supply shall meet the [55:17.7.31
following requirement�:
5.1.3.10.7.4 \'\'here a vaporize1· uses an external thermal
(l ) It shall be manifolcted \,�th no fewe1· than three gas cylin
source, the flow of the CMG shall be unalfecte<l by the loss of
ders.
the external thermal source by one of the following methods:
(2) It shall have a pressure switch or sensor to monitor the
contents using manifold p1·ess1u-e. (l ) Reserve ambient heat trn.nsfer vaporizers sized for at least
(3) It shall have a check valve to prevent backflow into the one <lay"s a\·erage supply and piped so that the flow of the
system. CMG is una!lecte<l by flow stoppage through the external
thermal source vaporizer
2021 Edition
(2) A noncryogenic source capable of providing at least one (B) The 1·elief valve info1·mation shall be permanently identi
day's average supply fied either on the name plate of the relief valve or on a perma
nently attached metal tag. r55:17.10.3.2l
r55:17.7.4l
5.1.3.10.11 Tubing and Valves.
5.1.3.10.7.5 Where vaporizers are used in the reserve system,
they shall be as follows: 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
( l) Sized by the supplie1· to provide a source of vaporized
CMG from the reserve bulk liguid storage vessel during (A) Tubing shall comply with ASTM B8 1 9, Standard Spn:ifira
times when the reserve system is operational tion for SPamlPs.1 CoppPr TubP for MPdiral Gas Systnns.
(2) Able to provide a flow rate egual to at least that of the r55:17.l l.l.ll
main system vap01·ize1·(s); however, the duration of flow
might be diflerent (B) Tubing shall be capped and bear the marking OXY or
(3) Indin,ctly heated by ambient air MEDICAL oi- be othenvise packaged and labeled to indicate it
is clean fot· oxvgen service according to the supplie1·'s policy.
r55:1 1.1.51 155:17.1 1.1.21
5.1.3.10. 7.6 Low-temperatun, protection systems that inter 5.1.3.10.11.2
rupt or 1-educe flow shall not be used on the resen,e system of
cryogenic fluid central supply systems. r55:l7.7.Gl (A) Instrumentation tubing shall be constructed of annealed
copper tubing or seamless stainless steel tubing. r55:17.1 1.2. ll
5.1.3.10.8 High-Pres.sure Manifolds.
(B) Copper tubing shall comply with ASTM B8 8, Standmd Sper:
5.1.3.10.8.1 Manifold assemblies shall be fit for service and ifimtion for Seamle.u CoppPr Vl'rltfr Tithe. r55:l7.l l.2.2l
shall have support� that are independent of the cylinders.
r55:1 7.8.ll 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
5.1.3.10.8.2 Cylinders on the manifold shall be secured ponion of an oxygen piping system opernting above 4 3 5 psi
against falling.'r55:17.8.21 r 3000 k Pal. r55:17.l 1.3l
5.1.3.10.8.3* Cylindei-s on the manifold shall have the same 5.1.3.10.11.4
sen,ice p1·essu1·e rating 01· the filled pressure of each cylinde1·
shall not exceed the service pressure rating of the lowest rated (A)* Alternate materials of construction fot· piping, tubing,
cylinder on the manifold. r55:l7.8.3l 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
5.1.3.10.9 Pres.sure Control Devices. The final pressure
control device assembly or assemblies shall not be fabricated (B) Technical documentation of alternate materials shall be
on-site. r55:17.9l submitted to the health ca1·e facility QA rep1·ese11tative to
demonstrate eguivalency. r55:17.l l.4.2l
5.1.3.10.10 Pres.sure Relief Devices.
5.1.3.10.12* Alarms. The cryogenic fluid central supply
5.1.3.10.10.1 Pressure relief devices (PRDs ) shall meet the system shall have a local signal that visibly indicates the operat
following 1·eguirement�: ing status of the eguipment and an indicator at all master
(l) PRDs shall have a 1·elief pt·essure setting not higher than alarms under the following conditions:
the maximum allowable working pressure (MA"\VP ) of the (l ) "\Vhen, or at a predetermined set point before. the main
component with the lowest wo1·king pressm·e 1·ating in the supply reaches an average day's supply, indicating low
ponion of the system being protected. content�
(2) PRDs shall be of brass 01· bronze construction. (2) When, or at a predetermined set point before, the reserve
(3) PRDs shall be designed for the specific gas service. supply begins to supply the system, indicating 1-ese1·ve is in
(4) PRDs shall have the discharge protected to prevent the use
entry of rain or snow. (3) "\Vhen, or at a predetermined set point before, the 1·eserve
(5) PRDs shall be designed in accordance with ASME B3 1.3, supply content� fall to one day's average supply, indicat
ProrPss Piping. ing low reserve
r55:11.10.11 (4) If the rese1·ve is a Ct"yogenic vessel, when, or at a predeter
mined set point before. the reserve internal pressure falls
5.1.3.10.10.2 PRDs shall have an identifier that contains the too low fot· the 1·esen,e to operate propedy, indicating
date of manufactut·e or test. r55:17.10.2l reserve failure
(5) Where the1·e is more than one main supply vessel, when,
5.1.3.10.10.3 The final line pt·essure relief valves shall he 01· at a pt·edetermined set point before, the secondary
approved by a nationally recognized organization and shall
vessel begins to supply the system, indicating changeove1·
have a relief capacity g1·eater than or egual to the maximum
throughput of the final line 1·egulator. r55:17.10.3l r55:17.1 2l
(A) The pressure relief valve shall be set at 50 percent above 5.1.4* Valves.
the normal wod<ing pressure , but no highe1· than the MA"\'\'P, of
the health ca1·e facility pipeline. r55:l7.10.3.ll 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-
2021 Edition
bution system for maintenance. repaic or planned futu1·e Tobie 5.l.4.I.6(b) Vacuum and WAGD
expansion need and to facilitate periodic testing.
5.1.4.1.2 Security. All valves, except valves in zone valve box Valve Size MinimumCv
assemblies. shall be secu1·ed hy any of the following means: (in.) (full open)
(1) Located in secured areas Y,, 17
(2) Locked or latched in thei1· opernting position % 31
(3) Located above ceilings, but remaining accessible and not l 60
obstructed 11/1 110
l½ 169
5.1.4.1.3 Labeling. All valves shall be labeled as to ga5
supplied and the area(s) contrnlled, in acco1·dance with 2 357
5.1.11.2. 2½ 196
3 302
5.1.4.1.4 Accessibility. 4 GOO
5 1022
(A) Zone valves shall be installed in valve boxes with remova
ble covers large enough to allow manual operation of valves. 6 1579
8 3136
(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 5.1.4.2 Source Valve.
prnpriate access. f
5.1.4.2.1 A shutof valve shall be placed at the immediate
5.1.4.1.5 Flammable Gases. Valves for nonflammable medical connection of each central supply system to the piped distribu
ga�es shall not be installed with valves for flammable ga�es in tion system to allow the entire central supply system, including
the same zone valve box a5sembly with flammable ga�es. all accessory devices (e.g., ai1· dqrers, final line 1·egulators). to
be isolated from the fac ility.
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 5.1.4.2.2 The source valve shall be located in the immediate
conditions: vicinity of the central supply system.
(l) They have a minimum Cv factor in acc01·dance with 5.1.4.3* Main Line Valve.
either Table 5.1.4.1.G(a) or Table 5.l.4.l.6 (b).
They use a quartet· turn to off. 5.1.4.3.1 A shutoff \·alve shall be provided in the main supply
(2)
They a1·e constructed of materials suitable for the service. line inside of the buildings being setved, except where one 01·
(3)
They are provided with copper tube extensions by the more of the following conditions exist:
(4)
manufacturer for brazing 01· with corrngated medical (l) The sou1·ce and source valve are located inside the build
tubing (C:MT) fittings. ing se1·ved.
(f>) They indicate to the operator if the valve is open or (2) The source system is physically mounted to the wall of the
closed. building served, and the pipeline enters the building in
(G) They pe1·mit in-line serviceability. the immediate vicinity of the source valve.
(7) They are cleaned for m.-ygen service by the manufacturer
if used for any positive-pressure service. 5.1.4.3.2 The main line valve shall be located on the facility
They have threaded purge port5 on the patient side and side of the source valve and out5ide of the source room, the
(8)
the source side. enclosure. 01· whe1·e the main line first ente1·s the building.
(9) They have a minimum working pt·essure equal to or 5.1.4.4 Riser Valve. Each riser supplied from the main line
greater than the relief valve protecting the piping system shall be provided with a shutoff valve in the riser a(ljacent to
on which the valve is installed for any positive-pressure the main line.
sen1ce.
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
Table 5.l.4.I.6(a) Po sitive Pressure Gases 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
Valve Size M.inimumCv branch of of a riser, rega1·dless of how many zone valve boxes
(in.) (full open) are installed on that lateral.
½ 17 5.1.4.5.3 Service valves shall he placed in the branch piping

'Vi 31 prim· to any zone valve box assembly on that branch.
l GO
5.1.4.6 Zone Valves.
l 1/1 110
l½ 169 5.1.4.6.1 All station outlet�/inlet5 shall be supplied through a
2 357 zone valve. which shall be placed as follows:
2½ 390 (1) It is installed so that a wall intervenes between the valve
3 912 and the outlet�/inlet5 that it controls.
4 1837
2021 Edition
(2)* It is 1·eadily operable from a standing position. 5.1.5* Station Outlets/Inlets.

(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, 5.1.5.1 Each station outlet/inlet fo1· me<lical gases 01- vacuums
such as behind n01·mally open 01· n01·mally closed noo1·s. shall be gas-specific, whether the outlet/inlet is th1·eaded or is a
(5) It is not installed in a room with the station outlets/inlet, noninte1·changeable quick couplet·.
that it controls. 5.1.5.2 Each station outlet shall consist of a primary an<l a
(6) It is not installed in rooms, a1·eas, or closet, that can be secon<la1·y valve ( or assembly).
closed 01· locked.
5.1.5.3 Each station inlet shall consist of a prima1y valve (or
5.1.4.6.2 A zone valve in each medical ga, or vacuum line shall assembly) and shall be permitte<l to include a secondary valve
be provinen for each Category 1 space ann anesthetizing loca (or assembly).
tion for moderate sedation, deep sedation, 01· general anesthe
sia specific for the occupancy, and shall he locaten as follows: 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
(1) They are installed immeniately outsine the area control- p1·imary valve (or assembly) is 1·emoved.
led.
(2) They are installed where they are visible and accessible at 5.1.5.5 Each outlet/inlet shall be legibly identifie<l in accord
all times. ance with 5.1.11.3.
5.1.4.6.3 Piping on the patient side of zone valves shall be 5.1.5.6 Threaded outlet�/inlet� shall be noninte1·changeable
arranged to provide the following: connections complying with the mandatory requirement, of
( 1) Shutting off the supply of medical gas or vacuum to one CGA V-5, Dimllfler Index Safety System (Noninten-hangmble Low
zone will not affect the supply of medical gas or vacuum Pressure Conmctions for M.edi,:al Gm Appli,:ations).
to another zone or the rest of the system. 5.1.5.7 Each station outlet/inlet, inclu<ling those mounte<l in
(2) Service will only be to outlet,/inlets located on that same columns, hose 1·eels, ceiling tracks, or other special installa
story. tions, shall be designed so that parts or components that are
(3) All gas delive1·y columns, hose 1·eels, ceiling tracks, requiren to he gas-specific for compliance with 5.1.5.1 and
control panels, pennant,, booms, or other special installa 5.1.5.9 cannot be interchange<l between the station outlet/
tions are located on the patient side of the zone valve. inlet for rlifferent gases.
5.1.4.6.4 A presstu-e/vacuum innicator shall be prnvided on 5.1.5.8 The use of common pa1·t� in outlet s/inlet�, such as
the station outlet/inlet side of each zone valve. springs, O-rings, fasteners, seals, an<l shutoff poppet�, shall be
5.1.4.7 In-Line Shutoff Valves. Optional in-line valves shall be permitten.
f
pe1·mitten to be installed to isolate or shut of piping fot· servic 5.1.5.9 Component., of a vacuum station inlet necessa ry for
ing of innividual rooms or areas. the maintenance of vacuum specificity shall be legibly marked
5.1.4.8 Valves for Future Connections. to identify them as component, 01· pa1·t5 of a vacuum or suction
system.
5.1.4.8.1 Future connection valves shall be labeled as to gas
content. 5.1.5.10 Components of inlets not specific to a vacuum shall
not be requi1·ed to he marked.
5.1.4.8.2 Downstream piping shall be closen with a brazen cap
with tubing allowance for cutting ann rebrazing. 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
5.1.4.9 In-Line Check Valves. New or replacement check terminal shall be not less than DN8 (NPS Y,) (% in. O.D.) size,
valves shall be as follows: with 8 mm (0.3 in.) minimum inside <liamete1·.
(1) They shall be of brass or bronze construction. 5.1.5.12 Factory-installed copper outlet tubes on station inlet�
(2) They shall have brazed extensions. exten<ling no further than 205 mm (8 in.) from the bo<ly of the
(3) They shall have in-line se1·viceabili ty. te1·minal shall be not less than DN l0 (NPS %) (½ in. O.D.) size,
(4) They shall not have tlu·eaden connections. with 10 mm (0.4 in.) minimum insi<le diameter.
(5) They shall have threaded purge point, of¼ in. NPT.
(6) They shall be sized to have a maximum velocity which 5.1.5.13 Station outlets/inlets shall be permitted to be
does not exceen the manufacturer's recommennations. recessed or otherwise prntected from damage.
5.1.4.10 Auxiliary Source Connection. All etyogenic fluin 5.1.5.14 \-\'hen multiple wall oullet,/inlets are installed, they
central supply systems shall be provinen with an auxilia ry shall be spaced to allow the simultaneous use of adjacent
source connection point of the same size as the main line, outlets/inlet� with any of the various types of therapy equip
which shall be located immediately on the patient side of the ment.
source valve.
5.1.5.15 Station outlet� in systems ha\ing nonstanda1·d operat
5.1.4.10.1 The connection shall consist ofa tee, a valve, and a ing pressures shall meet the following ad<litional requi1·ements:
removable plug or cap. (1) TI1ey shall be ga,-specific.
5.1.4.10.2 The auxilia1·y sout-ce connection valve shall be (2) TI1ey shall be pt·essure-specific where a single gas is piped
normally closed and secured. 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.
2021 Edition
(3) If operated at a pressure in excess of 550 kPa (80 psi), for Test for Sur/are Burning ChamdPri�tic� of Building Material�. m
they shall be either D.I.S.S. connectors or comply with shall comply with the reguirement� for heat release in accord
.",.1.5.1.">( 4). ance with NFPA 286 as described in Section 10.2 ofNFPA 101.
(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 5.1.6.7 Manufactured assemblies employing flexible hose 01·
designed so as to prevent the removal of the adapter until tuhing shall he attachect to the pipelines using station outlet�/
the pressure has been relieved to prevent the actapter inlets.
injuring the user or others when removed from the 5.1.6.8 Manufacturect assemhlies employing hose or flexible
outlet. connectors, where the station outlet/inlet attached to the
5.1.5.16 WAGD netw01·ks shall provide a WAGD inlet in all piping is not h.tlly anct immectiately accessible (i.e., cannot be
locations where nitrous oxide 01· halogenated anesthetic gas is manipulatect without the removal of panels, do01·s, anct so
intenctect to he actministerect. forili). shall have station outlets/inlet� \\�th ilie following adcti
tional characteristics:
5.1.5.16.1 Station inlet� for V11AGD sen,ice shall have the (1) TI1ey shall be ga�-specific connections v.�th positive lock
following actditional charactet·istics: ing mechanisms that ensure the connector is firmly
( l) They shall not be interchangeable with an y other systems, seated and cannot ctetach without intentional actuation
inducting mectical-sut·gical vacuum. of the release (e.g., D.I.S.S. connectot·s).
(2) Component� necessa1·y for the maintenance of \\'AGD (2) In pressut·e gases. they shall be permitted to omit the
specificity shall be legibly markect to ictentify them as secondary valve (or assembly) reguired in 5.1.5.2.
componenl� of a WAGD inlet. (3) In vacuum and WAGD, they shall he pe1·mitted to omit
(3) They shall he of a type appropriate for the flow and hoth primar y anct seconctar y vah·es (or a�semblies) ftx
vacuum level reguirect by the facility's gas anesthetic minimum restriction to flow.
machines. (4) They shall be provided with a second terminal at which
( 4) They shall be located to avoid physical ctamage to the the user connect� anct disconnects that complies with
inlet. 5.1.5.
5.1.5.17 ,-\-11ere installed in a down-facing position, such as in 5.1.6.9 Hose or flexihle connectors employed in manufac
a ceiling or ceiling column. station outlets/inlet� shall be tured assemblies shall be labeled by stenciling or acthesive
D.I.S.S. connectors. markers that identify the patient medical gas, the medical
support gas, or the vacuum system and inclucte the following:
5.1.6* Manufactured Assemblies.
(1) Name of the ga� 01· vacuum system or the chemical
5.1.6.1 Manufactured assemblies shall be pretested by the symbol pe1· Table 5.1.11
manufactm·e1· prior to atTival at ilie installation site in accorct (2) Gas or vacuum system color code per Table 5.1.11
ance with the following: (3) Where positive-pressure piping systems operate at pres
(1) Initial hlowctown test per 5.1.12.2.2 su1·es other than the standard gauge pressure in Table
(2) Initial pressure test pet· 5.1.12.2.3 5.1.11, the operating pt·essm-e in addition to the name of
(3) Piping purge test per 5.1.12.2.5 the gas
( 4) Standing pressure test per 5.1.12.2.6 01· :,.1.12.2.7, except (4) Date of installation
as permittect under 5.1.6.2 5.1.6.10 Station outlets/inlets installect in manufacturect
(5) Operational pt·essure test pet· 5.1.12.4.10, except that the a�semblies connected to the pipeline by brazing shall comply
test gas is permitted to be in accorctance with the manu with 5.1.5.
facture1·'s process regui1·ements
5.1.6.11 The installation of manufacturect assemhlies shall be
5.1.6.2 The leakage from a completed manufactured assembly tested in accorctance \\1th 5.1.12.
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 5.1.7* Surface-Mounted Medical Gas Rails (MGR).
and shall not exceect 0.002 cm�/sec (0.00012 in.�/sec) for
5.1.7.1 Medical gas rail (MGR) assemblies shall be pet·mittect
vacuum and \\'AGD systems when staned at 635 mm (25 in.)
to be installed where multiple uses of medical gases and
HgV.
vacuum at a single patient location at·e 1·egui1·ed or anticipated.
5.1.6.3 The manufacturer of the assembly shall provicte ctocu
5.1.7.2 MGR a�semblies shall be entit·ely visible in ilie mom,
mentation certifying ilie peti·01·mance and succe��ful comple
not pa�sing into or through walls, partitions, anct so forth.
tion of ilie tests reguirect in 5.1.6.1.
5.1.7.3 MGR assemblies shall be made of materials wiili a
5.1.6.4 Manufactured assemblies employing flexible hose shall melting point of at least 538° C ( lO0O OF).
use hose and flexible connectors v.�th a minimum but·st gauge
p1-essure of 6895 kPa ( 1000 psi). 5.1.7.4 MGR a�semblies shall be cleanect per 5.1 10.1.1.
5.1.6.5 The manufacturer of the assembly shall provide docu 5.1.7.5 Station outlets or inlets shall not be placed on the encts
mentation certifying that the flexible hose assembly has a mini of MGR assemhlies.
mum burst gauge pressure of 6895 kPa (1000 psi).
5.1.7.6 Openings for station outlets/inlet� in the MGR shall
5.1.6.6 Components of manufacttu-ed a�semhlies shall have a be gas-specific.
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 5.1.7.7 Openings in the MGR not occupied by station outlets/
Burning Chararteristin of Building MatPrial�. m UL 723. Standard inlet� (e.g., fot· fi.1tut·e use) shall be capped or plugged so that a
2021 Edition
special tool is required fot· removal (i.e .. cannot be 1·emoverl by 5.1.9 Category I Warrung Systems.
a wrench, pliers, a screwdriver, or other common tool).
5.1.9.1 General. All master. area. and local alarm systems used
5.1.7.8 MGR assemblies shall connect to the pipeline through for medical gas anrl ,-a.cuum systems shall include the following:
fittings that are brazed to the pipeline. ( 1) Separate visual indicators for each conrlition monitored,
5.1.7.9 Where the pipeline and the MGR assembly are of except as permitted in 5.1.9.5.2 for local alarms that are
dissimilar metals, the connections shall be plated or othetwise displayerl on master ala1·m panels
protected from interaction between the metals. (2) Visual inrlicators that remain in alarm until the situation
that has caused the ala rm is resolved
5.1.7.10 1he installation of the MGR shall be testerl in accoi-d (3) Cancelable audible inrlication of each alarm condition
ance with 5.1.12. that produces a sounrl with a minimum level of 80 dBA
5.1.8 Pressure and Vacuum Indicators. at 0.92 m (3 ft)
( 4) Means to indicate a lamp or LED failure anrl audible
5.1.8.1 General. f ailme
(5) Visual and audible indication that the communication
5.1.8.1.1 P1·essure indicatm·s and manometers fo1· medical gas with an alarm-initiating de\ice is disconnected
piping systems shall be cleanerl for oxygen service. (6) Labeling of each inrlicator, indicating the condition
5.1.8.1.2 Gauges shall comply with ASME B40.100, PrP.mm monitot·ed
(',r,ugps nnrl GaugP AttnrlmtPnt�. (7) Labeling of each ala1·m panel for it� area of surveillance
(8) Reinitiating of the audible signal if another alarm condi
5.1.8.1.3* The scale range of positive pressm·e analog inrlica tion occurs while the audible alarm is silenced
tors shall be such that the normal operating p1·essu1·e is within (9) Powe1· for master ala1·ms, area alarms, sensors, and
the middle third of the total range fe.g., an indicator of O to switches from the life safety branch of the essential elec
2070 kPa (0 to 300 psi) would have a lower third of 0 to t1·ical system as rlescribed in Chapter 6
690 kPa (0 to 100 psig), a mirldle third of 690 kPa to 1380 kPa (10) Powe1· fo1- local alam1s, dew point sensm·s. anrl carbon
( 100 psig to 200 psig), and a top thi1·d of 1380 kPa to 2070 kPa monoxirle sensm·s permitted to be from the same essen
(200 psig to 300 psig) l . tial electrical branch a� is used to power the air compres
5.1.8.1.4 The accuracy of digital indicators shall be ±5 percent sm· system
of the operating pressm·e at which they are userl. (11) ,vhere used for communications, wi1-ing from switches
or sensors that is supervised 01· protected as required by
f
5.1.8.1.5 The scale range of vacuum indicators shall he O to 517.30(C)(3) o NFPA. 70 for life safety anrl critical
760 mm (0 to 30 in.) gauge HgV. Indicatm·s with a noi-mal branches ci1·cuit� in which protection is any of the
range display shall indicate normal only above 300 mm (12 in.) following types:
gauge HgV. (a) Conduit
5.1.8.1.6 Indicators a<"!jacent to ma�te1· ala1·m actuators anrl (b) Free air
area alarms shall be lahelerl to identify the name of, or chemi (c) Vfo·e
cal symbol for, the particular piping system that they monitor. (rl) Cable tray
(e) Raceways
5.1.8.2 Locations. (12) Communication rle\ices that do not use electrical wiring
5.1.8.2.1 Pressm·e/vacuum inrlicators shall he rearlahle from a for signal transmission and are supervised such that fail
standing position. ure of communication initiates an alarm
(13) A�surance by the 1·esponsible authm·ity of the facility that
5.1.8.2.2 Pn�ssu1·e/vacuum indicatot·s shall be prnvided at the the labeling of ala1-ms, whe1·e mom numbers or rlesigna
following locations, as a minimum: tions are used, is accurate and up-to-date
( 1) Arljacent to the ala1-m-initiating rle\ice for source main (14) Provisions for automatic restart after a power loss of
line pt·essure and vacuum alarms in the master alarm 10 seconrls (e.g., during generator start-up) without
system giving false signals 01· 1·equi1·ing manual reset
(2) At or in area alarm panels to inrlicate the pressure/ (15) Alarm switches/sensors installed so a� to be removable
vacuum at the ala1·m-activating device for each system that and accessible fo1· service anrl testing
is monitored by the panel 5.1.9.2* Master Alarms. A maste1· alarm system shall be prmi
(3) On the station outlet/inlet sirle of zone valves rlerl to monitor the operation anrl conrlition of the source of
5.1.8.2.3 All pressure-sensing devices anrl main line pressure supply, the 1·eserve sout-ce (if any), and the p1·essm·e in the
gauges downst1·eam of the source valves shall be provided \\ith main lines of each medical gas and vacuum piping system.
a g-ds-specific demanrl check fitting to facilitate service testing 5.1.9.2.1 The master alarm system shall consist of two or more
or replacement. alarm panels located in at least two separate locations, as
5.1.8.2.3.1 Ga�-specific demand check fittings shall not be follows:
required on zone \a.Ive pressure inrlicators. (1) One master alarm panel shall be located in the office or
work space of the on-site indivirlual responsible for the
5.1.8.2.4 Demand check fittings shall he prmided fot· all maintenance of the medical gas and vacuum piping
monitors. systems.
(2) In orrler to ensure continuous surveillance of the merlical
gas and vacuum systems while the facility is in operation,
2021 Edition
the secon<l master alarm panel shall be locate<l in an are a power source for the 1·elays shall be indepen<lent of any of the
of continuous observation (e.g., the telephone switch master alarm panels.
f
boar<l, secu1·ity office, 01· other continuously staf e<l loca
tion). 5.1.9.2.3.B Multiple ma�ter ala1·ms shall be pe1·mitted to moni
t01· a single initiating <le\ice.
5.1.9.2.2 A centralize<l computer system shall be permitte<l to
be substituted for one of the master ala1·ms required in 5.1.9.2.4 Maste1· ala1·m panels for medical gas an<l vacuum
f
5.1.9.2.1 i the compute1· system complies with 5.1.9.3. systems shall each include the follomng signals:
(1) Alarm indication when, or just before, changeover
5.1.9.2.3 The master alarm panels required in 5.1.9.2.1 shall occurs in a medical gas system that is supplie<l by a mani
communicate di1·ectly to the alarm-initiating de\ices that they fold or other alternating-type bulk system that has as a
monit01·. p art of it� 1101·mal operntion a changeover from one
5.1.9_2_3.l If communication is achieve<l by wires, the follow portion of the operating supply to another
ing shall apply: (2) Alarm indication fm a cryogenic fluid centrnl supply
sptem when the main supply reaches one average day"s
(A) Each of the two mandatory alarms shall be wire<l inde supply, in<licating low content�
pendently to the initiating device(s) for each signal. (3) Alarm indication when, or just before, the changeover to
(B) The wiring bet\veen each mandatory alarm (s) and the the 1·ese1ve supply occurs in a medical gas system that
initi ating device(s) shall not utilize common conductm·s that, if consists of one or more unil� that continuously supply
interrupte<l, woul<l disable more than one signal. the piping system while another unit remains as the
1·ese1·ve supply and ope1·ates only in the ca�e of an emer
(C) Each set of wi1·es (in whateve1· number a� 1·equi1·e<l by the gency
al,ll'm) shall run to tl1e initiating <levice(s) without interruption ( 4) Alarm indication for cylin<ler reserve pressure low when
other than in-line splices necessary to complete the necessary the content of a cylinder rese1ve header is reduced
length of½fre. below one avernge <lay's supply
(5) Fm· c1yogenic fluid centrnl supply systems, an alarm
(D) Vihere initi ating <levices are remote from the building when or at a predetermine<l set point before the rese1ve
and the ,\/:iring is to run u ndergroun<l in compliance with supply content5 fall to one average day's supply, in<licat
i\lFPA 70, the following e xceptions shall be pe1·mitted to be
ing low rese1ve
use<l: (6) \-\'he1·e a c1yogenic liqui<l storage unit is use<l as a reserve
(1) Wiring from the initiating device and through the under for a cryogenic fluid central supply system, an alarm
ground section shall be permitted to be run to a junction indication when the ga.� pressm·e available in the rese1ve
box located whe1·e the wiring first ente1·s the building. unit is below that 1·equire<l for the medical gas system to
(2) A single set of ,,fres complying ,,�th 5.1.9.2.3. l(B) an<l function
5.1.9.2.3.l(C) for each signal shall be permitte<l to (7) Alarm indication when the pressure in the main line of
connect the initiating <levice an<l the junction box. each separnte medical gas system increa5es 20 pet-cent 01·
(3) Between the junction box and the two mandatory ala1·m deueases 20 percent from the normal operating pres
panels, wiring shall comply mth 5.1.9.2.3.1(A) through sure
5.1.9.2.3.l(C), 5.1.9.2.3.4, and 5.1.9.2.3.5 in all respect�. (8) Alarm indication when the medical-sm·gical vacuum
pressm·e in the main line of each vacuum system drops
5.1.9.2-3.2 If communication is achieved by means other than to or below 300 mm (12 in.) gauge HgV
,\/:ires, the follmving shall apply: (9) Alarm indication(s) from the local alarm panel(s) as
(A) Each of the mandatory ala1·ms shall communicate inde desCl"ibe<l in 5.1.9.5.2 to indicate when one 01· more of
pen<lently to the initiating device(s) fo1· each signal. the conditions being monitore<l at a site is in alarm
(10) Medical air <lew point high alarm from each compressor
(B) The me ans of communication between each man<latory site to in<licate when the line pressure <lew point is
ala1·m(s) an<l the initiating device(s) shall not utilize a common g1·eater than +2"C ( +35"F)
communication <levice that, if interrupted, would <lisable the (11) \VACD low ala1·m when the \'VAGD vacuum level or flow
signal from another initiating device(s). is below effective operating l imits
5.1.9.2.3.3 A single initiating device shall be permitte<l to (12) An instrument ai1· dew point high alarm from each
actuate multiple master ala1·ms. compressor site to indicate when the line p1·essu1·e dew
point is g1·eater than -30"C (-22"F)
5.1.9.2.3.4 The man<latory master alarm panels shall not be (13) Alarm indication if the primary or rese1ve production
arrnnge<l such that failm·e of eithe1· panel would <lisable any stops on a proportioning system
signal on the other panel . (14) \Vhen oxygen is supplied from an oxygen central supply
system using concentrators (.�ff 5.1. 3. 9j, the follm,1ng
5.1.9.2-3.5 'Where a relay is required to ensure correct opera signals shall be provi<le<l:
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 (a) For each concentrat01· unit use<l in the oxygen
ble the relay. central supply system, an alarm in<lication that
oxygen concentration from that m..-ygen concentra
5.1.9_2_3.6 Master alarm signals shall not be relayed from one tor unit is below 91 percent
maste1· alarm panel to another. (b) For each oxygen concentrat01· unit used in the
5.1.9-2.3.7 'Where multi-pole alarm relays are used to isolate oxygen central supply system, an alarm indication
the alarm-initiating signals to master ala1·m panels, the control that the isolating valve fo1· that oi.-ygen concentrn
tor unit is close<l and the unit is isolated
2021 Edition
(c) Fo1· each cylinder hearler userl as a source. an (3) 1l1e ala1·m algorithm shall include activation of an audi
alarm indication that the header is in use ble alert, activation of any remote signaling protocol, and
(d) Fo1· each cylinder header userl as a smll"ce. an display of the specific condition in alarm.
ala1·m inrlication that the cylinder contents are (4) 1l1e alarm algorithm shall provirle fo1· compliance ½':ith
below one average day's supply 5.1.9.1(1) through 5.1.9.1(5), anrl 5.1.9.1(8).
(e) If the sou1·ce in use changes because of a failure to
apprnpt-iately supply the system, an alarm indica 5.1.9.4* Area Alarms. Area alarm panels shall be provirlerl to
tion that an unexpected oxvgen supply change ha� monitor all medical gas, medical-surgical vacuum, and piped
occurred WAGD systems supplying the following:
(f) An alarm inrlication that the p1·essm·e in the (1) A.nesthetizing locations whe1·e moderate sedation, deep
common line on the source side of the line pres sedation, 01· general anesthesia is administererl
sure controls is low (2)* Category l space
(g) An alarm indication that the oxygen concentration
from the supply system is below 91 pe1·cent 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.
5.1.9.2.5 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 5.1.9.4.2 Area alarm panels for medical gas systems shall indi
lines immerliately downstream (on the patient 01· use side) of cate if the p1·essu1·e in the lines in the area being monito1·ed
the source valves. \\!here it is necessary to install a main line inct·eases or rlec1·eases by 20 percent from the n01·mal line p1·es
valve in addition to a source valve (WP 5.1.4.Jj, the sensors shall sure.
be located downstream (on the patient or use side) of the main 5.1.9.4.3 A1·ea ala1·m panels for merlical-surgical vacuum
valve. systems shall indicate if the vacuum in the a rea drops to or
5.1.9.3 Master Alarms by Computer Systems. Computer below 300 mm (12 in.) gauge HgV
systems userl as substitute master alarms as 1·equired by 5.1.9.4.4* A.lann sensors for a1·ea alarms shall be located as
5.1.9.2. l (2) shall have the mechanical and electrical characte1· follows:
istics described in 5.1.9.3. l and the programming characteris
tics rlescrihed in 5.1.9.3.2. ( l)* Category l spaces, other than anesthetizing locations
addressed in 5.1.9.4.4(2), shall have the ala1·m sensors
5.1.9.3.1 Computer systems used to substitute for alanns shall installerl on the patient or use side of each of the indivirl
have the following mechanical and electrical characteristics: ual zone valve box assemblies.
(I) The computer system shall he in continuous uninterrup (2)* Anesthetizing locations where moderate sedation, deep
terl operation anrl prnvirlerl with power supplies as sedation, or general anesthesia is administered shall have
needed to ensure such reliability. the sensors installed either on the source side of each of
(2) The computer system shall be continuously attenrlerl by the individual room zone valve box assemblies or on the
1·esponsible indivirluals 01· shall provide remote signaling patient or use side of each of the indi,idual zone valve
of 1·esponsible parties (e.g .. through pagers. telephone box assemblies.
autodialers, or other such means). 5.1.9.4.5 One area alarm panel shall be acceptable to monitor
(3) ,111h.ere computer systems rely on signal interface rle,ices multiple rooms located \\':ithin an immerliate vicinity meeting
(e.g., electronic interfaces, othe1· ala1·m panels, 4 mA to the requirement� of 5.1.9.4.4(2).
20 IJLJ\ cards), such intedaces shall be supervised such
that failure of the device(s) shall initiate an alarm(s). 5.1.9.4.6 Area alarm panels for medical gas systems shall
(4) If the compute1· system does not power the signaling provirle visual and aurlible indication in the event a mismatch
switches/sensors from the same power supply 1·equirerl in occt\l"s between the transducer(s) anrl it� a�sociated ci1·cuit
5.1.9.3.1(1). the power supply fm the signaling switches/ hoa1·rl(s).
sensors shall be powered from the life safety branch of 5.1.9.5* Local Alarms. Local alarms shall be installerl to
the essential electt·ical system a� desn·ibed in Chapter 6. monitor the function of the ai1· compressor system(s), medical
(5) Computer systems shall be permitted to communicate surgical vacuum pump system(s), ''\'AGD systems, instrument
directly to the sensors/switches in 5.1.9.2.3 in the same air systems, and proportioning systems.
manner as an ala.rm panel if operation of another alarm
panel(s) is not impai1·ed. 5.1.9.5.1 The signals referencerl in 5.1.9.5.4 shall be permitted
(6) Communication from the compute1· svstem to the signal to be located as follows:
ing switches or sensors shall be supervised such that fail (1) On or in the control panel(s) for the central supply
m·e of communication shall initiate an alarm. system or supply som·ce being monitored
(7) Computer systems shall be providerl with an aurlio alen (2) Within a monitoring device (e.g., dew point monitor or
per f>.1.9.1(:\), except the aurlio alert shall he pe1·mitterl carbon monoxide monitor)
to be only as loud a� needed to alert the system operator. (3) On a sepa1·ate alarm panel(s)
(8) The facility shall ensure compliance with 5.1.9. l (13).
5.1.9.5.2 The master alarm shall inclurle at least one signal
5.1.9.3.2 The operating program for compute1· systems used from the source equipment to indicate a problem with the
to substitute for alarms shall inclurle the following: som·ce equipment at this location. 1l1is master alarm signal
(1) The medical gas alarm shall be allocated the p1·iority of a shall activate when any of the required local ala1·m signals for
life safety signal. this som-ce equipment activates.
(2) A merlical gas alarm signal shall interrupt any other activ
f
ity o a lesse1· priority to run the alar m algorithm(s). 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
2021 Edition
supply system and pipeline for the same gas in the building, 5.1.10 Category I Distribution.
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 5.1.10.1 Piping Materials for Field-Installed Positive Pressure
5.1.9.2.4. Medical Gas Systems.
5.1.9.5.4 The following functions shall be monitored at each 5.1.10.1.1 Tubes, valves, fittings, station outlet�, an<l other
local ala1-m site: piping componenl� in medical gas systems shall have been
cleaned for o}.-ygen service by the manufacture1· prior to instal
(1) Low medical air resen,e capacity, to indicate when the lation in accordance with the mandatory requirements of CGA
medical air source is operating under a demand that G-4.1, Clfrming Equipnwnt for Oxygen Sfrvirf, except that fittings
coul<l not be managed if one compressor ceased to oper shall he permitted to be cleaned by a supplie1· or agency othe1-
ate than the manufacture!".
(2) High carbon monoxide level, to indicate when the
carbon monoxi<le level in the medical air system is 10 5.1.10.1.2 Each length of tube shall be delivere<l plugged or
ppm or highe1· cappe<l by the manufacture1- an<l kept sealed until p1·epa1·ed fo1-
(3) Me<lical ai1· <lew point high, to indicate when the line installation.
pressure dew point is greater than +2 ° C (+35'F) 5.1.10.1.3 Fittings, valves, and other component5 shall be
( 4) Low medical vacuum rese1·ve capacity, to indicate when delive1·ed sealed and labele<l and kept seale<l until p1·epa1-e<l fix
the medical vacuum sou1·ce is operating un<le1· a installation.
<lemand that could not he managed ifone pump cease<l
to operate 5.1.10.1.4* Tubes shall be one of the following:
(5) Low WAGD rese1-ve capaci ty, to indicate when the '"'AGD ( 1) Har<l-drawn seamless copper in acc01·dance with ASTM
source is operating under a demand that could not be 8819, Standard Spl'cijialtion for Sramles.1 Copµ,r Tube for
manage<l if one producer cea�e<l to operate Medir:al (',as Systm1s, medical ga� tube. Type L. except Type
(G) Instrument air dew point high, to indicate when the line K shall be used where operating pressm·es a1·e above a
pressure dew point is greater than -30'C (-22'F) gauge pt·essme of 127:> kPa ( 185 psi) and the pipe sizes
(7) Low instrument air reserve capacity, if instrument ai1· is a1·e large1· than DN80 fNPS 3 (3¼ in. O.D.) l.
pr0vide<l by a source with more than one compressor, to (2)* Listed corrugate<l medical tubing (CMT) fabricated from
in<licate when the instrument air sou1·ce is operating copper alloy No. 51000 st1·ip, meeting ASTM 8103/
f
un<le1· a demand that coul<l not be managed i one 8103M, Standard SpPCijication far PhosphM BmnZP Plate,
compressor ceased to operate Sheet, Strip, and Rolled Bar, with a design margin of 3.5,
(8) For compressor systems using liquid ring compressors or exten1ally coated with a nonmetallic sheath ma1·ked with
compressors with wate1°cooled components, high water the manufacturer's marking. The listing shall inclu<le test
in the receive1· tank. to indicate when the water level in ing to <lemonstrate that CMT S)'litems can be consistently
the receiver tank has reached a level determine<l to be gas-purged with results equivalent to comparable medical
<letrimental to the operation ofthe system gas copper tubing.
(9) Fo1· comp1·esso1· systems using liqui<l ring comp1·ess01·s,
high wate1· in the separator 5.1.JO_J.5 CMT shall have a flame spread index of 25 or less
( 10) For compressor systems using other than liquid ring and a smoke developed index of 50 or less a� determined by
compressors, high discha1·ge air temperatm·e ASTM E84, Standard Tl's/ kiethod for Surfar;, Burning Oiararteri.1-
( 11) Proportioning systems high/low in<licator when the tir:s of Building MatPriall.
O}.')'gen concentration is out5i<le the 19.5 percent to
23.5 percent oxygen range 5.1.10.1.6 CMT shall be identified by the manufacturer as suit
( 12) Proportion systems 1·eserve system in operation able for m..--ygen set·vice at a minimum ofeveqr 0.92 m (3 ft).
(13) ,'\'hen oxygen is supplie<l from an oxygen central supply 5.1.10.1.7 ASTM B819, Standard Sper:ification fM Smmll'ss CoppPr
system using concentrators (sff 5.1.3.9), the following 7lihe far Medical (',as Systems, medical ga5 tube shall be i<lentifie<l
signals shall be provided at the system's local ala1·m by the manufacture1·'s markings "OXY," "MED," ·'OXY/MED,"
site(s): "OXY/ ACR," or "ACR/MED" in blue (Typ e L) 01· g1·een (Type
(a) For each cylin<ler header used as a source, an K).
alarm indication that the header is in use 5.1.JO_J.8 The installer shall furnish documentation cenifying
(b) For each cylinde1· heade1· used as a source, an that all installed piping mate1·ials comply with the 1·equirements
alarm indication that the cylinde1· contents a1-e of5.l .10.l.l .
below one average day's supply
f
(c) If the source in use changes because o a failm-e to 5.1.10.2 Piping Materials for Field-Installed Medical-Surgical
appropriately supply the sv11tem, an alarm indica Vacuum and WAGD Systems.
tion indicating an unexpecte<l 0}.')'gen supply
change has occurred 5.1 .I 0.2.1 Tubes for Vacuum_ Piping for vacuum systems shall
(d) An alarm in<lication that the pressure in the be constructed ofany ofthe following:
common line on the sou1·ce si<le of the line pt·es ( l) Hard-drnwn seamless copper tube in acc01·dance with the
sure controls is low following:
(e) An ala1·m indication that the oxygen concentration (a) ASTM B88, Standard Sper:ifiration fM Seamless CoppPr
from the supply system is below 91 percent Water Tube. copper tube (Type K. Type L. or
Type M)
2021 Edition
(h) ASTM B280, Standard Spnifii:ation for Smmles s CoppPr made using mechanically formerl. drilled, anrl extruded tee
Tubefor Air ('.onditioningand &frig'f!ration FiPld Servit:P, branch connections that are formed in accordance with the
copper ACR tube tool manufactut·er's instntctions. Such branch connections
(c) ASTM B819, Standard Spn:ifirationforSmmless Copper shall bejoined by brazing, as rlesc1·iherl in 5.1.10.4.
Tube for Mediral Gas SystPni�. copper medical ga�
tubing (Type Kor Type L) 5.1.10.3.4 Branch connections marle using mechanically
(2) Stainless steel tube in accorrlance with the following: formed, drilled, and extrurle rl tee-hrnnch connections shall be
prnhibited in CMT systems.
(a) ASTM A269/A2G9M, Standard SperifirationforSeam
lPt� and M'l'ldPd Austenitir Stainless Stefl Tubingfor 5.1.10.3.5 WAGD systems designed for operation below
Gmeral Serviff, TP304L 01· 316L 130 mm (5 in.) HgV shall be pe1·mitted to bejoined using any
(b) ASTM A312/A312M, Standard Speiifiration far Seam method that will 1·esult in a leak-free netw·ork when tested per
less, Welded, and Heavily Cold Worked Austmitir Stain 5.1.12.4.2.
less Stt'!'l PipPs, TP304L 01· 316L 5.1.10.4 BrazedJoints.
(c) A312 TP 304L/316L, Sch. :>S pipe, anrl
A403 WP304L/316L, Sch. 5S fittings 5.1.10.4.1 General Requirements.
(3) CMT meeting the requirement� of 5.1.10.1.4(2)
5.1.10.4.1.1 Fittings shall be wrought copper capilla1·y fittings
5.1 .I 0.2.2 Vacuum Tube Marking Where R eq uired. complying \vith ASME BlG.22, Wrought CappPr and Coptier Alloy
SoldM-joint PrPsszm Fittin�, or hrazerl fittings complying with
5.1.10.2.2.1 If copper or CMT vacuum tubing is installerl ANSI/ASME B lG.50, Wrought CoppPr and Copper Alloy Bmzf-joint
along with any medical gas tubing, the vacuum tubing shall, Pressure Fzttin�.
prior to installation, be prominently labeled 01· othenvise irlen
tified to pr·eclude using materials 01· installation prncedm·es in 5.1.10.4.1.2 Cast copper alloy fittings shall not be permitterl.
the medical gas system that are not suitable for oxygen service.
5.1.10.4.1.3 Brazed joints shall be made using a brazing alloy
5.1.10.2.2.2 If merlical gas tube in accot·dance with ASTM that exhibits a melting temperatu1·e in excess of 538'C
B8 l 9, Standard Specijiratirm far SmmlPss Capper Tube far A1ediral ( lO0OOF) to retain the integrity of the piping system in the
(',as Sy stems, is userl for vacuum piping, such special marking event of fire exposure.
shall not be 1·eguired.
5.1.10.4.1.4 Brazed tube joint� shall be the socket type.
5.1.10.2.3 WAGD System Piping. WAGD systems shall be
piped as follows: 5.1.10.4.1.5 Filler metals shall bond with and be metallurgi
cally compatible with the base metals beingjoined.
(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 5.1.10.4.1.6 Fillet· metals shall comply with ANSI/AWS
mum vacuum only, using any noncorrorling tube or rluct A5.8M/A5.8, Sfrdfiration for Filler I\1etal1 far Brazing and Braze
work Wdding.
5.1.10.2.3.1 If joined to the vacuum piping, ,-v-AGD system 5.1.10.4.I.7 Coppet"-to<opper joint� shall he hrnzerl using a
piping shall be connected at a minimum distance of 1.5 m copper-phosphorus or copper-phosphorus-silver brazing filler
(5 ft) from any vacuum inlet. metal (BCuP se1·ies) without flux.
5.1.10.2.3.2* Systems meeting 5.1.10.2.3.1 shall be labeled a� 5.1.10.4.1.8 Brazing performed between cryogenic fluid
indicaterl in 5.1.11 for both WA.GD and vacuum. central supply system vessels and their ,-aporizers (i.e., subject
to cq'Ogenic exposure) shall be permitted to be lxazed using
5.1.10.3 Joints. BAg brazing alloy with flux by a brazer qualified to the manda
5.1.10.3.1 * Positive pressure patient gas systems, medical tory 1·eguirement� of CGA M-1, Standard far Alediral Gas Supply
support gas systems, vacuum systems, anrl WAGD systems Sy sll'lns at Hmlth Care FarilitiP s.
constructed of hard-rlrawn seamless copper or stainless steel 5.1.10.4.1.9 Joints to be brnzed in place shall be accessible for
tubing shall have all turns, ofE�ets, and other changes in direc necessary p1·eparntion, assem hly, heating, filler application,
tion made using fittings or techniques appropriate to any of cooling, cleaning, and inspection.
the follmving acceptable joining methorls:
5.1.10.4.1.10 Braze joints shall he continuously purgerl with
(1) Brazing. as described in 5.1.10.4
nitrogen NF.
(2) Welrling, a� described in 5.1.10.5
(3) Memory metal fittings, a� described in 5.1.10.6 5.1.10.4.2 Cutting Tube Ends.
(4) Axially swagerl, elastic p1·eload fittings, as desc1·ibed 111
5.1.10.7 5.1.10.4.2.1 Tube ends shall be cut square using a sharp
(5) Threaded, as describerl in 5.1.10.8 tubing cutter to avoid deforming the tube.
5.1.10.3.2 Positive p1·esst11"e patient ga� systems, medical 5.1.10.4.2.2 The cutting wheels on tubing cutters shall he free
suppot·t g-as systems. vacuum systems. and WAGD systems from grea�e, oil, 01· other lubricant not suitable for oxygen serv
constructed of CMT shall have turns, offsets, anrl other changes ice.
in direction made by benrling the tubing up to the minimum 5.1.10.4.2.3 The cut ends of the tube shall be rollerl smooth
bend rndius 01· by fittings in accorrlance \vith 5.1.10.3.1. or debutTed with a shat-p, clean deburring tool, taking care to
5.1.10.3.3 Vacuum systems and WAGD systems fahricaterl from pt·event chips from ente1·ing the tube.
coppe1· tubing shall be pe1·mitterl to have branch connections
2021 Edition
5.1.10.4.3 OeaningJoints for Brazing. 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
5.1.10.4.3.1 The interior sul'faces of tubes, fittings, and other enstlt'e complete cove1·age and wetting of the sui-faces v.�th flux.
component� that are cleaned fot· oxygen service shall be st01·ed
and handled to avoid contamination prim· to assembly and 5.I. 10.4.4.5 Where possible, short sections of copper tube
brazing. shall be brazed onto the noncopper component, and the inte
rim· of the subassembly shall be cleaned of flux prior to installa
5.1.10.4.3.2 1l1e exterior sudaces of tube ends shall be tion in the piping system.
deaned pt·ior to brazing to remove any surface oxides.
5.1.10.4.4.6 On joint� DN20 (NPS %) (¾ in. O.D.) size and
5.1.10.4.3.3 \¾11en cleaning the exte1·ior surfaces of tube ends, smaller, flux-coated brazing rods shall be permitted to be used
no matter shall be allowed to enter the tube.
in lieu of applying flux to the surfaces beingjoined.
5.1.10.4.3.4 If the interior surfaces of fitting socket� become 5. I.I 0.4.5* Nitrogen Purge.
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 5. I.I0.4.5.1 '\,\'hen brazing, J01t1ts shall be continuously
bt·azing with a clean. oil-free, stainless steel or brass wire brush. purged with oil-free, dry niu·ogen NF to prevent the formation
of copper oxide on the inside surfaces of the joint.
5.1.10.4.3.5 Clean, nonshedding, abrasive pads shall be used
to clean the exterior surfaces of the tube ends. 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
5.1.10.4.3.6 1l1e use of steel wool or sand cloth shall be content is low.
prohibited.
5.1.10.4.5.3 The purge gas flow rate shall be controlled by the
5.1.10.4.3. 7 The cleaning process shall not 1-esult in grooving use of a pressure regulator and flowmeter, or combination
of the surfaces to be joined.
thereof.
f
5.1.10.4.3.8 A ter being abraded, the sul'faces shall be wiped 5.1.10.4.5.4 Pressure regulators alone shall not be used to
using a clean, lint-free white cloth .
control purge gas flow rates.
5.1.10.4.3.9 Tubes, fittings, valves, and other components shall 5.1.10.4.5.5 In m·der to ensm·e that all ambient air ha� been
be visually examined internally befo1·e being joined to verify
removed from the pipeline prior to brazing, an oxygen
that they have not become contaminated for oxygen service
analyzer shall be used to verify the effectiveness of the purge.
and that they are free of obstructions or debris.
The oxygen analyzer shall 1·ead below l pe1·cent oxygen
5.1.10.4.3.10 The inte1·io1· surfaces of tube ends, fittings, and concentration before brazing begins.
other component� that we1·e cleaned fot· oxygen service by the
5.I.I 0.4.5.6 Dm·ing and afte1· installation, openings in the
manufacturer, but that became contaminated prior to being
piping system shall be kept sealed to maintain a nitrogen
installed, shall be permitted to be recleaned on-site by the
atmosphere within the piping to prevent debris or other
installer by thoroughly scrubbing the interim· surfaces with a
contaminants from entering the system.
dean, hot wate1·-alkaline solution, such as sodium carbonate or
trisodium phosphate, using a solution of 450 g (I lb) of sodium 5.1.10.4.5.7 While ajoint is being brazed, a discl1a1·ge opening
ca1·bonate or tt·isodium phosphate to 11 L (3 gal) of potable shall be provided on the opposite side of the joint from where
wa.te1·, and thoroughly rinsing them with clean, hot, potable the pu1·ge gas is being introduced.
water.
5.1.10.4.5.8 The flow of purge gas shall be maintained until
5.1.10.4.3.11 Othe1· aqueous cleaning solutions shall be the joint is cool to the touch.
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 5.1.10.4.5.9 Afte1· the joint has cooled, the purge discha1·ge
mandatory requirement� of CGA G-4.1, ClPaning Eq mp,nmt for opening shall be sealed to prevent contamination of the inside
O:rygm Smlir:e. of the tube and maintain the nitrogen atmosphere within the
piping system.
5.1.10.4.3.12 Material that ha� become contaminated inter
nally and is not clean for oxygen service shall not be installed. 5.1.10.4.5.10 The final brazed connection of new piping to an
existing pipeline containing the system gas shall be permitted
5.1.10.4.3.13 Joints shall be brazed within 8 hou1·s afte1· the to be made without the use of a nitrogen pu1·ge.
surfaces are cleaned for brazing.
5.1.10.4.5.11 After a final brazed connection in a positive pres
5.1.10.4.4 Brazing Dissimilar Metals. sure medical gas pipeline is made without a nitrogen purge, an
outlet in the immediate downstream zone of the affected
5.1.10.4.4.1 Flux shall only be used when bt·azing dissimilar portion(s) of both the new and existing piping shall be tested
metals, such as copper and bronze or brass, using a silver (BAg
in accordance with the final tie-in test in 5 .1.12.4.9.
series) brazing filler metal.
5.1.10.4.5.12* When using the autogenous 01-bital welding
5.1.10.4.4.2 Sul'faces shall be cleaned for brazing in accord process, joint� shall be continuously purged inside and outside
ance with 5.1.10.4.3.
with inert gas(es) in accordance with the qualified welding
5.1.10.4.4.3 Flux shall be applied spat-ingly to m1111m1ze procedure.
contamination of the inside of the tube with flux.
2021 Edition
5.1.10.4.6 A<.sembling and Heating Brazed Joints. with Section IX. "Welding an<l Brazing Qualifications," of the
ASME Boiler and Pressure Ve.uel Code.
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 5.1.10.5.1.3 Welder qualification procedures shall include a
minimum cup depth (overlap) specified by ANSI/ASME bend test an<l a tensile test in accordance with Section IX,
B l6.50. Wrought Coppl'r and Copper Alloy Brtl7..fjoint Pmmm "Wel<ling and Brazing Qualifications;· of the ASME Boill'f and
Fittinff>. Pres.mre l-Pssel (',odeon each tube size diametel'.
5.1.10.4.6.2 \'\'hei-e flux is permitted, the joint shall be heate<l 5.1.10.5.1.4 Each welder shall qualify to a welding procedure
slowly until the flux has liquefied. specification (WPS) for each tube diameter.
5.1.10.4.6.3 Afte1· flux is liquefied, or where flux is not pe1·mit 5.1.10.5.1.5* GTAW autoge nous orbital welded joints shall be
te<l to be used, the joint shall be heated quickly to the brazing purge<l <luring welding with a comme1·cially available mixttll"e
temperature, taking care not to overheat the joint. of 75 percent helium (±5 percent) an<l 25 percent argon
(±5 percent).
5.1.10.4.6.4 Techniques for heating the joint, applying the
brazing filler metal. an<l making horizontal. vertical, and la1·ge 5.1.10.5.1.6 T he shield gas shall be as requi1-ed in 5.1.10.5.1.5.
diameter joint� shall be a� state<l in sections on applying heat
and bt·azing and hm·izontal and venical joint� in Chaplet· VII, 5.1.10.5.I.7 Test coupons shall be welde<l an<l inspected. as a
''Braze<ljoint�," in the C DA Coppl'r Titbf Handbook 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
5.1.10.4.7 Inspection of Brazed Joints. en<l of the work period.
5.1.10.4.7.1 Afte1· brnzing, the outside of all joint� shall be 5.1.10.5.1.8 Test coupons shall be inspecte<l on the I.D. and
cleaned by washing with water and a wire bmsh to remove any O.D. by a qualified quality control inspectol'.
residue and allow clear visual inspection of the joint.
5.1.10.5.1.9 Test coupons shall also be welded at change of
5.1 .I 0.4. 7.2 \'\1he1·e flux has been use<l, the wash water shall be operator, weld head, welding power supply, or ga� source.
hot.
5.1.10.5.1.10 All production welds shall be \isually inspected
5.1.10.4.7.3 Each bt·azed joint shall be visually inspected afte1· on the O.D. by the operato1·, and any obvious wel<l failures shall
cleaning the out�ide surfaces. be cut out and re-welded.
5.1.10.4.7.4 Joint� exhibiting the following con<litions shall 5.1.10.5.2 Welding for Stainless Tube.
not be permitted:
5.1.10.5.2.1 Stainless tube shall be welded using metal inen
( l) Flux or flux residue (when flux or flux-coated BAg sei-ies gas (MIG) welding. tungsten inert gas (TIC) wel<ling, or other
rods are used with dissimilar metals) welding techniques suited to joining stainless tu be.
(2) Base metal melting or erosion
(3) Unmelte<l filler metal 5.1.10.5.2.2 Welders shall be qualifie<l to Section IX, "Welding
( 4) Failtu-e of the filler metal to be clearly visible all the \\"dY and Brazing Qualifications," of the ASME Boiler and Pressure
aroun<l the joint at the interface between the socket and ¼swlCode.
the tube 5.1.10.6 Memory Metal Fittings.
(5) Cracks in the tube or component
(6) Cracks in the braze filler metal 5.1.10.6.1 Memory metal fittings ha,ing a temperature rating
(7) Failure of the joint to hol<l the test pressure under the not less than 538 ° C (I000 ° F) and a pressure rating not less
installe1·-pedo1·med initial pt·essure test (see 5.1.12.2.3) than 2070 kPa (300 psi) shall be pe1·mitted to be used to join
and stan<ling pressu1·e test (sPP 5.1.12.2.6 or 5.1.12.2. 7) copper 01· stainless steel tube.
5.1.10.4.7.5 Braze<l joints that are i<lentified as defective 5.1.10.6.2 Memory metal fittings shall be installe<l by qualified
under the con<litions of 5.1 10.4.7.4(2) or 5.1.10.4.7.4(5) shall technicians in accor<lance with the manufacttlt'et·'s instt·uctions.
be 1·eplaced.
5.1.10.7 Axially Swaged Fittings.
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), 5.1.10.7.1 Axially swage<l fittings provi<ling metal-to-metal
5.1.10.4.7.4( 4), 5.1.10.4.7.4(6), or 5.1.10.4.7.4(7) shall be seals, suitable for sen,ice at 2070 kPa (300 psig) and able to
permitted to be repaired, except that no joint shall be reheate<l withstand a temperature of 538'C (l00O O F) and that, when
mo1·e than once before being replaced. complete, are permanent and nonseparable, shall be permitted
to be use<l to join coppe1· or stainless steel tube.
5.1.10.5 Weldedjoints.
5.1.10.7.2 Axially swaged fittings shall be installe<l by qualified
5.1.10.5.1 Gas Tungsten Arc Welding (GTAW) for Copper and technicians in accordance with the manufacturer's instructions.
Stainless Tube.
5.1.10.8 Threaded Fittings. Tiu·eaded fittings shall meet the
5.1.10.5.1.1 Welded joints for me<lical gas and medical-surgi following criteria:
cal vacuum systems shall be permitted to be made using a gas
(l ) They shall be limited to connections fot· pressure and
tunb�ten a1·c welding (GTA\V) autogenous m·bital proce<lu1·e. vacuum indicators, alarm devices, gas-specific demand
5.1.10.5.1.2 The GTAW autogenous m·bital proce<lure and the check fittings, and source equipment on the source si<le
welder qualification procedure shall be qualified in accordance of the sou1·ce valve.
2021 Edition
(2) They shall be tapered pipe threads complying with ASME 5. I. IO.I 1.3 Location of Piping.
Bl . 20. 1, Pipe Threads, (',eneral Purpose, lnrh.
(3)* They shall be made up with polytetrnfluornethylene 5. I. IO.I 1.3.1 Piping 1·isers shall be pe1·mitte<l to be installed in
(PTFE) tape or othe1· thread sealant 1·ecommended for pipe shaft� if protected from phys ical <lamage, effect� of exces
oxygen service, with sealant applied to the male threads sive heat. corrosion, or contact ...�th oil.
only and care taken to ensure sealant does not enter the 5. I.I0.11.3.2 Piping shall not be installe<l in kitchens, stai1·
pipe. wells, elevator shafts, elevat01· machine rooms, areas with open
5.1.10.9 Special Fittings. flames, electrical senice equipment over 600 volts, and areas
prohibited under Nl-PA 70 except for the follm,1ng locations:
5.1.10.9.1 Listed 01· apprnve<l metallic gas tube fittings that, (1) Room locations for me<lical air comp1·ess01· supply
when ma<le up, provide a pe1·manent joint having the mechani systems and me<lical-sm·gical vacuum pump supply
f
cal, thermal, and sealing integrity o a brazed joint shall be systems
permitted to be used. (2) Room locations for secon<lary distribution circuit panels
5.1.10.9.2 Dielectric Fittings. Dielectric fittings that comply and b1·eake1·s having a maximum voltage rating of
with the following shall be permitte<l only where require<l by 600 volt�
the manufacturer of special me<lical equipment to electrically 5. I.10.11.3.3 Me<lical gas pi ping shall be pe1·mitted to be
isolate the equipment from the system distribution piping: installe<l in the same service trench 01· tunnel with fuel gas
(l ) They shall be of brass or copper construction \\1th an lines, fuel oil lines, electrical lines, steam lines, and similar util
appropriate dielectric. ities, pro,i<le<l that the space is ventilate<l (naturally or mechan
(2) They shall be permitte<l to be a union. ically) an<l the ambient tempernture around the medical gas
(3) They shall be clean for oxygen where use<l for medical piping is limited to 54"C( 130° F) maximum.
gases and medical support gases.
5.1.10.11.3.4 Medical gas piping shall not be located where
5.1.10.10 Prohibited Joints. The following JOmts shall be subject to contact mth oil, including a possible flooding area in
prohibite<l throughout medical gas an<l vacuum disu·ibution the ca�e of a major oil leak.
pipeline systems:
5.1.10.11.4 Pipe Support.
(l )Flare<l and comp1·ession-type connections. including
connections to station outlet5 and inlet5, ala1·m devices, 5.1.10.11.4.1 Piping shall be supported from the buil<ling
and other component5 structure.
(2) Other straight-threa<le<l connections, including unions 5.1.10.11.4.2 Hangers and supports shall comply with and be
(3) Pipe-crimping tools used to permanently stop the flow of installe<l in accordance with MSS S P-5 8, Pipe Hangers and
medical gas and vacuum piping Support� - Matl'riafr, DPsign, Manufactim, SPlPrtion, A.ppliration,
(4) Removable an<l nonremovable push-fit fittings that and installation.
em ploy a quick assembly push fit connect01·
5.1.10.11.4.3 Support� for copper tube shall be size<l fm
5.1.10.11 Installation of Piping and Equipment. coppe1· tube.
5.1.10.11.1 Pipe Sizing. 5.1.10.11.4.4* Suppmt� for CMT shall be in accor<lance \\1th
5.1.10.11.1.1 Piping systems shall be designed and size<l to the CMT manufacturer's installation instructions.
<leliver the required flow rates at the utilization pressures. 5.1.10.11.4.5 In potentially <lamp locations, copper tube hang
5.1.10.11.1.2 Mains and branches in medical gas and \\'AGD e1·s 01· supports that are in contact mth the tube shall be plastic
piping systems shall be not less than DN15 (NPS ½) (% in. coated 01· otherwise be electrically insulated from the tube by a
O.D.) size. 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
5.1.10.11.4.7 Where requi1·ed, medical gas and vacuum piping (2) Cleaned at the factory for oxygen service and received on
shall be seismically restrained against earthquakes in accord the job site with certification of cleanliness
ance with the applicable building code. (3) Suitable fm se1·vice at 2070 kPa (300 psig) or above and
able to withstand temperatures of 538 ° C ( I00O"F)
5.I.IO.11 .5 U nderground Piping Outside of Buildings. (4) Provided with brazing extensions to allow brazing into
5.I.10.11.5.1 Buried piping out�ide of buildings shall be the pipeline per 5.1.10.4
installed below the local level of frost peneu·ation. (5) Supponed with pipe hangei-s and support� as requi1·ed
fot· their additional weight
5.1.10.11.5.2 The installation procedure for underground
piping shall protect the piping from physical damage while 5.1.10.11.6.4 Metallic flexible joints in accordance with
being backfilled. 5.1.10.11.6.3 shall be permitted to be concealed in walls. ceil
ings, or partitions.
5.1.10.11.5.3 If underground piping is protected by a conduit,
cover, or other enclosure, the following 1-equirement� shall be 5.1.10.II.7 Prohibited System I nterconnections.
tnet: 5.1.10.II.7.I Two 01· more medical gas 01· vacuum ptprng
(1) Access shall be provided at the joints for visual inspection systems shall not be interconnected for installation, testing, or
and leak testing. any other reason, except as permitted by 5.1.10.11.7.2.
(2) The conduit, cove1·, or enclosure shall be self-draining
and not retain gmundwate1· in prolonged contact with 5.1.10.11.7.2 Medical ga� and vacuum systems with the same
the pipe. content� shall be permitted to be interconnected with an in
line valve installed between the systems.
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· 5.I.10.11.7.3 Leak testing shall be accomplished by separately
its enclosure from excessive stresses. charging and testing each individual piping system.
5.1.10.11.5.5 The minimum backfilled cover above the top of 5.1.10.11.8 Manufact urer's Instr uctions.
the pipe 01· it� enclosure for buried piping out�ide of buildings 5.1.10.11.8.1 The installation of i ndividual components shall
shall be 900 mm (36 in.), except that the minimum cover shall be made in accordance with the instructions of the manufac
be pe1·mitted to be 1·educed to 450 mm (18 in.) whe1·e the1·e is tu1·er.
no potential for damage from sudace loads 01· sui-face condi
tions. 5.1.10.11.8.2 Manufacturer's insu·uctions shall include di1-ec
tions and information deemed by the manufacturer to be
5.1.10.11.5.6 T1·enches shall be excavated so that the pipe 01· adequate fot· attaining proper ope1·ation, testing. and mainte
its enclosure has fi1·m, substantially continuous bearing on the nance of the medical gas and vacuum systems.
bottom of the t1·ench.
5.1.10.11.8.3 Copies of the manufacturer's instructions shall
5.1.10.11.5.7 Backfill shall be clean, free from mate1·ial that be left with the system owner.
can damage the pipe. and compacted.
5.1.10.11.9 Changes in System Use.
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 5.1.10.11.9.1 \,Vhere a positive pressure medical ga� piping
pipe line by specific name. distribution system 01·iginally used 01· constructed fot· use at
one pt·essure and fot· one gas is converted for operation at
5.1.10.11.5.9 A continuous warning means shall also be provi another pressure or for another gas, all provisions of 5.1.10
ded above the pipeline at approximately one-half the depth of shall apply as if the system were new.
burial.
5.1.10.11.9.2 A vacuum system shall not be permitted to be
5.I.I0.11.5.10 \'\>l1ere underground p1pmg is installed converted for use as a gas system.
through a wall sleeve, the outdoor end of the sleeve shall be
sealed to prevent the entrance of groundwater into the build 5.1.10.1 I.IO Qualification of Installers.
ing. 5.I.IO.II.10.1 TI1e installation of medical gas and vacuum
5.1.10.11.6 Hose and Flexible Connectors. systems shall be made by qualified, competent technicians who
are expet·ienced in pedorming such installations, including all
5.1.10.11.6.1 Hose and flexible connectors, both metallic and personnel who actually install the piping system.
nonmetallic, shall be no longer than necessary and shall not
penetrate or be concealed in walls, floors, ceilings, or pani 5.1.IO.II.I0.2 Installers of medical gas and vacuum piped
tions. distribution systems, all appurtenant piping supporting pump
and comp1·ess01· source systems , and appunenant piping
5.1.10.11.6.2 Flexible connectors, metallic or nonmetallic, supporting source gas manifold systems not including perma
shall have a minimum btu-st pt·essure, with a gauge p1·essu1·e of nently installed bulk sout-ce systems. shall be cenified in
6895 kPa (1000 psi). accmdance with ASSE 60 l 0, Pmfessinnal Qualifiratinm Standard
5.1.10.11.6.3 Metallic flexible joints shall be permitted in the Jar l'viftlit:al (',as Systnns lnstallPrs.
pipeline whe1·e required for expansion joints, seismic protec 5.I.I0.11.10.3 CMT systems shall be installed by ASSE 6010-
tion, thermal expansion, 01· vibration control and shall be as qualified installe1·s using the CMT manufactm·e1·'s instructions.
follows:
(1) For all wetted sudaces, made of bronze, copper, or stain
less steel
2021 Edition
5.1.10.11.10.4 Installe1·s of medical gas and vacuum systems with the qualifien procedure for a period exceeding 6 months
shall not use their certification to oversee installation by or there is a specific reason to question the ability of the brazer.
noncenifien pe1·sonnel.
5.1.10.11.12 Breaching or Penetrating Medical Gas Piping.
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. 5.1.10.11.12.1 Positive pressure patient menical gas piping
and medical support gas piping shall not be hreachen or pene
5.1.10.11.10.6 P1·i01· to any installation wo1·k, the installe1· of trated by any means 01· process that will result in 1·esinual
medical ga� and vacuum piping shall provide and maintain coppe1· pat·ticles or other debris 1·emaining in the piping or
nocumentation on the job site for the qualification of brazing affect the oxygen-cleat1 interior of the piping.
procenm·es ann indi\idual braze1·s that is requi1·en unner
5.1.10.11.11. 5.1.10.11.12.2 1l1e breaching 01· penetrating process shall
ensm·e that any deb1·is createn by the process 1·emains
5.1.10.11.10.7 Health care organization personnel shall be contained ,vi thin the work area.
f
permitten to install piping systems i all of the requirement� of
5.1.10.11.10 a1·e met during the installation. 5.1.11* Labeling, Identification, and Operating Pressure.
Color and pt·essm·e requirement� shall be in accordat1ce with
5.1.I0.11.1I Qualification of Brazing Procedures and Brazing. Table 5.1.11.
5.1.10.11.11.1 Brazing procenures ann braze1· perfo1·mai1ce 5.1.11.1 Pipe Labeling.
fot· the installation of menical gas ann vacuum piping shall be
qualified in accordance with either Section IX, "Welding and 5.1.11.1.1 Piping shall be labeled by stenciling or anhesive
Brazing Qualifications,'' of the ASME Boill'r and Prrss1aP Vr.i�Pl markers that inentify the patient menical gas, the medical
CodP, or AWS B2.2/B2.2M, Spnijiration for Brazing PmrPdurP and support gas, or the vacuum system and inclune the following:
PerformanrR Qualifimtion, both as monified by 5.1.10.11.11.2 ( 1) Name of the ga� or vacuum system or the chemical
through 5.1.10.11.11.5. symbol per Table 5.1.11
(2) Gas or vacuum system color cone per Table 5.1.11
5.1.10.11.11.2 Brazers shall be qualified by visual examination
of the test coupon followed by sectioning. 5.1.11.1.2 '\'here positive pressure gas piping systems operate
at p1·essures other than the standarn gauge pressure in Table
5.1.10.11.11.3 The brazing procedure specification shall 5.1.11, the operating pt·essure in adnition to the name of the
adnress cleaning, joint cleai·ance, ovedap, internal pm·ge ga�, gas shall he labeled.
purge ga� flow rate, and filler metal.
5.1.11.1.3 Where vacuum svstems are used to serve WAGD
5.1.10.11.11.4 The brazing procedu1·e qualification recorn systems in accordance with 5.1.10.2.3.1, piping in the immedi
and the record of brazer pedormance qualification shall docu ate a1·ea of the \,\!AGD system shall be labeled to innicate both
ment filler metal usen, base metals, cleaning, joint clearat1ce, systems.
overlap, internal purge gas and flow rate during brazing of
coupon, and absence of internal oxination in the completed 5.1.11.1.4 Pipe labels shall be locaten as follows:
coupon. At intervals of not more than 6.1 m ( 20 ft)
( 1)
5.1.10.11.11.5 Brazing procenures qualified by a technically (2) At least once in or above every room
competent group or agency shall be pern1itted unde1· the (3) On both sines of walls or partitions penetrated by the
following conditions: piping
(4) At least once in evety stoty height traversed by risers
( l) The brazing procedure specification at1d the procedure
qualification records meet the requirement� of this code. 5.1.11.1.5 Medical ga� piping shall not be painted.
(2) The employer obtains a copy of both the brazing proce
dure specification and the supporting qualification 5. I.I 1.1.6 Labeling of piping fot· compressor intakes, vacuum
recmTls from the group or agencv and signs ann dates exhaust�, ann relief valve vent lines shall meet the require
these recm·ds, thereby accepting 1·esponsibility for the men l� of 5.1.11.1. l ann state the specific function to distin
qualifications that were pedormen by the group or guish them from the patient supply piping.
agencv. 5.1.11.2 Shutoff Valves.
( 3) The employer qualifies at least one braze1· following each
brazing procedure specification used. 5.1.11.2.1 Shutoff valves shall be inentified with the following:
5.1.10.11.11.6 An employer shall be permitted to accept ( 1) Name or chemical symbol for the specific medical gas or
bt·azer qualification recorns of a previous employer unne1· the vacuum system
following conditions: ( 2) Gas or vacuum system col01· code in acc01·nance with
Table 5.1.11
( l) The brazer has been qualified following the same or an (3) Room or areas served
equivalent procenure that the new employer uses. (4) Caution to not close 01· open the valve except in eme1·-
(2) The new employe1· obtains a copy of the recm·d of brnzer gency
performance qualification tests from the pre\ious
employer and signs and nates these records, thereby 5. I.I 1.2.2 VVl1ere positive pressure gas piping sylltems operate
accepting responsibility for the qualifications pedormen at pt·essures othe1· than the standat·d gauge pressure of 345 kPa
by the pt·evious employe1·. 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,
5.1.10.11.11.7 Performance qualifications of brazers shall the valve identification shall also inclune the nonstandard
1·emain in effect indefinitely, unless the brazer does not braze operating p1·essu1·e.
2021 Edition
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 5.1.11.2.7 T he service valve(s) shall be labeler! in substance as
systems in ac cm·dance with 5.1.10.2.3.1, valves that are on the follows:
source si<le of the connection to the WAGD system shall be
labeler! to in<licate both systems. SERVICE VALVE FOR THE (GAS/VACUUM NAME)
SERVING (NAME OF THE AREA/BUILDING
5.1.11.2.4 Sou1·ce valves shall be labeled in s ubstance as SERVED BY THE PARTICULAR VALVE).
follows:
5.1.11.2.8* Zone valve box assemblies shall be labeled with the
SOURCE VALVE 1·ooms, areas, or spaces that they contt·ol a� follows:
FOR THE (SOURCE NAME).
ZONE VALVES FOR THE (GAS/VACUUM NAME)
5.1.11.2.5 Main line valves shall be labeled in substance as SERVING (NAME OF ROOMS OR SPACES SERVED
follows: BY THE PARTICULAR VALVE).
MAIN LINE VALVE FOR THE (GAS/VACUUM NAME) labeling shall either be visible from outside the zone valve
SERVING (NAME OF THE BUIIDING). box assembly through the covet· or be replicated on the
out�i<le. but not affixe<l to the removable cover.
5.1.11.2.6 1he rise1- valve(s) shall be labeled in substance as
follows: 5.1.11.3 Station Outlets and Inlets.
RISER FOR THE (GAS/VACUUM NAME) SERVING 5.1.11.3.1 S tation outlets and inlet� shall be i<lentified as to
(NAME OF THE AREA/BUILDING SERVED BY THE the name 01· chemical symbol for the specific medical gas or
PARTICULAR RISER). 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
(2) Ga� 01· vacuum system color code in accordance with 5.1.12.1.2 Inspection and testing shall include all component�
Table 5.1.11 of the system, or portions thereof, including, but not limitert
to, gas hulk source(s); manifolds; comp1·essert air source
5.1.11.3.1.1 In sleep labs, whe1·e the outlet is downstt·eam of a systems (e.g., comp1·ess01·s, rtrye1·s, filters, regulators); source
flow contrnl device, the station outlet identification shall alarms and monitoring safeguards; master alarms; pipelines;
include a warning not to use the outlet for ventilating patient�. isolation valves; a1·ea alarms; zone valves; and station inlets
5.1.11.3.2 Where medical gas systems opernte at pt·essut·es (vacuum) anrt outlets (pressure gases).
other than the standard gauge pr·essm·e of 345 kPa to 380 kPa 5.1.12.1.3 All systems that are breachert anrt component� that
(50 psi to 55 psi) or a gauge pressure of 1100 kPa to 1275 kPa are subject to additions, renovations, or replacement (e.g., new
(160 psi to 185 psi) for nitrngen, the station outlet identifica gas sout-ces: bulk, manifolds, com pressors, dtyern. alarms) shall
tion shall include the nonstandat·d operating pressu1·e in addi be inspected anrt testert.
tion to the name of the gas.
5.1.12.1.4 Sys tems shall be deemert breached at the point of
5.1.11.4 Alarm Panels. pipeline intrusion by physical separntion 01· by system comp�
5.1.11.4.1 Labeling of alarm panels fot· each indicat01· shall nent removal, replacement, 01· artrtition.
indicate the condition monitored and its area of surveillance. 5.1.12.1.5 B1·eachert portions of the systems subject to inspec
5.1.11.4.2* A.i-ea alarm panels shall be identified with the tion anrt testing shall be confinert to only the specific alterert
following: zone and component� in the immediate zone or area that is
locatert upstream for vacuum systems anrt downstream for pres
(1) Name or chemical symbol of the specific medical gas or sure gases at the point 01· a1·ea of intrusion.
vacuum system being monito1·ed
(2) Ga� or vacuum system color code, in accm·dance with 5.1.12.1.6 The inspection anrt testing reports shall be submit
Table 5.1.11. of the specific medical gas or vacuum system ten directly to the party that contracted for the testing, who
being monito1·ert shall submit the 1·eport thrnugh channels to the Responsible
(3) Area(s) monit01·ert by the ala1·m panel Facility Auth01·ity and any others that a1·e 1·equired.
5.1.11.4.3 Vihere medical gas systems operate at pressures 5.1. 12.1. 7 Report� shall contain detail en listings of all finrtings
other than the standard gauge pressut·e of 345 kPa to 380 kPa anrt results.
(:"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 5.1.12.1.8 The Responsible Facility Authority shall review
alarm panel identification shall include the nonstanrtard oper these inspection anrt testing records prior to the use of all
ating pressut·e in artrtition to the name of the ga�. systems to ensure that all findings and 1·esults of the inspection
and testing have been successfully completed.
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 5.1.12.1.9 All documentation pertaining to inspections and
area in which the WAGD system is used shall be labelert to indi testing shall be maintained on-5ite within the facility.
cate both systems. 5.1.12.1.10 Before piping systems are initially put into use, the
5.1.11.5 Source Equipment. facility authority shall be responsible for ascertaining that the
gas/vacuum deliverert at the outlet/inlet is that shown on the
5.1.11.5.1 Source equipment shall be labelert or taggert to outlet/inlet label and that the prnpe1· connecting fittin� are
irtentify the patient mertical gas, the mertical support gas, or installed for the specific gas/vacuum senice.
the vacuum system and include the following information:
5.1.12.1.11 Acceptance of the ve1·ifier's final report shall be
(l) Name o f the gas o r vacuum system pe1·mitted to satisfy the requirement� in 5.1.12.1.10.
(2) Ga� or vacuum system color code
(3) Rooms, areas, or buildings served 5.1.12.1.12 The removal of component� within a source
(4) Eme1·gency contact information for the department or system for 1·epai1· and reinstallation, 01· the 1·eplacement of
indivirtual 1·esponsible for maintaining the equipment component� like for like, shall be treated a� new work for the
purposes of testing whenever such work involves cutting 01·
5.1.11.5.2 Where vacuum systems are usert to serve \VAGD brazing new piping. or both.
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 5.1.12.1.12.1 ·where no piping is changed. functional testing
systems. shall be performed a� follows:
5.1.12* Performance Criteria and Testing - Category 1 ( l) To ve1·ify the function of the 1·eplaced device
(Gases, Medical-Surgical Vacuum, and WAGD). (2) To ensure no othe1· equipment in the system has been
artve1·sely impactert
5.1.12.1 General.
5.1.12.1.12.2 Vihere no piping is changert, in art<lition to test�
5.1.12.1.1 Inspection and testing shall be pedormert on all of genernl fi.mction required by 5.1.12.1.12.1, testing shall be
new piped mertical gas and vacuum systems, additions, 1·enova pei-formert as follows:
tions, temporary installations, or repaired systems to ensure, by ( l) Pressure gas sources shall be tested for compliance with
a rtocumentert prncess and prncedure, that all applicable provi :"J. l.12.4.14.2 as applicable to the equipment type.
sions of this rtocument have been arthe1·ed to anrt svstem integ (2) Medical air and instrument air sources shall be testert to
rity has been achievert or maintained. 5.1.12.4.14.3.
(3) Vacuum anrt ,VAGD systems shall be tested to
5.1.12.4.14.6.
2021 Edition
(4) Alarm systems shall be teste<l to 5.1.12.4.5.2 and 5.1.12.2.4.1 All p1pmg systems shall be reduce<l to atmos
5.1.12.4.5.3. pheric pressure.
(5) All affected component� shall be teste<l as appropriate to
that specific component (e.g., a replace<l dew point moni 5.1.12.2.4.2 Som·ces of test gas shall be disconnecte<l from all
tor would be tested to 5.1.3.6.3.13). piping systems, except for the one system being tested.
5.1.12-1.13 The rated accurncy of p1·essm·e and vacuum indica 5.1.12.2.4.3 The system un<ler test shall be cha1·ge<l with oil
tors used fo1· testing shall be l percent (foll scale) 01· bette1·. free, dry nitrogen NF to a gauge pressure of 34!"'> kPa (50 psi).
5.1.12.2 Installer-Performed Tests. 5.1.12.2.4.4 After the installation of the in<lividual faceplates
with appropriate a<lapters matching outlet/inlet labels, each
5.1.12.2.1 General. individual outlet/inlet in each installed me<lical gas and
vacuum piping system shall be checked to <letennine that the
5.1.12.2.1.1 TI1e test� required by 5.1.12.2 shall be performed test ga� is being dispensed only from the piping system being
and documented by the installer p1·io1· to the test� liste<l in tested.
5.1.12.4.
5.1.12.2.4.5 The crnss-connection test 1·efe1·ence<l in 5.1.12.2.4
5.1.12.2.1.2 The test gas shall be oil-free, <l ry nitrogen NF. shall be repeate<l for each installed me<lical gas and vacuum
5.1.12.2.1.3 Whe1·e manufactured assemblies are to be in piping system.
stalle<l, the test� required by 5.1.12.2 shall be pel"formed a� f
5.1.12.2.4.6 The proper labeling and i<lentification o system
follows: outlet�/inlets shall be confirmed <luring these test�.
( l) After completion of the distribution piping, but before
the standing pressure test 5.1.12.2.5 Initial Piping Purge Test. The outlet� in each medi
(2) Prior to installation of manufactured assemblies supplied cal gas piping system shall be pu1·ged to remove any particulate
through flexible hose or flexible tubing matter from the <listribution piping.
(3) At all station outleN/inlet� on installe<l manufactured 5.1.12.2.5.1 Using appropriate adapters, each outlet shall be
assemblies supplied through coppe1· tubing purge<l with an intermittent high-volume flow of test ga� until
5.1 .I 2.2.2 Initial Piping Blowdown. Piping in medical gas an<l the purge produces no discoloration in a clean white cloth.
vacuum distribution systems shall be blown clear by means of 5.1.12.2.5.2 The purging 1·equire<l in :U .12.2.5. l shall be star
oil-free, dry nitrogen NF after installation of the <listribution te<l at the closest outlet/inlet to the zone valve and continue to
piping but before installation of station outlet/inlet rough-in the furthest outlet/inlet within the zone.
assemblies and othe1· system component� (e.g., pressure/
vacuum alarm <levices, pressu1·e/vacuum in<licat01·s, pressure 5.1.12.2.6 Standing Pressure Test for Positive Pres.sure Medi
relief valves, manifolds, source equipment). 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
5.1.12.2.3 In.iiial Pressure Test. be subject to a standing p1·essm·e test.
5.1.12.2.3.1 Each section of the piping 111 medical ga� an<l 5_1.12.2.6.1 * Tests shall be conducted al ·ter the final installa
vacuum systems shall be pressure teste<l. tion of station outlet valve bo<lies, faceplates, and all other
5.1.12.2.3.2 Initial pressu1·e test� shall be conducted as follm11S: <listribution system components.
( l) After blowdown of the distribution piping 5.1.12.2.6.2 The source valve shall be closed <lu1·ing this test.
(2) After installation of station outlet/inlet rough-in assem 5.1.12.2.6.3 The piping systems shall be subjected to a 24-hour
blies standing p1·essu1·e test using oil-free, dq; nitrogen NF.
f
(3) P1·io1· to the installation o components of the <listribution
piping system that woul<l be damaged by the test pressure 5.1.12.2.6.4 Test pressures shall be 20 percent above the
(e.g .. pressure/vacuum alarm <le,ices, p1·essm·e/vacuum normal system operating line pressure.
indicat01·s, line p1·essure relief valves)
5.1.12.2.6.5* The leakage ove1· the 24-houi· test shall not
f
5.1.12.2.3.3 The source shutof valve shall remain close<l exceed 0.5 percent of the starting pressure r e.g., 2 kPa (0.3 psi)
during the test� specified in 5.1.12.2.3. starting at 415 kPa (60 psig) l. except that attributed to specific
changes in ambient tempernture.
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 5.1.12.2.6.6 Leaks,f if any, shall be locate<l, repaired (if permit
less than a gauge p1·essure of 1035 kPa (150 psi). ted) or 1·eplaced (i requi1·ed), an<l retested.
5.1.12.2.3.5* The test p1·essure shall be maintained until each 5_1.12.2.6.7 The 24-hour standing p1·essu1·e test of the positive
joint has been examined for leakage by means of a leak detec pressure system shall be witnessed by an ASSE 6020 inspector,
tant that is safe for use with oxygen an<l does not contain an ASSE 6030 ve1·ifier, 01· the authority having jurisdiction or it�
ammonia. designee. A form indicating that this test has been ped·ormed
and witnessed shall be provide<l to the verifier at the start of
5.1.12.2.3.6 Leaks, if any, shall be located, repaired (if permit the test� require<l in 5.1.12.4.
te<l). 1·eplace<l (if requi1·ed). and 1·eteste<l.
f
5.1.12.2.7 Standing Vacuwn Test for Vacuwn Piping. A ter
5.1.12.2.4 Initial Cross-Connection Test. It shall be <lete1· successful completion of the initial p1·essu1·e tests under
mined that no cross-connections exist between the various 5.1.12.2.3, vacuum distribution piping shall be sul?jecte<l to a
medical gas and \acuum piping systems. standing vacuum test.
2021 Edition
5.1.12.2.7.1 Test� shall be conducted after installation of all 5.1.12.4.1.3 Testing shall be conducted by a party technically
component� of the vacuum system. competent and experienced in the field of medical gas and
\acuum pipeline testing and meeting the requi1·ement� of
5.1.12.2.7.2 The piping systems shall be subjected to a 24-hour ASSE 6030, Professional Qualifimtinns Standard fnr NlPdiral Gas
standing vacuum test. Systnns Verijifrs, except as required by 5.1.12.4.1.4.
5.1.12.2.7.3 Test pressure shall be between 300 mm (12 in.) 5.1.12.4.1.4 Testing of the cryogenic fluid central supply
HgV and full vacuum. system shall be conducted by a panv technically competent and
5.1.12.2. 7.4 Dming the test, the source of test vacuum shall be experienced in the field of cryogenic fluid systems and meeting
disconnected from the piping system. the requirement� of ASSE 6035, Pmfe.t�innal Qualifirations Stand
ard fnr Bull!. Afrdiral Gm Systnm Vi!rifirrs. in accordance with the
5.1.12.2.7.5* T he leakage ove1· the 24-hour test shall not mandatory 1·equi1·ements in CGA M-1, Standard for Nledi,:al (',as
exceed 0.5 percent of the starting pressure f e.g., 0.3 mm Suppl,• Systmis at Hmlth Cam Farilities.
(0.125 in.) HgV sta1·ting at 635 mm (25 in.) HgVl except that
attributed to specific changes in ambient tempernture. 5.1.12.4.1.5 Testing shall he performed by a pa1·ty other than
the installing contractol'.
5.1.12.2. 7.6 1l1e 24-hour standing pressure test of the vacuum
system shall be witnessed by the authority havingjurisdiction or 5.1.12.4.1.6 \<\'hen systems have not been installec-J. by in-house
it� designee. A fo1·m indicating that this test has been pe1·sonnel. testing shall be permitted by personnel of that
perfo1·med and witnessed shall be provided to the verifie1· at organization who meet the requi1·ement� of 5.1.12.4.1.3.
the start of the test� required in 5.1.12.4. 5.1.12.4.1.7 All test� required under 5.1.12.4 shall be
f f
5.1.12.2. 7.7 Leaks, i any, shall be located. 1·epai1·ed (i permit pel'fonned after installation of any manufactured assemblies
t
ted) or 1·eplaced (if -equi1·ed), and retested. supplied through tubing or flexible hose.
5.1.12.3 System Inspection. 5.1.12.4.1.8 ,-v11ere there a1·e multiple possible connection
point� fo1· terminals. each possible position shall be tested inde
5.1.12.3.1 General. pendently
5.1.12.3.1.1 System inspections shall be performed prior to 5.1.12.4.1.9 The ga.� of system designation shall be permitted
concealing piping distribution sptems in walls, ceilings, chases, to he used fo1· all test�. regardless of the size of the system,
trenches, undeq;round, or otherwise hidden from view. which include the following:
5.1.12.3.1.2 The test gas shall he nitrogen NF. (1) Standing pressure (sPe 5.1.12.4.2)
(2) Cross-connection (see5.1.12.4.3)
5.1.12.3.1.3 Inspections shall be conducted by a party techni (3) Ala rms (sed.1.12.4.5)
cally competent and experienced in the field of medical ga� (4) Piping purge (�Pe 5.1.12.4.6j
and vacuum pipeline inspections and testing and meeting the (5) Piping particulates (se,, 5.1.12.4. 7)
1·equirement� of ASSE 6020, Prnfessinnal Qualifiratinns Standard
fnr MPdiral Gm Systnm Inspertars, or ASSE 6030, PmJe.��itinal Qual 5.1.12.4.2* Standing Pressure Test. Piping systems shall he
ifiratinns Standard far Mtdiral Gas Systnm ¼rifiPrs. subjected to a !().minute standing pressure test at operating
line pressure using the following procedm-e:
5.1.12.3.1.4 Inspections shall be performed by a party other
than the installing contract01·. (l ) ,\fter the system is filled \\�th nitrogen or sou1·ce ga.�. the
source v-alve and all zone Vdlves shall be closed.
5.1.12.3.1.5 ,<\l1ere systems have not been installed by in (2) The piping system shall show no decrease in pressure
house personnel, inspections shall be pe1·mitted by pe1·sonnel afi:e1· 10 minutes.
of the organization who meet the 1·equirements of 5.1.12.3.1.3. (3) Any leaks found shall be located, repaired, and 1·etested
5.1.12.3.2 Inspections. per 5.1.12.2.6.
5.1.12.3.2.1 The initial p1·essure test� pel'formed by the instal 5.1.12.4.3 Cross-Connection Test. After the closing of walls
ling contrnctor shall be \\�tnessed by an ASSE 6020 inspect01·, and completion of the 1·equirement� of 5.1.12.2, it shall be
an ASSE 6030 verifier, or the authority having jurisdiction or it� determined that no cross-<:onnection of piping systems exists by
designee. A form indicating that this test has been pedormed either of the methods detailed in 5.1.12.4.3. l or 5.1.12.4.3.2.
and witnessed shall he provided to the ve1·ifier at the start of 5.1.12.4.3.1 Individual Pressurization Method.
the tests required in 5.1.12.4.
(A) All medical gas and vacuum piping systems shall be
5.1.12.3.2.2 1l1e presence and cotTectness of labeling and 1·educed to atmospheric pressm·e.
valve tagging required by this code fo1· all concealed compo
nents and piping distribution systems shall be inspected. (B) All sources of test ga.� from all of the medical ga.� and
vacuum systems, with the exception of the one system to be
5.1.12.4 System Verification. checked, shall be disconnected.
5.1.12.4.1 General. (C) The system being checked shall he pressurized to a gauge
5.1.12.4.1.1 Verification tests shall be performed only after all pressure of 345 kPa (50 psi).
test� required in 5.1.12.2, Installe1·-Pedormed Test�. have been (D) With adapte1·s matching outlet labels, each individual
completed. station outlet/inlet of all medical ga.� and vacuum systems
5.1.12.4.1.2 1l1e test ga.� shall be oil-free, d1·y nitrogen NF or installed shall be checked to determine that test gas is being
the system gas whe1·e permitted.
2021 Edition
dispense<l only from the outlet�/inlet� of the piping system 5.1.12.4.4.1 Records shall be made listing the rooms 01· a1·eas
being tested. controlled by each valve for each gas.
(E) The source of test gas shall be disconnecte<l, an<l the 5.1.12.4.4.2 The information shall be utilize<l to a�sist and
system tested re<luce<l to atmosphet-ic pressu1·e. verify the proper labeling of the valves.
(F) Proceed to test each additional piping system until all 5.1.12.4.5 Alarm Test.
medical ga� and vacuum piping systems a1·e free of cross
connections. 5.1.12.4.5.1 General.
5.1.12.4-3.2 Pressure Differential Method. (A) All warning systems for each medical gas and vacuum
system(s) shall be tested to ensut·e that all components func
(A) The pr·essure in all medical ga� systems shall be reduced to tion properly prim· to placing the system in service.
atmospheric.
(B) Permanent records of these test� shall be maintained.
(B) The test gas pt·essure in all medical gas piping systems
shall he inct'ease<l to the values indicate<l in Table (C) Warning systems that are part of an addition to an existing
5. l.12.4.3.2(B), simultaneously maintaining these nominal piping system shall be tested prim· to the connection of the new
pressu1·es throughout the test. piping to the existing system.
(C) Systems with nonstandat·d opernting pt·essut·es shall be (D) Tests of warning systems fo1· new installations (initial test�)
teste<l at a gauge pressure of at least 70 kPa ( 10 psi) higher or shall be performed a1·ter the cross-connection testing (.�ff
lowe1· than any other system being teste<l. 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
(D) Any vacuum systems shall be in operation so that these through 5.1.12.4.14.)
vacuum systems are tested at the same time the medical ga�
systems are teste<l. (E) Initial tests of warning systems that can he include<l in an
ad<lition or extension to an existing piping system shall be
(E) Following the a<ljustment of pt·essures in acc01·dance with completed before connection of the addition to the existing
5. l.12.4.3.2(B) and 5. l.12.4.3.2(C), each station outlet for each system.
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 (F) Test gases for the initial test� s hall be oil-free, <l1·y nitrogen
co1Tect test pt·essm·e/vacuum is pt·esent at each outlet/inlet of NF, the gas of system <lesignation, or opernting vacuum.
each system as liste<l in Table 5.l.12.4.3.2(B). (G ) w·here computer systems are used a� substitutes for a
(F) Each test gauge used in pedo1·ming this test shall be cali 1·equired alann panel as pern1itte<l under 5.1.9.2.2, the
brated v.�th the p1·essure in<licator use<l for the line pressure computer system shall be included in the alarm test� as modi
regulator use<l to provi<le the source pressure. 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
5.1.12.4.6.2 After the purge is started. it shall be rapidly inter 5.1.12.4.9.4 Fm· pressure gases. imme<liately after the final
rupted several times until the purge produces no discoloration brazen connection is mane an<l leak-tested, an outlet in the
in a white cloth loosely hel<l over the adapter during the purge. 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
5.1.12.4.6.3 In 01·de1· to avoid possible damage to the outlet purged in accordance with the applicable requirements of
and its component�, this test shall not be con<lucte<l using any 5.1.12.4.6.
implement other than the proper adapter.
5.1.12.4.9.5 Befo1·e the new work is used for patient ca1·e, posi
5.1.12.4.6.4* No pronounce<l or objectionable ocl01· shall be tive pressure gases shall be teste<l for operational pressure and
<liscernible from any positive pressure outlet. gas concentration in accor<lance with :i.1.12.4.10 and
5.1.12.4. 7 Piping Particulate Test. For each positive pressut·e 5.1.12.4.11.
gas system, the cleanliness of the piping system shall be ve1·i 5.1.12.4.9.6 Permanent records of these tests shall be main
fie<l. tained in accordance with 5.1.14.7.
5.1.12.4.7.1 A minimum of 1000 L (35 ft3) of gas shall be 5.1.12.4.10 Operational Flow Pressure Drop Test. Opera
filtered through a clean, white 0.4:> micron filter at a minimum tional flow pressure drop tests shall be petformed at each
flow rnte of 100 NI/min (3.5 SCFM). station outlet/inlet or terminal where the user makes connec
5.1.12.4.7.2 Twenty-five pe1·cent of the zones shall be tested at tions and disconnections.
the outlet most remote from the source. 5.1.12.4.10.l Tests shall be performed with the gas of system
5.1.12.4. 7.3 The filter shall accrue no mo1·e than 0.001 g designation or the operating vacuum.
( l mg) of matter from any outlet tested. 5.1.12.4.10.2 All gas outlets with a gauge pressure of 34:i kPa
5.1.12.4. 7.4 If any outlet fails this test, the most remote outlet (50 psi), including, but not limited to, oxygen, nitrous oxide,
in every zone shall be teste<l. 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
5.1.12.4. 7.5 The test shall be perform eel with the use of oil ( :> psi) and static pt·essure of 345 kPa to 380 kPa ( 50 psi to
free, dry nitrogen NF. :i5 psi).
5.1.12.4.8* Verifier Piping Purity Test. For each medical gas 5.1.12.4.10.3 Medical support gas outlets shall delive1· 140
f
system, the purity of the piping system shall be verified in SLPM ( 5.0 SCFM) with a pressure drop o not mm·e than
accordance with 5.1.12.4.8. 35 kPa (:i psi) gauge and static pressure of 1100 kPa to
1275 kPa (160 psi to 185 psi) gauge.
5.1.12.4.8.1 TI1ese test� shall be ped,xme<l with oil-free, d ry
nitrogen NF or the system gas. 5.1.12.4.10.4 Medical-surgical vacuum inlets shall draw
85 NI/min (3 SCFM) without reducing the vacuum pressure
5.1.12.4.8.2 The outlet most remote from the sou1·ce shall be
below 300 mm (12 in.) gauge HgVat any adjacent station inlet.
teste<l fot· total nonmethane hydrocarbons an<l halogenated
hydrocarbons and compared to the source gas. 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
5.1.12.4.8.3 If the s�tem gas is use<l a� the source ga�, it shall
(6 SCFM) for 3 seconds.
be tested at the source equipment.
5.1.12.4.10.6* \\'he1·e outlets are being fed with non-standat·d
5.1.12.4.8.4 The difference between the two tests shall in no
line pressure, volume, or gas content, for clinical reasons, they
case excee<l :> ppm of total non-methane hydrocarbons.
shall be labeled in accordance with 5.1.11.
5.1.12.4.8.5 TI1e diffe1·ence between the twu tests shall m no
5.1.12.4.11 Medical Gas Concentration Test. .'\..li:er purging
case exceed :> ppm halogenated hy<lrocarbons.
each system with the gas of system designation, the following
5.1.12.4.8.6 TI1e moisture concentration of the outlet test shall be pnformed:
shall not exceed 500 ppm or an equivalent pt·essttl'e clew point (1) Each presstu-e gas source and outlet shall be analyzed fot·
of-12"C (10 ° F) at a gauge pt·essure of 345 kPa ( 50 psi). concentration of gas, by volume.
5.1.12.4.9 Final Tie-In Test. (2) Analysis shall be conducted with instrument� designed to
measttl'e the specific gas dispensed.
5.1.12.4.9.1 P1·i01· to the connection of any wo1·k or any exten (3)* Allowable concentrations shall be as indicated in Table
sion or a<ldition to an existing piping system, the test� in 5.1.12.4.11.
5.1.12.4.l through :>.1.12.4.8 shall be successfully performed on
the new work. 5.1.12.4.12 Medical Air Purity Test for Compressor Sources.
5.1.12.4.9.2 Each joint in the final connection between the 5.1.12.4.12.l The medical air source shall be analyzed for
new work and the existing system shall be leak-teste<l with the concentt·ation of contaminant� by volume prior to the source
gas of s�tem designation at the normal operating pressure by valve being opened.
means of a leak detectant that is safe for use with oxygen and 5.1.12.4-12.2 A sample(s) shall be taken for the air system test
noes not contain ammonia. at the system sample port.
5.1.12.4.9.3 Vacuum joint� shall be tested using an ultrasonic 5.1.12.4.12.3 The test result� shall not exceed the paramete1·s
leak detect01· or other means that will allow detection of leaks in Table 5.1.12.4.12.3.
in an active vacuum s�tem.
2021 Edition
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
(7) The accurncy of the central system oxygen monitor shall 5.1.13.3-2.2 Design and construction of locations for ct)'O
be calibrated in acconfance ,vith the manufacturer's spec genic fluid central supply systems shall meet the requirement�
ifications. of 5.1.3.10.
(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 5.1.13.3_3 Ventilation. Ventilation for medical suppon gas
been opened to atmosphere (e.g., during service or central supply systems shall meet the requirements of 5.1.3.:l.3.
replacement). 5.1.13_3.4 Storage- Storage fot· merlical support gas central
5.1.12.4.14.5 Proportioning Sr.,tems for Medical Air USP. supply systems shall meet the 1·equi1-ements of 5.1.3.3.4.
(A) The system apparatus shall be testerl for proper fimction, 5.1.13.3.5 Control Equipment. Control equipment for medi
inclurling the changeover from primary to secondaty (if appli cal suppon gas central supply systems shall meet the 1·equire
cable) and operation of the resetve, before the system is put ment� of 5.1.3.4.
into setvice. 5.1.13.3.6 Nitrogen NF Central Supply Systems. Nitrogen NF
(B) Test5 shall include the purity of the ai1· quality and test of centrnl supply systems shall be permitted to consist of the
the alarm sensors after calibration and setup per the manufac following:
turer's instructions. ( l) Manifolrls for gas cylinrlers in accorrlance with 5.1.3.5.11
(2) Manifolds fot- cryogenic liquid containers in accot·dance
(C) Tests shall be conrlucterl at the sample port of the propor with 5.1.3.5.12
tioning system. (3) Cryogenic fluirl central supply systems in accorrlance with
(D) The operntion of the control sensoi·s anrl all quality moni 5.1.3.10
toring sensors and controls shall be checked for proper opern 5.1.13.3.6_1 General.
tion anrl function before the system is put into service.
(A) Nitrogen NF central supply systems shall be obtained from
5.1.12.4.14.6 Medical-Surgical Vacuum Systems. The proper a supplie1· or manufacturer familia1· with their proper construc
functioning of the merlical-sm·gical vacuum source system(s) tion anrl use.
shall be tested before it is put into service.
(B) Nitrogen NF central supply systems shall be installed in
5.1.13 Category 1 Medical Support Gases. accordance with the manufacture1··s instructions.
5.1.13. 1 * Applicability. 5.1.13.3.6.2 Medical Support Gases. Nitrogen NF central
5.1.13.1.1 Merlical suppo1·t gases consist of nitrogen NF or supply systems for medical support ga�es shall not be piperl to,
instrument air and are userl prima1·ily for powering equipment or used for, any purpose except medical support application.
used in patient ca1·e procedm-es. Medical support gas applica 5.1.13.3.6_3 Materials. Materials userl in nitrogen NF central
tions require rlelivery at pressures, cleanliness, or purities supply systems shall meet the requirement� of 5.1.3.5.4.
specific to their intended function (s) (e.g., to operate merlical
sm·gical tools). Medical support gases shall be permitted to be 5.1.13.3.6.4 Controls for Line Pressure. Controls for line
piped into areas intenrlerl for any merlical support purpose pressure userl for nitrogen central supply systems shall meet
and, if appropriate to the procedures, to be piped into labm·a the criteria in 5.1.:1.5.5.
to1·ies.
5.1.13.3.6.5 Relief Valves. Relief Valves used for nitrogen
5.1.13.1.2* Medical support ga5 sources shall be permitted to central supply systems shall meet the criteria in 5.1.3.5.6.
be used for many general utility uses.
5.1.13.3.6.6 Multiple Pressures. Whe1-e a single nitrogen
5.1.13.1.3 Merlical suppon gas systems shall not convey oxirliz cenu·al supply system supplies separate piped distt·ibution
ing gases other than air or gases intended for patient or staff networks, operating at different pressures, each piperl distribu
1·espiration. tion netw-ork shall meet the criteria in 5. Ul.5.7.
5.1.13.2 Nature of Hazards. Design, installation, and opern 5.1.13_3,6. 7 Local Signals-
tion of merlical support gas systems shall consider all hazards
involved with any pressurizerl gas except those associaterl ,vith (A) The following nitrogen NF central supply systems shall
oxidizing gases and haza1·rls associaterl with the elevated pt·es have local signals locaterl at the sout·ce equipment:
f
sut·es typical o these systems. ( l) Manifolds fot· gas cylinrlers ,vithout reserve supply (.�ef
5.1.3.5.11)
5.1.13.3 Medical Support Gas Central Supply Systems_ Manifold� fix cryogenic liquid containers (se;, 5.1.3.5.12)
(2)
5.1.13.3.1 General. Medical support gas centrnl supply (3) Ctyogenic fluid centi-al supply systems (.�ef 5.1.3.10)
systems shall be locaterl to meet the requirements of 5.1.3.3. l (B) Local signals shall meet the requirement� of 5.1.:1.5.8.2.
through 5.1.3.3.1.10.
5.1.13.3.6.8 Headers. In nitrogen NF central supply systems
5.1.13.3.2 Desi gn and Construction. using cylinders containing eithet· gas 01· liquirl, each headet·
5.1.13.3.2.1 Locations for medical support gas central supply shall meet the requirement5 of 5.1.3.5.9.
systems , excluding cryogenic fluirl centrnl supply systems, anrl 5.1.13.3.6_9 Nitrogen NF Manifolds for Gas Cylinders. Mani
fo1· the stornge of positi\·e-pressure gases shall meet the 1·equi1·e folds fo1· ga� cylinders shall be in accordance with 5.1.3.3. l and
ments of 5.1.3.3.2. shall meet the requirement� of 5.1.3.5.11.
2021 Edition
5.1.13.3.6.10 Nitrogen NF Manifolds for Cryogenic Liquid system peak calculated demand at design conditions an<l with
Containers. Manifolds for cryogenic liqui<l containers shall be the following element� and characteristics:
in acco1·dance with 5.1.3.3.1 and shall meet the requirement� Activated carbon filte1·s located upst1·eam (source side ) of
(1 )
of5.l.3.5.l. t.he final line filte1·s
5.1.13.3.6.11 Nitrogen NF Cryogenic Fluid Central Supply (2) line filters located upstream (source side ) of the final
Systems. Cryogenic fluid central supply systems shall be in line regulatm·s an<l <lownstream ofthe ca rbon filters rated
accor<lance with 5.1.3.3.1 and shall meet the requirements of fo1· a minimum of 98 pe1·cent efficiency at 0.01 micron
5.1.3.10. (3) Equippe<l with a continuous visual indicatm· showing the
status of the line filter element life
5.1.13.3. 7* Instrnment Air Supply Systems. (4) Constructed of materials deemed suitable by the manu
5.1.13.3.7.1 Quality of Instrument Air. The quality of instru factu1·er
ment air shall be a� follows: (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
( 1) Compliant with ANSI/ISA S-7.0.01, Quality Standard for used
Imtnunmt Air
(2) Filtered to 0.01 micron 5.1.13.3.7.9 Instrument Air Accessories. Accessories use<l for
( 3) Free ofliquids (e.g., water, hydrocarbons, solvents) instrument air sources shall comply with the following subpara
( 4) Free of hydrncadJOn vapors graphs:
(5) Dry to a dew point of-400 C (-40'F) ( 1) For aftercoolers, 5.1.3.6.3.!'>
5.1.13.3. 7.2 Instrument air supply systems shall be locate<l pet· (2) For air receivers, 5.1.3.6.3.6
5.1.3.3 as follows: (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
(1) Indoors, in a <le<licated mechanical equipment a rea that
is adequately ventilated an<l with any required utilities 5.1.13.3.7.10 Instrument Air Piping Arrangement and Redun
(2) In a room ventilated per 5.1.3.3.3.3 dancies. Instrument air sources shall comply with 5.1.3.6.3.9.
( 3) For air-cooled equipment, in a mom designe<l to main except fo1· the follo\,�ng:
tain the ambient temperature range as recommended by (1 ) Systems employing a stan<lby header shall be permitted to
the equipment manufacturer have simplex aftercoolers and d ryers.
5.1.13.3.7.3 Instrument air sources shall prn,ide air with the (2) Systems employing a stan<lby hea<ler shall not 1·equire a
following characteristics: three-valve receiver bypass.
(3) Stan<lby headers. whe1·e prnvi<led, shall be isolated from
( 1) A gauge pressm·e a<lequate for the intended line pressure the compressor by a check valve to prevent backflow
and pressu1·e controls (sl'i' Ta/;!,, 5.1.11) through the comp1·ess01·.
(2) The quality ofinstrument air, as <lescribed in 5.1.13.3.7.1
5.1.13.3.7.11 Instrument Air Monitoring and Alarms.
5.1.13.3.7.4 Instn1ment ai1· sources shall be of eithe1· of the
follm,�ng fo1·mat�: (A) Instrument air sources shall include the following alarms:
( 1) At least two compressors ( 1) A manual-reset local alarm that indicates when the
(2) One compressor an<l a standby hea<ler complying with capacity ofthe instrument ai1· central supply system not in
:>.1.3.5.9 use is less than the equivalent capacity of one compressor
(2) Local alarm and alarms at all master alarm panels that
5.1.13.3. 7.5 Instrument air compressors shall be permitted to activate when the dew point at system pressure exceeds
be of any type capable of the output pressure needed for the -30"C (-22'F), in<licating a high dew point
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. (B) For sources with standby hea<lers, the follm,fog additional
conditions shall activate a local alarm at the compressor site, a
5.1.13.3. 7.6 Instrument Air Standby Headers. \'\'he1·e instru local signal at the header location, and alarms at all ma�ter
ment air systems are prnvi<le<l with a standby headec the alarm panels:
header shall meet the following requirements:
(1) Ala rm that activates when or just before the reserve
( 1) It shall comply with 5.1.3.5.9, except that the number of begins to supply the system, indicating reserve in use
attached cylinders shall be sufficient for 1 hour of normal (2) Ala rm that activates when or just before the reserve falls
operation. below one average hour's supply, indicating reserve is low
(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 5.1.13.3.7.12 Electrical Power and Control.
CylindPr l-alve Outlel and InlPt Connections (ANSI B57.1) . (A) Instrument air source systems with compressors shall be
( 3) It shall enter the system upstream of the final line filters. controlled to ensure continuous supply of air at pressures
( 4) It shall automatically se1·ve the system in the event of a consistent with Table 5.1.11 unde1· all conditions of system use
failu1·e of the compressor. as follows:
5.1.13.3. 7. 7* Intake Air. Intake air for instrument air ( 1) Automatic activation of compressor (s) a� necessary to
comp1·ess01·s shall be pe1·mitted to be drawn from out�ide, from supply the demand.
ducted ai1·, 01· from the equipment location. (2) If provided with mm·e than one comp1·ess01·, managing
5.1.13.3.7.8 Instrument Air Filters. Instrument air sources the operation to equalize wea r on all compressors. Where
f
shall be prnvided with filtt·ation size<l for 100 pe1·cent of the this equalization is achieved manually, the facility staf
shall arrange a sche<lule for manual alternation.
2021 Edition
(B) Contrnls shall provide the following functions: (1) Ahle to maintain stable pressu1·es within the limit� of
\�'here instrument air source systems having two or more Table 5.1.11
(1)
compr·essorn employ any elect1·ical ci1·cuit device that (2) Ahle to flow 100 pe1·cent of the peak calculated demand
f
upon failure could prevent supply o air, the contrnls (3) Redundant, such that each component of the control
shall be provided with an automatically activated alterna mechanism can be isolated for service or replacement
tive method for ensut·ing supply (e.g., redundant compo while maintaining normal operation
nent(s). an alternate electrical supply path, or other (4) Prntected against ove1·pressure (sPP 5.1.3.5.6)
equivalent method). (:>) Be constructed of mate1·ials deemed suitable fot· the se1·v-
(2) Control circuit� shall be arranged in such a manner that ice by the manufacturer
isolation of one comp1·essor 01· component from the 5.1.13.9 Warning Systems.
system (e.g., for maintenance 01· 1·epair) does not inter
rupt the operation of other compressor(s) or compo 5.1.13.9.1 General requirement� for medical support gas
nent(s). warning systems shall be in accordance with 5.1.9.1.
(3) An automatic 1·estart function shall be included, such that 5.1.13.9.2 Master alarm requirements for medical support gas
the supply of air will resume n01·mally after power inter shall be in accordance �th 5.1.9.2.
ruption without manual intervention.
5.1.13.9.3 Area alarm 1·equi1·ement� fot· medical support gas
(C) Each compressor motor shall be prnvided with electrical
shall be in acc01·dance with 5.1.9.4.
component� including, but not limited to, the follov,�ng:
( l) Dedicated disconnect switch installed in the electrical 5.1.13.9.4 Local alarm requirement� for medical support gas
cit-cuit ahead of each motor starte1· shall he in accordance with 5.1.9.5.
(2) Motor starting device 5.1.13.10 Distribution. Requirement� fot· medical support gas
(3) Overload prntection piping distribution shall be in accordance with 5.1.10.1,
(D) Instrument air compressor system contrnls shall be prnvi 5.1.10.3, 5.1.10.4, 5.1.10.4.1 thrnugh 5.1.10.4.6, 5.1.10.10,
ded with electrical systems including at a minimum: 5.1.10.10( 1), 5.1.10.10(2), 5.1.10.10(3), and 5.1.10.11.
( l) Bui lt-in disconnect means to allow appropriate operation 5.1.13.11 Labeling and Identification. Requirement� for
of multiple compressor systems and protect service medical support gas labeling shall be in accordance with
personnel from exposu1·e to live voltages 5.1.11.1 thrnugh 5.1.11.4.
(2) Control circuits shall be arranged so that failure of any 5.1.13.12 Performance Testing. Requirement� for medical
component of the control cit-cuit, or shutdown of one support gas pedormance testing shall be in accordance with
comp1·ess01· (e.g., fot· service), does not interrupt auto 5.1.12, with the following exceptions:
matic operation of the standby compress01·
(3) An automatic restart function such that the compres (1) The piping purity test (see 5.1.12.4.8) shall be permitted
sor(s) will 1·estart afi.e1· powe1· interruption without to be omitted.
manual intervention (2) The medical ga� concentration test (.w 5.1.12. 4.11) shall
(4) Where component� are common to more than one be permitted to be omitted.
control circuit (e.g., autodrains), the common device 5.1.14* Category 1 Operation and Management.
shall be prnvided with electrical prntection to pt·event loss
of the contrnl circuit�(s) in the event of short circuit in 5.1.14.1 Responsible Facility Authority.
the device
5.1.14.1.1 General. Each health care facility shall designate
(E) Electrical installation and wi1·ing shall conform to the one 01· more individuals to be the Responsible Facility Author
1·equirement� of NFPA 70. ity with 1·espect to the facility's medical gas and vacuum systems.
(F) Emergency electrical service for the compressors shall 5. I.14.1.2 Responsibilities.
conform to the 1·equirements of the essential electrical system,
as desc1·ibed in Chapter 6. 5.1.14.1.2.1 The Responsible Facility Authority shall have
primary responsibility for implementation of the piped medical
5.1.13.4 Valves. Requirement� for medical support gas valves gas and vacuum system requirement� of this code for the
shall be in accordance with 5.1.4.1. l thrnugh 5.1.4.8. health care facility, including all medical gas, support gas,
medical vacuum, and WAGD svstems.
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 5.1.14.1.2.2 The Responsible Facility Authoritv shall be
thrnugh 5.15.8, 5.1.5.11, and 5.15.13 thrnugh 5.1.5.15. responsible for the following:
5.1.13.6 Manufactured As.semblies. Requirement� for medical ( l) Advising on Section 1.3 and the risk assessment in accord
support gases in manufactured assemblies shall be in accord ance with Section 4.2, as these apply to piped medical gas
ance with 5.1.6. l thrnugh 5.1.6.11. and vacuum systems, and the interp1·etations of Sections
5.1 through 5.3, as they apply to the facility
5.1.13. 7 Pressure Indicators. Requirement� for medical (2) Writing and upkeep of the portions of the health care
support gas pressure indicators shall he in accordance with facility's eme1·gency plan that might affect or be affected
5.1.8.1.1 thrnugh 5.1.8.1.4, 5.1.8.1.6, and 5.1.8.2. by piped medical gas and vacuum quality, quantity, and
5.1.13.8 Line Pressure Control. Instrument air systems shall continuity of supply
be provided with means to contrnl line pressure at the source (3) Ensuring that the health care facility's emergency plan
with at lea�t the following characteristics: specifically addresses unusual or exceptional 1·equire-
2021 Edition
ment� necessary for patient an<l staff safety arising from (6) This code is obsetved in the execution of maintenance,
element� of design or construction of the building repair, or construction procedures
( 4) Developing and enftxcing pern1it-to-wo1·k n!les penain (7) The affected portions of the systems are correctly tested
ing to the piped medical gas an<l vacuum systems an<l in acc01·dance with 5.1.12 and 5.1.13 an<l <lemonstrated
equipment to maintain patient, staff, an<l visitor safety to be acceptable for patient use
during repair, modification, or construction of those
systems 5.1.14.3 Special Precautions - Patient Gas, Vacuum, WAGD,
Evaluation an<l acceptance of the test 1·eports 1·equi1·ect in and Medical Support Gas Systems.
(5)
accordance with 5.1.12 5.1.14.3.1 * Piping systems shall not be used for the distribu
(6) Maintenance of the facility's 1·ecords on pipe<l medical tion of flammable anesthetic gases.
ga� and vacuum system installations an<l operations
5.1.14.3.2 Piping systems shall not be use<l as a grounding
5.1.14.1.3 Qualifications. electro<le.
5.1.14.1.3.1 The person(s) designated as the Responsible 5.1.14.3.3* Liquid or deb1·is shall not be introduced into the
Facility Authority shall he qualifie<l to interpret, implement medical-surgical vacuum or WAGD systems for disposal.
and advise on this Co<le.
5.1.14.3.4* The medical-surgical vacuum and WAGD systems
5.1.14_1.3.2 Appropriate qualification shall be demonsu·ate<l shall not be use<l for nonmedical applications (e.g., vacuum
by any of the following: steam condensate return).
( l) Completion of an educational program acceptable to the 5.1.14.3.5* When clinical spaces are converted to nonclinical
health care facility's governing body and substantially spaces, me<lical gas inlet� an<l outlets that are not accessible for
equivalent 01· superior to either 5.1.1 4.1.3.2(2) 01· maintenance an<l testing shall be eithe1· 1-emoved 01· decommis
5.1.14.1.3.2(3) sioned.
(2) Credentialing to the 1-equi1·ement� of ASSE 6010, Props
sional Qualifirations Standard for Ivfrdiral Gm Systnns Instal 5.1.14.4 Maintenance of Medical Gas, Vacuum, WAGD, and
lers, and technical competence on the specific equipment Medical Support Gas S)Stems.
an<l design of that facility
Credentialing to the 1·equi1·ement� of ASSE 6020, Profes 5.1.14.4.1 * General. Health ca re facilities with installed medi
(3)
sional Qualifirations Standard for Medi,:al Gas Systnn.� Inspff cal ga�, vacuum, \\'AGD, 01· me<lical support gas systems, or
tors, and technical competence on the specific equipment combinations thereof, shall <levelop and document periodic
and <lesign of that facility maintenance programs for these systems an<l their subcompo
Credentialing to the 1-equi1·ement� of ASSE 6030, Props nent� as appropriate to the equipment installe<l.
( 4)
sional Qiialifirations Standard for Mediral (',as Systnm Verifi 5.1.14.4.2 Maintenance Programs.
ers, and technical competence on the specific equipment
an<l design of that facility 5.1.14.4.2.1 Inventories. lnvento1·ies of me<lical gas, vacuum,
(5) Credentialing to the 1·equi1·ement� of ASSE 6040, Profes WAGD, and medical support ga� systems shall inclu<le at least
sional Qualifications Standmd for I\ledi,:al (',as Maintenana all source subsystems, control \-alves, alarms, manufactut·ed
Per.wmwl, and technical competence on the specific a�semblies containing patient gases, and outlets.
equipment an<l design of that facility 5.1.14.4.2.2* Inspection Schedules. Schedule<l inspections for
5.1.14.2 Permit-to-Work System. equipment and proce<lm·es shall be establishe<l through the
risk assessment of the facility and develope<l with consideration
5.1.14.2.1* The Responsible Facility Authority of the health of the original equipment manufactut·e1· recommendations and
care facility shall develop, maintain, and manage a permit-to othe1· 1·ecommendations a� required by the auth01·ity having
work system ensuring uninterrupted quality, quantity, and jurisdiction.
continuity of supply during all piped medical gas an<l vacuum
system maintenance, 1·epair, or const1uction wo1-k. 5.1.14.4.2.3 Inspection Procedures. The facility shall he
permitted to use any inspection proce<lure(s) 01· testing meth
5.1.14.2.2 The Responsible Facility Authority's plan shall ods establishe<l through its own risk assessment.
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 for equipment and procedures shall be established thrnugh the
approp1-iately in communication prior to any work on risk assessment of the facility an<l developed with consi<leration
piped medical g"dS and vacuum systems of the original equipment manufacturer recommen<lations and
(2) Alternative supply 01· a<ljustment� in patient care arrange othe1· 1·ecommendations a� requi1·ed by the autho1-ity having
ment� are in place prior to system inte1n1ption, including jtffis<liction.
monitoring, a� appropriate, of the work being performed
and the alternate arrangements in use 5.1.14.4.2.5 Qualifications.
(3) All work on piped me<lical gas and vacuum systems is
perftxmed by competent in<lividuals holding appropriate (A) Persons maintaining these systems shall be qualifie<l to
qualifications for the work perform these operations.
( 4)* Procedut·es for shutdown and restoration of medical (B) Apprnpriate qualification shall he demonstrated by any of
gases a1-e <lescrihed, communicate<l, and ohserve<l by all the following:
persons w01·king on 01· with the systems
(1) A documented training program acceptable to the health
(5) Safety procedures are in place and are observe<l for all
pe1·sons involve<l in working on the systems care facility by which such persons are employed or
2021 Edition
contracted to work with specific equipment as installed in 5.1.14.7.3 A.n annual 1·eview of cryogenic fluirl central supply
that facility sy�tem capacity shall be conducterl to ensure the source system
(2) Credentialing to the requirement� of ASSE 6040, Profes has sufficient capacity.
sional Qualifir:atiom Standard for Afrdiral Gas Afaintmanr.e
Personnel, and technically competent on the specific 5.1.14.7.4 Central supply systems fot· nonflammable medical
equipment as installed in that facility. gases shall conform to the following:
(3) C1·edentialing to the requirement� of ASSE 6030, Profes ( 1) They shall be inspected annually.
sional Qualifications Standard for I'viediral Gas Systnn� Verifi (2) Thev shall be maintainerl by a qualified 1·ep1·esentative of
ers, and technically competent on the specific equipment the equipment owner.
as installed in that facility. (3) A reco1·d of the annual inspection shall be available fo1·
1·eview by the auth01·ity having jurisdiction.
5.1.14.4.3* Inspection and Testing Operations.
5.1.14.7.5 A periodic testing procerlure for nonflammable
5.1.14.4.3.1 Manufactured �ernblies Employing Flexible medical gas anrl vacuum anrl relaterl alarm systems shall be
Connection(s) Between the User Terminal and the Piping implemented.
System.
5.1.14.7.6 Whenever modifications are marle that breach the
(A) Nonstationar y booms and articulating assemblies, other pipeline, any necessar y installe1· and ve1·ificatio11 test specified
than head walls utilizing flexible connectors, shall be tested for in 5.1.12 shall be conducted on the downsu·eam ponions of the
leaks, per manufactu1·er's recommendations, every 18 months merlical gas piping system.
or at a duration as determined by a risk assessment.
5.1.14.7.7 Procedut·es, as specifierl, shall be established for the
(B) The system pt·essure to nonstationary booms anrl articulat following:
ing a1·ms shall be maintained at operating pressure until each
joint has been examinerl for leakage by effective means of leak (1) Maintenance program for the merlical air compressor
rletection that is safe fot· use with oxygen. supply system in accorrlance with the manufacturer·s
1·ecommendations
(C) Safe wmking condition of the flexible assemblies shall be (2) Facility testing and calibration procedm·e that ensures
confirmerl. carbon monoxide monitors are calibrated at lea�t annu
(D) D.I.S.S. connectors internal to the boom anrl assemblies ally 01· mclt'e often if 1·ecomme11rled by the manufacturer
shall be checkerl fot· leakage. (3) Maintenance prog1·am for both the medical-sm·gical
vacuum piping system anrl the seconrlaty equipment
f
(E) Leaks, if any, shall be repairerl (i pe1·mitterl), or the attached to merlical-surgical vacuum station inlet� to
component� replaced (if requi1·ed), and the equipment retes ensure the continued good performance of the entire
ted prior to placing Lhe equipment back into service. merlical-surgical vacuum system
(4) Maintenance program for the WAGD system to ensure
(F) Additional testing of nonstationa1-y booms or articulating perfo1·mance
arms shall be pedormed at inte1·vals rlefined by documented Facility testing and calibration procedut·e that ensures
(5)
perfo1·mance data. that oxygen concentration monitors are calibrated at least
f
5.1.14.5 Medical Gas and Vacuum Systems Information and every three months, or more often i recommenrlerl by
Warning Signs. the manufacturer
(6) Where oxygen sout·ces include concentrat01· units, main
5.1.14.5.1 1l1e gas content of medical gas and vacuum piping tenance programs for the oxygen concentrator units and
systems shall be labelerl in accordance with 5.1.11.1. all essential subcomponent�
5.1.14.5.2 Labels for shutoff valves shall be in acc01·rlance with 5.1.14.7.8 Audible and visual ala1·m indicators shall meet the
5.1.11.2 and updated when morlifications are made changing following requirement�:
the areas served.
( 1) They shall be pet-iodically testerl to dete1·mine that they
5.1.14.5.3 Station inlets and outlets shall be irlentified in a1·e functioning propedy.
accordance with 5.1.11.3. (2) Recorrls of the test shall be maintained until the next test
is performed.
5.1.14.5.4 Alarm panel labeling shall be in accordance with
5.1.11.4 and updaterl when modifications are made changing 5.1.14.7.9 Medical-surgical Yacuum station inlet terminal
the areas served. performance, as required in 5.1.12.4.10.4, shall be testerl as
follows:
5.1.14.6 Source equipment labeling shall be in accordance
with 5.1.11.5. ( 1) On a regular preventive maintenance schedule as dete1·
f
minerl by the facility maintenance staf
5.1.14. 7 Medical Gas and Vacuum Systems :Maintenance and (2) Based on flow of free air (NI/min or SCFM) into a station
Record Keeping. inlet while simultaneously checking the vacuum level
5.1.14.7.1 Permanent recorrls of all test� 1·equired by 5.1.12.4. l 5.1.14.7.10 Where oxygen central supply systems using
through 5.1.12.4.14 shall be maintainerl in the organization's concentrators are userl and one or more of the three sources is
files. a cylinde1· header, the facility shall establish procerlut·es to
5.1.14. 7.2 The supplier of the ctyogenic fluid central supply enstu-e the facility is always provirlerl with one average day's
system shall, upon request, prmide rlocumentation of vapor supply of oxygen meeting the supply system product purity
izer( s) sizing Cl'itet-ia to the facility. specification in reserve, as follows:
2021 Edition
( 1) The facility shall establish a minimum cylinde1· pressure 5.2.3 Sources.

that will permit one average rlay's supply. That value will
5.2.3.1 Central Supply System Identification and Labeling.
be included as part of the standa1·d operating prncedure
for the oxygen supply system. Category 2 systems shall comply with 5.1.3.1.
(2) The cylinders shall be inspected daily and any loss of pres 5.2.3.2 Central Supply Operations. Catego1y 2 systems shall
sure noted. comply with 5.1.3.2.
(3) Vihen the cylinrle1·s are found to have lost pressure due to
use 01· leakage and thus are below the pre-establisherl 5.2.3.3 Central Supply System Locations. Categ01y 2 systems
pressure, the cylinders shall be exchanged. shall comply with 5.1.3.3.
5.1.14. 7.11 * Access to valves and alarms shall be made part of 5.2.3.4 Central Supply Systems. Category 2 systems shall
the standa1·d operating prncedu1·es for the facility anrl shall comply with f',.1.3.5.
inclurle the following: 5.2.3.5 Medical Air Supply Systems. Categ01y 2 systems shall
(1) No items are to be placed in front of 01· a!Rxed to any comply with 5.1.3.6, except as follows:
alarm panel that woulrl restrict the view or diminish the (1) Medical air compressors, rl1yers, aftercoolers. filters. and
sounrl of the ala rm. regulators shall be permitted to be simplex.
(2) Valves in secured a1·eas a1·e to be specified as follows: (2)
f
The facility staf shall develop thei1· emergency plan to
(a)* The valve is visible from the intenrlerl operato1·'s rleal with the loss of medical ai1·.
position.
(b) The valve is operable with no more than ordinary 5.2.3.6 Oxygen supply systems using concentrators shall be
airls, such as a larlrle1·. permitted to consist of two sources, one of which shall be a
(c) If the valve is provided with security hardwa1·e, such cylinder header with sufficient cylinrler connections for one
hardware is visible and readily removeable when average rlay's supply.
needed. 5.2.3.7 Medical-Surgical Vacuum. Categoty 2 systems shall
5.2 Category 2 Piped Gas and Vacuum Systems. comply with 5.1.3.7, except as follows:
(1) Merlical-surgical vacuum systems shall be permitted to be
5.2.1 * Applicability. simplex.
5.2.1.1 These requirement� shall apply to health care facilities (2) The facility staff shall rlevelop their emergency plan to
that qualify for Category 2 systems as referenced in Chapter 4. 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
( 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. 5.3.3.5.9 Local Signals. Category 3 systems shall comply with
Categot)' 3 systems shall comply with 5.1.3.1. 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
(1 ) Gas cylinder or ct"yogenic liquid containe1· headers shall (3) Emergency electrical se1·vice shall conform to the requi1·e-
be in accordance with 5.1.3.5.9, with sufficient cylinder ment� of Section G.6 and NfPA 70.
connections to pt·o,ide fot· at least one average day's
supply, and with the apprnp1·iate numher of connections 5.3.3.9 lnslrument Air Compres.sor Systems. Catego1y 3
determined only after consideration of the delivery systems shall comply ,..nth 5.1.3.5 and 5.1.13.3.7. except as
schedule, the proximity of the facility to alternate follows:
supplies, and the facility's emergency plan. (1) Instrument ai1· compressor systems shall be permitted to
(2) The header(s ) shall have a local signal that visibly inrli be simplex with no standby header.
cates the operating status of the equipment and complies (2) 1l1e facility staff shall develop an emergency plan to deal
with 5.1.3.5.8. with the loss of instrument ai1·.
f
(3)* The facility staf shall rlevelop an eme1·gency plan to deal (3) Emergency electrical sen,ice shall confo1·m to the requi1·e-
,..nth the loss of the hearlers' medical gas. ments of Section 6.6 and NI·PA 70.
5.3.3.5.11 Oxygen Cenlral Supply Systems Using Concenlra 5.3.4 Valves. Categoq' 3 systems shall comply \..ith 5.1.4.
tors. Category 3 systems shall comply with 5.1.3.5, 5.1.3.9.1,
and 5.1.3.9, except as follows: 5.3.5 Station Outlets and Inlets. Categm·y 3 systems shall
com ply with :>.1.5.
(1 ) Oxygen supply systems using concenu·atm·s shall be
permitted to consist of one sou1·ce. 5.3_6 Manufactured As.semblies. Categmy 3 systems shall
f
(2) The facility staf shall rlevelop an eme1·gency plan to deal comply with 5.1.6.
,..nth the loss of oxygen . 5.3.7 Surface-Mounted Medical Gas Rails. Categot)' 3 systems
(3) Emergency electt·ical sen'ice shall conform to the require- shall comply with 5.1.7.
ments of Section 6.6 and NfPA 70.
5.3.8 Pressure and Vacuum Indicators. Category 3 systems
5.3.3.5.12 Manifolds for Gas Cylinders. Category 3 systems shall comply with f>.1.8.
shall comply with 5.1.3.5 and 5.1.3.5. l()_
5.3.9 Warning Systems. Warning systems associated \\�th Cate
5.3.3.5.13 Manifolds for Cryogenic Liquid Containers. Cate gory 3 systems shall provide the master, area, and local alarm
gory 3 systems shall comply with 5.1.3.5 and 5.1.3.5.11. functions of a Catego1y 1 system as required in 5.1.9, except as
5.3.3.5.14 Cryogenic Fluid Central S upply Systems. Category follows:
3 systems shall comply with 5.1.3.5 and 5.1.3.5.12. (1) \-\'arning systems shall be permitted to be a single ala1·m
5.3.3.6 Medical Air. panel (i.e., a comhination master/area alarm panel ).
(2) 1l1e ala1·m panel shall be locaterl in an area of continuous
5.3.3.6.1 Medical Air Compres.sor Systems. Category 3 surveillance while the facility is in operntion.
systems shall comply with 5.1.3.5 and 5.1.3.6, except as follows: (3) Pressure anrl vacuum switches/sensors shall be mounted
Medical air compressors, drye1·s, aftercoolers, filte1·s, anrl at the smu-ce equipment with a pressut·e indicato1· at the
(1)
1·egulators shall be permitterl to be simplex . master ala1·m panel.
(2) The facility staff shall develop an emergency plan to rleal (4) Electrical power for warning systems shall be in accm-d
with the loss of medical air. ance \\�th Section 6.6 for Category 3 and Category· 4
Emergency electt-ical service shall confo1·m to the require- spaces .
(3)
ment� of Section 6.6 and NfPA 70. 5.3.10 Dislribution. Category 3 systems shall comply with
5.3.3.6.2 Proportioning Air Systems. Category 3 systems shall 5.1.10.
comply ,..nth 5.1.3.5, 5.1.3.6, and 5.1.3.6.3.14. 5.3.11 Labeling and Identification. Categmy 3 systems shall
5.3.3.7 Medical-Surgical Vacuum Systems. Category 3 systems com ply with 5.1.11.
shall comply v.�th 5.1.3.5 and 5.1.:\. i, except as follows: 5.3.12 Performance Criteria and Testing - Gas, Medical
(1 ) Medical-surgical vacuum systems shall be permitted to be Surgical Vacuum, and WAGD. Categmy 3 systems shall comply
simplex. ,..nth 5.1.12.
f
(2) The facility staf shall develop an emergency plan to rleal 5.3.13 Medical Support Gases. Category 3 systems shall
,,� th the loss of merlical-surgical vacuum . comply with 5.1.13, except a� follows:
( 3) Emergency electt·ical service shall confo1·m to the require-
ment� of Section 6.6 and NfPA. 70. (1) Instrument air compressor systems shall be permitted to
be simplex with no standby header.
5.3.3.8 Waste Anesthetic Gas Disposal Systems (WAGDs). (2) 1l1e facility staff shall develop an emergency plan to deal
Categmy 3 systems shall comply \vi th 5.1.3.5 and 5.1.3.8, except with the loss of instrument ai1·.
as follows:
5.3.14 Operation and Management. Category zl systems shall
(1) Medical WAGD pumps shall be permitted to be simplex . com ply with 5.1.14.
(2) The facility staff shall rlevelop an eme1·gency plan to rleal
,..nth the loss ofWAGD.
2021 Edition
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. (A) Receptacles Serving Patient Bed Locations in Category 2
Spaces. Each patient bed location shall be provided with a
6.2.4.1 Essential electt·ical system component5 shall be located minimum of eight non-locking-type, 125-volt, 15- 01· 20-ampere
to minimize interruptions caused by natural forces common to 1·eceptacles. at least fou1· of which shall be connected to eithe1·
the area (e.g., storms, floods, earthquakes, or hazards created the normal branch circuit or a critical branch circuit supplied
by adjoining structures or acti\ities). by a diffe1·ent transfe1· switch othe1· than the receptacles at the
6.2.4.2 Installations of electrical seni.ces shall be located to same location. These receptacles shall be permitted to be of
reduce possible interruption of normal electrical services the single, duplex, or quadruplex type, or any combination
resulting from similar causes as well as possible disruption of thereof. Other receptacles (e.g., portable x-ray receptacles)
no1·mal electrical service due to internal wiring and equipment serving special-pm·pose. cord-and-plug-connected equipment
failmes. 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 (B) Receptacles Serving Patient Bed Locations in Category I
of the feeders of the alternate smu-ce and from the feede1·s of Spaces Otber than Operating Rooms. Each patient bed loca
f
the nm·mal electrical source to prevent possible simultaneous tion shall be pro\ided with a minimum o 14 non-locking-tvpe,
interruption. 125-volt, l:>- or 20-ampere receptacles, at least seven of which
shall be connected to either the normal branch circuit or a crit
6.3 General. ical branch circuit supplied by a different transfer switch othe1·
than the receptacles at the same location. 1l1ese 1·eceptacles
6.3.l Sources. Each health care appliance requiring electrical
shall be permitted to be of the single. duplex. or quadruplex
line power for operation shall be supported by power sources type, 01· any combination the1·eof. Othe1· receptacles (e.g., pon
that provide power adequate for each service. able x-ray receptacles) serving special-put-pose, co1·d-and-plug
6.3.1.1 Power/Utility Company. (Reserved) connecten equipment shall be permitted to be of the locking
or non-locking-type.
6.3.1.2 On-Site Generator Set. (Reserved)
(C) Receptacles in Operating Rooms. Each operating room
6.3.2 Distribution. shall be provided \,i.th a minimum of 36 12:>-volt, 15- or 20-
6.3.2.1* Distribution system arrangement5 shall be designed ampere receptacles, at least 12 of which shall be connected to
to minimize interruptions to the electrical systems clue to inter either the normal branch cit"Cuit or a c1·itical branch circuit
nal failtu-es by the use of adequately rated equipment. 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
ing special-put·pose, conl-and-plug-<"onnected eguipment shall 6.3.2.3.4* Operating rooms shall be conside1·ed to be a wet
be permitted to be of the locking or non-locking-type. procedure location, unless a risk assessment conducted by the
health care governing body determines othenvise.
(D) Receptacles in Bathrooms or Toilet Rooms. Receptacles
shall not be reguired in bathrooms 01· toilet rooms. 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
(E) Receptacles for Special Rooms. Receptacles shall not be that the operating room is not a wet procedun· location, then
reguired in 1·ooms where medical reguirement� mandate othe1· the special protection of 6.3.2.3 shall not be 1·egui1·eti..
wise (e.g., ce1·tain psychiau·ic, pediatt·ic, 01· hydrotherapy
rooms). 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
6.3.2.2.3 Polarity of Receptacles. Each receptacle shall be
dtlt"e, acceptable to the authority having jut·isdiction, is
wired in accm·dance with NFP/1. 70 to ensut·e c01-rect polarity.
performed by a designated inti.i,idual at the hospital to imli
6.3.2.2.4 Other Services Receptacles. Receptacles provided cate that eguipment grounding conductors for 120-V, single
for othe1· senices having diffe1·ent voltages, freguencies, 01· phase. 15-A anti. 20-A receptacles; eguipment connecteti. by
types on the same premises shall be of such design that attach corti. and plug; anti. fixeti. electrical eguipment are installeti. a..L1d
ment plugs and caps used in such receptacles cannot be maintained in accordance with 1\/FPA. 70, the applicable
connected to circuit.� of a different voltage, freguency, 01· type, performance 1·eguirements of this chapte1·, and Chapter 10 of
but shall be interchangeable within each classification and this coti.e.
rating reguired for two-wire, 125-V, single-phase ac service. (A) The procedure shall incluti.e electrical continuity test� of
6.3.2.2.5* Use of Isolated Ground Receptacles. all reguired eguipment, grounding conductoi-s, and their
connections.
(A) A11 isolated grounti. receptacle, if useti., shall not defeat the
purposes of the safety features of the grounding systems (B) Fixeti. receptacles, eguipment connected by cord a..L1d
detaileti. in 6.3.2.8.4. plug, and fixed electt·ical eguipment shall be tested a� follows:
(B) An isolateti. ground receptacle shall not be installed within ( l) iVhen first installed
a patient care vicinitv. (2) Where there is evidence of ti.amage
f
(3) A te1· any 1·epaii-s
(C) Isolated grounding receptacles installeti. in brnnch circuit.�
6.3.2.3.7 The use of an isolated power system (IPS) shall be
for patient ca1·e spaces shall be connecteti. to an insulated
eguipment grounding conductor in accordance with permitteti. a� a protective means capable of limiting grounti.
250.146(D) of NFPA 70 in ati.ti.ition to the two eguipment fault current without powe1· intetTuption. When installerl, such
grounding conti.uctor paths 1·egui1·ed in 6.:).2.5.1.4. 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
(D) The eguipment grounding conti.uctor installeti. for isola
ted grounding receptacles in patient care area� shall be clearly tions shall be protected by either isolated power 01· grounrl
identified using g1·een insulation with one 01· more y ellow fault ci1·cuit interrupters.
stripes along it.� entire length. 6.3.2.3.9 Where GFCI protection is used in an operating
6.3.2.2.6 Special-Purpose Outlets. Branch circuits sen,ing room, one of the following shall apply:
only special-purpose outlet� 01· receptacles (e.g., p01·table x-rny ( l) Each receptacle shall b e an individual GFCI device.
receptacles) shall not be reguireti. to conform to the reguire (2) Each receptacle shall be individually protected by a single
ment5 ofG.4.3. GFCI device.
6.3.2.2.7* □inical Laboratories. Outlet.� with two to fom 6.3.2.4" Circuits.
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 6.3.2.4.1 Normal branch circuits serving a patient bed loca
usage areas, a..L1d eithe1· installation shall be at least 80 mm tion shall be fed from not more than one normal branch
(3.15 in.) above the countenop. circuit distt·ibution panel.
6.3.2.4.2 Branch circuits sening a patient bed location shall
6.3.2.3 Wet Procedure Locations.
be permitteti. to be fed from m01·e than one critical branch
6.3.2.3.1 * \\'et procedure locations shall be provided wi Ll1 circuit distt·ibution panel.
special protection against electric shock.
6.3.2.4.3 Only authorized personnel shall have access to over
6.3.2.3.2 This special protection shall be proviti.ed a� follows: cut-rent protective devices serving Category l and Category 2
( l) Power distribution system that inhe1·ently limits the possi spaces.
ble ground-fault current due to a first fault to a low value, 6.3.2.4.4 Overcurrent protective devices serving Category l
without interrupting the powe1· supply and Category 2 spaces shall not be permitted to be located in
(2) Power distribution system in which the powe1· supply is public access spaces.
interrupted if the grounti.-fault current does, in fact,
exceed the trip value of a Class A GFCI 6.3.2.4.5 Where used in locations such as in Category l spaces,
isolateti. power panels shall be pern1itted in those locations.
6.3.2.3.3 Patient beds, toilets, bidet�, and wash basins shall not
be reguireti. to be considered wet procedure locations. 6.3.2.4.6 Low-voltage ,viring shall comply with either of the
following:
2021 Edition
(1) Fixe<l systems of 30 V (ck or ac rn1s) or less shall be ing screw(s) securing the faceplate to a grounded outlet
permitte<l to be ungroun<le<l, provi<le<l that the insula box or groun<le<l v.�ring device.
tion between each ungroun<le<l conductor and the (5) Luminaires more than 2.3 m (7½ ft) above the floor an<l
prima ry circuit, which is supplie<l from a conventionally switches located out�i<le of the patient care vicinity, which
grounded distribution system, is the same protection as shall be permitted to he connected to an equipment
required for the primary voltage. grounding return path complying \\�th 6.3.2.5. l .4(A) and
(2) A grounded low-voltage system shall he permitted, provi 6.3.2.5. l.4(B).
ded that loa<l current� are not carrie<l in the grounding
conductors. 6.3.2.5.1.5* Grounding Interconnects. In patient ca re spaces
supplie<l by the normal distribution system and any branch of
6.3.2.5 Grounding. the essential electrical system. the groun<ling system of the
normal distribution system an<l that of the essential electt·ical
6.3.2.5.1 Grounding requirement� shall comply with the system shall he interconnected.
1·equirement� in 6.3.2.5.1. l through 6.3.2.5.1.5.
6.3.2.5.2 Patient Equipment Grounding Point. A patient
6.3.2.5.1.1 Grounding Circuitry Integrity. Grounding ci1·cuit� equipment grounding point comprising one or m01·e groun<l
and conductors in patient care spaces shall be installed in such ing terminals or jacks shall he permitted in an accessible loca
a way that the continuity of other pa1·ts of those circuits cannot tion in the patient care vicinity.
be inte1-rupted nm· the 1·esistance rnised above an acceptable
f
level by the installation, removal, and replacement o any in 6.3.2.5.3* Special Grounding in Patient Care Rooms. In ad<li
stalled equipment, inducting power receptacles. tion to the grounding required to meet the performance
requi1·emenl� of 6.3.3.1, additional grounding shall be permit
6.3.2.5.1.2 Reliability of Grounding. The equipment ground te<l whe1·e special ci1·cumstances so dictate.
ing conductorn shall conform to NFPA. 70. Brnnch circuits serv
ing electrical equipment within the patient care vicinity shall be 6.3.2.6 Battery-Powered Lighting Units.
provided with effective ground-fault current paths dual-fe<l by a
wi1·ing method that qualifies as an equipment grounding 6.3.2.6.1 One or m01·e batte1·y-powered lighting unit� shall be
con<luctor and by an insulate<l coppe1· equipment grounding provided within locations where deep sedation and general
con<luctor. anesthesia is a<lministered .
6.3.2.5.1.3 Separate Grounding Conductor. V17hen existing 6.3.2.6.2 The lighting level o f each unit shall be sufficient to
consu·uction does not have a separate grounding conductor, terminate proce<lures inten<le<l to he pedormed within the
the continued use of the system shall be permitted, provided operating room.
that it meet� the perfo1·mance requirements in 6.3.3.1. 6.3.2.6.3 The sensor fo1· unit� shall he wi1·ed to the unswitche<l
6.3.2.5.1.4 Grounding of Receptacles and Fixed FJectrical portion of branch ciITuit(s) serving general lighting within the
Equipment in Patient Care Spaces. room.
(A) Wning Methods. A.JI branch ci1·cuit� sening patient ca1·e 6.3.2.6.4 The Level l or Level 2 EPS f eme1·gency powe1·
spaces shall be provi<le<l with an effective ground-fault current supplyl equipment location(s) shall be provided with battery
path by installation in a metal raceway system, or a cable having powered emergency lighting. This requirement shall not apply
a metallic armor or sheath assembly. 1l1e metal rnceway system, to unil� located out<lo01·s in enclosures that do not incl ude
01· metallic cable armor, or sheath assembly shall itseU' qualify as walk-in access. fll0:7.3. l l
an equipment grounding conductor. 6.3.2.6.5 The emergency lighting charging system and the
(B) Insulated Equipment Grounding Conductors and Insulated normal sen,ice room lighting shall he supplied from the loa<l
Equipment Bonding Jumpers. The following shall be <lirectly side of the transfer switch. fll0:7.3.21
connecte<l to an insulate<l copper equipment grounding 6.3.2.6.6 The minimum average horizontal illumination prmi
conducto1· that is clearly i<lentified along it5 entire length by ded by normal lighting som·ces in the sepa1·ate building 01·
green insulation, with no yellow stripes, and installe<l with the room housing the EPS equipment for Level l shall be 32.3 Lux
brnnch ciITuit conduct01·s in the v.fring methods a� provided in (3.0 ft-candles) measured at the floor level, unless otherwise
6.3.2.5. l .4(A): specified by a requirement recognized by the authority having
(l) The groun<ling terminals of all receptacles other than jurisdiction. fll0:7.3.31
isolated groun<l receptacles. 6.3.2.6.7 Unit� shall be capable of providing lighting for
(2) Where receptacles are mounted in metal receptacle
11/,, hours.
outlet boxes, metal device boxes, or metal enclosm·es, the
performance of the connection between the 1·eceptacle 6.3.2.6.8 Unit� shall be tested monthly fo1· 30 seconds, an<l
grounding te1·minal and the metal box or enclosm·e shall annually fo1· 30 minutes.
he equivalent to the performance provided by copper
wire sized in acc01·<lance with 250.146 an<l Table 250.122 6.3.2.7 Other Non-Patient CareAreas. (Reserved)
of NFPA 70, hut no smaller than 12 A\'\'G. 6.3.2.8 Ground Fault Protection.
(3) All non-current-<:arrying conductive surfaces of fixed elec
u·ical equipment likely to become energized an<l subject 6.3.2.8.1 Applicability. The requirement� of 6.3.2.8.2 shall
to pe1·sonal contact, operating at over 100 volt�. apply to health care facilities housing Category l spaces or
( 4) Metal faceplates. which shall be connected to the equip utilizing life-suppon equipment and buil<lings that provide
ment grounding conductor by means of a metal mount- essential utilities or senices fo1· the operation of Category l
spaces or electrical life-support equipment.
2021 Edition
6.3.2.8.2 Vihere ground-fault prntection is provided for opera 6.3-2.9.3 Line Isolation Monitor.
tion of the service or feeder disconnecting means, an addi
tional step of ground-fault protection shall be provided in the 6.3.2.9.3.1 * In addition to the usual contrnl and prntective
next level of feeder downstt·eam toward the load. devices, each isolated power system shall be provided with an
approved, continually opei-ating line isolation monitor that
6.3.2.8.3 Ground-fault protection for operation of the sen,ice indicates possible leakage or fault currents from either isolated
and feeder disconnecting means shall be fully selective such conduct01· to g1·ound.
that the downstream device and not the upstream device shall
open for downstream ground fault�. 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
6.3.2.8.4* Equipment Protection. The main and downstt·eam isolation monitor is utilized. remains lighted when the system is
ground-fault protective devices (where 1·equired) shall be co01· adequately isolated from ground; and an a�acent 1·ed signal
dinated as required in 6.3.2.8. lamp and an audible warning signal (remote if desired) shall
be energized when the total hazard cut-rent (consisting of
6.3.2.8.5 Personnel Protection. If used, ground-fault ci1·cuit possible 1·esistive and capacitive leakage cut-rent�) from either
interrupters (GFCls) shall be listed. isolated conductor to ground 1·eaches a th1·eshold value of
6.3.2.9* Isolated Power Systems. 5.0 mA under normal line voltage conditions. l11e line isola
tion monitor shall not alarm for a fault hazard cun-ent of less
6.3.2.9.1 Isolation lransformer. An isolated powe1· system than 3.7 mA.
shall not be 1·equired to be installed in any patient care space,
except as specified in 6.3.2.3. 6.3.2.9.3.3* The line isolation monitor shall comply with
eithe1· of the following:
6.3.2.9.1.1 The isolation trnnsfo1·mer shall be listed and
approved for the put·pose. (1) It shall have sufficient internal impedance such that.
when properly connected to the isolated svstem, the
6.3.2.9.1.2 The pt·imary winding shall be connected to a maximum internal current that will flow through the line
power source so that it is not ene1·gized with mm·e than 600 V isolation monito1·, when any point of the isolated system is
(nominal). grounded, shall be l mA.
(2) It shall be permitted to be of the low-impedance type
(A) If present, the neutt·al of the pt·imary winding shall be such that the current through the line isolation monito1·,
grounded in an approved manne1·. when any point of the isolated system is grounded, will
(B) If an electrostatic shield is present, it shall be connected to not exceed twice the alarm threshold value for a period
the refe1·ence grounding point. not exceeding 5 milliseconds.
6.3.2.9.1.3 Vfo·ing of isolated powe1· systems shall be in acc01·d 6.3.2.9.3.4* An ammete1· connected to indicate the total
ance with 5 17.160 of JVFPA. 70. hazard current of the system (contribution of the fault hazard
current plus monitor hazard current) shall be mounted in a
6.3.2.9.2 Impedance of Isolated Wiring. plainly visible place on the line isolation monitor with the
6.3.2.9.2.I * The impedance (capacitive and resistive) to "alarm on" zone (total hazard cutTent = 5.0 m.A) at approxi
ground of either conductor of an isolated system shall exceed mately the center of the scale. A line isolation monitor shall he
200,000 ohms when installed. l11e installation at this point located in the ope1·ating room.
shall include 1·eceptacles but is not required to include lighting 6.3.2.9-3.5 Means shall be provided for shutting off the audi
fixtures or components of fixtures. This value shall be deter ble alarm while leaving the red warning lamp activated. V1'hen
mined by energizing the system and connecting a low the fault is cot-rected and the green signal lamp is n,activated,
impedance ac milliammete1· (0 to l tIL'\. scale) between the the audible ala1·m-silencing ci1·cuit shall reset automatically, or
reference g1·ounding point and either conduct01· in sequence. an audible or distinctive \-isual signal shall indicate that the
This test shall be permitted to be performed with the line isola audible alarm is silenced.
tion monit01· (sl'f' 6.3.2. 9.3.1) connected, provided that the
connection between the line isolation monitor and the 1·efe1· 6.3.2.9.3.6 A 1·eliable test switch shall be mounted on the line
f
ence grounding point is open at the time of the test. A ter the isolation monitor to test its capability to operate (i.e., cause the
test is made, the milliammeter shall be removed and the alarms to operate and the meter to indicate in the "alarm on"
grounding connection of the line isolation monit01· shall be zone). This switch shall transfe1· the grounding connection of
rest01·ed. When the installation is completed, including perma the line isolation monitor from the reference grounding point
nently connected fixtures, the reading of the meter on the line to a test impedance arrangement connected across the isolated
isolation monito1·, which cot-responds to the unloaded line line; the test impedance (s) shall be of the appropriate magni
condition, shall be made. This meter 1·eading shall be 1·ecorded tude to produce a meter 1·eading cot-responding to the rated
as a 1·eference for subsequent line impedance e\<1luation. This total hazard current at the nominal line voltage, 01· to a lesser
test shall he conducted with no phase conductors grounded. alarm hazard current if the line isolation monitor is so rated.
The operntion of this switch s hall break the grounding connec
6.3.2.9.2.2 An approved capacitance suppressor shall be tion of the line isolation monit01· to the reference grounding
pet·mitted to be used to improve the impedance of Lhe perma point before transferring this grounding connector to the test
nently installed isolated system; however, the resistive impe impedance(s), so that making this test will not add to the
dance to ground of each isolated conduct01· of the system shall haza1·d of a system in actual use; nor will the test include the
be at least l megohm pt·ior to the connection of the suppres eflect of the line-to-ground stray impedance of the system. The
sion equipment. Capacitance suppressors shall be installed so test switch shall be of a self�restoring type.
as to p1·event inadvertent disconnection dm·ing norn1al use.
2021 Edition
6.3.2.9.3.7 The line isolation monitor shall not generate grnunding contact of 10 percent of all receptacles within the
energy of suflicient amplitude or frequency, as measured by a patient care vicinity.
physiological monitor with a gain of at least 104 with a source
impedance of 1000 ohms connected to the balanced difleren• 6.3.3.1.4.2 The impedance measut·ement shall be the ratio of
tial input of the monitor, to create interference or artifact on voltage developed (either 60 Hz 01· de) between the point
human physiological signals. TI1e output voltage !'rom the under test and the reference point to the current applied
amplifier shall not exceed 30 mV when the gain is 104. The between these ti.vo points.
f
impedance of 1000 ohms shall be connected to the ends of 6.3.3.1.5 Test Equipment. Elecu'ical sa ety test instrument�
typical unshielded electrode leads that are a normal part of the shall be tested periodically, but not less than annually, for
cable assembly furnished with physiological monitors. A 60 Hz acceptable pe rfo1·mai1ce.
notch filte1· shall he used to reduce ambient interference, as is
typical in phvsiological monitor design. 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
6.3.2.9.4 Identification of Conductors for Isolated (Ungroun 1000 ohms :t 10 percent at frequencies of 1000 Hz 01· less.
ded) Systems. The isolated conduct01·s shall be identified in
accordance with f>l 7.160(A) (5) of 1VJ·PA 70. 6.3.3.1.5.2 The voltage acrnss the te1·minals (01· between anv
terminal and ground) of resistance-measuring instrument�
6.3.3 Performance Criteria and Testing. used in occupied patient care rooms shall not exceed 500 mV
6.3.3.1 Grounding System in Patient Care Spaces. rms or 1.4 de or peak to peak.
6.3.3.1.1* Grounding System Testing. The eflectiveness of the 6.3.3.1.6 Criteria for Acceptability for New Construction.
grounding system shall be dete1·mined by voltage measu1·e 6.3.3.1.6.1 The voltage limit shall be 20 mV.
ment� and impedance measu1·ement�.
6.3.3.1.6.2 The impedance limit shall be 0.2 ohm for svstems
6.3.3.1.1.1 For new construction, the eflectiveness of the containing isolated ground 1·eceptacles and 0.1 ohm for all
grounding system shall be evaluated before acceptance. others.
6.3.3.1.1.2 Small wall-mounted conductive surfaces not likely 6.3.3.2 Receptacle Testing in Patient Care Spaces.
to become energized, such as surface-mounted towel and soap
dispense1·s. mirrors. and so fonh, shall not be requi1·ed to be 6.3.3.2.1 The phys ical integrity of each receptacle shall be
intentionally grounded or tested. confirmed hy visual inspection.
6.3.3.1.1.3 La1·ge metal conductive surfaces not likely to 6.3.3.2.2 The continuity of the grounding circuit in each elec
become energized, such as windows, door frames, and drains, trical 1·eceptacle shall be ve1·ified.
shall not be 1·equired to be intentionally grounded or periodi 6.3.3.2.3 Con-ect polai·ity of the hot and neutral connections
cally tested. in each elecu·ical receptacle shall he confirmed.
6.3.3.1.1.4" Viheneve1· the electrical system has been alte1·ed 6.3.3.2.4 The 1·etention fot·ce of the grounding blade of each
01· replaced, that portion of the system shall be tested. electrical receptacle (except locking-type receptacles) shall be
6.3.3.1.2 Reference Point. The voltage and impedance meas- not less than 115 g (4 oz).
111·ements shall be taken with 1·espect to a refe1-ence point, 6.3.3.2.5 Whe1·e hospital-grade receptacles a1·e requi1·ed at
f
which shall be one o the following: patient bed locations and in locations where deep sedation 01·
(l) Reference grounding point (sl'f ChaptPr 3) general at1esthesia is administered, testing shall be performed
(2) Grounding point, in 01· near the room under test, that is after initial installation, replacement, or servicing of the device.
electrically remote from receptacles (e.g., an all-metal
cold-water pipe) 6.3.3.2.6 Additional testing of receptacles in patient care
Grounding contact of a receptacle that is powe1·ed from a spaces shall be performed at intervals defined by documented
(3)
diffe1·e11t branch ci1·cui t from the 1·eceptacle unde1· test. pedormance data.
6.3.3.1.3* Voltage Measurements. 6.3.3.2.7 Receptacles not listed as hospital-grnde, at patient

bed locations and in locations where deep sedation or general
6.3.3.1.3.1 The voltage mea�urement� shall be made under anesthesia is administe1·ed, shall be tested at intenals not
no-fault conditions between a 1·eference point and exposed exceeding 12 months.
fixed electrical equipment with conductive surfaces in a patient
ca1·e vicinity. 6.3.3.3 Isolated Power Systems.
6.3.3.1.3.2 The voltage mea�urement� shall be made with an 6.3.3.3.1 Patient Care Spaces. If installed, the isolated powe1·
accuracy of :t 5 percent. sys tem shall be tested in accordance with 6.3.3.3.2.
6.3.3.1.3.3 Voltage mea.�urements for faceplates of wi1·ing devi 6.3.3.3.2 Llne Isolation Monitor Tests. The line isolation
ces shall not be required. monit01- (LIM) circuit shall be tested after installation, at1d
prim· to being placed in service, by successively grounding each
6.3.3.1.4* Impedance Measu rements. The impedance meas- line of the energized distribution system through a resistor
111·ement shall be made with an accuracy of :t 5 percent. 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
6.3.3.1.4.1 Fm· new construction, the impedance measure activated.
ment shall be made between the reference point and the
2021 Edition
6.3.3.3.3 The LIM circuit shall be tester! at intervals of not 6.7.1.1.1 Current-sensing devices. phase and ground, shall be
more than l month by actuating the LIM test switch (.�Pe selected to minimize the extent of interruption to the electrical
6.3.2.9.3.6). For a LIM circuit with automated self-test and self: system due to abnormal cut-rent caused by overload 01· shon
calibration capabilities, this test shall be pei-formed at intervals circuit�, or both.
of not more than 1 2 months. Actuation of the test switch shall
activate both visual and audible alarm indicators. 6.7.1.1.2 Essential electrical systems shall have a minimum of
the following tw-o inrlependent sources of power: a n01·mal
6.3.3.3.4 After any repair or renovation to an electrical distri source generally suppl1ing the entire electrical system and one
bution system, the LIM circuit shall be tested in accorrlance or more alternate sources for use when the normal source is
with 6.3.3.'.i.2. interrupted.
6.3.3.4 Growid-Fault Protection Testing. When equipment 6.7.1.1.3 Where the normal source of powe1· consist� of gener
ground-fault protection is first installed, each level shall be ating unit� on the premises, the alternate source shall be either
performance-tested to ensure compliance with 6.3.2.8. another generating set or an external utility service.
6.3.4 Administration of Electrical System. 6.7.1.2 General. Alternate powe1· sout·ces fo1· essential electt·i
cal systems shall be rlesignerl to meet the requirement� of such
6.3.4.1 Record Keepi ng. service.
6.3.4.1.1 * A rec01·d shall be maintained of the test� requirer! 6.7.1.2.1" Power Source. Type l anrl Type 2 essential electt·i
by this chapter anrl associaterl 1·epai1·s or morlification. cal system power sources shall he classified as Type 10, Cla�s X,
6.3.4.1.2 At a minimum. the 1·ecord shall contain the <late, the Level l generator sets per NFPA 1 10.
rooms or a1·eas tested, anrl an indication of which items have 6.7.1.2.2 Use for Essential Electrical System.
met, or have failed to meet, the pei-formance requir·ements of
this chapter. 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
6.3.4.1.3 Isolated Power System (Where Installed). A perma of peak rlemand control, internal voltage control, loarl 1·elief
nent record shall be kept of the r·esults of each of the test�.
for the external utility, cogeneration, or other approved uses.
6.4 Category 1 Spaces. 6. 7.1.2.2.2* An essential electrical system(s) shall be designed
6.4.1 Category l spaces shall be served by an essential electri to meet the maximum demand likely to be produced by the
cal system in accordance with 6.75. connected loarl and he consistent with the facility's emergency
operations plan with any single power source of the system out
6.4.2 Category l spaces shall not be server! by an essential of setvice.
electrical system in accordance with 6.7.6.
6. 7.1.2.2.3"
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· (A) Optional loads shall be permitted to be served by the
switch anrl a minimum of one circuit served by the n01·mal essential elecu·ical system generating equipment.
power distribution system or by a system originating from a
(B) Optional loads shall be served by their own transfer
seconrl critical branch automatic t1·ansfer switch.
means, such that they "'ill not be tra.nsfetTed onto the genernt
6.4.4 A11 essential electrical system in accordance with 6.7.5 ing equipment if the transfe1· woulrl overload the equipment
serving a Category l space shall be permitted to setve Category and will be shed prior to a generating equipment overloarl.
2 spaces in the same facility. (C) Use of the generating equipment to setve optional loads
6.5 Category 2 Spaces. shall not constitute "othe1· pm·poses"' as rlesc1·ihed in 6.7.1.2.2.l
and, therefore, shall not require multiple generator set�.
6.5.1 Category 2 spaces shall be served by a Type l or Type 2
EES. 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
6.5.2 Category 2 spaces serverl by a Type l 01· Type 2 EES shall to meet the requirement� of NFPA 101 for emergency egress
be served by circuit� from a branch panel(s) served from a unrler load-sherl conrlitions.
single automatic transfer switch anrl a minimum of one circuit
se1·ved by the n01·mal power distribution system or by a system 6.7.1.2.3 Location.
originating from a seconrl automatic transfer switch.
6.7.1.2.3.1 Indoor EPS Installations. The EPS shall be in
6.6 Category 3 and 4 Spaces. stalled in a room dedicaterl to altenrnte power sout·ces for
Level l installations.
6.6.1 Categnry 3 or Category 4 spaces shall not be 1·equi1·ed to
be served by an EES. (A) The EPS room shall be separated from the rest of the
building by constrnction \\ith a 2-hout· fit·e resistance rating.
6.7* Essential Electrical Systems. fll0:7.2.1.11
6.7.1 Sources. (B) EPSS femergency power supply system l equipment shall
6.7.1.1* Design Considerations. Dual sources of n01·mal be pe1·mitted to he installed in the EPS room. fll0:7.2.1.21
power shall not constitute an alternate power source as de (C) No othe1· equipment, including at"Chitecturnl appurtenan
scribe rl in this chapter. ces, except those that serve this space, shall be permitted in the
EPS room. fll0:7.2.1.31
2021 Edition
ELECfRICAL !-,YSTEMS 99--81
6.7.1.2.3.2 Outdoor EPS Installations. 6.7.1.2.7.2 The annunciator shall be hard-wired to indicate
alarm conditions of the emergency or auxiliary power source as
(A) The EPS shall eithe1· be installed in a suitable enclosure indicaterl in 6.7.l.2.7.2(A) through 6.7.1.2.7.2(1).
located outside the building and capable of 1·esisting the
entrance of snow or rain at a maximum winrl velocity as (A) Inrlivirlual visual signals shall indicate the following:
required by local builrling codes or be constructerl such that it (l ) \Vhen the emergency or auxilia1y power source is operat-
is capable of resisting the impacts of snow or min. ing to supply powe1· to load
(B) EPSS equipment shall be pe1·mitted to be installed in the (2) \,Vhen the battery charge1· is malfunctioning (if provirled)
EPS enclosure. r110:7.2.2.2l (B)* A remote, common audible alarm shall be provided as
(C) No other equipment, including architectural appurtenan specified in G.7.1.2. 7.2(H). 1"110:5.6.6]
ces, except those that serve this space, shall be permitted in the (C) For Level I EPS, at a minimum, local annunciation and
EPS enclosure. r110:7.2.2.3l either facility or network remote annunciation shall be provi
6.7.1.2.3.3 Level I EPSS equipment shall not be installed in ded.
the same room with the normal se1·vice equipment, where the (D) For the purposes of defining the types of annunciation in
service equipment is rated over 150 volts to ground anrl equal 6.7. l.2.7.2(C), the following shall apply:
to or greater than 1000 amperes. ruo:7.2.31
(1) Local annunciation is located on the equipment itself 01·
6.7.1.2.3.4 The rooms, enclosures. 01· separate buildings hous within the same equipment room.
ing Level l or Level 2 EPSS equipment shall be designerl and (2) Facility remote annunciation is located on site but not
located to minimize damage from flooding, including that within the room whe1·e the equipment is located.
caused by the following: (3) Netw01·k remote annunciation is located off site.
(1) Flooding resulting from fire fighting rtl0:5.G.G.31
(2) Sewer wate1· backup (E) A..11 alarm-silencing means shall be provided, and the panel
(3) Othe1· disa�te1·s or occurrences shall include repetitive ala1·m circuiuy so that, afte1· the audible
r110:1.2.41 alarm ha� been silenced, it reactivates after the fault condition
6.7.1.2.3.5 Minimizing the possibility of rlamage resulting has been clearerl and has to be rest01·erl to its normal position
from intetTuptions of the eme1·gency sout·ce shall be a design to be silenced again. r110:5.6.G.4l
consideration for EPSS equipment. ruo:7.2.51 (F) In lieu of the requirement in 5.6.6.4 of NFPA 110, a
6.7.1.2.3.6 Design conside1·ations shall minimize the effect of manual ala1·m-silencing means shall be permitted that silences
the failut·e of one ene1·gy converte1· on the continued operation the audible alann afte1· the occut-rence of the alarm conrlition,
of other unit�. r110:7.2.7l provided such means rlo not inhibit any subsequent alarms
from sounding the audible alarm again without further manual
6.7.1.2.4* Capacity and Rating. The gene1·ator set(s) shall action. r110:5.6.G.5.I
have the capacity and rating to meet the maximum rlemand
likely to be produced by the connected load of the essential (G) Inrlividual alarm indication to annunciate any of the
electrical system(s) and be consistent with the facility's emer conditions listed in Table 6. 7.1.3.8.2 shall have the following
gency operations plan. characte1·istics:
6.7.1.2.5 Load Pickup. The energy converte1·s shall have the (1) It shall be battery powe1·ed.
required capacity and response to pick up anrl cany the load (2) It shall be visually indicaterl.
within the time specified in Table 4.1(b) ofNFPA 110 after loss (3) It shall have additional con tact.� 01· ci1·cuits fot· a common
of pt·imary powe1·. audible alarm that signals locally anrl remotely when any
of the itemized conditions occurs.
6.7.1.2.6 Heating, Cooling, and Ventilating. Design of the (4) It shall have a lamp test switch(es) to test the operation of
heating, cooling, and ventilation system fo1· the EPS equipment all ala1·m lamps.
room shall inclurle provision fo1· factors including. but not limi
ted to, the following: (H)* A centralized computer system shall not be permitted to
be substituted for the alarm annunciat01· in G.7.1.2.7 but shall
(1) Heat be permitterl to be used to supplement the alarm annunciat01·.
(2) Cold
f
(3) Dust (I) Wireless transmission o the EPS rlata required by
(4) Humidity 6.7.1.3.8.2 anrl G.7. 1.3.8.3 shall be permitted.
(5) Snow and ice accumulations around housings
(fl) Louvers 6.7.1.3 Generator Set.
(7) Remote radiator fans, as applicable 6.7.1.3.1 General. A single generator set that operates the
(8) Prevailing winrls blowing against radiat01· fan discharge essential electt·ical system shall be pern1itted to be part of the
au- system supplying the othe1· put·poses a� specifierl in 6.7.1.2.2.1,
6.7.1.2.7 Alarm Annunciator. provided that any such use will not decrease the mean periorl
between service overhauls to less than 3 years.
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 6.7.1.3.2 Location. The EPS equipment shall be installed in a
room in a location readily observed by operating personnel at a location that permits ready accessibility and a minimum of
1·egula1· work station. 0.9 m (% in.) from the skid rails' outermost point in the direc
tion of access fo1· inspection, 1·epair, mai ntenance, cleaning, 01·
2021 Edition
replacement. This 1·ec1ui1·ement shall not apply to unil� Ill 6.7.1.3.6 Compressed Air Starting Devices. Other types of
outrloor housings. r110:7.2.Gl stored energy starting systems (except pyrotechnic) shall be
permitterl to be userl whe1·e recommended by the manufac
6.7.1.3.3 Maintenance of Temperature. The EPS shall be tut·er of the prime mover and subject to approval of the authm·
heaterl as necessaq; to maintain the water jacket and batteq; ity having jurisrliction, under the following conditions:
temperature determined by the EPS manufacturer for colrl
start and I oarl acceptance fo1· the type of EPSS. r 110:5. 3.1 ·1 ( l) Where two complete periods of cranking cycles are
completerl without replacement of the stm·ed ene1·gy
6.7.1.3.4* Heating, Cooling, and Ventilating. \'\'ith the EPS (2) \\There a means for automatic restoration from the emer
running at rated loarl, ventilation airflow shall be provirlerl to gency source of the stored energy is providerl
limit the maximum air temperature in the EPS room 01· the (3) Whe1·e the stored energy system has the cranking capacity
enclosure housing the unit to the maximum ambient ai1· specified in 5.6.4.2. l of NFPA 110
temperature reguired by the EPS manufacturer. r110:7.7.fl (4) Where the stored energy system has a "black start" capa-
6.7.1.3.4.1 Considerntion shall be given to all the heat emitted bility in addition to normal discha1·ge capability
to the EPS eguipment room by the energy converter, uninsula r110:5.6.4.1.2l
ted or insulated exhaust pipes, anrl other heat-producing 6.7.1.3.7 Fuel S upply. The fuel supply for the generator set
eguipment. r110:7.7.1.1 l shall comply with Sections 5.5 and 7.9 of NFPA 110.
6.7.1.3.4.2* If reguirerl by the manufactut·e1·, ventilation shall 6.7.1.3.8 Requirements for Safety Devices.
be supplied to the alternate power source eguipment.
6.7.1.3.8.l Internal Combustion Engines. Internal combus
(A) Fm· EPS supplying Level l EPSS, ventilation air shall be tion engines serving generato1· sets shall be eguipped with the
supplied directly from a source oul�ide the building by an exte following:
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 (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
(B) For EPS supplying Level 1 EPSS, rlischarge ai1· shall be (2) Sensor devices plus visual p1·e-ala1·m warning device to
directed outside the building by an exterior wall opening or to inrlicate the following:
an exterim· opening by a 2-hour fire-rated air transfer system. (a) High engine temperature (above manufacture1·'s
fl 10:7. 7.2.21 1·ecommended safe operating temperatm·e rnnge)
(C) Fire dampers, shutters. or other self-closing devices shall (b) Low lubricating oil presstu-e (below manufacturer·s
not he permitterl in ventilation openings or rluctwork for recommenrlerl safe operating range)
supply or retum/discha1·ge ai1· to EPS eguipment ftx Level 1 (c) Lowwate1· coolant level
EPSS. r110:7.7.2.3l (3) Automatic engine shutdown device plus visual device to
inrlicate that a shutrlown took place due to the follmving:
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 (a) Ove1uank (failed to start)
or from a som·ce outside the builrling by a 2-hour fire-rated ai1· (b) Ove1·speed
transfer system. r110:7.7.3l (c) Low lubricating oil pressure
(d) Excessive engine temperature
6.7.1.3.4.4 Ventilation air shall be providerl to supply and (4) Common aurlible alarm device to warn that one 01· mo1·e
discharge cooling air fo1· rnrliator cooling of the EPS when of the p1·e-ala1·m 01· alarm conditions exist
running at rated load. rno:7. 7.41
6.7.1.3.8.2 Safety Indications and Shutdowns. Safety indica
(A) Ventilation air supply and discha1·ge for radiato1"'-Coolerl tions and shutdowns shall he in accm·dance with Table
EPS shall have a maximum static 1·estriction of 125 Pa (0.5 in. G.7.1.3.8.2.
of water column) in the discharge rluct at the radiator outlet.
r110:7.7.4. l l
6.7.1.3.8.3 Indivirlual visual signals plus a common audible
signal to warn of an engine-generntm· alarm condition shall
(B) Rarliato1· air discharge shall be ducterl outrloors 01· to an indicate the following:
exterior opening by a 2-hmu- raterl ai1· transfe1· system. (1) Low lubricating oil pressure
1110:7.7.4.21 (2) Low water temperattu·e (below that regui1·erl in 6.7.1.3.3)
6.7.1.3.4.5 Motm--opernted rlampers. when used. shall be (3) Excessive water temperatut·e
spring operated to open and motm· closed. Fi1·e dampers, shut (4) Low foe! when the main foe! storage tank contains less
ters. or other se!f:dosing devices shall not he permitterl in than a 4-hour operating supply
ventilation openings or ductwork for supply or return/ (5) Overcrank (failed to start)
discharge ai1· to EPS eguipment for Level 1 EPSS . r110:7.7.5.I (6) Overspeerl
6.7.1.3.4.6 The ambient air temperature in the EPS eguip 6. 7.1.4 Battery. Batte1-y systems shall meet all 1·eguiremenl� of
ment room or outdoor housing containing Level 1 rotating NFPA 111.
eguipment shall stabilize at not less than 4.5 ° C ( 40'F) when the 6. 7.1.5 Fuel Cell Systems.
eguipment is not opernting. fl 10:5.3.5]
6. 7.1.5.1 Fuel cell systems shall be pe1·mitted to serve as the
6.7.1.3.5* Energy Converters. Internal combustion engine alternate powe1· source for all or part of an essential electrical
energy converte1·s anrl associated cranking batte1·ies shall be in system.
accorrlance with the reguirements of NFPA 110.
6.7.1.5.2 Installation shall comply v.�th NFPA 853.
2021 Edition
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

time-<lelay device shall be provi<le<l to delay transfer and
6.7.2.1 General Requirements. sequence load trnnsfer to the EPS to avoid excessive voltage
6.7.2.1.1 * Coordination. drop when the transfet· switch is installed for Level l use.
fll0:6.2.71
6.7.2.1.1.1 Overcurrent protective <levices ser,ing the essential
electrical system shall be co01-dinated for the period of time (A) Time Delay Commencement. The time delay shall
that a fault's <lurntion extends beyond 0.1 second. commence when propet· EPS voltage an<l frequency are
achieve<l. fll0:6.2. 7.1 l
6.7.2.1.1.2 Coordination shall not be required a� follows:
2021 Edition
99.84 HEALTH CARE FACILITIES CODE
(B) Time Delay at Engine Control Panel. Time delays shall be 6.7.2.1.2.17* Nonantomatic lransfer Switch Features. Switch
permitted to be located at the engine control panel in lieu of ing devices s hall be mechanically held and shall be operated by
in the transfer switches. r110:6.2. 7.21 direct manual or elect1·ical 1·emote manual contt·ol.
r110:6.2.161
6.7.2.1.2.7* Time Delay on Retransfer to Primary Source. An
adjustable time-delay de\ice with automatic bypass shall be (A) Interlocking. Reliable mechanical interlocking, or an
provided to delay retransfer from the EPS to the primary approved alternate method, shall prevent the inadvertent inte1·
source of powe1·, and allow the primary source to stabilize connection of the pt·imary power source and the EPS.
before retransfer of the load. r110:6.2.8l r110:6.2.16.l l
6.7.2.1.2.8 Time Delay Byp� If EPS Fails. The time delay (B) Indication of Switch Position. Two pilot light� with identi
shall be automaticall y bypassed if the EPS fails. r110:6.2.9l fication nameplates, 01· othe1· approved position indicat01·s,
shall be provided to indicate the switch position. r110:6.2.16.2l
(A) The transfer switch shall be permitted to be programmed
for a manually initiated 1·etransfer to the pt·imary source to 6.7.2.1.3 Nonautomatic Transfer Device Cl�ification.
provide for a planned momentary interrnption of the load. Nonautomatic transfe1· devices of 600 V 01· less shall be listed
r110:6.2.9.l l for the purpose and approved.
(B) If used, the an-angement in 6.2.9.l of NFPA 110 shall be 6. 7.2.1.4 Nonautomatic lransfer Devic e Features.
provided with a bypass feature to allow automatic retransfer in
the event that the EPS fails and the primary source is available. 6. 7.2.1.4.1 General. Switching devices shall be mechanically
held and shall be operated by direct manual or electrical
6.7.2.1.2.9 Time Delay on Engine Shutdown. A minimum r·emote manual control. r110:6.2.16"1
time delay of 5 minutes shall be provided for unloaded
running of the EPS prior to shutdown to allow for engine cool 6.7.2.1.4.2 Interlocking. Reliable mechanical intedocking, or
down. r110:6.2.10l an approved alternate method, shall prevent the inadvertent
inte1·co1111ection of the p1·imary power source and the EPS.
(A) The minimum 5-minute delay shall not be 1·equi1·ed on r110:6.2.16.11
small (lf, kW or less) air-<:ooled prime movers. r110:6.2.10.l l
6. 7.2.1.4.3 Indication of Switch Position. Two pilot lights with
(B) A time-delay device shall not be requi1·ed, provided it is identification nameplates. or other approved position indica
included with the engine control panel, 01· if a utility feeder is tors, shall be prmided to indicate the switch position.
used as an EPS. r110:6.2.10.2l r110:6.2.16.2l
6.7.2.1.2.10 Test Switch. A test means shall be provided on 6.7.2.1.5 Byp� and Isolating lransfer Switches. Bypa�s
each automatic u·ansfe1· switch (ATS) that simulates failure of isolation switches shall be permitted fot· bypa�sing and isolating
the primary power source and then transfers the load to the the transfer switch and installed in accordance with 6.4.2, 6.4.3,
EPS. r110:6.2.12l and 6.4.4 ofNFPA 110. 1110:6.4.l l
6.7.2.1.2.11* Indication of lransfer Switch Position. Two 6.7.2.1.5. I Bypass-Isolation Switch Rating. The bypass
pilot lights with identification nameplates or other approved isolation switch shall have a continuous current rating and a
position indicators shall be provided to indicate the transfer current rating compatible with that of the associated t1·ansfer
switch position. r110:6.2.13l switch. fl 10:6.4.2 I
6.7.2.1.2.12 Motor Loa d Transfer. Provisions shall be inclu 6. 7.2.1.5.2 Bypass-Isolation Switch Oassification. Each bypa�s
ded to reduce currents 1·esulting from motor load transfe1· if isolation switch shall be listed for emergency electrical service
such current� could damage EPSS equipment or cause a� a completely factory-assembled and factory-tested apparatus.
nuisance tripping of EPSS ovetTurrent protective devices. r110:6.4.3l
1110:6.2.141
6.7.2.1.5.3* Operation. With the u·ansfer switch isolated or
6.7.2.1.2.13* Isolation of Neutral Conductors. Provisions disconnected, the bypass-isolation switch shall be designed so it
shall be included for ensuring continuity, transfe1·, and isolation can function as an independent nonautomatic transfer switch
of the p1·ima1y and the EPS neutral conductors whe1·eve1· they and allow the load to be connected to either powe1· source.
are sepa rately grounded to achieve ground-fault sensing. r110:6.4.4l
fl 10:6.2.1 5 l
6.7.2.1.5.4 Reconnection oflransfer Switch. Reconnection of
6.7.2.1.2.14 Retransfer. If the emergency power source fails the transfe1· switch shall be possible y.,jthout a load interrnption
during a test, provisions shall be made to immediately retrans greater than the maximum time, in seconds, specified by the
fer to the normal source. type of system. r110:6.4.5 l
6.7.2.1.2.15 Switch Rating. lhe rating of the transfer switches 6. 7.2.2 Branches.
shall be adequate for switching all cla�ses of loads to be served
and for withstanding the effect� of available fault currents with 6.7.2.2.1 The di'vision between the branches shall occur at
out contact welding. trnnsfer s\\,jtches where more than one u·ansfer switch ts
1·equired.
6.7.2.1.2.16 Automatic Transfer Switch. Transfer of all loads
shall be accomplished using an automatic transfer switch(es). 6. 7.2.2.2 Each branch shall be arranged for connection,
Each automatic tra.11sfe1· switch of 600 V or less shall be listed within time limits specified in this chapter, to an alternate
for the put-pose and approved fot· emer·gency electrical se1·vice powe1· source following a loss of the n01·mal som·ce.
(.w Sfl:tion 700.3 of NFPA 70j as a complete assembly.
2021 Edition
6.7.2.2.3 The number of trnnsfer switches to be user! shall be time delay. as rlescribed in 6.7.2.1.2.6, 01· nonautomatically and
based upon reliability, design, and load consirlerations. in such a sequential manner as not to overload the generator.
6.7.2.2.3.1 Each brnnch of the essential electrical system shall 6.7.3.5 When the nm·mal powe1· sou1·ce is restored, and after a
have one or more transfe1· switches. time delay, as described in 6.7.2.1.2.7, the automatic transfe1·
switches shall rlisconnect the alternate power source anrl
6.7.2.2.3.2 One transfer switch shall be permitted to se1·ve one connect the loads to the normal powe1- som·ce. The alternate
01· more brnnches in a facility with a continuous loarl on the power sotlt'ce generator set shall continue to run unloarlerl fot·
switch of 1 50 kVA ( 1 20 k\'\') or less. a preset time delay, a� describer! in 6.7.2.1.2.9.
6.7.2.2.3.3 \'\'here a single transfe1· switch is used, as permitted 6. 7.3.6 If the emergency power sou1·ce fails anrl the normal
in G. 7.2.2.:l.2 , rli,ision into separate branches shall not be power sou1·ce has been restored , 1·etransfe1· to the normal
1-equirerl. source of power shall be immerliate, bypassing the retransfer
6.7.2.2.4 Feeders from Alternate Power Source. delay timer.
6.7.2.2.4.1 A single feeder supplied by a local or remote alter 6.7.3.7 Nonautomatic transfer switching de,.,ices shall be
nate power source shall be permitted to supply the essential restored to the normal power source a� soon as possible alter
electrical system to the point at which the life safety. ci-itical, the return of the normal source or at the rliscretion of the
anrl equipment branches are separnted. operatot·.
6.7.2.2.4.2 Installation of the u·ansfer equipment shall be 6.7.4 Administration.

permitted at locations othe1· than that of the alternate power 6.7.4.1 Maintenance and Testing of Es.sential Electrica l System.
source.
6.7.4.1.1 Ma intenance and Testing of Alternate Power Source,
6.7.2.2.5 Receptacles. The requirement� for receptacles shall Transfer Switches, and Associated Equipment.
comply with 6. 7.2.2.S(A) and 6. 7.2.2.5(B).
6.7.4.1.1.1 Maintenance of Alternate Power Source. The
(A) Branch-ci1·cuit ove1·cun-ent devices shall be 1·eadily accessi generator set or othe1· alte1·nate powe1· sout"Ce anrl associated
ble to authorized personnel. equipment, inclurling all appurtenance part�, shall be so main
(B)" The electrical receptacles or the covet· plates fot· the elec tained as to be capable of supplying service within the shortest
trical 1-eceptacles supplied from the life safety and Cl'itical time practicable and within the 10-seconrl interval specifier! in
branches shall have a rlistinctive color or marking so as to be 6.7.1.2.5 and 6.7.5.:l.l.
1-eadily identifiable. 6. 7.4.1.1.2 The 10-second c1·ite1·ion shall not apply during the
6.7.2.2.6 Switches. Switches of all types shall be permitterl in monthly testing of an essential electrical system. If the 10-
the lighting circuit� connected to the essential electrical system second criterion is not met during the monthly test, a process
in accordance with NFPA JOI. shall be provided to annually confirm the capability of the life
safety and critical branches to comply with 6.7.5.3.1.
6.7.2.2.7 Secondary circuit� of transformer-powered commu
nication or signaling systems shall not be required to be 6. 7.4.1.1.3 Maintenance shall be performer! in accorrlance
enclosed in 1·aceways unless otherwise specified by Chapters 7 with Chapter 8 ofNFPA 1 10.
m 8 of NFPA 70. f
6.7.4.1.1.4 Maintenance o the electrical equipment for the
6.7.3 Performance Criteria and Testing. life safety branch, critical branch, and equipment branch shall
be maintained in accordance with the manufacturer's instruc
6.7.3.1 Transfer Switches. All ac-powered suppon anrl acces tions and pt·eventative maintenance programs.
sory equipment necessary to the operation of the EPS shall be
supplied from the load sirle of the automatic transfer 6.7.4.1.1.5 Inspection and Testing. Criteria, conditions, anrl
switch(es). or the output terminals of the EPS, ahead of the personnel requirements shall be in accorrlance with
main EPS ove1·cu1Tent prntection to ensu1·e continuity of the G. 7.4.1.1..'>(A) thrnugh 6.7.4.l.l .5(C).
EPSS operntion and performance. fll0:7.1 2.51 (A)* Test Criteria. Generator sets shall be tested 1 2 times a
6.7.3.2 The essential electrical system shall be served by the year, with testing intervals of not less than 20 days nor more
1101·mal power source, except when the normal power sout-ce is than 40 rlays. Generator sel� serving essential electt-ical systems
inten-upted or drops below a predetermined voltage level. s hall be tested in acco1·dance with Chapter 8 ofNFPA 1 10.
f
Settings o the sensors shall be determined by careful study of (B) Test Conditions. The scherluled test under load condi
the voltage 1·equi1·ements of the loarl. tions shall include a complete simulated cold start and appni
6.7.3.3 Failure of the normal source shall automatically start priate automatic and manual transfer of all essential electrical
f
the alternate source generator a ter a short delay, as describer! system loads.
in 6.7.2.1.2.4. 'When the alten1ate powe1· sout-ce has attained a (C) Test Personnel. The scherlulerl test� shall be conducterl
voltage and frequency that satisfies minimum operating by qualified personnel to keep the machines rearlv to function
f
requirement� o the essential electrical system, the load shall be anrl, in addition, serve to detect causes of malfunction and to
connected automatically to the alternate power source. train personnel in ope1·ating prncedures.
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
2021 Edition
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 (10) Additional task illumination, receptacles, and select
(5) Elevator cab lighting, control, communications, and power cit-cuit� needed for effective facility operation.
signal systems inclurling single-phase fractional horsepower mot01·s,
(6) Elect1·ically powe1·ed doorn used for building eg1·ess which are permitted to be connecterl to the critical
(7) Fire alarms and auxilia1y functions of fire alarm combina branch
tion systems complying with NI-PA 72
2021 Edition
6.7.5.1.4 Equipment Branch. the needs of all confined patienl� rthen only such
room(s) need be heatedl
6.7.5.1.4.1 General. The equipment lxanch shall be connec (3) Elevator(s) selected to provide service to patient, surgical,
ted to equipment desct"ihed in fi.7.5.1.4.3 through G.7.5.1.4.4. obstetrical, and ground floors during
6. 7 .5.1.4.2 Connection to Alternate Power Source. (4) Supply, return, and exhaust ventilating systems for surgi
cal and obstetrical delive1y suites, intensive care, corona1y
(A) The equipment branch shall be installed and connected ca1·e, nurseries , and eme1·gency treatment spaces
to the alternate power source, such that equipment described (:>) H yperbaric facilities
in 6.7.5.1.4.3 is automatically restored to operation at appropri (fi) Hypobaric facilities
ate time-lag intervals following the energizing of the life safety (7) Autoclaving equipment, which is pe1·mitted to be
and c1·itical branches. an-anged fm· either automatic 01· manual connection to
(B) The arrangement of the connection to the alternate the alternate source
powe1· source shall also provide for the subsequent connection ( 8) Controls for equipment listed in fi. 7.5.1.3
of equipment described in fi.7.5.1.4.4. (9)* Other selected equipment
6.7 .5.1.5 Generator load-shed circuits designed for the
6.7 .5.1.4.3* Equipment for Delayed-Automatic Connection.
purpose of load reduction or for load priority systems shall not
(A) The following equipment shall be pe1·mitted to be shed lif·e safetv branch loads, ct"itical branch loads sen,ing Cate
arranged for delayed-automatic connection to the alten1ate gory l spaces. medical ai1· compressors. medical-sut·gical
power source: vacuum pumps, fire pumps, the pressure maintenance (i.e.,
( l) Cenu·al suction systems se1·ving medical and sm-gical func jockey) pump(s) for ,rater-based fire protection systems. gene1·
tions, including controls, with such suction systems ator fuel pumps, or other generator accessories.
permitted to be placed on the critical branch 6. 7.5.2 Wiring Requirements.
(2) Sump pumps and other equipment required to operate
fot· the safety of major apparatus, including associated 6. 7.5.2.1 * Separation from Other Circuits. The life safety
control systems and alarms branch and critical branch shall be kept independent of all
(3) Compressed air systems serving medical and surgical other wiring and equipment.
functions, including controls, with such air systems 6.7 .5.2.2 Mechanical Protection of the Life Safety and Critical
permitted to be placed on the c1·itical branch Branches. l11e wi1·ing of the life safety and ffitical branches
(4) Smoke control and stai1· pressurization systems shall be mechanically protected by raceways, as defined in
(5) Kitchen hood supply or exhaust systems, or both, if NFPA 70.
required to operate during a fire in or unde1· the hood
(6) Supply. return. and exhaust ventilating systems for the 6. 7.5.2.3 Flexible power co1·ds of appliances or other utiliza
following: tion equipment connected to the life safety and critical
(a) i\.irborne infectious/isolation rooms branches shall not he 1·equi1-erl to be enclosed in 1·aceways.
(b) Protective environment rooms 6.7.5.3 Performance Criteria and Testing.
(c) Exhaust fans for laboratory fi.tme hoods
(d) Nuclear medicine areas where radioactive material 6.7.5.3.1 Source. The life safety and critical branches shall he
is used installed and connected to the alternate power source specified
(e) Ethylene oxide evacuation in 6.7.1.1.2 and 6.7.1.1.3 so that all functions specified herein
(f) Anesthetic evacuation for the life safety and critical branches are automatically
restored to operation within 10 seconds after interrnption of
(B) Where delayed-automatic connection is not appropriate, the nm·mal sou1·ce.
the ventilation systems specified in 6.7.5. l.4.3(A)(6) shall he
permitted to be placed on the critical branch. 6.7.6* Type 2 Essential Electrical System Requirements.
6.7.5.1.4.4* Equipment for Delayed-Automatic or Manual 6.7.6.1 Sources. The 1·equiremenl� for smu-ces fot· Type 2
Connection. The following equipment shall be pe1·mitted to essential elecu·ical systems shall confo1·m to those listed in
be arranged for either delayed-automatic or manual connec 6.7. l.
tion to the alternate power source (alm ser A.. 6. 7.5.1.4. 3): 6 .7.6.2 Distribution.
(l) Heating equipment used t o prmide heating for operat
ing, delivery, labor, recovery, intensive care, coronary 6. 7.6.2.1 * Branches.
care, nurseries, infection/ isolation rooms, emergency 6. 7.6.2.1.1 The numbe1· of t1·ansfer switches to be used shall
tt·eatment spaces, and general patient 1·ooms; and pt·es he based upon reliability, design, and load considerations.
sure maintenance Gockey or make-up) pump(s) for
water-based fire protection systems 6. 7.6.2.1.2 The essential electrical system shall he divided into
(2)* Heating of general patient rooms during disrnption of the following two branches:
the normal sou1·ce shall not be 1·equi1·ed under any of the (1) Life safety branch
following conditions: (2) Equipment branch
(a) Outside design temperature ts lower than -G.7'C 6. 7.6.2.1.3 Each branch of the essential electt·ical system shall
(+20'F) have one 01· m01·e transfer switches.
(b) Outside design temperature is lower than -fi.7'C
(+20'F). where a selected room(s) is provided for
2021 Edition
6.7.6.2.1.4 One trnnsfer switch shall be pe1·mitted to serve one (d) Nurses' stations - unless adequately lighted by
or more branches in a facility with a continuous load on the corridor luminaires
switch of 150 kVA (120 kW) m less. (2) Supply, 1·eturn, and exhaust ventilating systems for
ai1·horne i nfectious isolation rooms
6.7.6.2.1.5 Life Safety Branch.
(3) Sump pumps and other equipment required to operate
(A) F01· the pmposes of this code, i\sticle 700 of NFPA 70 shall for the safety of major apparatus and associated control
only be applied to the life safety brnnch. systems and alanns
( 4) Smoke control and stai1· pt·essm·ization systems
(B) The f ollowing portions of Article 700 of 1'.'FPA 70 shall he (5) Kitchen hood supply or exhaust systems, or both, i f
amended as follows: 1·equired to ope1·ate during a fit-e in 01· under the hood
(l) 700.4 shall not appl y. (6) Nu1·se call systems
(2) 700.l0(D)(l) through (D)(3) shall not apply. (7) HVAC systems sening the EF, TER, and TR
(3) 700.l7 Branch circuits that supply emergency lighting (E)* Delayed-Automatic or Manual Connections to Equipment
shall be installed to provide service from a source comply Branch. The equipment in G. 7.6.2.l.6(E) (l) and
ing with 700.12 when the nmmal supply for lighting is G.7.G.2.l.G(E)(2) shall be permitted to be connected to the
interrupted or where single circuits supply luminaires equipment branch and shall be arranged for either delayed
containi ng secondary batte1·ies. automatic or manual connection to the alten1ate powe1· sout·ce:
( 4) 700.32 shall not apply.
(l) Heating Equipmml to Provide Hmting for (',eneml Patient
(C) The life safety branch shall supply power as follows: Rnmm. Heating of general patient rooms during disrup
(l) Illumination of means of eg1·ess in acco1·dance with tion of the normal source shall not be required unde1· any
NFPA 101 of the following conditions:
(2) Exit signs and exit directional signs in accordance with (a)* 1l1e out�ide design temperature is higher than
NFPA 101 -6.7° C (+20° F).
(3) Alarm and alerting systems, including the following: (b) The out�ide design tempernture is lower than
(a) Fire ala rms -G.7'C (+2 0'F) and, where a selected room(s) is
f
(b) Alarms required for systems used for the piping of provided for the needs o all confined patients, then
nonflammable medical gases as specified in Chap only such room (s) need be heated.
ter 5 (c) The facility is se1·ved by a dual sout·ce of n01·mal
( 4)* Communications systems, where used for issuing instruc power. (See A.fi. 7.1.1Jar mm·e information).
tions dut·ing eme1·gency conditions (2)* fievatar Servia. In instances whe1-e interruptions of power
(5) Task illumination and select 1·eceptacles at the generat01· would result in elevat01·s stopping bet\veen flooi-s, throw
set location over facilities shall he provided to allow the tempornry
(6) Elevator cab lighting, conu·ol, communications, and operation of any elevator for the release of passengers.
signal systems (3) optional Connn:tiom to the Equipmmt Bmni:h. Additional
illumination, receptacles, and equipment shall be permit
(D) No functions, other than those listed in G.7.6.2.l.5(C)(l) ted to be connected only to the equipment branch.
through 6.7.6.2.l.5(C) (G), shall be connected to the life safety. (4) J\lf.ultiple Systems. \\'here one switch serves multiple systems
6.7.6.2.1.6 Equipment Branch. as pe1·mitted in 6.7.6.2. trnnsfe1- for all loads shall be
nondelayed automatic.
(A) The equipment branch shall be installed and connected
6.7.6.3 Wiring Requirements.
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 6.7.6.3.1" Separation from Other Circuits. The life safety and
priate time-lag intervals following the restoration of the life equipment branches shall he kept entirely independent of all
safety branch to operation. other wit-ing and equipment.
(B) The equipment branch arrangement shall also provide fot· 6.7.6.3.2" Receptacles. The electt·ical 1·eceptacles or the cover
the additional connection of equipment listed m plates for the electrical receptacles supplied from the life safety
6.7.6.2.l.6(D). and equipment branches shall have a distinctive color or mark
(C) AC Equipment for Nondelayed-Automatic Connection. ing so as to be readily identifiable.
Generntor access01·ies including, but not limited to, the trans 6.7.6.4 Performance Criteria and Testing.
fer fuel pump, electrically operated louvers, and other genera
tor accesso1·ies essential fot· generator operntion shall he 6.7.6.4.1 Source. The lif·e safety and equipment bt·anches
arrnnged for automatic connection to the alternate powe1· shall be installed and connected to the alternate power sout·ce
source. 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
(D) Delayed-Automatic Connections to Equipment Branch. cally 1·esto1·ed to operntion within l 0 seconds after interruption
The following equipment shall be permitted to be connected of the normal source.
to the equipment branch and shall be arranged for delayed
automatic connection to the alternate powe1· sotu-ce: 6.8 Site Acceptance Testing.
(l) Task illumination and select 1·eceptacles in the following: 6.8.1" Site acceptance testing shall be pe1-f01·med on the elec
(a) Patient care spaces trical sy stem and all electrical component� se1ving Category l
(b) Medication p1·epa1·ation spaces and Catego1y 2 spaces.
(c) Pharmacy dispensing spaces
2021 Edition
6.8.1.1 Acceptance testing is requirerl after initial installation 6.9.2.4.2 Archiving of 1·ecords by any means shall be permitted
or major renovation prior to the system being placerl into serv if hard copies of the records can be provirlerl promptly when
ice. requested.
6.8.2* Site acceptance testing procedures shall be in accorrl 6.9.3 Corrective Measures.
ance with inrlustry-recognizerl standards anrl practices for
equipment testing and system commissioning. 6.9.3.1 * Analysis of Inspection, Testing, and Maintenance
f
Reports. Analysis o inspection, testing, anrl maintenance
6.8.3 Site Acceptance Testing Records. 1-eports shall be followed by the implementation ofappropt-iate
corrective mea�ures.
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. 6.9.3.2 All cotTective measures shall be documented in
accorrlance with the 1·equirement� of6.9.2.
6.8.3.2 Site acceptance testing records shall be retained for 5
years. 6. 9.4 EPM Intervals.
6.8.3.3 Record Medium. 6.9.4.1 * EPM inten•als shall be 111 accordance ,,�th Table
6.9.4.l.
6.8.3.3.1 The recorrls shall be on a medium that will survive
the 1·etenti on pe riorl. 6.9.4.2* Alternative Equipment Maintenance (AEM) Program.
6.8.3.3.2 Pape1· or electronic media shall be permitted. 6.9.4.2.1 EPM intervals shall be permitterl to be rleveloperl as
part of an alternative equipment maintenance (AEM)
6.8.3.4 Record Reporting and Archiving. program.
6.8.3.4.1 The 1·ecord shall be available for examination and, if 6.9.4.2.2 The AEM shall inclurle the following element�:
requirerl, reported to the authority havingjurisrliction.
(1 )* l11e AEM program shall be based on accepted standanls
6.8.3.4.2 At·chiving of recorrls by any means shall be permitted ofpractice fot· electt·ical equipment maintenance.
f
if hard copies o the rec01·ds can be provided promptly when (2) The AEM program 1-equirements (including EPM scherl
requesterl. ules) shall be clearly documented and available for
6.9 Electrical Preventive Maintenance (EPM). inspection by the authority havingjtu-isdiction.
(3) The A.EM program shall be developed anrl administererl
6.9.1 EPM Program. by qualified personnel, regardless of whether they are
health care facility employees or contractors.
6.9.1.1 * All electt·ical component� which are part of an elect1·i (4)* l11e AEM program shall consider the typical health anrl
cal system sening a Category l and Category 2 space shall be safety risks associated witl1 the equipment's use, including
part of an electrical preventive maintenance (EPM) program. "critical equipment" for which there exist� a risk of seri
6.9.1.2 The EPM program shall include the following ous i1�ury 01· rleath to a patient or staff person if the
element�: equipment fails.
(l) Listing of all equipment and systems included as part of 6.10 Health Care Microgrids.
the prog1·am
(2) Schedule of inspection, testing, and servicing (mainte 6.10.1 General Requirements.
nance) of equipment 6.10.1.1 Applicability. (Reserved)
(3) Survey and analysis of electrical equipment and systems to
dete1·mine maintenance requirements and pt·iorities 6.10.1.2* Purpose. The pu1-pose of Section 6.10 shall be to
( 4) Scherluled routine inspections and test� describe 1·equirement� fot· multiple�out-ce health care micn>
(5) Review of inspection and test reporl� so that proper grid systems, ac or de, utilizerl as all or a portion of EPSSs for
CotTective measures can be prescribed health care facilities.
(6) Pedormance of necessa1·y work 6.10.1.3* Campuses. Health care microgrirls shall be permit
(7) Complete 1-ecorrls ted to serve ind i\irlual buildings or campuses consisting of
6.9.2 EPM Records. seve1·al buildings.
6.9.2.1 A record of all testing anrl maintenance described in 6.10.1.4 Non-Health Care Buildings. Health ca1·e microgrids
6.9.4 shall be maintained. shall be permitted to sen'e builrlings that fall into multiple use
categories as rlescribed in Chapter 4.
6.9.2.2 EPM program inspection, testing, anrl maintenance
1-ecorrls shall be 1-etained fot· 5 yea1·s. 6.10.2 Sources.
6.9.2.3 EPM Record Medium. 6.10.2.1 All sources shall meet the installation and mainte
nance 1·equi1-ement� of the applicable NFPA code.
6.9.2.3.1 The records shall be on a merlium that will sun,ive
the retention period. 6.10.2.2 Any combination of generation, storage, or transfo1·
mation assets shall be permitterl to serve as the essential power
6.9.2.3.2 Papet· or electronic media shall be permitted. source (EPS) for all or a portion of health care microg1·ids.
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.
2021 Edition
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 6.10.6.3 Design. The <lesign of health care microg1·i<l control
sufficient reliability to provide effective facility operation systems shall inclu<le a sequence of operations for manual
consistent with the facility's emergency operations plan. controlling of sources in the event of system failure.
6.10.3.2* Health care microg1·id system components shall not 6.10.6.4 Controller Backup Power. Health care microg1·id
be compromised by failure of the normal source. controllers shall have a dedicated battery backup having a mini
mum 90-minute capacity.
6.10.4 Interconnection to an Electrical Utility. Health care
microgri<ls that at·e interconnected to an extet·nal elect1·ical 6.10.6.5 Annunciation.
utility shall comply with regulations relevant to the serving util
ity. 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
6.10.5 Distribution System. (Reserved) ating.
6.10.6* Control System. Health care microgri<l control 6.10.6.5.2 The amount of power prm,ided to the health care
systems shall comply with the requirement� of this subsection. microg1·id hy each sou1·ce shall be visible at all times.
6.10.6.1* Network Segregation. 6.10.6.6 Security. (Reserved)
6.10.6.1.1 Health care microgrid control system networks shall 6.10.7 Commissioning. Health care microgrid systems shall be
be seg1·egated from other networks. commissioned in accot·dance with their sequence of opern
tions.
6.10.6.1.2 Intelligence and memory of health care microgrid
control systems shall not be <le pendent on ofl�site resources. 6.10.7.1 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-
2021 Edition
tion of the means an<l metho<ls necessary to document and 6.10.8.4 Health ca1·e microg1·i<l systems shall be 1·ecommis
verify that the system an<l iL� associated controls and safety sioned for operation when the system configuration changes or
systems are in proper working condition. every five years, whichever occurs first.
6.10.7.2 Commissioning Plan. Commissioning plans shall 6.11 Classification of Emergency Power Supply Systems
include the following: (EPSSs).
(l ) An overview of the commissioning process developed 6.1 I.I General. The EPSS shall provide a source of electrical
specifically fot· the health ca1·e microgri<l and it� control power of requi1·ed capacity, 1·eliability, and quality to loads for a
f
ler to be installe<l and a narrative description of the activi length o time as specified in Table 6.11.l (a) and within a
ties to be conducte<l specified time following loss 01· failure of the n01·mal powe1·
( 2)* Roles and responsibilities for all those itn-olved in the supply as specifie<l in Table 6.11.l (b). r110:4.ll
planning, design, construction, installation, and opera
tion of the health care microgri<l 6.11.2 Class. The class <lefines the minimum time, in hours,
( 3) Means and metho<ls whereby the commissioning plan will fot· which the EPSS is designe<l to operate at it� rated load \,�th
he made available du1·ing the implementation of the out being 1·efuele<l or recharged. [See Table 6.11.l(a).J r110:4.2l
health care microgrid project 6.11.3 Type. The type defines the maximum time, in second�,
( 4) Plans and specifications necessary to undei-stand the that the EPSS will permit the load terminals of the transfe1·
installation and operation of the health ca1·e microg1·id sv,�tch to be without acceptable elect1·ical powe1·. Table
and all a�sociated component�. operational controls, an<l 6.11.l (h) provides the types defined by this standard. r110:4.3l
safety systems
(:,) A detailed description of each activity to be conducted 6.11.4 Level. This standat·d recognizes two levels of equip
f
during the commissioning process, who will perfo1·m ment installation, pe1- orma11ce, an<l maintenance. r110:4.4l
each activity, and at what point in time each activity is to
be con<lucted 6.11.4.l Level l systems shall be installe<l where failure of the
(6) Procedures to be used in documenting the prope1· opera equipment to pei-form coul<l result in loss of human life or seri
tion of the health ca1·e microgrid an<l all associated ous injmies. r110:4.4.ll
component�, operational controls, and safety systems 6.11.4.2 Level 2 systems shall be installed where failure of the
(7) Gui<lelines an<l fot·mat ftx a commissioning checklist, EPSS to pedorm is less critical to human life and safety.
relevant operational testing forms, and necessary commis r110:4.4.2l
sioning
(8) Means an<l methods whereby facility operation and main 6.11.4.3 A.ll equipment shall be permanently installed.
tenance staff will be trained on the system r110:4.4.3l
(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 Table 6.11.l(a) Oa.s.sification ofEPSSs
documenting the commissioning process and the results shall
be provided. 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)]
2021 Edition
6.11.4.4 Level 1 and Level 2 systems shall ensure that all loads (F) The EF shall be locate<l in an area not sul�ect to flooding.
served by the EPSS are supplied with alternate power that
meet� all the following criteria: (G) The EF shall be as close as pt·acticable to the building
communications set·vice entrance point.
(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 7.3.1.2.1.5 Working Space. (Reserved)
6.11. l(a) 7.3.1.2.1.6 Security. Access to the EF shall be detet·mined
(3 ) iVithin the time specified for the type as define<l in Table based on a security vulnerability a�sessment.
fi.11. l(b)
fl 10:4.4.4 l 7.3.1.2.1.7 Power Requirements.
(A) Circuit� serving the EF shall be dedicate<l to serving the
Chap ter 7 Information Technology and Communications EF.
Systems
(B) Circuits sening equipment in the EF shall be connected
7.1* Applicability. This chaptet· shall apply to new health care to the critical branch of the essential electt·ical system.
facilities as specified in Section 1.3. (C) A minimum of one duplex receptacle served from normal
7.2 Reserved. power shall be prmided on one wall of the EF for service and
maintenance.
7.3 Category I Systems.
7.3.1.2.1.8 Environmental Requirements.
7.3.1 Information Technology and Communications Systems
Infrastructure. (A) Tempernture and humidity in the EF shall be controlled
in accm·<lance with the manufacturer's equipment requit·e
7.3.1.I Premises Distribution System (Fiber and Copper). ment�.
7.3.1.1.1 Cables and installation shall be in compliance with (B)* HVAC systems sen,·ing the EF shall be connected to the
NFPA 70 and TIA/EIA 568-B, Cmnmen:ial Building 1elPt:mmnuni equipment branch of the essential electrical system.
rations Cabling Standard.
(C)* A positive-pressure <lifferential v.-ith respect to surround
7.3.1.1.2 Distribution s ys tem cable labeling, t·ecord keeping, ing areas shall be provided.
an<l alphanumeric schemes shall be in accm·<lance with
(D) Sprinklers shall be provide<l with wire cages or shall he
TIA/EIA fi0fi-B, Administration Standard for Commm:ial 1;,zffm11-
munirations InfmstrudurP. recesse<l to prevent accidental operation.
7.3.1.2* Telecommunications Sys tems' Spaces and Pathways. 7.3.1.2.1.9 Other Requirements. (Reserved)
7.3.1.2.1 Entrance Facility (EF). 7.3.1.2.2 Telecommunications Equipment Room (TER). Each
facility shall have at least one TER space that meets the mini
7.3.1.2.1.1 General. The EF location shall be permitted to be mum requirement� of this chapter.
combined with the telecommunications equipment room
(TER). 7.3.1.2.2.1 General.
7.3.1.2.1.2 Not less than two physically separnte<l sen:tce (A) The TER houses the main networking equipment and
entrance pathways into this location shall be required. shall be permitted to also house application servers and data
storage devices that serve the health care facilitv.
7.3.1.2.1.3 Remote Primary Data Cen ter. In a facility where
(B) Central equipment for other communications systems
the primaty data centet· is locate<l t·emotely, two EFs and t·e<lun
<lant telecommunications service entrances shall be pro,ided. shall be permitted to be housed in the TER.
7.3.1.2.1.4 Location Requirements and Restrictions. 7.3.1.2.2.2* The EF shall be permitted to be combined with
the TER space.
(A) The EF shall be permitted to be located with the TER.
7.3.1.2.2.3 Reserved.
(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 7.3.1.2.2.4 Location Requirements and Restrictions.
accommodate the telecommunications service pt·ovidei··s space (A) Electrical equipment or fixtures (e.g., trnnsformers, panel
and access requirement�. boa rds, conduit, wiring) that are not <lirectly related to the
(C)* The EF shall be dedicated to low-voltage communication suppon of the TER shall not be installed in, pass through, or
systems. enter the TER.
(B) Any mechanical equipment or fixtures (e.g., water or
(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 drninage piping of any kind, <luctwork, pneumatic tubing) not
suppon of the EF shall not be installe<l in or pass thrnugh the <lirectly t·elate<l to the support of the TER shall not be installed
EF. in, pass through, or enter the TER.
(E) Mechanical equipment and fixttu·es (e.g., water or drnin (C) The TER shall be locate<l in a nonsterile at·ea of the
age piping of any kind, ductwork, pneumatic tubing) that are facility.
not <lirectly related to the support of the EF shall not be in
stalled in, pass through, ot· enter the EF.
2021 Edition
INFORMATION TECHNOLO(;y AND COMMUNICATIONS SYSTEMS 99-93
(D) In geogi-aphic areas prone to huri-icanes or tornadoes. the (E) A TR shall only se1·ve the floor where it is located and shall
TER shall be located away from exterior curtain walls to be located so as to not exceed the maximum cable length in
pi-event wind and ,11ater damage. 7.3.1.2.3.2.
(E) The TER shall he located 01· designed to avoid vibi-ation 7.3.1.2.3.5 Working Space. Wm·king space about communica
from mechanical equipment or other sources. tions cabinet�, racks, or other equipment shall he in accord
ance with l 10.26(A) of NFP/1. 70.
7.3.1.2.2.5 Working Space. \\'orking space about communica
tions cabinets, i-ach, or othe1- equipment shall he in accont 7.3.1.2.3.6 Security. Access to TR� shall be determined based
ance with l l0.26(A) of NFP.A. 70. on a security vulnerability assessment.
7.3.1.2.2.6 Security. Access to the TER shall be dete1·mined 7.3.1.2.3.7 Power Requirements.
ba�ed on a security vulnei-ability assessment.
(A) Circuits serving the TR and the equipment within the TR
7.3.1.2.2.7 Power Req uirements. shall be dedicated to se1·ving the TR.
(A) Ci1·cuit� sening the TER and the equipment within the (B) Cit"Cuit� serving the TR shall be connected to the critical
TER shall be dedicated to serving the TER. branch of the essential electrical system.
(B) Circuits serving other communications equipment in the (C) A minimum of one duplex receptacle shall be prmided in
TER shall be connected to the essential electrical system. each TR and shall be connected to not·mal powe1· fix service
and maintenance.
(C) A minimum of one duplex outlet shall be provided on
each wall and shall be connected to normal power for service 7.3.1.2.3.8 Environmental Req uirements.
and maintenance.
(A) Temperature and humidity in the TR shall be controlled
7.3.1.2.2.8 Environmental Requirements. in accordance with the manufacturer's equipment require
ment�.
(A) Tempei-ature and humidity in the TER shall be controlled
in accordance with the manufacture1·'s equipment 1·equire (B) Spt·inklers shall be provided with wire cages or shall be
ments. recessed to prevent accidental discharge.
(B) HVAC systems serving the TER shall be connected to the 7.3.1.2.3.9 Other Requirements. Suspended ceilings shall not
equipment branch of the essential electrical system. be 1·equired in the EF, TER, and TR.
(C) A positive pressure differential with respect to surround 7.3.1.2.4 Cabling Pathways and Raceway Requirements.
ing areas shall be provided.
7.3.1.2.4.1 Backbone Distribution. Redundant pathways shall
7.3.1.2.2.9 Other Requirements. (Reserved) be provided between the EF and TER.
7.3.1.2.3 Telecommunications Room (fR). 7.3.1.2.4.2 Conduit� shall be provided for cabling in inaccessi
ble ceiling spaces.
7.3.1.2.3.1 General. A TR houses telecommunications equip
ment, cable terminations, and cross-connect cabling. 7.3.1.2.5 Outside Plant (OSP) Infrastructure.
7.3.1.2.3.2 Sufficient TRs shall be provided so that the hori 7.3.1.2.5.1 General. OSP infrastn1cture shall consist of the
zontal cable to any data or communications outlet in the build conduits, vault�. and other pathways and cabling used to
ing can be reached without exceeding 90 m (295 ft) maximum connect buildings on a campus and to provide services from
cable length as tested electrically from the termination point in off-campus service providers.
the TR to the outlet.
7.3.1.2.5.2 Path.ways.
7.3.1.2.3.3 Reserved.
(A) Dual telecommunications service entrance pathways shall
7.3.1.2.3.4 Location Requirements and Restrictions. be pt·mided to the EF.
(A) Switchboards, panelhoards, transformers, and similar elec (B) Service enu·ance pathways shall he a minimum of fl.I m
trical equipment that a1·e not di1·ectly related to the suppon of (20 ft) apart.
the TR shall not be installed in the TR.
(C) Underground conduits for technology systems shall he a
(B) Any mechanical equipment or fixtures (e.g., water or minimum of 0.61 m (2 ft) from underground steam and water
dt·ainage piping of any kind, ductwork, pneumatic tubing) not piping if crossing perpendicularly, and a minimum of 1.83 m
directly related to the support of the TR shall not be installed ( 6 ft) if parallel.
in, pa�s through. or enter the TR.
(D) Underground conduits for technology systems shall be a
(C) In geogi-aphic a1-eas prone to huITicanes or tornadoes. minimum of 0.61 m (2 ft) below grade.
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.
2021 Edition
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) Visual signal in the corridor at the patient room door or
communications shall not serve m01·e than two adjacent berls care space
with calling devices. (2) Visual signals at coITirlor i nte1·sections whe1·e individual
patient room door or care space signals a1·e not di1·ectly
7.3.3.1.2.3* Call stations at patient bed locations shall be visible from the associated nursing station
pe1·mitterl to provide supplemental signaling of merlical device ( 3) Visible anrl audible signals at the nurse maste1· station anrl
alarms. associated duty stations
(4) Visible signals at the calling station from which the call
7.3.3.1.2.4 v\1hen provided, supplemental signaling of a merli
01·iginates
cal device alarm shall be in accorrlance with 7.3.3.1.8.
(5) A \�sual or aural signal indication at each aurlio calling
7.3.3.1.2.5 Bath stations shall be provided at each inpatient station to indicate voice circuit operation
toilet, bath, shower, or sitz bath and shall be accessible to a
patient lying on the floor.
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 99-95
7.3.3.2 Patient Tracking. (Reserved) 7.3.3.7.5* Requirement� for utilizing the independent 1·edun
dant net\vork paths and monitoring the operational integrity of
7.3.3.3 Equipment and As.set Tracking. (Reserved)
the clinical IT net\vork s hall he established in the clinical IT
7.3.3.4 Staff and Visitor Tracking. (Reserved) netwm·k risk management plan maintained by the health care
facility's governing body.
7.3.3.5 Wireless Phone and Paging Integration.
7.3.3. 7.6 An event management process fot· the clinical IT
7.3.3.5.1 Wi1·eless phone and paging systems that a1·e used for net\Vot·k shall be documented by the health care facility's
enhanced clinical staff communications and that can be inte governing body and include at least the following:
grated ,...,jth the nurse call system or with a shared interoperable
clinical IT network shall pro,ide listed electrical safety and FCC (1) Switchover from one pathway to the othe1· when deemed
certifications that a1·e appropt·iate fot· the intended use. necessary
(2) Record all negative events and 1·emediation actions
7.3.3.5.2* Wireless phone and paging systems that are used (3) Report of event�, actions, and findings by the clinical IT
for enhanced clinical stall communications and notification of net\vork 1·isk manage1·
nurse call evenl� or interoperable clinical alarm evenl� shall he (4) Evaluate evenl�, rea�sess risks, and propose appropt·iate
managed and controlled as described in 7.3.3.7.1. changes through change-release management processes
and, t1·ack all cotTective and p1·eventive actions
7.3.3.6 Patient and Equipment Monitori ng Systems.
(Reserved) 7.3.3.B Pharmacy. (Reserved)
7.3.3.7 Clinical Information Systems. 7.3.3.9 Material Management Information Systems. (Reserved)
7.3.3.7.1" The clinical IT network shall be managed and 7.3.3.10 Electronic Medical Records and Dictation Systems.
controlled in accordance with the following: (Reserved)
(1) The overall responsibility for risk management of the 7.3.3.1I Medical Imaging Systems. (Reserved)
clinical IT netwo1·k shall be that of the 1·esponsible 01·gani
zation. 7.3.3.12 Archiving Systems. (Reserved)
(2) The responsible organization shall establish, maintain, 7.3.4 Security Systems.
and be accountable for the clinical IT network risk
management file. 7.3.4.1 Internet Protocol (IP) Security Cameras Systems.
(3) The health care facility's governing body shall be account (Reserved)
able fo1· all policies, resources, and risk management
7.3.4.2 Digital Video Recording. (Reserved)
processes.
(4) The health ca1·e facility's governing body shall appoint a 7.3.4.3 Intrusion Detection Systems. (Reserved)
clinical IT network risk manager.
(5) The clinical IT network risk manager shall be responsible 7.3.4.4 Sitewide Monitoring. (Reserved)
fot· all duties. 7.3.4.5 Access Control Systems. (Reserved)
(fl) Manufacturers for each device placed on the clinical IT
network shall provide all required documentation. 7.3.4.6 ID Badging Systems Integrated with Point of Sales
(7) The health ca1·e facility's governing body shall be account- Systems. (Reserved)
able for document control and procedures.
7.3.4.7 T hreat Protection Systems. (Reserved)
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 7.3.4.B Parking Access Systems. (Reserved)
nurse call system is listed to UL l069, Standard for Hospital 7.4 Category 2 Systems.
Sign aling and Nurw Call Equipmmt, and identified for use in a
shared net\vork e11vit-onment. 7.4.1 InforllUltion Technology and Communications Systems
Infrastructure.
7.3.3.7.3* The clinical IT net\vork shall provide at least t\vo
independent pathways where the operational capability of each 7.4.1.1 Requirements for information technology and
pathway to each device shall be verified through end-to-end communications systems infra�tructure shall be in accordance
communication. with 7.3.1, except as specified in 7.4.1.1.1.
7.3.3.7.3.1 \\'here one single addressable device is served 7.4.I.I.I Redundant patlm0dys and cabling for the backbone
(e.g., an end-point te1·minal device \,,jth a single connection to distribution system shall not be required.
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.
2021 Edition
7.4.2 Voice, Data, Communications, and Cable Television 7.5.1.1.1 Dual service entrnnce pathways into the EF are not
Systems. required.
7.4.2.1 Voice/Telecommunications. (Reserved) 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
7.4.2.2 Local Area Networks (LANs). (Reserved)
electrical system.
7.4.2.3 Wireles.s Local Area Network (LAN) S ystems and Public 7.5.1.1.3 HVAC systems serving the EF, the ER, and TR� shall
WiFi Hot Spots. (Reserved)
not be required to be connected to the essential electric al
7.4.2.4 Wrreles.s Voice Systems and In-Building Cellular system.
Networks. (Reserved)
7.5.1.1.4 Redundant pathways and cabling for the backbone
7.4.2.5 Cable Television. (Reserved) distribution system shall not be requi1·ed.
7.4.3 Other Communications Systems. 7.5.2 Voice, Data, Communications, and Cable Television
Systems.
7.4.3.1 Nurse Call Systems.
7.5.2.1 Voice/Telecommunications. (Reserved)
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. 7.5.2.2 Local Area Networks (LANs). (Reserved)
7.4.3.1.2 Provisions for medical de'vice alarms and code calls 7.5.2.3 Cable Television. (Reserved)
shall not be 1·equired. (Sff 7.3.3.1.1.3.) 7.5.3 Other Communications Systems.
7.4.3.2 Patient lracking. (Reserved) 7.5.3.1 Nurse Call Systems. (Reserved)
7.4.3.3 Equipment and &set Tracking. (Reserved) 7.5.3.2 Electronic Medical Records and Dictation Systems.
7.4.3.4 Staff and Visitor lracking. (Reserved) (Reserved)
7.4.3.5 Wrreles.s Phone and Paging Integration. Wireless 7.5.3.3 Medical Imaging Systems. (Reserved)
phone and paging integration systems shall be in acconfance 7.5.3.4 Archiving Systems. (Reserved)
with 7.33.5.
7.5.4 Security Systems.
7.4.3.6 Patient and Equipment Monitoring Systems.
(Reserved) 7.5.4.1 Internet Protocol (IP) Security Cameras Systems.
(Reserved)
7.4.3.7 Clinical Information Systems. Clinical info1·mation
systems shall be in accordance with 7.:1.3. 7. 7.5.4.2 Digital V ideo Recording. (Reserved)
7.4.3.8 Electronic Medical Records and Dictation Systems. 7.5.4.3 Intrusion Detection Systems. (Reserved)
(Reserved)
7.5.4.4 Access Control Systems. (Reserved)
7.4.3.9 Medical Imaging Systems. (Reserved)
7.4.3.10 Archiving Systems. (Reserved) Chapter 8 Plumbing
7.4.4 Security Systems. 8.1 Applicability.

7.4.4.1 Internet Protocol (IP) Security Cameras Systems. 8.1.1 This chapter shall apply to construction of new health
(Reserved)
care facilities, except as noted in 8.1.2 and 8.1.:l.
7.4.4.2 Digital V ideo Recording. (Reserved) 8.1.2 This chapter shall also apply to the alte1·erl, renovated,
7.4.4.3 Intrusion Detection Systems. (Reserved) or modernized ponions of existing systems 01· individual
component�.
7 .4.4.4 Sitewide Monitori ng. (Reserved)
8.1.3 A.n existing system that is not in sn·ict compliance with
7.4.4.5 Access Control Systems. (Reserved) the prmisions of this code shall be permitted to be continued
7.4.4.6 ID Badging Systems Integrated with Point of Sales
in use, unless the authority ha'vingjurisdiction has determined
Systems. (Reserved) that such use constitutes a distinct hazard to life.
8.2 System Category Criteria. The health care facility's
7.4.4.7 Threat Protection Systems. (Reserved)
governing body that has the 1·esponsibility fo1· the building
7.4.4.8 Parking Access Systems. (Reserved) system componenrn as identified in this chapter shall designate,
in accordance with the function of each space, building system
7.5 Category 3 Systems. categories in accm·rlance with Sections 4.1 and 4.2.
7.5.1 Information Technology and Communications Systems
Infrastructure.
8.2.1* The category of risk applied to each plumbing system
serving a space shall be independent of the categm·y of risk
7.5.1.1 Requirements for i11fo1·mation technology and applied to othe1· systems serving that same space.
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
HEATIN(;, VENTILATION. AND AIR CONDITIONING (H\�C) 99-97
8.3 General Requirements. izes the \\'ater in a breathing zone or has direct contact with
humans.
8.3.1 Potable Water. Potable water systems shall comply with
applicable plumbing codes and the applicable volume of FGI 8.3.11.4 Excess clear waste wate1· shall be discha1·ged to a
guidelines. st01·m sewe1·. held in detention ponds, 01· recharged into the
water table as permitted by applicable plumbing codes.
8.3.2 Nonpotable Water. Nonpotahle water systems shall
comply with applicable plumbing co,les and the applicable 8.3.12 Drainage S ystems. Drainage systems shall comply with
volume ofFGl guidelines. applicable plumbing codes and the applicable volume of FGl
guidelines.
8.3.3 Water Heating. Maximum hot water temperatm·es shall
comply with applicable plumbing codes and the applicable 8.4 Category I. (Reserved)
volume of FGI guidelines.
8.5 Category 2. (Reserved)
8.3.4 Water Conditioning. \,Vate1· shall be treated or heated to
control pathogens in the water. 8.6 Category 3. (Reserved)
8.3.5 Nonmedical Compres.sed Air.

Ch.apter 9 Heating, Ventilation, and Air Conditioning (HVAC)
8.3.5.1 Nonmedical ai1· compressors shall be listed or
approved. 9.1 Applicability.
8.3.5.2 Nonmedical compressed air shall not be used for 9.1.1 This chapter shall apply to construction of new health
powe1·ing medical instrnmenl� 01· fo1· human respirntion. ca1·e facilities, except as noted in 9.1.2 and 9.1.:1.
8.3.5.3 Nonmedical compressed ai1· shall meet the quality and 9.1.2 This chapter shall also apply to the altered, renovated,
pressure requirement� of the equipment connected to the or modernized portions of existing systems or individual
system. component�.
8.3.6 Special Use Water Systems. \-\'hen special use water 9.1.3 A..11 existing system that is not in su-ict compliance with
systems are required, the applicable volume of FGI guidelines the provisions of this code shall be permitted to be continued
01· the applicable ANSI-1·eviewed standard shall be followed. in use, unless the authority ha\ing jurisdiction has dete1·mined
that such use constitutes a distinct hazard to life.
8.3.7 Grease Interceptors.
9.2 S ystem Category Criteria. The health care facility's
8.3.7.1 Sizing for grease interceptors shall be pe1·mitted in governing body that ha� the responsibility for the building
acc01·dance with local plumbing codes 01· an engineered calcu system componenl� as identified in this chapter shall designate.
lation fact01·ing meals served per day. in accordance with the function of each space, building system
8.3.8 Fixtures. Plumbing fixtures shall be in accordance with categ01·ies in accordance with Sections 4.1 and 4.2.
the applicable volume of FGI guidelines. 9.2.1 * The categ01·y of risk applied to each HVAC system se1·v
8.3.9 Black Waste Water. Black waste water shall be ing a space shall be independent of the category of risk applied
discha1·ged to a sanitary sewer or private on-site waste u·eatment to other systems sening that same space.
system as pe1·mitted by applicable plumbing codes. 9.3 General.
8.3.10 Gray Waste Water. 9. 3. 1 Heating, Cooling, Ventilating, and Proces.s Systems.
8.3.10.1 Grny \\'aste water shall he permitted to he stored on 9.3.1.1 Heating, cooling, ventilating, and process systems serv
site and used for nonpotable water systems as permitted by ing spaces or providing health care functions covered by this
applicable plumbing codes. code or listed within ASHAAE 170, Ventilation of Hmlth Cart
8.3.10.2 Grny waste water shall not be used f01· any system that Facilities, shall be provided in accordance with ASHRAE 170.
aerosolizes the water in a breathing zone 01· has direct contact 9.3.1.2 Laborntories shall comply with NFPA 45.
with humans.
9.3.1.3* Anesthetizing Locations. A.nesthetizing locations
8.3.10.3 Excess grny wa�te water shall be discharged to a sani shall not be 1·equi1·ed to have a smoke purge system.
tary sewe1· or private on-site wa�te treatment system as permit
ted by applicable plumbing codes. 9.3.2 Energy Conservation. Heating, cooling, and ventilating
srtems serving spaces 01· providing health care functions
8.3.11 Oear Waste Water. covered by this code shall comply with ASHRA.E 90.1, EnPrgy
8.3.11.1 Clear waste water shall be permitted to be stored on Standard for Buildings 1'.xa•pt Lm,,-Rw RPsidPntial Buildings, m
site and used for nonpotable water systems as permitted by another locally adopted energy code.
applicable plumbing codes. 9.3.3 Commissioning.
8.3.11.2 Clear wa�te water that has been treated to potable 9.3.3.1 Heating. cooling, ventilating, and process systems serv
water standards shall be permitted to be used as nonpotable ing spaces or providing health care functions cove1·ed by this
wate1·. code shall be commissioned in acc01·dance with ASHRA.E 90.1,
8.3.11.3 Clear waste water that has not been u·eated to potable EnPrgy Standardf()r Buildings Exapt Low-Ri�P RPsidmtial Buildings.
water standards shall not be used for any system that aerosol- 9.3.3.2* Commissioning shall follow any publicly 1·eviewed
document acceptable to the authority havingjm·isdiction.
2021 Edition
9.3.4 Piping. Heating. cooling, ventilating. aml process 9.3.6.5.3.3 Mechanical exhaust inlets shall be unobstrncted
systems serving spaces or providing health care functions and shall draw air from within 300 mm (1 ft) of the floor and
covered by this code shall utilize piping systems complying with adjacent to the cylinder 01· containers.
applicable mechanical co<les.
9.3.6.5.3.4 Mechanical exhaust air fans shall be supplied with
9.3.5 Ductwork. Heating, cooling, ventilating, an<l process electrical power from the essential elecu·ical system. \-\'here an
systems se1·ving spaces or providing health ca1-e functions essential electrical system is not provided, a risk assessment
covered by this code shall utilize ductwm·k systems complying shall be conducted to dete1·mine if continuous ventilation shall
with NFPA 90A or applicable mechanical codes. be provi<le<l by alternate means.
9.3.6 Medical Gas Storage or Transfilling. 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
9.3.6.1 All ga�es, othe1· than medical gases, shall be provided contain combustible or flammable materials.
with ventilation per NFPA 55.
9.3.6.5.3.6 The exhaust duct material shall be noncombusti
9.3.6.2 Outdoor stornge/installations fot· me<lical gases an<l ble.
cryogenic fluids shall be provided with ventilation per
NFPA 55. 9.3.6.5.3.7 A means of make-up air shall be prmided accord
ing to one of the following:
9.3.6.3* Medical ga�es and ct"yogenic fluids that are in use pet·
Chapter 11 shall not reguire special ventilation. ( l) Air shall be permitted via noncombustible <luctwork to be
transferre<l from aqjacent spaces, from out�ide the build
9.3.6.4 Transfilling a1·ea shall be provide<l with ventilation in ing, or from spaces that do not contain combustible or
accordance with NFPA 55. flammable mate1·ials.
9.3.6.5 In<loor storage or manifold areas an<l storage or mani (2) Air shall be pe1·mitted to be transferre<l from a corridor
fold buildings fix medical gases and cryogenic fluids shall be under the door up to the greater of 24 L/sec (50 cfm) or
provided with natural ventilation or mechanical exhaust venti 15 petTent of the room exhaust in accordance ½':ith
lation in acc01·<lance with 9.3.6.5.l through 9.3.6.8. NFPA 90A.
(3) Supply air shall be permitted to be provi<le<l from any
9.3.6.5.1 * For the purposes of this section the volume of fluid building ventilation system that <loes not contain flamma
(ga� and liguid) to be used in detennining the ventilation ble m· combustible vapors.
reguirement� shall be the volume of the stm·ed fluid when
expande<l to st an<lard temperature an<l pressure (STP) of 9.3.6.6 Discharge from the natural an<l mechanical ventilation
either the largest single vessel in the enclose<l space or of the systems shall be site<l by a minimum sepa1·ation distance in
entire volume of the connecte<l vessels that are on a common accordance with NFPA 55.
manifold in the enclosed space, whichever is larger. 9.3.6.7 A storage room shall maintain a temperature not
9.3.6.5.2 Natural Ventilation. greate1· than 52"C ( 125'F).
9.3.6.5.2.1 Natural ventilation shall consist of two nonclosable 9.3.6.8 A transfer or manifol<l room shall maintain a tempera
louvered openings, each having an aggregate free opening area ture not greater than 52 ° C (125'F) and not less than -i'C
(20 ° F).
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 9.3.7 Waste G�.
(72 in.�).
9.3.7.1 Removal of excess anesthetic gases from the anesthesia
9.3.6.5.2.2 One opening shall be locate<l within 30 cm ( l ft) circuit shall be accomplished by waste anesthetic gas disposal
of the floor, and one shall be located within 30 cm (1 ft) of the (WAGD), as <lesc1·ihe<l in Chapter 5, m· by an active or passive
ceiling. scavenging ventilation system.
9.3.6.5.2.3 The openings shall be locate<l to ensure cross 9.3.7.I.I Active Systems. A dedicated exhaust system \\':ith an
ventilation. exhaust fan shall be provided to interconnect all of the anes
thesia gas circuit� to provide sufficient airflow and negative
9.3.6.5.2.4 Natural ventilation openings shall he <li1·ectly to the pr·essure in the gas disposal tubing so that cross contamination
out�ide atmosphe1·e without ductwork. <loes not occut· in the other· ci1·cuit� connecte<l to the system.
9.3.6.5.2.5 Mechanical ventilation shall he prmided if natural 9.3.7.1.2 Passive Systems.
ventilation reguirement� cannot he met.
9.3.7.I.2.I A dedicated exhaust system with an exhaust fan
9.3.6.5.3 Mechanical Ventilation. shall be provided to exhaust snorkels at all of the anesthesia gas
9.3.6.5.3.1 Mechanical exhaust to maintain a negative pres circuits to provi<le sufficient airflow to capture the gases,
sure in the space shall be provided continuously, unless an vapors, and pa1·ticles expelled from the gas <lisposal tubing.
alternative design is approved by the authority having jut·is<lic 9.3. 7.1.2.2 The snorkel shall include a minimum 25.4 mm
tion. (1 in.) diameter tubing connecte<l to the exhaust system.
9.3.6.5.3.2 Mechanical exhaust shall be at a rate of l L/sec of 9.3. 7.2 All the exhausted ai1· shall be vented to the external
airflow for each 300 L (1 cfm per 5 ft3 of flui<l) designed to be atmosphe1·e.
stored in the space and not less than 24 L/sec (50 din) nm·
mme than 235 L/sec (500 cfin).
2021 Edition
ELECTRlCAL EQUlPMENT 99-99
9.3.7.3 The excess anesthetic ga�es shall be deposited into the vicinity shall be provided with a tlu·ee-wire powe1· cot·d and a
exhaust stream either at the exhaust grille or further down three-pin grounding-type plug.
stt·eam in the exhaust duct.
10.2.2.1.2 Double-insulated appliances shall be pe1·mitted to
9.3.8 Medical Plwne Evacuation. have two conductor cords and shall be rated as Class II devices.
9.3.8.1" Plumes from medical procedures, including the use 10.2.2.2 Attachment Plugs. Attachment plugs listed for the
of lase1·s, shall he captut·ed by one of the following methods: purpose shall be used on all cord-connected appliances.
( l )* Dedicated exhaust system that discharges in accordance 10.2.2.3 Construction and Use. The attachment plug shall be
with 9.3.8.2 a tw"O--pole, three-wi1·e grounding type.
(2) Connection and return or exhaust duct after air cleaning
through HEPA and gas phase filtration 10.2.2.3.1 Appliances supplied by othe1· than 120-V single
(3) Point of use smoke evacuator for air cleaning and return phase systems shall use the grounding-type plug (cap) appro
to the space priate fo1· the particula1· power system.
9.3.8.2 The exhaust shall be located as follows: 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
(I) Outdoors receptacle.
(2) At least 75 m (25 ft) from any door, window, air intake,
or othe1· openings in buildings tll" places of public assem I0.2.2.3.3 If sct"ew terminals a1·e used, the stt·anded conduct01·
bly shall be twisted to prevent stray strand�. but the bundle shall
(3) At an elevation diflerent from ai1· intakes not be tinned after twisting.
(4) \'\'he1·e prevailing winds, adjacent huildings, topography,
or other influences will not divert the exhaust into occu I 0.2.2.3.4 If the conducto1· is not twisted, it shall be attached
pied area� or prevent dispersion of the exhaust hy an approved terminal lug.
9.3.9 Emergency Power System Room. Heating, cooling, and 10.2.2.3.5 The powe1· cord conduct01·s shall be arranged so
ventilating of the emergency powe1· system shall be in accord that the conductors are not under tension in the plug.
ance with 6. 7.1.3.4. 10.2.2.3.6 The grounding conductor shall be the last one to
9.3.10 Ventilation During Construclion. Ventilation during disconnect when a failure of the plug's strain 1·elief allows the
construction shall comply with the applicable volume of FGI energized conductors to be disrupted.
guidelines. 10.2.2.3. 7 Strain Relief. Strain relief shall be provided.
9.4 Category I. (Reserved) 10.2.2.3.7.1 The strain relief shall not cause thinning of the
9.5 Category 2. (Reserved) conductor insulation.
9.6 Category 3. (Reserved) 10.2.2.3.7.2 The strain relief of 1·eplaceable plugs shall be
capable of being disassembled.
Chapter 10 FJectrical Equipment 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. I* Applicability. 10.2.2.3.8 Tesling. The wiring of each cord assembly shall be
IO.I.I TI1is chapter shall apply to the performance, mainte tested for continuity and polarity at the time of manufacture,
nance, and testing of electrical equipment in new and existing when assembled into an appliance, and when repaired.
health ca1·e facilities. 10.2.3 Power Cords.
10.1.2 Experimental or research apparatus built to or<ler or 10.2.3.1 Material and Gauge.
unde1· development shall be used unde1· qualifie<l supervision
an<l shall have a deg1·ee of safety that is equivdlent to that 10.2.3.1.1 The flexible cord, including the grounding conduc
<lescrihed herein or that has been deemed acceptable by the tor, shall be of a type suitable for the particular application;
facility. 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
10.1.3* Reserved. ampacity, as given in Table 400.5(A) of NFP./1. 70, equal to m
10.2 Performance Criteria for Patient Care-Related FJectrical greater than the current rating of the device.
Appliances and Equipment. 10.2.3.1.2 "Hard Service" (SO, ST. or STO). 'Junim Ha1·d
10.2.1 Perffillllently Connected - Fixed Equipment. Patient Se1·vice"' (SJO, SJf, or �TO), 01· equivalent listed flexible cmd
connected electric appliances shall be grounded to the equip shall be used , except where an appliance with a cor<l of
ment grounding bus in the distribution panel by an insulated anothe1· designation has been listed fot· the purpose.
grounding conduct01· run with the power conductors. I0.2.3.2 Grounding Conductor.
10.2.2 Cord- and Plug-Connected - Portable Equipment. 10.2.3.2.1 Each electric appliance shall be provided with a
I 0. 2. 2.1 Grounding of Appliances. grounding conduct01· in its powe1· cord.
10.2.2. I. I All cor<l-<:onnected electrically powered appliances 10.2.3.2.2 The grounding conductor s hall be not smaller than
that a1·e not double insulated and are used in the patient ca1·e 18AWG.
2021 Edition
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

10.2.4.2.2 Attachment plugs an<l fittings shall be liste<l for the
purpose.
accidental disconnection would not present an unacceptable
hazatTI 01· if a mechanism that reliably prevents ina<lvertent 10.2.4.2.3 The cabling shall comply �th 10.2.3.
disconnection is used.
10.2.4.3 Oved1ead powe1· receptacles shall be permitte<l to be
10.2.3.3.2 Detachable power cords shall be designed so that supplied by a flexible cord with strain 1·elief (ceiling drop) that
the grounding conductot· is the first to be connected and the is connected at a ceiling-mounted junction box in either of the
last to be disconnected. follm\1ng w ays:
10.2.3.3.3 The cord set to the appliance shall be listed for the (1) Pe1·manenti y
purpose. (2)* Utilizing a locking-type attachment plug cap an<l recepta-
cle combination, or other metho<l of retention
10.2.3.4 Connection to Circuit and Color Codes.
10.3 Testing Requirements - Patient Care-Related Electrical
10.2.3.4.1Power cot·ds, rega1·dless of whether intended fot· use
Appliances and Equipment.
on grounded or isolate<l power systems, shall he connected in
accordance "1th the conventions of a grounded system. *
10.3.1 Physical Integrity. The physical integrity of the power
cord assembly composed of the power cord, attachment plug,
10.2.3.4.2 lhe circuit con<luctors in the cord shall be connec an<l cord-strain 1·elief shall be confirmed by visual inspection.
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 10.3.2* Resistance.
connected to the ungrounded conductm·:
10.3.2.1 For appliances that a re used in the patient care vicin
( 1) Center contact of an Edison b ase lampholder ity, the resistance between the appliance chassis, or any
(2) Solitary fuseholder exposed conductive sudace of the appliance, an<l the ground
(3) Single-pole, ovet-cun-ent protective <levice pin of the attachment plug shall be less than 0.50 ohm un<ler
(4) Any othe1· single-pole, current-inten-upting device 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. 10.3.6.3 An acceptable test configurntion shall be as illustrnted
in Fi gu re l0.3.6.3.
10.3.4.1 Permanently wfred appliances in the patient ca1·e
vicinity shall be tested p1·i01· to installation while the equipment 10.3.6.4 The leakage cuITent shall not exceed LOO µA fo1·
is temporarily insulated from ground. ground wi1·e closed and 500 �Lo\ ac for ground ,\lire open.
10.3.4.2 The leakage current flowing through the ground 10.4 Nonpatient Electrical Appliances and Equipment.
conductm· of the power supply connection to ground of perma
nently wired appliances installed in Categmy l or Categmy 2 10.4.1 Permanently Connected -Fixed. (Reserved)
spaces shall not exceed IO.O mA (ac or de) with all grounds 10.4.2 Cord- and Plug-Connected - Portable Equipment in
lifted. Patient Care Vicinity.
10.3. 5 Touch Current -Portable Equipment. 10.4.2.1 Nonpatient care-related electrical equipment, includ
10.3.5.1 Single Power Cord Supplying Power. If multiple devi ing facility- or patient-owned appliances that are used in the
ces are connected together and one powe1· cm·d supplies patient ca1·e vicinity and ,viii, in rnKmal use, contact patient�,
f
powe1·. the touch current shall be measu1·ed as an assembly. shall be visually inspected by the patient's care staf or othe1·
personnel.
10.3.5.2 Mult iple Power Cords Supplying Power. ·when multi
ple devices are connected together and mm·e than one power 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
cm·d supplies power, the devices shall be separnted into groups
according to their power supply cord, and the touch current service or reported to the appropriate maintenance staff
shall he measured independently fo1· each group a5 an assem 10.4.2.3 Household 01· office appliances not commonly e
bly. quipped with grounding conductors in their powe1· cords shall
10.3.5.3 Touch Leakage Test Procedure. Measurement� shall be permitted, provided that they are not located \\/ithin the
be made using the circuit, such as the one illustrated in Figm·e patient ca re vicinity Double-insulated appliances shall be
10.!l.5.3, with the appliance ground brnken in tw'o modes of pe1·mitted in the patient ca1·e "icinity.
appliance operation as follows : 10.5 Administration.
( l) Powe1· plug connected 1101·mally with the appliance on 10.5.1 R esponsibilities of the Health Care Facility's Governing
(2) Powe1· plug connected nmmally with the appliance off (if Body. (Reserved)
f
equipped with an on/of switch)
10.5.2 Policies.
10.3.5.3.1 If the appliance has fixed redundant grnunding
(e.g., permanently fastened to the grnunding system), the 10.5.2.1 Testing Intervals.
touch leakage cmTent test shall be conducted with the redun
dant grounding intact. 10.5.2.1.1 The facility shaft establish policies and protocols to
identify what patient ca1·e-1·elated electrical equipment
10.3.5.4"' Touch Current - Portable Equipment. The touch 1·equi1·es pe1·iodic inspection and. whe1·e applicable, the type of
cmTent for cord connected equipment shall not exceed 500 µA test and intervafs of testing.
,vith normaf polarity and the ground wire disconnected (if a
grnund wire is provided). 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
10.3.6* Lead Leakage Current Tests and Limits - Portable I0.3.5.3 m 10.3.6 befo1·e being put into senice for the first time
Equipment. and after any repair or modification that might have compro
mised electrical safety.
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.
Patient lead selector
10.3.6.2 The leakage cutTent between all patient leads This connection is at switch (if any) Patient-
the service entrance (activated as required) connected
connected together and ground shall be measured with the leads
or on the supply side .
ground switch open and ,vith the ground switch closed. 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
I 0.5.2.2* Protection of Patients with Direct Electrical Pathways (13) Preventive an<l c01-rective maintenance. inspection. and
to the Heart. Only equipment that is specifically designe<l for repair proce<lures
the put-pose fi.e., prmide<l with suitable isolated patient lea<ls
or connections (ca1·diac floating, also known a� CF, acco1·<ling
10.5.4 Administration of Oxygen Therapy.
to ANSI/AAMI ES60601- l, MNliral Plertriral equipm,mt - Part I: 10.5.4.1 Electrical Equipment in Oxygen-Enriched Atmos
(',eneral m1uirnnmt� for basir safety and essmtial pr,rfrmnanre) l shall pheres. Appliances, or a part(s) of an appliance or a system
be connecte<l directly to electt-ically conductive pathways to a (e.g., pillow speaker, remote control, pulse oximete1· prnbe), to
patient's hean. be used in the site of intentional expulsion shall comply with
one of the following:
10.5.2.3 Adapters and Extension Cords.
( l) They shall be listed for use in oxygen-enriched atmos
10.5.2.3.1 A<lapters and extension c01·ds meeting the require
phe1·es.
ment� of 10.2.4 shall be permitted to be used.
(2) They shall be sealed so as to prevent an m..-ygen-enriched
10.5.2.3.2 1l1ree- to two-prong adapters shall not be pe1·mit atmosphere from 1·eaching elec trical components, 'll>ith
ted. sealing mate1·ial of the type that will still seal even after
repeated exposu1·e to water, oxygen, mechanical vibra
I 0.5.2.3.3 The ·wiring shall be tested for all of the following: tion, an<l heating from the external circuitry.
( l) Physical integ1-ity (:I) They shall be ventilate<l so as to limit the oxygen concen
(2) Polarity tration sut-rounding electt·ical components to below
(3) Continuity of grounding at the time of assembly and peri- 23.5 percent by volume.
odicall y the1·eafte 1· ( 4) They shall have both of the following characte1·istics:
°
(a) No hot surfaces over 300'C (573 F), except for
10.5.2.4 Devices Likely to Be Used During De.fibrillation.
small (less than 2 \'\') hermetic ally sealed heating
Devices that are critical to patient safety and that a re likely to
elements, such as light bulbs
be attached to the patient when a defibrillat01· is use<l (such a�
(b) No expose<l switching 01· spa1·k.ing points of electt·i
ECG monitors) shall be marked as "defibrillation prnof," a�
cal energy that fall to the 1·ight of the curve fo1· the
<lefined in ANSI/ AAMI ES60601- l, lvlediral flfftriml NJ1tipment
appropriate type of circuit illustrated in Figure
- Part 1: (',eneral m1uimn,mts for basir sapty and r,ssmtial perform
10.5.4. l (a) thrnugh Figure 10.5.4. l (f), with the <le
anre.
(or peak ac) open-ci1-cuit voltage and short-ci1·cuit
10.5.2.5* System Demonstration. Any system consisting of cuITent required to be used
several electric appliances shall be <lemonstrated to comply
with this code as a complete system.
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
I 0.5.2.6 Appliances Not Provided by the Facility. Policies shall the control 01· signal leads shall be 1·equired to comply with
be established for the control of appliances not supplied by the 10.5.4. l .
facility.
10.5.4.3 Subparagrnphs 10.5.4. l an<l 10.5.4.2 shall not apply
10.5.3 Servicing and Maintenance of Equipment. to small (less than 2 \Al), hermetically sealed heating element�
s uch as light bulbs.
10.5.3.1 The manufacturer of the appliance shall fi.m1ish
document.� containing at least a technical <lescription, instruc 10.5.4.4 Electrical equipment sold '111th the intent to be used
tions fo1· use, and a means of contacting the manufactu1·e1·. in oxygen-enriche<l atmospheres shall he liste<l for use in
oxygen-enriche<l atmospheres.
10.5.3.2 The document� specifie<l in 105.3. l shall inclu<le the
following, where applicable: 10.5.4.5* Elec trical equipment used \\1thin oxygen delivery·
equipment shall be listed for use in O>..')'gen-enriched atmos
( l) Illustrations that show the location of controls
pheres in accor<lance with ANSI/AA.Ml ES60601- l, Mediral Plff
( 2) Explanation of the fimction of each control
triral equipmmt - Part 1: (',ennal requireml'nts fnr basir. sapty and
(3) Illustt·ations of prnpe1· connection to the patient 01·
essential pPrfo rmanre.
other equipment, 01· both
( 4) Step-by-step proce<lures for testing an<l proper use of the 10.5.4.6* High-energy-delivering probes (such as defibrillator
appliance paddles) 01· othe1· electrical <levices that do not comply with
(5) Safety considerntions in use and servicing of the appli 10.5.4. l an<l 10.5.4.2, that a1·e deeme<l es sential to the care of
ance an indivi<lual patient, an<l that must be use<l within an a<lminis
(6) Precautions to be taken if the appliance is use<l on a tt·ation site or within oxygen-delivery· equipment shall be
patient simultaneously with other electt·ic appliances permitted.
(7) Schematics, wiring diagrams, mechanical layout�. pa1·t�
list�. an<l other pertinent <lata for the appliance 10.5.5 Laboratory.
(8) Instructions for cleaning. disinfection, or sterilization
10.5.5.1* The laboratory· shall establish policies and protocols
(9) Utility supply requi1-ements (electrical, gas, ventilation,
for the type of test an<l intei-vals of testing fo1· appliances.
heating, cooling, and so forth)
( 10) Explanation of figures, symbols, and abbreviations on I 0.5.6 Record Keeping - Patient Care Appliances.
the appliance
( 11) Technical perforn1ance specifications
10.5.6.1 Instruction Manuals.
(12) Instructions for unpacking, inspection, installation, 10.5.6.1.1 Instruction and maintenance manuals shall be
adjustment, and alignment accessible to the group 1·esponsible fo1· the maintenance of the
appliance.
2021 Edition
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 10.5.7 Use. (Reserved)
accessible to the user.
I 0.5.8 Qualification and Tuaining of Personnel.
10.5.6.1.3 Any safety labels an<l condensed operating instruc
tions on an appliance shall be maintaine<l in legible condition. 10.5.8.1* Pe1·sonnel concerned for the application 01· mainte
nance of electric appliances shall he trained on the risks associ
10.5.6.2* Documentation. ated \,�th their use.
10.5.6.2.1 A 1·econi shall be maintaine<l of the tests requi1·ed 10.5.8.1.1 The health care facilities shall provi<le programs of
by this chapter and associated repairs or modifications. continuing e<lucation for it� pe1·s01rnel.
10.5.6.2.2 At a minimum, the rec01·d shall contain all of the 10.5.8.1.2 Continuing e<lucation programs shall include peri
following: odic review of manufacturers' safety guidelines and usage
( l) Date requi1·ement� for electrosut·gical units and similar appliances.
(2) Unique identification of the equipment tested 10.5.8.2 Personnel involve<l in the use of energy-delivering
(3) In<lication of which items have met or have failed to meet de½ces including, but not limited to, elecu·osut·gical, sut·gical
the performance requirements of Section l 0.2 laser, and fihe1°optic <levices shall 1·eceive pe1·iodic training in
10.5.6.3 Records Retention. l11e reco1·ds shall he maintained fire prevention an<l suppression.
an<l kept for a period of time in acc01·dance with a health ca1·e 10.5.8.3* Equipment shall be sen-ice<l by qualified personnel
facility's recor<l retention policy. only.
2021 Edition
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
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
Chapter 11 Gas Equipment 11.2.9 Cylindet· valve outlet connections fot· nitrous oxide
shall be Connection No. 326 or Connection No. 910 as de
11.1 Appli cability. sct"ibed in the mandatory t·equirement� of CGA V-1, Standardfor
Cmnpm��ed Gas Cylinder ValvP Out!Pt and InM Conntr.tions (ANSI
11.1.1 This chapter shall apply to the performance, mainte B57. l).
nance. and testing of gas equipment in new and existing health
care facilities. 11.3 Cylinder and Container Storage Requirements.
11.1. 2* This chapter shall apply to the use, at nm·mal atmos 11.3.1 For the put·pose of this section, the health care facility's
f
pheric pressure, o all of the following: governing body shall define criteria for determining full cvlin
( 1) Nonflammable medical g-ases ders and containet·s.
(2) Vapors and aerosols 11.3.2 Full cylinders and containers shall be stored in accm·d
(3) Equipment required for the administration of 11.1.2(1) ance with this section.
and 11.1.2(2)
11.3.3 Full cylinders and containet·s shall be segt·egated from
11.1.3 When used in this chapter, the tet·m oxygim shall be all others.
intended to mean oxygen USP as well as mixtures of oxygen
and air. 11.3.4 Full and empty cylinders shall be pt·evented from reach
ing temperatut·es in excess of 52'C (125"F).
11.1.4* This chaplet· shall not apply to special atmospheres,
such as those encountered in hyperharic chan1bers. 11.3.5* Design and Construction.
11.1.5* Reserved. 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
11.2 Portable Cylinder and Container Source. such installations are approved existing installations, which
11.2.1 Cylinder valve outlet connections shall confonn to the shall be permitted to he continued in sei·vice.
mandatory t·equit·ements of CGA V-1, Standard for Compressed 11.3.5.2 Locations for the storage of nonflammable ga�es shall
(',as Cylinder ValvP Outlet and Inlet Connedions (ANSI B57.1) meet the following requirements:
(includes Pin-Index Safety System for medical gases).
( 1) l11ey shall he constructed with access to move cylinders
11.2.2 W'hen low-pressure tht·eaded connections are and containers in and out of the location on hand trucks
employed, they shall be in accordance with the mandatory complying with 11.4.3.1.1.
requirement� of CGA V-5, Dianwtl'r Index Sajfty Systnn (Noninter (2) They shall be provided wilh lockable doors 01· gates or
i:hangeable Low Pre.mire ConnPrtiom Jar lvlfdir:al (',as lippliratiom), otherwise able to be secured.
for noninterchangeable, low-pressure connections fot· medical (3) If outdoors, they shall be provided with an enclosure
gases, air, and suction. constructed of noncombustible materials.
(4) If indoors, they shall have interior finishes of noncom
11.2.3 Low-pressut·e quick couplet· connections shall be
bustible or limited-<:ombustible matet-ials.
nonintet-changeable between gas services.
(5) * If indoors, the room shall be separated from the rest of
11.2.4 Pressure-reducing regulators and gauges intended for the building by walls and flom·s having a 1-hour fire
use in high-pt·essure senice shall be listed for such ser,ice. t·esistance rnting with dom·s and othet· opening protec
tives having a ¾-hour fire protection rating.
11.2.5 Pressure-reducing regulators shall be used on high (6)* l11ey shall comply with NFP.A. 70 for unclassified (non
pressure cylinders to reduce the cylinder pressure to operating hazardous) locations.
pressu t·es. (7)* Fuel-fit·ed equipment shall not be located in the room.
11.2.6 Approved pressure-reducing regulators or other gas (8) If they require heat, the maximum allowable tempera
flow control de..,ices shall he used to t·educe the cylinder pres tun, of the in-room heating element shall be 130'C
sure of ever y cylindet· used for medical put-poses. 1\ll such (266'F).
devices shall have connections so designed that they attach only (9) They shall be provided with racks, chains, or other
to cylinders of gas for which they are designated. fa�tenings to secure all cylinders from falling, whether
full or empty.
11.2. 7* Equipment that could allow the intermixing of diffrt·· (10) They shall be supplied with electt·ical powet· compliant
ent gases, either through defect� in the mechanism 01· through v.'ith the requirement� for essential electrical systems as
error in manipulation in any portion of the high-pressure side described in Chaplet· 6.
of any system in which these gases might flow, shall not be used (11) They shall have rncks, shelves, and support�, whet·e
for joining cylinders containing compressed gases. provided, constructed of noncombustible materials or
limited-combustible materials.
11.2.8 Cylinder valve outlet connections for oxygen shall be
(12) * They shall protect electt-ical de'1ices from phpical
Connection No. 540 or Connection No. 870 as described in the
damage.
mandatory t·equit·ement� of CGA V-1, Standard Jar Compressed
(13)* They shall allow access by delivery vehicles and manage
(',as Cy!indrr Valve Outlet and Inlet Connertions (ANSI B57.l).
ment of cylinders.
(1 4) If indoors, ventilation for medical ga� storage rooms
shall com ply with 9.3.6.
2021 Edition
GAS EQUIPMENT 99-107
11.3.6* Storage for nonflammable gases greater than 8.5 m3 11.3.10 In<lividual small-.;ize (A. B. D. or E) cylinders available
(300 ft 3), but less thau 85 m3 (3000 ft3), at STP shall comply for immediate use in patient care spaces shall not be consid
with the 1·equiremenl� in 11.3.6.1 through 11.3.6.8. e1·e<l to be in storage.
11.3.6.1 Stm·age locations shall he out<loors i n an enclosure or 11.3.11 Cylinde1·s shall not be chaine<l to portable or movable
within an enclose<l inte1·ior space of noncombustible or apparatus such as be<ls and oxygen tenl�.
limited-combustible construction. with doors (or gates
11.3.12 Signs.
outdoors) that can be secured against unauthorized entry.
11.3.12.1 Storage locations meeting the requirement� of
11.3.6.2 Oxidizing gases such as oxygen an<l nitrous oxide 11.3.5 or 11.3.6 shall have p1·ecautiona1·y signage, readable
shall not be stored with any flammable ga�. liquid, or vapor.
from a distance of 1.5 m (5 ft), displayed on each door or gate
11.3.6.3 Oxidizing gases such as oxygen an<l nitrous oxide of the stoi-age room or enclosure.
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:
w01·ding as a minimum:
f
(1) Minimum distance o 6.1 m (20 ft)
(2) Minimum distance of 1.5 m (5 ft) if the entire storage CAUflON
location is protected by an automatic sprin kler system NO Smoking or Open Flame
designe<l in accor<lance with NFPA 13
(3) A gas cabinet in acconiance with NFPA 55 Positive Pressure Gases
11.3.6.4 Full and empty cylinders shall he pt·evente<l from Room May Have Insufficient Oxyge n
reaching temperatures in excess of 52 ° C (125 ° F).
Open Door and Allow Room to Ventilate Before Entering
11.3.6.5 Cylinde1· or container restraint� shall comply with 11.3.12.2.1 Existing signage that is not in strict compliance
11.6.2.3.
with the prmisions of this code shall be pe1·mitted to be contin
11.3.6.6 Smoking, open flames, electric heating elements, and ue<l in use as long as the authority having jurisdiction has
other sources of ignition shall he prohibite<l v.�thin storage <letermine<l that such use does not constitute a distinct hazar<l
locations and within 6.1 m (20 ft) of out�ide storage locations. to life.
11.3.6. 7 Cylin<ler valve protection caps shall comply ,,�th 11.3.12.3 In health care facilities whe1·e smoking is permitte<l,
11.6.2.2(4). signs shall inclu<le the following wording as a minimum:
11.3.6.8 Ventilation for indoor medical gas storage rooms CAUflON

shall comply with 9.3.6. NO SMOKING OR OPEN FIAME
11.3. 7 Stm·age for nonflammable gases with a total volume OXIDIZING GAS (ES) STORED WITHIN
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. 11.3.12.3.1 Existing signage that is not in stt·ict compliance
with the prmisions of this code shall be permitted to be contin
11.3. 7.1 Individual cylinde1· storage a�sociate<l with a smoke ued in use as long as the authority having jurisdiction has
compartment in accordance with NFPA 101 shall not be <lete1·mine<l that such use does not constitute a distinct haza1·<l
require<l to be stored in enclosures. to life.
11.3. 7.2 P1·ecautions in han<lling cylinde1·s specifie<l 111 11.3.12.4 In health care facilities where smoking is prohibited,
11.3.7.1 shall be in accordance ,,�th 11.6.2. signs shall inclu<le the following wo1·ding as a minimum:
11.3.8* Storage ftx nonflammable gases less than 85 m3 CAUflON
(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 NO OPEN FIAME
following also applies: OXIDIZING GAS (ES) STORED WITHIN
(1) Storage is limite<l to cylinde1·s.
11 .3.12.4.1 Existing signage that is not in stt·ict compliance
(2) There a re no flammables or combustibles in the cabinet.
with the prmisions of this co<le shall be permitte<l to be contin
(3) The temperature limitations of 5.1.3.2.11 are met.
ue<l in use as long as the authority having jurisdiction has
(4) The cylinders are secu1·ed.
dete1·mined that such use does not constitute a distinct haza1·<l
(5) When st01·ing nitrous oxide, the cabinets are lockable.
to life.
11.3.9 "\,\Then small-.;ize (A, B. D, or E) cylinders are in use,
11.3.12.5 Replacement of existing signage that inclu<les "No
they shall be attached to a cylinde1· stand or to medical equip
Smoking" for health care facilities that prohibit smoking shall
ment <lesigne<l to 1·eceive an<l hold comp1·esse<l ga� cylinders.
not be 1·equired.
2021 Edition
11.4 Performance Criteria and Testing. 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
ll.4.1 Portable Patient Care Gas Equipment. translucent material, shall be impervious to contained solutions
ll.4.1.1 * Anesthetic apparatus shall be subject to approval by an<l medications, an<l shall allow obsenation of the liquid level
the authority having_jurisdiction. and consistency.
I 1.4.1.2* Each yoke on anesthetic apparatus constructed to ll.4.2.5 Humidifiers and nehulizers shall he equipped \\�th
allow attachment of a small cylinder equipped with a flush-l),-pe prnvisions for overp1·essu1·e relief or ala1·m if the flow becomes
valve shall have tw·o pins installed as specified in the mandatory obstructed.
requirements of CGA V-1, Standard f11r Comprl'SSl'd Gas Cylindl'r 11.4.2.6 Humi<lifie1·s and nebulizers shall be incapable of
Valvl' Out!Pt and lnlPl Connfftions (ANSI B57. l ). tipping 01· shall be mounted so that any tipping 01· alteration
ll.4.1.3 Testing. from the vertical shall not interfere with function or accuracy.
I 1.4.1.3.1 Interventions requmng testing shall include, but 11.4.3 Nonpatient Gas Equipment.
not be limited to, the following: 11.4.3.1 Carts and Hand Trucks.
(1) Alteration of pipeline hose or pipeline fittings
11.4.3.I.I Construction. Cart� an<l hand trucks for cylinders
(2) Alteration of internal piping
and containers shall be constructed fot· the intended purpose,
(3 ) Adjustment of selector switches or flush valves
be self�supponing, and be prnvi<le<l with apprnpriate chains or
( 4) Replacement or repair of flowmeters or bobbins
stays to retain cylinders or containers.
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 11.4.3.2 Medical Devices. Medical devices not for patient ca1·e
or the pneumatic power supply connections for the anesthesia that requii-e medical gases or medical suppon gases shall meet
ventilator, or other pneumatically powered device, if one is the following:
present, and befo1·e use on patienl�. the gas anesthesia appara (1) Be listed for the intended pmpose by the U.S. Food and
tus shall be tested at the final common path to the patient to Drug A<lministt·ation
determine that oxygen, an<l only m..-ygen, is delivered from the (2) Be under the direction of a licensed medical professional
oxygen flowmete1·s and the oxygen flush valve, if any. (3) Not be permanently attached to the piped distt·ibution
system (.�ff5.J.3.5.2)
ll.4.1.3.3 Befo1·e the gas anesthesia apparatus is returned to Undet·go a risk assessment conducted by the health care
(4)
service, each fitting and connection shall he checked to verify facility's governing bo<ly to determine the cha racter of
its prnper indexing to the 1·espective ga� service involved. the processes and operntions conducted in the facilil),-·
ll.4.1.3.4 Before the gas anesthesia apparatus is returned to an<l whether medical gases or medical support gases a1-e
service, an oxygen analyzer, or a simila r device, shall be used to acceptable for use by the medical device
verify the oxygen concentt·ation. 11.5 Administration.
ll.4.1.4* Yoke-type connections between anesthesia apparatus 11.5.1 Policies.
and flush-type cyli nder valves (commonly use<l with anesthetic
gas cylinders) shall be of the Connection No. 860 type in 11.5.1.I Elimination of Sources of Ign ition.
accordance with the mandatory requirement� of CGA V-1,
Standard for Crmiprl'svd (',as Cy lindl'r Hzlve Out!Pt and lnlft Conni'<' 11.5.I.I.I Smoking mate1-ials (e.g., matches, cigarettes, light
tions (ANSI B5 7.1). ers, lighter fluid. tobacco in any form) shall be removed from
patienl� recei,ing respiratory therapy.
11.4.2 Apparatus for Administering Respiratory Therapy.
I 1.5.I.I.2* \'\'hen a na�al cannula an<l il� associated supply
11.4.2.1 Oxygen-<lelivery equipment intended to rest on the tubing are delivering oxygen out�ide of a patient care space, no
floor shall be equipped with a base designed to rende1· the sources of open flame shall be permitted in the site of inten
entire assembly stable <luring storage, transport, an<l use. tional expulsion.
I 1.4.2.2 Oxygen enclosures of rigi<l materials shall be fabrica 11.5.1.1.3* When any other oxygen delivery equipment not
ted of noncombustible materials. 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.
ll.4.2.3 Equipment supplied from cylinders or containei-s
shall be <lesigne<l and constructed for setvice at full cylinder or I 1.5.I.I.4* Solid fuel-burning appliances shall not be permit
container pressut·e or consn-ucte<l for use \,�th, or equipped ted in the area of administration.
with, p1-essure reducing regulatot·s.
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.
2021 Edition
GAS EQUIPMENT 99-109
11.5.1.2 Misuse of Flammable Substances. (4) The individual transfilling the container(s) has been
properly trained in the transfilling proce<lures.
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. I1.5.2.3.2* \\!here transfilling to liqui<l oxygen portable
containers at 344.74 kPa (50 psi) and un<ler, the following
11.5.1.2.2 Oil, grease, or other flammable substances shall not conditions shall be met:
be used on/in oxygen equipment.
( l) The a1·ea is well ventilate<l and ha� noncombustible floo1·
11.5.1.2.3 Flammable an<l combustible liquids shall not be ing.
permitte<l within the site of intentional expulsion. (2) The a rea is posted with signs indicating that smoking in
11.5.1.3 Servicing and Maintenance of Equipment. the area is not permitted.
(3) The individual transfilling the liquid oxygen portable
I 1.5.1.3. I Defrctive equipment shall he immediately removed containe1· has been propedy trnine<l in the transfilling
from service. procedure.
(4) The mandatory requirements of CGA P-2.6, Tmnsjilling of
11.5.1.3.2 Areas designate<l for the servicing of oxygen equip Liquid Oxygen U�Pd for &spimtion, are met.
ment shall be clean an<l free of oil, grease, 01· other flammable
substances. 11.5.2.4* Filling Cylinders from Oxygen Concentrators. Fill
ing cylinders from oxygen concentrntors, including in the
11.5.1.3.3* A sche<luled preventive maintenance program patient care vicinity, shall be in accordance with the manufac
shall be followed. turer's instructions, not to exceed the limit� in 11.5.2.4. l
I 1.5.2 Gases in Cylinders and Liquefied Gases in Containers. through 11.5.2.4.4.
I I. 5.2. I Qualification and Training of Personnel. I 1.5.2.4.1 The cylin<le1· content� shall not exceed 700 L
(25 f\.3).
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 I 1.5.2.4.2 The flow shall not excee<l :> L/min (0.2 ft�/min).
ga�es and the cylin<lers that contain the medical gases shall be
I 1.5.2.4.3 The pressure shall not excee<l the DOT rating of
traine<l on the risks associate<l with their handling and use.
the cylinder or 20,700 kPa (3000 psi), whichever is less.
I1.5.2. 1.2 Health ca1·e facilities shall provide programs of
I 1.5.2.4.4 The cylinders shall be in accordance with DOT
continuing e<lucation for thei1· personnel.
requi1·ement5 01· those of the applicable regulatory agency.
11.5.2.1.3 Continuing e<lucation programs shall include peri
I 1.5.2.5 Ambulatory Patients. A1·eas where ambulat01·y
odic 1·eview of safety guidelines and usage 1·equirement5 for
patient5 on oxygen therapy are permitted access shall be flame
medical gases and their cylinders.
an<l smoke-free a rea�.
11.5.2.1.4 Equipment shall be serviced only by personnel
trained in the maintenance and operation of the equipment.
I 1.5.3 Use (Including Information and Warning Signs).
I1.5.2. 1.5 If a CJyogenic fluid central supply sys tem is present,

I 1.5.3.1 Labeling.
the supplier shall provi<le annual training on it� operation. I 1.5.3.1.1 Equipment listed for use in oxygen-e111·iche<l atmos
pheres shall he so labeled.
I 1.5.2.2 lransfilling Cylinders.
11.5.2.2.1 Mixing of compressed gases in cylinders shall be I 1.5.3.1.2 Oxy gen-metering equipment and pressure reduc
prohibited. ing 1-egulatoi-s shall be conspicuously labeled as follows:
I1.5.2.2.2* Transfilling of gaseous oxygen from one cylin<ler OXYGEN - USE NO OIL
to another shall be in accor<lance with the mandatory require 11.5.3.1.3 Flowmeters, pressure reducing regulators, and
ment� in the mandatory 1·equirement� of CGA P-2.5, Tmmjilling oxygen-dispensing apparatus shall be cleady and permanently
of High PrPssurP Gase,im Oxygm U�fd Jar RPspiration. labele<l , designating the g-ds 01· mixture of gases for which they
I 1.5.2.2.3 Transfilling of any gases from one cylinder to are inten<le<l.
anothe1· in the patient care vicinity shall be prohibited. I1.5.3.1.4 Apparatus whose calibration 01· fimction is <lepend
I 1.5.2.3 lransfilling Liquid Oxygen. Transfilling of liquid ent on ga� density shall he labeled as to the proper supply gas
oxygen shall comply with 11.5.2.3. l or 11.5.2.3.2, as applicable. gauge pressure (kPa/ psi) for which it is intended.
11.5.2.3.1 Transfilling to liquid oxygen base reservoir contain I 1.5.3.1.5 Oxy gen-mete1-ing equipment, p1·essu1·e re<lucing
ers or to liquid oxygen portable containers over 344.74 kPa 1-egulat01·s, humidifie1·s, and nebulizers shall be labeled with
(50 psi) shall include the following: the name of the manufacturer or supplier.
(l ) A designated area is separated by a fire baITier of 1-hour 11.5.3.1.6 Cylinders and containers shall be labeled in accord
fi1·e-resistive constrnction from any portion of a facility ance with th� mandatory· 1·equirements of CGA C-7, Guide to
where patients are house<l, examined, or treated. Clrmijiwtion and Labl'Nng of C01nprl'ssed Gases. Color co<ling shall
(2) The a1·ea is mechanically ventilated, is sp1·inklered, and not be utilize<l as a prima r y method of <letern1ining cylinde1· 01-
has cernmic or concrete flom·ing. container content.
(3) The area is posted with signs in<licating that transfilling is
occurring and that smoking in the immediate area is not
permitte<l.
2021 Edition
99-II0 HEALTH CARE FACILITIES CODE
11.5.3.1.7 All labeling shall be durnble and \\�thstand cleans 11.6.1.3 Policies for enforcement shall include the following:
ing or disinfection. Regulations for the storage and handling of cylinders and
( 1)
11.5.3.2* Si gns. containers of oxygen and nitrous oxide
(2) Prompt evaluation of all signal warnings and all necessary·
11.5.3.2.1 In health care facilities where smoking is not measures taken to re-establish the proper functions of the
prohibited, precautionary signs readable from a distance of medical gas and vacuum systems
1.5 m (5 ft) shall he conspicuously displayed wherever supple (3) Organizational capability and 1·esout-ces to cope with a
mental oxygen is in use and in aisles and walkways leading to complete loss of any medical gas or vacuum system
such an area. (4) Successful completion of all tesl� required in 5.1.12.4
11.5.3.2.2 The signs shall be attached to adjacent doonvays 01· prim· to the use of any medical gas or vacuum piping
to building walls 01· be supported by othe1· appropriate means. system fot· patient care
(5) Locations intended for the delivery vehicle delivering
11.5.3.2.3 In health ca1·e facilities whe1·e smoking is prohibited cryogenic liquid to cryogenic fluid centt·al supply systems
and signs are prominently (strategically) placed at all maj01· to remain open and not be used for any othe1· put·pose
entrnnces. secondary signs with no smoking language shall not (e.g., vehicle parking, stornge of trash containers )
be required.
11.6.2 Special Precautions for Handling Oxygen Cylinders and
11.5.3.2.4 The nonsmoking policies shall be strictly enfo1·ced. Manifolds. Handling of oxygen cylinde1·s and manifolds shall
be based on the mandatory requirement� of CGA G-4, Oxygen.
11.5.3.3 Transportation, Storage, and Use of Equipment.
11.6.2.1 Oxygen cylinders, containe1·s, and associated equip
11.5.3.3.1 Flow-control valves on administe1·ing equipment ment shall be protected from contact with oil 01· grease by
shall be closed p1·i01· to connection and when not in use. means of the following specific precautions:
11.5.3.3.2 Apparatus shall not he stored or transported with (1) Oil, grease, or 1·eadilv flammable materials shall not be
liquid agents in resen,ui1·s. pe1·mitted to come in contact with oxygen cylinde1·s.
11.5.3.3.3 Care shall be taken in attaching connections from valves, pressure reducing regulators, gauges, 01· fittings.
ga.� services to equipment and from equipment to patient�. (2) Pressure reducing regulators, fittings, or gauges shall not
be lubricated with oil or any othe1· flammable substance.
11.5.3.3.4 Fixed or adjustable orifice mechanisms, metering (3) Oxygen cylinde1·s 01· apparatus shall not be handled witl1
,·alves, pressure reducing regulators, and gauges shall not be oily 01· greasy hands, gloves, or rngs.
connected directly to high pressure cylinders, unless specifi
cally listed for such use and prm�ded with appropriate safety 11.6.2.2 Equipment associated with oxygen shall be protected
devices. from contamination by means of the following specific precau
tions:
11.5.3.3.5 Equipment shall only be serviced by qualified (1) Particles of dust and dirt shall he cleared from cylinder
pe1·sonnel. valve openings by slightly opening and closing the valve
11.6 Operation and Management of Cylinders. hefo1-e applying any fitting to tl1e cylinder valve.
(2) TI1e high pressure valve on the oxygen cylinder shall be
11.6.1 Administration. Administrative auth01·ities of health opened slowly before bringing the appa1·atus to the
care organizations shall provide policies and procedm-es fot· patient or the patient to the apparntus.
safe practices. (3) An oxygen cylinder shall not be draped with any materials
11.6.1.1 Purcha.�e specifications shall include the following: such as hospital gowns, masks, or caps.
(4) Cylinder-valve protection caps, where provided, shall he
(1) Specifications for cylinders kept in place and be hand-tightened, except when cylin
(2) Marking of cylinders, regulators, and valves ders are in use or connected for use.
(3) Prope1· connections on the cylinders supplied to the (5) Valves shall be dosed on all empty cylinders in storage.
facility
11.6.2.3 Cylinders shall be protected from damage by means
11.6.1.2 Training procedures shall include the following: of the following specific procedures:
(1) Maintenance programs in accordance with tl1e manufac (1) Oxygen cylinders shall be protected from abnonnal
turer's recommendations fot· the piped gas system mechanical shock, which is liable to dan1age the cylin
(2) Use and transport of equipment and the proper handling der, valve, or safety device.
of cylinders, containers, hand trucks, support�, and valve (2) Oxygen cylinde1·s shall not he stored neat· elevat01·s or
protection caps gangways or in locations where heavy moving objects will
(3) Verification of ga� content and mechanical connection strike them or fall on them.
specificity of each cylinder or container prior to placing it (3) Cylinders shall be protected from tampering by unau
into service 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.
2021 Edition
GAS EQUIPMENT 99-ll l
(7) A torch flame shall not be pe1·mitted. under any circum 11.6.3 Special Precautions for Making Cyli nder and Container
stances, to come in contact with a cylinder, cylinder Connections.
valve, or safety de"ice.
(8) Sparks and flame shall be kept away from cylinde1·s. 11.6.3.1 Cylinder valves shall be opened and connected in
(9) Even if they are considered to be empty, cylinders shall accordance with the following procedure:
not be used a� rollers, supports, or for any purpose other ( 1) Make certain that apparatus and cylinde1· valve connec
than that fot· which the supplie1· intended them. tions and cylinder v...-enches are free of foreign matet-ials.
(10) La1·ge cylinders (exceeding size E) and containers larger (2) Turn the cylinde1· valve outlet away from personnel
than 45 kg ( 100 lb) weight shall be transported on a following these safety procedures:
proper hand trnck 01· can complying with 11.4.3.1. (a) Stand to the side - not in front and not in back.
( 11) F1·eestanding cylinde1·s shall be propedy chained or (b) Beftxe connecting the apparatus to the cylinde1·
supported in a proper cylinder stand or cart. valve, momentarily open the cylinder valve to elimi
( 12) Cylinders shall not be supported by radiators, steam nate dust.
pipes, 01· heat duct�. (3) Make connection of the apparntus to the cylinde1· valve,
11.6.2.4 Cylinde1·s and their content� shall be handled with and tighten the connection nut securely with a wrench.
care, which shall include the following specific procedures: (4) Release the low-pressure adjustment screw of the
p1·esstu-e-1·educing 1·egulator com pletely.
(1) Oxygen fittings, valves, pressu1·e 1·educing 1·egulators, or (5) Slowly open cylinde1· valve to the foll-open position.
gauges shall not be used for any service other than that (6) Slowly turn in the low-pressure a�ustment screw on the
of oxygen. pressure reducing regulator until the proper operating
(2) Ga�es of any type shall not be mixed in an oxygen cylin pt·essm·e is obtained.
der or any othe1· cylindei-. (7) Open the valve to the utilization apparatus.
(3) Oxygen shall always be dispensed from a cylinder
through a pressure reducing regulator. 11.6.3.2 Connections for containers shall be made in accord
( 4) The cylinde1· valve shall be opened slowly, with the face ance with the containe1· manufacturer's opernting instructions.
of the indicat01· on the pressure reducing 1·egulator
pointed away from all persons. 11.6.4 Special Precautions for the Care of Safety Mechanisms.
(5) Oxygen shall be refeITed to by it� proper name, oxygrn, 11.6.4.1 Personnel using cylindern aml containers aml othe1·
not air, and liquid oxygen shall be refetTed to by it� equipment cove1·ed in this chapter shall be familia1· with the
f
proper name, not liquid air. mandatory requirement� o CGA Pin-Index Safety System and
(6) Oxygen shall not be used as a substitute for compressed the CGA Diameter-Index Safetv System, which are both
f
311". designed to pt·event utilization o the wrong gas.
(7) The markings stamped on cylinde1·s shall not be
tampered with, because it is against federal statutes to 11.6.4 .2 Safety relief mechanisms, non interchangeable
change these ma1·kings. connectors, and other safety features shall not be removed,
(8) Markings used for the identification of contents of cylin altei-ed, or 1·eplaced.
ders shall not be defaced or 1·emoved, including decals, 11.6.5 Special Precautions - Storage of Cylinders and
tags, and stenciled marks, except those labels/tags used Containers.
fm indicating cylinde1· status (e.g., foll, in use, empty).
(9) The owner of the cylinde1· shall be notified if any condi 11.6.5.1 Storage shall be planned so that cylinders can be used
tion has occurred that might allow any foreign substance in the order in which they are received from the supplier.
to enter a cylinder or valve, gi"ing details and the cylin
der number. 11.6.5.2 If empty and full cylinders are stored within the same
( 10) Neither cylinders nor containei-s shall be placed in the enclosure, empty cylinde1·s shall be segregated from full cylin
proximity of radiators, steam pipes, heat duct�, or other ders.
sources of heat. 11.6.5.2.1 ,'\'hen the facility employs cylinde1·s with integral
( 11) Very cold cylinders or containers shall be handled with pressure gauge, it shall establish the threshold pressure at
care to avoid injury. which a cylinder is considered empty.
11.6.2.5 Oxygen equipment that is defective shall not be used 11.6.5.3 Empty cylinde1·s shall be marked to avoid confusion
until one of the following tasks has been pedormed: and delay if a full cylinder is needed in a rapid manner.
( 1) It ha� been repaired by competent in-house personnel. 11.6.5.4 Cylinders stored in exterior locations shall be as
(2) It has been 1·epaired by the manufactme1· or his or her follows:
authorized agent.
(3) It ha� been replaced. (1) Seemed against falling or tipping
(2) Stored in a well-drained location and protected from
11.6.2.6 P1·essm·e reducing regulators that a1·e in need of prolongen contact with soil
1·epair or cylinders having valves that do not operate properly (3) P1·evented from reaching temperntures lower than the
shall not be used. 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)
2021 Edition
99-ll2 HEALTH CARE FACILITIES CODE
11.6.5.5* Storage of nitrnus oxide cylinders shall be secured 11.7.3.5* Liquid Oxygen Portable Containers.
against unauthorized access.
11.7.3.5.1 Liquid oxygen pmtable containers shall be kept in
11. 7 Liquid Oxygen Equipment. an up1·ight position.
11. 7.1 General. The storage and use of liquid oxygen in 11.7.3.5.2 Liquid oxygen portable containers shall not be
liquid oxygen base 1·eservoir containers and liquid oxygen port carried unde1· clothing 01· other covering.
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 11.7.3.5.3 Liquid oxygen portable containers shall he kept
code. away from ignition sources, electrical hazards, and high
tempe1·ature devices dut·ing filling and use.
11.7.2 Information and Instructions. The liquid oxygen selle1·
shall provide the user with documentation that includes, but is 11.7.3.6 The transfilling of containe1·s shall he in accordance
not limited to, the following: with the manufacturer's instructions and the requirements of
11.7.3.6.1 thrnugh 11.7.3.6.2.
(1) Manufacttlt'et·'s instructions, including labeling for st01·
age and use of the containe1·s 11.7.3.6.1 Liquid oxygen containers shall be filled outdoors or
(2) Requirements for storage and use of containers away in compliance with 11.5.2.3.1.
from ignition sources, exits, electt-ical hazards, and high 11.7.3.6.1.1* A drip pan compatible with liquid oxygen shall
temperature devices be prnvided unde1· the liquid oi.·ygen base resetvoir containe1·'s
(il) Methods fo1· containe1· restraint to prevent falling filling and vent connections used during the filling process,
( 4) Requirements for container handling unless the filling is performed on a noncombustible surface
(5) Safeguards for 1·efilli ng of contain e1·s such as concrete.
11. 7.3 Container Storage, Use, and Operation. 11.7.3.6.2 Liquid oxygen portable containers shall be permit
11. 7.3.1* Containe1·s shall be stm·ed, used, and operated in ted to be filled indoors when the liquid oxygen base 1·eservoir
accordance with the manufacture1·'s instructions and labeling. containet' is designed fot· filling such containers and the written
instructions prmided by the container manufacturer a1·e
11. 7.3.2 Containers shall not be placed in the following areas: followed.
(1) '\Vhere they can be tipped ove1· by the movement of a 11.7.4 Maximum Quantity.
door
(2 ) v\-'here they interfere with foot traffic 11.7.4.1 The maximum total quantity of liquid oxygen permit
(3 ) '\,\'here they a1·e subject to damage from falling objects ted in storage and in use in a patient bed location 01· patient
( 4) Where exposed to open flames and high-temperature care vicinity shall be 120 L (31.6 gal), prnvided that the patient
devices bed location or patient care vicinity, or both, a1·e separated
from the remainder of the facility by fire harriers and horizon
11. 7.3.3* Liquid oxygen base reservoir containe1·s shall be tal assemblies having a minimum fit·e resistance rating of
secu1·ed by one of the following methods while in storage 01· 1 hour in acc01·dance with the adopted building code.
use to prevent tipping ove1· caused by contact, vibration, or seis
mic activity: 11.7.4.2 One liquid oxygen portable container llimited to
Securing to a fixed object ,,'ith one or more 1·estt·aints 1.5 L (0.396 gal) capacity l pet· patient is permitted to be stored
( 1)
Securing within a framework, stand, or assembly designed or used in a patient bed location or patient care 'vicinity \\'ith
(2)
to resist container movement out having to meet the fire separation requirement� of 11.7.4.1.
(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
EMERGENCY MANAC;EMENT 99-ll3
Chapter 12 Emergency Management 12.3 Emergency Management Categories. 1l1e application of

requirement5 in this chapter shall be based on the emergency
12.1* Applicability. This chaplet· shall apply to new ancl exist management category of the health ca1·e facility as clefined in
ing health care facilities. Table 12.3.
12.1.1* This chapter shall pr0vicle those with the responsibil 12.4 General.
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 12.4.1 * Health care facilities shall develop an eme1·gency
from emergencies of any origin. management program with a documented eme1·gency opern
tions plan based on the category of the health care facility as
12.1.2 1l1is chapter shall be the source for emergencv defined in Table 12.3.
management in health care facilities ancl is based on the foun
clations of NfPA. 1600. 12.4.1.1* The emergency management prngrnm shall include
elements as required to manage an emergency during all four
12.1.3 1l1is chapter shall aid in developing, maintaining, and phases: mitigation. pt·epareclness, response. and recovery.
evaluating effective emergency management progrnms in new
and existing facilities. 12.4.1.2 The eme1·gency management progrnm shall comply
with applicable regulations, directives, policies, ancl industty
12.2 Responsibilities. standa1·cls of prnctice.
12.2.1 * Authority Having Jurisdic lion. 12.4.2* When cleveloping it� emergency management
program, the facility shall communicate its needs ancl vulnera
12.2.1.1 The autho1·ity having jurisdiction shall be cognizant bilities to community emergency n·sponse agencies and iden
of the requirement� of a health care facility with respect to it� tify the capabilities of its community in supporting thei1·
uniqueness for continuecl operation of the facility in an emer llllSStOn.
gency.
12.4.3 The medical facility, in combination with the local 01·
12.2.1.2 1l1e authority having ju1·isdiction shall ensure health federnl authorities, 01· both, shall establish the 1·equired eme1·
ca1·e facility eme1·gency management programs meet the gency management categoty as defined in Table 12.3.
requirements of this chapter.
12.5 Emergency Management Category 1 and Emergency
12.2.2 Senior Management. Management Category 2 R equirements.
12.2.2.1 The senior management shall actively participate in 12.5.1 All emergency management Categoty l and emergency
ancl suppo1·t eme1·gency management planning. management Category 2 health care facilities shall be requirecl
12.2.2.2 Senior management shall provide the 1·equi1·ed to clevelop ancl maintain an eme1·gency management pt·ogram
resources to develop ancl support the emergency management that addresses all program elements as prescribed in 12.5.2 ancl
prog1·am. 12.5.3.
12.2.2.3 At least one representative of senior management 12.5.2 The element� and complexity of the subsequent code
shall provide a clocumentecl re\iew of aftet'-action reports and sections in this chapter shall apply, as appropriate to the hazard
the annual evaluation of the eme1·gency operations plan vult1e1·ability analysis (HVA), the community's expectations,
(EOP). and the leaclership's defined mission of the health care facility.
12.2.2.4 Senior management shall direct the prioritization of

opportunities for improvement identifiecl during exe1·cises and
actual event�.
Table 12.3 Emergency Management Categories
12.2.2.5 Senior management shall appoint a program coordi
nato1·. Emergency
Management
12.2.3* Emergency Management Committee. The emergency
Category Definition
management committee shall include representatives of senior
management and clinical and suppon senices. Those inpaLient faciliLies I.hat remain operable to
provide actvanced life support services to injurect
12.2.3.1* The membership of the emergency management responcters anct disasrer victims, or those inpatient
committee shall include a chairperson, the emergency facilities that serve as a receiving facility for
prog1·am co01·clinat01·, and leadership representatives of those evacualing health care facilities. These facilities
clepartments, services, and areas that have a significant role in manage the existing inpalient load as wel l as plan
the facility's eme1·gency management activities. for the influx ofact ctitional patienL, as a result ofan
emergency.
12.2.3.2 The eme1·gency management committee shall have
the responsibility fot· the emergency management program 2 Those inpatient or omparient faciliLies 1har augmem
within the facility. 1.he criLical mission. These facilities manage the
existing inpaLiem or outpa1ie111 loads hlll do 1101
12.2.3.3* The eme1·gency management committee shall plan to receive act ctilional patienL, a, a resuh of an
moclel the eme1·gency operntions plan on an incident emergency or cto 1101 plan to remain operable
command system (ICS) in coorclination with feclernl, state, ancl should essential ut iliries or services be lost.
local emergency response agencies, as applicable.
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 99-ll5
(5) Managing staff support activities. such as housing. trans (8) Fuel for essential transportation
portation, incident stress debriefing, sanitation, hy<lra (9) Medical gas anci vacuum
tion. nutrition, comfort, morale, an<l mental health (10) Info1·mation technology
f
(6) Managing staf family support needs, such as child ca1·e,
elder care, pet care, and communication to home 12.5.3.3.6.6 Exterior Connections. For essential utility systems
(7)
f
Providing staf, equipment, and transportation vehicles in Emergency Management Category l facilities only, anci
needed ftx evacuation based on the facility's I-IVA, consideration shall be given to the
installation of exterior building connectors to allow fo1· the
12.5.3.3.6.3* Safety and Security- The facility shall plan for attachment of portable emergency utility mociules.
the following during an emergency:
12.5.3.3.6.7 St.if£ Roles.
( l) Inten1al secu1·ity and safety operations
f
(2) Roles of agencies such a� police, she1·if, an<l national (A) Staff roles shall be defineci for the a1·eas of communica
guar<l tions, resources anci asset�, safety an<l securitv, essential utilities,
(3) Managing hazardous matet-ials an<l wa�te and clinical activities.
(4) Radioactive, biological, and chemical isolation and (B) Staff shall 1·eceive training fot· their assigned roles in the
decontamination EOP.
(5) Patients susceptible to wandering
(6) Controlling entrance into the health care facility during (C) 1l1e facility shall communicate to licensed indepen<lent
emergencies health care provi<lers their roles in the EOP.
(7) Conducting a risk assessment with applicable authorities f
f
i it becomes necessary to contrnl egress from the health (D) The facility shall ensure that staf, voluntee1·s, and othe1·
care facility pe1·so1mel a1·e cre<lentialed by the facility for thei1· assignment
(8) Controlling people movement within the health care an<l wear visible identification demonstrating such Cl'edential
facility ing while on-site at the facility.
(9) Controlling traffic access to the facility (E) The facility shall include in its plan the alerting, manag
12.5.3.3.6.4 Oinical Support Activities. The facility shall plan ing, anci tracking of all staff in an eme1·gency.
for the following during an emergency: (F) The facility shall inclucie in it� plan a process fo1· integrat
( l ) Clinical acti"ities that could need modification or ing the use of volunteers, including those of the federal govern
discontinuation during an eme1·gency, such as patient ment, in their emergency response.
scheduling, triage, assessment, treatment, admission, 12.5.3.3.6.8 The facility shall inclucie the following in it� EOP:
transfer, discl1a1·ge, and evacuation
(2) Clinical senices for special needs populations in the ( l )* Stancia1·ci commanci structure that is consistent with its
community, such a� pediatric, geriatric, disabled, and community
chrnnically ill patients, and those with acidictions (Emer (2) Reporting structure consistent with the command struc
gency Management Category I only) trn·e
(3) Process to shelter patients in place (3) Activation anci cieactivation of the response an<l 1·ecove1y
(4) Patient cleanliness and sanitation phases, including the authority and process
(5) Behavioral needs of patients (4) Facility capabilities and appropriate response effo1·t�
(6) Mortuary services when the facility cannot be supponed from the out�i<le
(7) Evacuation both horizontally and, when requireci by for extended pe1·iods in the six critical a1·eas v,':ith an
circumstances, vertically, when the environment cannot acceptable response, including examples such as the
support care, treatment, and senices following:
(8) Transportation of patient�, anci thei1· me<lications and (a) Resource conservation
equipment, an<l staff to an alternative care site(s) when (b) Seni ce curtailment
the envi1·onment cannot support care, tt·eatment, and (c) Partial or total evacuation consistent with the staff's
serVIces designateci role in community response plan
(9) Transportation of pertinent patient information, induct (5) Alternative treatment sites to meet the neecis of the
ing essential clinical and medication-relate<l informa patients
tion, to an alternative cai·e site(s) when the environment
cannot support ca1·e, treatment, and setvices 12.5.3.3.7 St.if£ Education.
( 10) Documentation and tracking of patient location and 12.5.3.3.7.1 Each facility shall implement an educational
patient clinical information prngram in emergency management that includes training,
12.5.3.3.6.5* Fssential Utilities and Sr.-tems. The facility shall drills, and exercises.
plan for continuitv of operations during the loss or interrup 12.5.3.3.7.2 The eciucational program shall inclucie an over
tion of the following utilities anci systems <luring an eme1·gency, view of the components of the emergency management
as applicable: program and concepts of the incident command system (ICS).
(l) Electricity
(2) Potable water 12.5.3.3.7.3 Individuals who are expected to perform a5 inci
(3) Nonpotable wate1· dent commanders or to he a�signed to specific positions within
( 4) Wastewate1· the command structure shall he u·aineci in an<l familia1· with
(5) HVAC the ICS anci the particular levels at which they are expected to
(6) Fire prntection perform.
(7) Fuel for building operations
2021 Edition
99-II6 HEALTH CARE FACILITIES CODE
12.5.3.3. 7.4 Education concerning the sta ff's specific duties 12.5.3.4 Response.
and responsibilities shall be conducted.
12.5.3.4.1 * The facility shall declare itself in an emergency
12.5.3.3. 7.5 General overview education of the eme1·gency mode baserl on cu1Tent conrlitions that leadership considers
management program and the ICS shall he conducted at the extraordinary.
time of hire.
12.5.3.4.2 Once an emergency mode has been decla1·ed, the
12.5.3.3. 7.6 Department- and staff'.specific education shall he facility shall activate it� EOP.
f
conducted upon appointment to depanment/staf a�signment�
or positions and annually thereafter. 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
12.5. 3.3. B* Testing Emergency Plans and Op erations. ance with the facilitv's activation cr iteria.
12.5.3.3.B.I The facility shall test it� EOP at least twice annu 12.5.3.4.4 The decision to deactivate the EOP shall be made
ally, either through functional 01- full-scale exercises or actual by the incident commander in the health care m·ganization in
events. coordination with the applicable external command authority.
12.5.3.3.B.2 Exercises shall be based on the HVA priorities 12.5.3.4.5* The organization shall make provisions for emer
and be as realistic as feasible. gency Ct'edentialing ofvoluntee1· clinical staff.
12.5.3.3.B.3 For Eme1·gency Management Category 1 only. an 12.5.3.4.5.1 At a minimum, a pee1· evaluation of skill shall be
influx of volunteer or simulated patient� shall be tested annu conducted to validate proficiency for volunteer clinical staff.
ally, either through a fonctional or full-scale exercise or an
actual event. (SPP TablP 12.3.) 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
12.5.3.3.B.4 Annual table top, functional, or full-scale exerci verified.
ses shall include the following:
12.5.3.4.5.3 Pe1·sonnel rlesignated or involverl in the EOP of
(1) Community integration the health ca1·e facility shall be supplied with a means of irlenti
(2) Assessment of sustainability fication, which shall be worn at all times in a visible location.
12.5.3.3.B.5 For Em ergency Management Category 1 only, if 12.5.3.4.5.4 Irlentification issued to volunteers shall rlistin
f
so 1·equired by the community designation to 1·eceive infectious guish volunteers from staf members.
patient�. the facility shall conduct at least one exercise a y ear
that includes a surge of infectious patient�. (SPP TablP 12.3.) 12.5.3.4.6 The commanrl staff shall actively monitor condi
tions present in the environment and remain in communica
12.5.3.3.B.6 The irlentified exe1·cises shall be conrlucted inde tion with community eme1·gency 1·esponse agencies during an
pendently or in combination. emergency response.
12. 5.3.3.9 Scope of Exercises. 12.5.3.4.7 When conrlitions approach untenable, the
12.5.3.3.9.1 Exe1·cises shall be monitorerl hy at least one desig command stafl; in combination with community emergency
nated evaluator who has knowledge of the facility's plan and response agencies, shall determine when to acti.-ate the facility
who is not involved in the exercise. evacuation plan.
12.5.3.3.9.2 Exel'Cises shall monit01- the critical firnctions. 12.5.3.4.B Evacuation to the alternative care site shall follow
the planning conducted <luring the preparedness phase.
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 12.5.3.4.9* Crisis Standards of Care. C1·isis stanrlards of ca1·e
event. shall he developed through a communitywirle approach, as
approved by the authoritv havingjurisdiction.
12.5.3.3.9.4 The rlebriefing shall include all key inrlivirluals.
including obse1·ve1·s; administration; clinical staf( including a 12.5.3.4.9.1 The decision to implement crisis stanrlards of
physician(s); and appropt·iate support staff. care shall be coordinated with the community leadership.
12.5.3.3.9.5 Exe1·cises anrl actual event� shall he critiqued to 12.5.3.4.9.2 Upon implementation of crisis standards of care
identify a1·eas fot· improvement. in a community, the following shall be consirlered:
(l) The triage process
12.5.3.3.9.6 The critiques requirerl hy 12.5.3.3.9.5 shall irlen f
The allocation o medical services across the population
(2)
tify deficiencies anrl opp01-tunities fo1· improvement baserl
upon monitoring activities anrl observations dut·ing the exe1· 12.5.3.4.9.3 Standards of ca1·e shall be returnerl to normal at
cise. the earliest feasible time.
12.5.3.3.9. 7 Opportunities for improvement identifierl in 12.5.3.4.10 Medical Surge Capacity and Capability. The
critiques shall be incot-pornterl in the facility's improvement requirement� of 12.5.3.4.10.1 and 12.5.3.4.10.2 shall apply only
plan. to those facilities designated as Eme1-gency Management Cate
gory 1 as defined by the HVA.
12.5.3.3.9.B* Improvement� made to the emergency manage
ment program shall be evaluaterl in subsequent exercises. 12.5.3.4.10.1 * TI1e facility shall plan for medical surge
capacity and capability.
2021 Edition
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 (c) Parent� know that they have the right to refuse to
ment release their child to any individual without valida
(7 ) Prnvide policy for inte1·action with law enforcement agen tion ofofficial hospital identification
ctes (16) Visiting family and friends not permitted to enter any
(8) Comply with applicable laws, regulations, and standards nursery area with an infant or a newborn from the
regarding security management operations outside
(9) Educate and train the facility security force to address the (17) Infant abduction dt·ills conducted pe1·iodically, based on
following: SV.A., to test effectiveness of chosen measu1·es
(a) Customer senice (18) Video surveillance eguipment, where it does not violate
(b) Use ofphysical restrai nl� HIPAA 01· othe1· patient ri ght�
(c) Use of.force 13.5.4* Medication storage and w01·k areas shall be secu1·ed
(d) Response criteria against admittance of unauthorized personnel through the use
(e) Fire watch prncedures of the following:
(f) Lockdown procedut·es
(g) Emer·gency notification procedut·es (1) Access control
(h) Emergency communications procedures (2) Unigue identification for the area
(3) Secure storage and contrnlled dispensing of drngs
13. 5 Security-Sensitive Areas.
13.5.5 Clinical and 1·esearch laboratm·ies shall be secu1·ed
13.5.1 All security-sensitive area�, as identified by the SVA, against admittance of unauthorized personnel through appro
shall be protected as appropriate. pt-iate protections, such a.� the following:
13.5.2 Emergency department secu1·ity shall include appropri (1) Access control
ate protection, including the following: (2) Unigue identification for the area
(3) Secure storage and controlled dispensing of regulated
(I)* Control and limitation of access by the general public chemical, biological, and radiological mate1-ials
(2) P1·ivate dut·ess alarm at the nurses' station and 1·eception (4) Video surveillance
for summoning immediate a�sistance
(3) Access-control of treatment area 13.5.6 Dementia or behavioral health unirn shall be secu1·ed
( 4) Lockdown procedure to secure the area when conditions against the admittance or 1·elease of unauthorized pe1·sonnel
th1·eaten the viability of the department through approp1·iate protections, such as the following:
(5) Bullet-resisting glazing material, as deemed necessatJ1 by (1) Access control
1·eview of the SVA (2) Unigue identification for the area
13.5.3 Pediat1·ic and infant care areas shall have a security (3)* Procedure to pt·event entry of contraband prior to a
plan for the prevention of, and response to, pediatric and person being admitted into the unit or department
infant abduction that shall include appropt-iate protections, (4) Elopement pt·ecautions
such as the following: (5) Maintenance of color photos with the medical informa-
tion of cut-rent patients to aid in identification
(1) Control and limitation of access by the general public
(2) Screening by nursing pri01· to allowing persons access to 13.5.7 Forensic patient t1·eatment areas shall provide appro
infant care area� pt-iate protections, such a� the following:
f
(3) Matching protocol with staf clearance to pair infant� (1)* Law enforcement attending the patient at all times
with parents (2) Treatment performed in an area separate from other
( 4) System to monitor and track the location of pediatric patient�
and infant patient� (3) Restraints applied 01· removed only under forensic staff
(5)* Facility alert system and lockdown procedures control
(6) Use of electronic monitoring, tracking, and access
control eguipment 13.5.8 Communications, data infrastrncture, and medical
(7) Use of an automated and standat·dized facilitv-wide alert 1·ecords storage areas shall be secured against the admittance of
f
ing system to announce pediatric or infant abduction unauthorized personnel or unauthorized release o confiden
(8) Remote exit locking 01· ala1·ming tial information through the use of approp1·iate prntections,
f
(9) Staf observation of all persons and inspection of all such as the following:
packages leaving the premises (1) Access control
f
(10) Prohibition on birth announcement� by staf (2) Unigue iclentification for the area
f
(11) Detection o the pt·esence of a nonidentified individual (3) Su1·veillance eguipment
constitutes a secut·ity breach Data encryption and passw01·d protection
(4)
(12) Movement of infant� restricted to ba�inets only - no
hand ca1-ries 13.6 Acces.s and Egres.s Security Measures.
f
( 13) Health care staf wear unigue identification or unifo1·ms
(14) Secure storage of scrubs and unif01·ms, both clean and 13.6.1 Public visitation controls shall be enforced.
dirty 13.6.2 A,:fte1�hours entrance by the public shall be restricted to
(15) Education in pediatt·ic and infant abduction as follows: designated areas, such as entrance lobbies and emergency
(a) Health ca.re staff are familiar with infant abduction department�.
scenarios 13.6.3 Health care facility security controls and procedures
(b) Parents know not to leave a child 01· an infant unat shall comply with life safety reguirement� fot· egress.
tended or in the care of an unidentified pe1·son
2021 Edition
HYPERBARIC FACILITIES 99-II9
13.6.3.1* Security plans for health care occupancies shall 13. 12 Program Evaluation.
ad<lress access and egress control during perio<ls of quarantine
and other event.� in conjunction with eme1·gency agencies. 13.12.1 * Pe1·iodic drills shall be con<lucted at various times
an ct locations.
13. 7* Media Control.
13.12.2 The drills shall be critique<l for plan effectiveness an<l
13.7.1 The secm·ity management plan shall include proce to identify opportunities for improvement.
du1·es to accommo<late me<lia 1·ep1·esentatives.
13.12.3 Identified opponunities for improvement shall be
13.7.1.1* A person shall be designate<l to serve as media incorporate<l into the security plan.
contact an<l 1·ep1·esentative for the 01·ganization in 1·egard to
media interactions. 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
14.1.2.2 Occupancy. Hyperharic chambe1·s shall be classified 2-hour fire-1·esistant-rated ban-ier shall he placed between the
accor<ling to the following criteria: facility an<l the contiguous structure.
(1) Cla�sA- Human, multiple occupancy 14.2.1.1.5 Whe1·e buil<ling exte1-io1· walls fmm part of the
(2) Cla�s B - Human, single occupancy facility boundary, that pmtion of the facility boundaty shall not
(3) Cla�s C -Animal, no human occupancy require 2-hour fire-resistant-rated construction.
14.1.3 Category. 14.2.1.1.6* If there are connecting <loors through such
14.1.3.1 Category I Hyperbaric Care. common walls of contiguity, they shall he at least B-lahel,
I ½-hou1· fire <loors.
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 14.2.1.1.7 When use<l for hyperbaric proce<lures, the room or
tors. the medical gas system shall he Category 1 for use in this rooms housing the Class A 01· Class B chambers shall be for the
chapter. exclusive use of the hyperbaric operation.
14.1.3.1.2 \'\'he1·e intetTuption or faihu-e of electt-ical sen,ice is 14.2.1.1.8 Senice equipment (e.g.. compressors) shall he
likely to cause major ittjury or death of patient�. staff, or visi permitted to be locate<l in multi-use spaces meeting the
tors, the electrical service shall he Category 1 for use in this 1·equirement� of 14.2.1.1.
chaplet·. 14.2.1.1.9 The supporting foun<lation for any chamber shall
14.1.3.2 Category 2 Hyperbaric Care. be <lesigne<l to support the chamber.
14.1.3.2.1 Where interruption or failure of medical gas supply 14.2.1.1.9.1 If on-site hy<lrostatic testing will he perfo1·med,
f
is likely to cause minm· ittjmy of patienl�, staf, or visitm·s, the the chamber supporting foundation shall be designe<l to
medical gas system shall be consi<lered Category 2 for use in support an a<lditional water weight.
this chapter. 14.2.1.2* The room housing a Cla�s A or Class B chamber and
14.1.3.2.2 \\'he1·e interruption or failu1·e of elect1·ical seP,ice is any ancillary equipment rooms shall be provided protection by
likely to cause minor i1tju1y of patient�. staff, or visitors, the one of the following systems:
electrical service shall be Category 2 for use in this chapter. ( l) * A hydraulically calculate<l automatic wet pipe sp1·inkler
system meeting the requirements of NFPA 13
14.1.3.3 Category3 Hyperbaric Care. (2) A.11 automatic water mist fire protection system installed
14.1.3.3.1 \'\'here interruption or failure of me<lical gas supply in accordance with NFPA 750
is not likely to cause i1tju1y to patient�, staff, 01· visitm·s, the (3)* A clean agent fire protection system in accordance with
medical gas system shall be consi<lered Category 3 for use in NFPA 2001
this chapter.
14.2.1.2.1 Class A or Class B chambers not contiguous to a
14.1.3.3.2 Where interruption or failure of elect1·ical se1·vice is health care facility an<l located in a mobile vehicle-mounted
not likely to cause i1tju1·y to patients, staff, or visitors, the elec facility shall not be required to be protected as specifie<l in
trical service shall be Category 3 for use in this chapter. 14.2.1.2.
14.1.3.4 Category4 Hyperbaric Care. (Reserved) 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
14.1.4 Applicable Code. Hyperha1·ic facilities that are fit·e extinguisher.
conducting any form of treatment and are not located in a
designate<l health care facility. including 1·esidential occupan 14.2.1.3 H}Perbaric Piping Requirements.
cies, shall comply w ith the 1·equi1·ement.� of the applicable code.
14.2.1.3.1* Except where other-wise 1·equireci by this chapte1·,
14.2 Co nstruction and Equipment. piping systems dedicated to the hyperba1·ic chambe1· shall meet
the requirement.� of ASME PVHO-1, Sa/Ny Standard for PrPssurP
14.2.1 Housing for Hyperbaric Facilities. Vf.t�el� for Human Oaupanry, for hyperbaric facility piping
14.2.1.1 For Class A chambers located inside a building, the systems.
chambei-(s) and all ancillary senice equipment shall be protec 14.2.1.3.2 Shutoff valves accessible to facility p ersonnel shall
te<l by 2-hour fi1·e-1·esistant-rated construction. be provided for piping specified in 14.2.1.3.1 at the point of
14.2.1.1.1 * Freestan<ling, <le<licated buildings containing only entt-y to the room housing the chamber(s).
a Class A chamber(s) an<l ancillary se1·vice equipment shall not 14.2.1.3.3 The supply piping for all air, oxygen, or other
be 1·equired to be protected by 2-hour fi1·e-resistant-rated breathing mixtures from certifie<l commercially supplie<l cylin
construction. ders and portable containers shall be provided with a particu
14.2.1.1.2 Class B an<l C chambers locate<l inside a huil<ling late filte1· of 66 microns m· fine1·.
shall not be 1·equired to be protected by 2-hour fit·e-1·esistant 14.2.1.3.3.1 The particulate filter shall meet the construction
rated construction. 1·equirement.� of ANSI/ ASME PVH0-1, Sajfty Standard far PrPs
14.2.1.1.3 T1·ailer 01· vehicle-mounted facilities shall be pe1·mit surP VP.t�d�for Human Or,:.upanry.
ted without a 2-hour fire-resistant-rate<l pe1·imete1·. 14.2.1.3.3.2 The particulate filter shall be located as close as
14.2.1.1.4 \\'hen trailer or vehicle-mounted facilities are loca p ractical to the sou1·ce.
ted contiguous to a health ca1·e facility or another structure, a
2021 Edition
HYPERBARIC FACILITIES 99-121
14.2.1.4 Hyperbaric Medical Oxygen System Requirements. (5) An IBER shall not be required fo1· the hype1·baric oxygen
system.
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 14.2.1.5 Hyp erbaric Medical Air System Requirements.
terl as a separate zone.
14.2.1.5.1 \Vhere merlical air systems ai·e installed for hyper
14.2.1.4.2 The 1·equirements of Chapte1· 5 shall apply to the baric use, the hyp e1·ba1·ic area(s) 01· facility shall be treaterl as a
medical oxygen system for hyperbaric use, from the source of separate zone.
supply to the fit-st in-line valve locaterl downstt·eam of the zone
valve(s). 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
14.2.1.4.3 l11e requi1·ements of ANSI/ASME PVHO-1, Sajfty first in-line valve located downstream of the zone valve(s).
Standard Jar Prl'ssurl' ¼ssl'l1 for Human Orrupanry, shall apply to
the medical oxygen system for hyperbaric use, starting immedi 14.2.1.5.3 ANSI/ASME PVHO-1, Sajfty Standard for Pressurl'
ately downstream of the fit-st in-line valve located afte1· the zone lhsl'l1 Jar Human Oi:rupanry, requi1·ement� shall apply to the
valve(s). rnerlical ai1· system for hyperbaric use, sta1·ting immerl:iately
downst1·eam of the first in-line valve located afi:e1· the zone
14.2.1.4.4 Hyperbaric oxygen systems for Category 1, Catego1y valve(s).
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 14.2.1.5.4 \Vl1ere a medical ai1· system is :installed fo1· hyper
cahle, except as noterl in 14.2.1.4.4. l. haric t1·eatment�, it shall comply with the requirement� for the
appropriate level as determinerl in 14.2.1.5.4.l through
14.2.1.4.4.1 Central Supply Systems. Oxygen systems shall 14.2.1.5.4.7.
comply with 5.1.3.5, as applicable, except as followli:
14.2.1.5.4.1 Hyp erbaric medical air systems for Category I,
(1) An emergency oxygen supply connection (EOSC) shall Category 2, and Categoty 3 hyperbaric care connected rlirectly
not be requirerl for the hyperbaric oxygen sy;tem. to a hospital's merlical ai1· system shall comply with Section 5.2,
(2) An in-building emergency reserve (IBER) shall not be a, applicable.
required for the hyperbaric m.-ygen system.
14.2.1.5.4.2 Reserved.
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 14.2.1.5.4.3 Hyp erba1·ic stand-alone medical air systems fo1·
Section 5.1, a� applicable, except a� noted in I 4.2.1.4.5. l. Categot·y l anrl Categor y 2 hyperbal"ic care shall comply with
Section 5.2. as applicahle.
14.2.1.4.5.1 Central Supply Systems. Oxygen sylitems shall
comply with 5.1.3.5, as applicable, except as follows: 14.2.1.5.4.4 Reserved.
( l) An EOSC shall not be requirerl for the hyperbaric oxygen 14.2.1.5.4.5 Merlical air systems for Catego1y l anrl Catego1y 2
system. hype1·haric ca1·e shall comply with Section 5.2, as applicable,
(2) An IBER shall not be 1·equi1·ed for the hyperbaric oxvgen except that warning systems shall be permitted to be a single
system. master/area alarm panel.
14.2.1.4.6 Warning Systems. 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
14.2.1.4.6.1 Oxygen systems shall comply with 5.1.9, as appli ble, except as noterl in 14.2.1.5.4.7.
cable, except that warning systems shall be permitterl to be a
single master/area alarm panel. 14.2.1.5.4.7 Medical air systems shall comply with Section 5.2
a, applicable, except as follows:
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 (1) Area anrl ma5ter alarms shall not be requirerl for Cate
monit01·ing by the chamber operator. gory 3 hyperbaric cai·e.
(2) A gas cylinder hearler pe1· Section f>.2 with sufficient cylin
14.2.1.4.7 Hype1·baric stand-alone oxygen systems fo1· Cate der connections to provide for at least an average day's
gory 3 hyperbaric care shall comply with Section 5.2. as applica supply with the appropriate number of connections being
ble, except as noted in 14.2.1.4.7.1. rletermined after consideration of delivery schedule,
14.2.1.4.7.1 Central Supply Systems. Oxygen systems shall proximity of the facility to alternate supplies, anrl the
comply with :U .3.5, as applicable, except as follows: facility's emergency plan shall be pe1·mitted.
(3) A medical air cylinder directly connecterl to a Class B or
( l) If the ope1·ating oxygen supply consists of high p1·essm·e Class C chamber ai1rl used to provide air to that chambe1·
cvlinders designerl with a primary anrl seconda1-y som·ce, shall he permitterl to he in the same room as the cham
no reserve supply shall be requirerl. ber.
(2) If the operating oxygen supply consists of liquid contain (4) \Vhe1·e a cylinrler is used as rlesc1·ibed in 14.2.1.5.4.7(3),
ers designerl with a primar y and seconrlary source, a the cylinde1· shall be consirle1·ed to be "in use" and shall
reserve with a minimum supply of 11' minutes shall he not be counted when determining the total volume of
required. merlical gas out�irle a storage area in Section 11.3.
(3) If the operating oxygen supply consists of a bulk primai·y,
a 1·eserve with a minimum supply of 15 minutes shall he 14.2.1.6 Storage and Handling of Medical Gases. Storage anrl
required. handling of medical gases shall meet the applicable require
( 4) An EOSC shall not be required for the hyperbai·ic oxygen ment5 of Chapter 5 anrl Chapter 11.
system.
2021 Edition
14.2.2 Fabrication of the Hyperbaric Chamber. 14.2.2.7.1 Access port� in Cla�s A chambers, access ports for
monitoring, and other electrical circuit� shall be housed in
14-2.2.1 * Chambe1·s for human occupancy and their support enclosures that a1·e weatherproof. both inside and out�ide the
ing systems shall be designed and fabricated to meet ASME chambe1·, fot· protection in the event of sprinkler activation.
PVH0-1, Sapty Standard for Pre.mire ¼>ssel� for Human Or.rupanr:y,
by personnel qualified to fabricate vessels under such codes. 14.2.2.7.2 Viewport5 and penetrator plates shall be designed
and fabt·icated acco1·ding to ANSI/ASME PVHO-1, Sapty Stand
14.2.2.1.1 Piping systems for hyp erha1·ic facilities shall he ard for PrPssurP Vessel�for Human Oa:upanry.
required to meet only the requi1·ements of this chapte1· and
Section 4, "Piping Systems," of ASME PVHO-1, Sapty Standard 14.2.3 Illumination.
for Pmm1re Ve.1:�els for Human Or.rupanry.
14.2.3.1 Sources of illumination mounted outside the pres
14.2.2.1.2 Piping that is installed in concealed locations in the sure chamber and atTanged to shine through chamhe1· ports or
building housing the hyperbaric facility, such a� inside building through chamber penetrators designed for fiber-optic or simi
walls 01· above false ceilings. shall use only those joining proce lar lighting shall meet the following requi1·ements:
dures permitted by Chapter 5.
( 1) lighting fixtures used in co1�unction with \iewports shall
14.2.2.2 The chamber shall be stamped in accordance with he designed so that t emperature ratings for the viewport
ASME PVH0-1, Sapty Standard for PrPss1ae Ve.1:sfls for Human matet-ial given in ASME PVHO-1, Sapty Standard for Pres
Oc,·upan,y. sure VP.�sels for Human Ocrupanry, are not exceeded.
(2) Gasket material shall be of a type that allows the move
14.2.2.3 Class C chambers shall he designed, fabricated, and ment of thermal expansion and shall be selected for the
stamped to meet Division l 01· Division 2 code 1·equi1·ements of temperatu1·es, pressures, and composition of ga�es
Section VIII of the ASME Boiln and Pre.mlTP VPssPl Codi'. involved.
14.2.2.4* The viewports for Class C chambers shall be (3) Gasket5 or 0-rings shall he confined to grooves or enclo
designed, fabricated, and ma1·ked to meet Section 2 of ASME sures, which will prevent their being blown out or
PVHO-1, Safety Standardfor PrPss1m Vessd�for Human Or.r:upanry. squeezed from the enclosures or comp1·ession flanges.
14.2.2.5 The floor of a Class A chamber shall be designed to 14.2.3.2 Emergency lighting for the interior of the chamber
suppon equipment and personnel necessa1·y for the operation shall be provided.
of the chamber according to it� expected purpose. 14.2.4 Chamber Ventilation.
14.2.2.5.1 The floor of Class A chambers shall be noncombus 14.2.4.1 Ventilation of Class A Chambers.
tible.
14.2.4.1.1 The minimum ventilation rate fot· a Cla�s A cham
14.2.2.5.2 If a bilge is installed, access to the bilge shall be ber shall be 0.085 m:'/min (3 ft�/min) of air per chamber occu
pro,ided for cleaning purposes. pant who is not using a breathing-mask ove1·hoard dump system
14.2.2.5.3 If the interior f1001· of a Class A chamher consist� of that exhausts exhaled gases.
removable floor (deck) plates, the plates shall be mechanically 14.2.4.1.1.1 The minimum threshold rate shall be
secured and electrically bonded to the chamber to ensure a 0.085 m�/min (3 ft1/min).
positive electrical ground and to prevent movement of the
plate, which could cause injury to personnel. 14.2.4.1.1.2 Provision shall be made ftx ventilation dtu-ing
nonpressurization of Class A chambers as well as during pres
14.2.2.6 The interior surface of Class A chambers shall be surization.
unfinished or u·eated with a paint/coating in accordance with
14.2.2.G. l. 14.2.4.1.2* Ventilation shall not be 1·equired when saturation
operations are conducted in the chamber, provided that
14.2.2.6.1* Interior paint/coating shall meet the performance carbon dioxide removal and odor cont rol are accomplished
criteria of NFPA 101, Class A interior finish, when tested in f
and that the monitoring requirements o 14.2.10.4.l and
accordance with ASTM E84, Standard Test IHethod for Suifaa 14.2.10.5 are met.
fluming Chamdrnstirs of Building Materials, or UL 723, Standard
for ]pst for Suiface Burning Chara,:tPrisli,:s of Building MatPriak 14.2.4.1.3 Individual breathing apparatus shall be available
inside a Class A chambe1· for each occupant for use in the event
14.2.2.6.2* One additional application of paint shall be that the chamber atmosphe1·e is fouled by combustion or othe1·
pe1·mitted, provided total paint thickness does not exceed wise.
½sin. (0.9 mm).
14.2.4.1.3.1 The bt·eathing mixtu1·e supplied to breathing
14.2.2.6.3 If the interior of a Class A chamber is treated (pain apparatus shall be independent of chamber atmosphe1·e.
ted), the cure procedure and minimum duration for each layer
of paint/coating to off�ga s shall be in acco1·dance with the 14.2.4.1.3.2 The lxeathing gas supply shall be designed for
manufacturer's application inst1·uctions. simultaneous use of all bt·eathing apparatus.
14.2.2.6.4* If sound-deadening materials are employed within 14.2.4.1.3.3 Breathing apparatus shall function at all pressures
a hyperba1·ic chamber, they shall be limited-combustible mate1·i that can be encountered in the chamber.
als.
14.2.4.1.3.4 In the event of a fi1·e within a chambe1·, provision
14.2.2. 7* Viewing ports, access ports for piping and wiring or shall be made to simultaneously switch all breathing apparatus
monitoring, and 1·elated leads shall be installed du1·ing initial to an ai1· supply that is independent of the chamber atmos
fabrication of the chamber. phere.
2021 Edition
14.2.4.2 Sources of Air for Chamber Atmospheres. 14.2.5.3 Class C chambe.-s shall be capable of rapi<l <lep1·essu
rization.
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. 14.2.5.4* A 1·isk assessment shall be ped·01·med to dete1·mine if
means for 1·espiratory and eye prntection from combustion
14.2.4.2.2 Compressor intakes shall be located away f om air r
pro<lucts allowing unrestricted mobility is required to he availa
contaminated by exhaust from activities of vehicles, internal ble outside all classes of hype1·haric chambers for use by
combustion engines, stationa ry engines, 01· building exhaust pe1·so11nel in the event the air in the vicinity of the chamber is
outlets. foule<l by smoke or other combustion product�.
14.2.4.2.3 Ai1· supply fo1· chamber atmosphere shall he moni 14.2.6 Fire Protection in Class A Chambers.
tore<l as requi1·ed in 14.2.10.6.
14.2.6.1 General.
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 14.2.6.1.1 A fire suppression system consisting of in<lepen<l
ment packages designe<l to meet the 1·equirement� of 14.2.10.6. entlv supplie<l and opernting ha.n<lline- and deluge-type wate1·
spray systems shall be installed in all Class A chambern.
14.2.4.2.5 Air compressor installations shall consist of two or
more individual comp1·essors with capacities such that 1·equi1·ed 14.2.6.1.2 Design of the fire suppression system shall be such
system flow rntes can be maintained on a continuous basis with that failure of component� in eithe1· the handline 01· deluge
any single comp1·ess01· out of operation, unless 14.2.9.2.6 is system will not render the othe1· system inoperntive.
satisfied.
14.2.6.1.3 System design shall be such that activation of eithe1·
14.2.4.2.5.1 Each c01np1·ess01· shall be supplied from separnte the handline 01· the deluge system shall automatically cause the
electrical hrnnch circuit�. following:
14.2.4.2.6 A.ii· compresso1· installations that supply medical air (1) Visual and aural indication of activation shall occur at the
to piped ga� systems a.� well as to hyperba1·ic facilities shall meet chambe1· operntor's console.
the requi1·ements of 5.1.3.6.3 and this chapter. (2) ."'11 ungrounded electrical leads fix power and lighting
circuil� conta.ine<l insi<le the chamber shall be disconnec
14.2.4.2. 7 Ai1· comp1·esso1· installations that a re used exclu te<l.
sively for hype1·baric facilities shall meet the requirements of (3) Emergency lighting (seP 14.2.3.2) and communication,
this chapter only. where used, shall be activated.
14.2.4.3 Temperature and Humidity Control. 14.2.6.1.3.1 Intrinsicallysafe ci1·cuit�, including sound
14.2.4.3.1 Warming or cooling of the atmosphe1·e within a powered communications, shall be permitted to remain
Cla�s A chamber shall be permitte<l by circulating the ambient connecte<l when either the handline or the <leluge system is
air within the chamber over 01· past coils through which a activated.
constant flow of warm 01· cool \\'3.ter or wate1/glycol mixture is 14.2.6.1.4 A means of communication shall be provi<le<l at the
circulated. chamber operator"s control console for notifying the fire
14.2.4.3.2 Dehumidification shall be pe1·mitted thrnugh the department.
use of cold coils. 14.2.6.1.4.1 Activation of the fire supp1·ession system shall
14.2.4.3.3 Humidification by the use of an air0powered water notify the facility's central fire alarm system, if present.
ne bulizer shall be pe1·mitte<l. 14.2.6.1.4.2 Trniler or vehicle-mounte<l facilities not conti gu
14.2.4.3.4 Noncombustible packing and nonflammable lub1·i ous to a health care facility shall confo1·m to one of the follow
cant shall be employed on the fan shaft. ing:
(1) They shall comply with 14.2.6.1.4.
14.2.4.4 Ventilation of Class B Chambers. (2) They shall have a means for imme<liately contacting the
14.2.4.4.1* The minimum ventilation rate for a Class B cham local fire depa rtment.
ber shall be 0.0283 m'/min (1 ft'/min). 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.
14.2.4.4.2 Class B chambers not <lesigned for 100 pe1·cent
oxygen environment shall comply with the monitoring requi1·e 14.2.6.1.6 Booster pumps, control circuitry, an<l other electri
ment� of 14.2.10.4. cal equipment involve<l in fire suppression system operation
14.2.4.4.3 For Class B chambers equipped with a breathing shall be powered from a CI"itical branch of the essential elecu·i
apparatus, the breathing apparatus shall function at all p1·es cal system as specified in 14.2.9. 2.1.2.
sures that can be encountered in the chamber. f
14.2.6.1.7 Signs prohibiting the intro<luction o flammable
r
14. 2. 5 Emergency Depressurization. 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).
14.2.5.1 Class A chambers shall be capable of dep1·essmizing
from 3 ATA (304.0 kPa) to ambient pressure in not more than 14.2.6.1.8 The fit·e suppression system shall be permitte<l to be
6 minutes. supplied from the local potable water service.
14.2.5.2 Class B chambers shall be capable of depressmizing 14.2.6.2 Deluge S)Stem. A fixed water deluge extinguishing
from 3 A.TA (304.0 kPa) to ambient pressure in not more than system shall be installe<l in all chambe1· compartment� that are
2 minutes. designe<l for ma.nned operations.
2021 Edition
14.2.6.2.1 In chambern that consist of m01·e than one chamber 14.2.6.3.6 Handlines shall be equipped with override valves
compartment (lock), the design of the deluge system shall that are accessible to personnel outside the chamber.
meet the requirement� of 14.2.6.2 when the chamber compart
ment5 a1·e at diffr1·ent depths (pressures). 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
14.2.6.2.2 The deluge system in different compartments above the maximum chamber pressure.
(locks) shall operate independently or simultaneously.
14.2.6.3 .7.1 The system shall he capable of supplying a mini
14.2.6.2.3 Fixed deluge systems shall not be required in cham mum of 18.9 L/min (5 gpm) simultaneously to each of any two
f
ber compartment5 that are used strictly as personnel trans fer o the handlines at the maximum chamber pressure for a
compartments (locks) and for no othe1· put-poses. period of not less than 4 minutes.
14.2.6.2. 4* Manual activation and deactivation deluge 14.2.6.4 Automatic Detection System. Automatic fit·e detec
controls shall be located at the operator's console and in each tion systems shall not be required.
chambe1· compartment (lock) containing a deluge system.
14.2.6.4.1 Surveillance fire detect01·s responsive to the radia
14.2.6.2.4.1 Controls shall be designed to pt·event unintended tion from flame shall be employed.
activation.
14.2.6.4.1.1 The type and arrangement of detectot·s shall he
14.2.6.2.5 \'Vate1· shall be delivered from the fixed discharge such as to respond within l second of flame origination.
nozzles as specified in 14.2.6.2. 7 within 3 seconds of activation
of any affiliated deluge control. 14.2.6.4.2* The number of detectors employed and their loca
tion shall be selected to cover the chamber inte1·i01·.
14.2.6.2.6* Average spray density at floor level shall be not less
14.2.6.4.3 The system shall be powered from the critical
than 81.5 L/min/m2 (2 gpm/ft 2), with no floor area larger
branch of the essential electrical system or shall have automatic
than l m2 (10.76 ft2) receiving less than 40.75 L/min/m 2
battery hack.up.
(1 gpm/ft2). f
14.2.6.4.4 I used to automatically activate the deluge system,
14.2.6.2. 7 \Vater shall be available in the deluge system to the requirements for manual activation/deactivation in
maintain the flow specified in 14.2.6.2. 6 simultaneously in each 14.2.6.2.4 and deluge system response time in 14.2. 6.2.5 shall
chambe1· compartment (lock) containing the deluge system fot· still applv.
l minute.
14.2.6.4.5 The system shall include self�monitoring functions
14.2.6.2. 7.1 The limit on maximum extinguishment duration for fault detection anrl fault alarms and inrlications.
shall be governed by the chamber capacity (bilge capacity also,
if so equipped) or it� drainage system, or both. 14.2.6.4.6 Automatic fire detection equipment. when used.
shall meet the applicable requirement� in 14.2.9.3.
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·. 14.2.7 Pneumatic Controls for Gass A Chambers. Class A
chambe1·s that utilize pneumatically opei-ated controls that are
14.2.6.2.9 All dedicated storage vessels used to pro.ide the related to fire suppression system operation, breathing gases,
deluge system with water shall be fitted with a suitable \vate1· or rapid exhaust valves shall be equipped with a means to ope1·
level indicat01·, with the level displayed at the chambe1· console. ate such controls or intended function i n the event that the
14.2.6.2.10 Deluge systems using pressurized water vessels pneumatic supply fails.
shall be designed to pt·event the driving gas supply from pres 14.2.8 Fire Protection in Class B and Class C Chambers.
surizing the hype1·ba1-ic ch am bet· if all the water is dt·iven out of Class B and Cla�s C chambe1·s shall not be required to comply
the water vessel. with 14.2.6.
14.2.6.3 Handline System. A handline extinguishing system 14.2.8.1 Signs prohibiting the introduction of flammable
shall be installed in all ch ambet· compartment5 (locks). liquids, ga�es, and othe1· articles not permitted by this chapter
14.2.6.3.1 At lea5t two handlines shall be strategically located into the chamber shall be posted at the chamber entrance(s).
in treatment compartment5 (locks). 14.2.8.2 A means for communication shall be pro.irled within
14.2.6.3.2 At least one handline shall be located in each the room housing the chambe1·(s) for notifying the fire depart
personnel transfer compartment (lock). ment.
f
14.2.6.3.3 If any chambe1· compartment (lock) is equipped 14.2.8.2.1 I the building housing the hyperba1·ic facility has a
with a bilge access panel, at least one handline shall n�ach the central fire alarm system, the communication shall be a pull
bilge area. station connected to the system.
14.2.6.3.4 Handlines shall have a 12.7 mm (0.5 in.) minimum 14.2.8.2.2 Traile1· 01· vehicle-mounted facilities not contiguous
internal diameter and shall have a i-ated operating pressure to a health cai·e facility shall confo1·m to one of the follm,�ng:
greater than the highest supply pressure of the supply system. (1) They shall comply with 14.2.8.2.
(2) 1l1ey shall have a means for immediately contacting the
14.2.6.3.5 Each handline shall be activated by a manual,
local fir·e depai·tment.
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
14.2.9 Electrical Systems. 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
14.2.9.1 General. ces of electt·ic power.
14.2.9.1.1 1l1e requirement� of NFPA 70 or local electrical 14.2.9.2.3.1 Fm· hyperbat·ic facilities using a prime-mover
codes shall apply to electrical wiring aml equipment in hyper rlriven generator set, they shall be designaterl as the life safety
baric facilities within the scope of this chapter, except as such anrl critical brnnches and shall meet the 1·equirement� of Chap
mies are modifierl in 14.2.9. ter 6 for hyperbaric systems based in health care facilities.
14.2.9.1.2 All hyp erbaric chamber service equipment, switch 14.2.9.2.3.2 Electrical equipment associated with lile-support
boa1·ds, panels, or control consoles shall be located out�ide of, functions of hype1·baric facilities shall be connecterl to the criti
anrl in the vicinity of, the chamber. cal branch of the essential electrical system, which 1·equi1·es that
14.2.9.1.3 Console or module spaces containing both oxygen such equipment shall have electrical power restored within
piping and electt·ical equipment shall be either one of the 10 seconrls of intermption of normal power.
following: 14.2.9.2.4 Electt·ic mot01·-rl1·iven compressors and auxiliaty
( l) Mechanically or naturally ventilated electrical equipment normally located out�ide the chamber
(2) Continuously monitorerl fo1· excessive o-,.,.-ygen concentt·a- anrl used for chamber atmosphe1·ic contt·ol shall be connecterl
tions whenever the electrical equipment is energized to the equipment system (.�PP ChaptfT 6) 01· the life safety anrl
critical branches (.w ArtidP 700 nf JW·PA 70) as applicable.
14.2.9.1.4 For the fixed electrical installation, none of the
following shall be permitted inside the chamber: 14.2.9.2.5 Electt·ic moto1·-driven compressors and auxiliaty
( l) Ci1·cuit b1·eake1·s electrical equipment shall be aiTanged fot· delayerl-automatic
(2) Line fuses or manual connection to the alten1ate power source so as to
(3) Motor controllers prevent excessive current rlraw on the system <luring restarting.
(4) Relays 14.2.9.2.6 Where reserve air tanks 01· a nonelectric compres
(1,) Transformers sor(s) is provirlerl to maintain ventilation ait·flow within the
(6) Ballasts chamber and supply air for chamber pressurization, the
(7) Lighting panels comp1·esso1·(s) and auxiliary equipment shall not be n,quirerl
(8) Powe1· panels to have an alternate powe1· sout·ce.
14.2.9.1.5 All electrical equipment connecterl to, or userl in 14.2.9.3* Wiring and Equipment Inside Class A Chambers.
conjunction with, hyp e1·baric patient� shall comply \\ith the The genet·al mies of 14.2.9.3.1 through 14.2.9.3.16.5 shall be
1·equirement� of Chapter 10 anrl with the applicable subpara satisfie d in the use of electt·ical devices anrl equipment. T hese
graphs of 14.2.9.3. requit·emenl� at·e intenrlerl to protect against the elevaterl fire
14.2.9.1.6 In the event of activation of the room sp1·inkler risks known to exist in a pressurized air environment anrl shall
system, electrical equipment shall be protected from sp1·inkler not be construed as cla�sifying the chain bet· interior as a Class I
f
wate1· but shall not be required to remain functional i manual (as definerl in Article 500 of NFPA 70) hazai·rlous location.
means to control and decompress the chamber are prmided. 14.2.9.3.1 Equipment or equipment component� installerl in,
14.2.9.2 Electrical Service. or userl in, the chamber shall not present an explosion 01·
implosion haza1·d undet· the conditions of hyperbaric use.
14.2.9.2.1* All hyperbaric facilities equipped with any of the
following electrically driven feature shall be provided with 14.2.9.3.2 All equipment shall be raterl, or tested anrl docu
some means of backup electt·ic power: mented, for intenrlerl hyperbaric conditions prior to use.
( l)* Chamber room emergency lighting, installerl per 14.2.9.3.3 Only the electt-ical equipment necessary fo1· the safe
f
Section 7.9 o NFPA J()J_ operation of the chamber and for requirerl patient care shall
(2)* Chamber emergency lighting, whether internally or exter- be pet·mitted in the chambet·.
nally mounterl 14.2.9.3.4 Only portable equipment necessaty for the logisti
(3)* Chamber intercommunications cal anrl operational support shall be permitted in the chamber
(4)* Alarn1 systems, including flame detectors during manned pressut·ization.
(5 )* Chamber fire supp1·ession system equipment and controls
(6)* Electrical controls used for chamber pressurization and 14.2.9.3.5 Wires and Cables. \'Vires and cables userl inside the
ventilation control chamber shall be resistant to the spread of fire by complying
with 14.2.9.3.!'>.l or shall be contained within equipment rle
14.2.9.2.1.1 Electt·ical control and alarm system design shall scriberl in 14.2.9.35.2.
be such that hazardous conrlitions (e.g., loss of chamber p1·es
sure control, deluge activation, spurious alarms) rlo not occur 14.2.9.3.5.1 ,-v·ires and cables shall comply with the spread of
rlm·ing powe1· interruption or during power 1·estoration. fire requirement� of "UL Flame Exposure, Vertical Tray Flame
Test" in UL 1685, Standard fnr Vertiral-Tray Fire-Pmpagatinn and
14.2.9.2.1.2 Booster pumps in the chamber fit·e suppression Smnkf-&lnw 'J!'sl fnr t:!Pt:triral and Gptiral-Fiber Cables, or shall
system shall be on separate branch circuit� serving no other exhibit damage (cha1· length) not to exceed 1.5 m (4 ft 11 in.)
loads. when perfot·ming the CSA "Venical Flame Test - Cables in
14.2.9.2.2 Article 700 of NFPA. 70 shall apply to hyp erbaric Cable Trays,'' as rlesct·ibed in CSA C22.2 No. 0.3, Test Metlwd� fnr
systems locaterl in facilities other than health care facilities. Elertriral WirP-� and Cables .
2021 Edition
14.2.9.3.5.2 Wires anrl cables that form an integrnl pan of (l) 1l1e 1·eceptacle-plug combination shall be of a locking
electrical equipment approved or listed specifically for use type.
inside hypet·baric chambers, including patient leads, shall not (2) The receptacle shall caITy a label wan1ing against unplug
be 1·equired to comply with the requi1·ement� of 14.2.9.3.5.l . ging unde1· load, anrl the power cm·rl shall not present a
trip hazard for personnel moving in the chamber.
14.2.9.3.6 Wiring Methods.
14.2.9.3.10 Switches. S\,�tches in the fixer! wiring installation
14.2.9.3.6.1 Fixed wiring shall be installed in conrluit utilizing shall be waterproof.
the following waterproof component�:
( l) Threaded metal joint� 14.2.9.3.10.1 * Switch make and break contacts shall be
(2) Fittings houser! in the electt·ical enclosure so that no sparks from a1-cing
(3) Boxes contact� can 1·each the chamber environment.
(4) Enclosures 14.2.9.3.11 * Temperature. No electrical equipment installed
14.2.9.3.6.2 A continuous grounrl shall be maintainer! or used in the chamber shall have an opernting surface tempe1·
benveen all conrluctive sudaces enclosing electrical circuit� anrl at1u-e in excess of 85"C (185"F).
the chamber hull using approver! grounding means. 14.2.9.3.12 Exposed Llve Eleclrical Parts. No exposer! live
14.2.9.3.6.3 .'\11 threaded conrluit shall be tlu-eaded with an electt·ical pa1·t� shall be permitted, except as specifier! in
NPT standard conrluit cutting die that provides a 19 mm tape1· 14.2.9.,\.12. l anrl 14.2.9.3.12.2.
per 0.3 m (0.75 in. taper per l ft). 14.2.9.3.12.1 Exposed live electrical part� that are intrinsically
14.2.9.3.6.4 All threarlerl conrluit shall be marle wrench-tight safe shall be permitted.
to prevent sparking when fault cut-rent flows through the 14.2.9.3.12.2 Exposed live electrical parts that constitute
conduit system. patient monitoring leads, which are part of electromedical
14.2.9.3.6.5 Wiring classified as intt·insically safe for any group equipment, shall be pe1·mitted, provided that they meet the
location anrl installed in accm·rlance with A..rticle 504 of requirement� of 14.2.9.3.16.
NFPA 70shall be permitted. 14.2.9.3.13* Motors. Motors locater! in the chamber anrl that
14.2.9.3.6.6 Threarlerl, liquidtight flexible metal conrluit a1·e not a component of medical equipment shall meet one of
installed in accorrlance with Article 350 of NI-PA. 70 shall be the following 1·equirement�:
permitted when protected from rlamage by physical barriers (1) 1l1ey shall comply with 501.125(A)( l ) of NFPA 70.
such as equipment panels. (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. 7 Drainage. Means of draining fixed conduit and
fixed equipment enclosures shall be provided. 14.2.9.3.14* Lighting.
14.2.9.3.B Flexible Electrical Cords. Flexible cords used to 14.2.9.3.14.1 Lighting installed 01· used insirle the chamber
connect portable utilization equipment to the fixer! elect1·ical shall be of a type that is not damaged by exposure to l ½ times
supply circuit shall meet all the following requirement�: the maximum allo\1,ahle wm·king pressm·e (MA\'\!J>).
( l) They shall be of a type approver! for extra-ha1·rl use in 14.2.9.3.14.2 Permanently installed fixtures shall meet the
acco1·dance with Table 400.4 of NI-PA. 70. following requirement�:
(2) Electrically conductive casings of all portable equipment
for use insirle the chamber shall be grounded. (l) They shall be rated and approved for Class I (Division l
(3) They shall meet the 1·equirements of 501.140 of NFP/i 70. or 2) classifier! areas.
(2) 1l1ey shall have lens guards installed.
14.2.9.3.B.l The normal cord supplier! with the portable (3) 1l1ey shall be located away from a1·eas where they would
utilization equipment shall be permitted when the pot·table experience phys ical damage from the normal movement
device is rated at less than 2 A and the cm·d is positionerl out of of people and equipment.
trnffic and protected from physical abuse.
14.2.9.3.14.3 Balla�t� and other energy storage component�
14.2.9.3.9* Receptacles Installed Inside the Chamber. that are pan of the lighting circuit shall be installer! out�irle the
chamber in accordance with 14.2.9.1.4.
14.2.9.3.9.1 Receptacles shall he waterproof.
14.2.9.3.14.4 Portable fixtures intended for spot illumination
14.2.9.3.9.2 Receptacles shall be of the type providing for shall be shatterproof or protected from physical damage.
connection to the grounding conductor of the flexible cm·d.
14.2.9.3.15 Low-Voltage, Low-Power Equipment. The requi1·e
14.2.9.3.9.3 Receptacles shall be supplied from isolated power ment� of 14.2.9.3.15. l through 14.2.9.3.15.5 shall apply to
circuits meeting the requirements of 14.2.9.4.2.
sensors anrl signaling, alann, communications, and remote
14.2.9.3.9.4 The design of the 1·eceptacle shall be such that control equipment installer! or used in the chamber for opera
sparks cannot be discha1·ged into the chamber environment tion of the chamber.
when the plug is inserted or withdrawn under electrical !oar!.
14.2.9.3.15.1 * Equipment shall be isolated from main power
14.2.9.3.9.5 One of the following shall he satisfied to protect by one of the following means:
against inadvertent withrlrnwal of the plug under electt·ical (1) Design of the power supply circuit
load: (2) Opto-isolation
(:'I) Other electronic isolation means
2021 Edition
14.2.9.3.15.2 Circuit� such as headset cables. sensor lea,ts. and 14.2.9.4.1.2 The material. size, and installation of the ground
so forth, not encloserl as requirerl in 14.2.9.3 .G, shall meet one ing conductor shall meet the requirement� of Part VI of Article
of the following requirement�: 250 of NFP.!l. 70for equipment grounding conrluctm·s.
(I) They shall be part of approved intt·insically safe equip 14.2.9.4.1.3 The resistance between the grounrlerl chambe1·
ment. hull and the electrical grounrl shall not exceed l ohm.
(2) They shall be limited by circuit design to not more than
28 V and 05 A unde1· normal or ci1·cuit-fault conditions. 14.2.9.4.2 All ac electrical power circuit� located within the
chamber shall be supplied from an ungrounded elecu·ical
14.2.9.3.15.3 Chamber speakers shall be of a design in which system.
the electrical ci1·cuitt·y anrl wiring is completely enclosed.
14.2.9.4.2.1 The ci1·cuit� specified in 14.2.9.4.2 shall meet the
14.2.9.3.15.4 The electrical rating of chamber speakers shall requi1·ement� of 517. lG0(A) and 517. lG0(B) of NI-PA 70.
not exceed 28 V rms and 25 W.
14.2.9.4.2.2 B1·anch circuit� shall not exceed 125 V or 15 A.
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 14.2.9.4.3 \A/iring located both inside and out�ide the cham
operaterl devices. ber, that serves line level circuit� anrl equipment locaterl insirle
the chamber, shall meet the grounding and bonding 1·equire
14.2.9.3.16 Portable Patient Care-Related Electrical Applian ment� of 501.30 of NFPA. 70.
ces.
14.2.9.5 Wiring O utside the Chamber. Those electrical
14.2.9.3.16.1 The appliance shall be designed, constructed, component� that must remain firnctional for the safe termina
inspected, and maintainerl in acco1·dance with Chapter 10. tion of chamber operations following activation of the room
14.2.9.3.16.2 The electrical anrl mechanical integrity of the sprinkler system shall be enclosed in wate1·proof housing.
appliance shall be verified and documenterl through an ongo 14.2.9.5.1 A.JI associated conduit� shall meet the following
ing maintenance program as required in Chapter 10. requirement�:
14.2.9.3.16.3 Appliances that utilize oxygen shall not allow ( l) They shall be waterproof.
oxygen accumulation in the electrical portions of the equip (2) They shall meet the requirements of NfPA 70.
ment unrle1· nOL·mal anrl abnOL·mal conditions. (3) They shall he equipperl with approved drains.
14. 2. 9. 3.16.4 Battery-Operated Devices. Bat tery-operaterl 14.2.9.5.2* All other electrical devices out�ide the chamber
devices shall meet the following requirements: shall meet the requirement� of NFPA. 70.
( l) Batteries shall be fully enclosed and secut·ed within the 14.2.9.6 Additional Wn-ing and Equipment Requirements
equipment enclostll'e. Inside Class B and Oass C Chambers. The requirements in
(2) Batteries shall not be damagerl by the maximum chamber 14.2.9.6 shall apply to Class C chambers pressurized with
pressu1·e to which they a1·e exposed. oxygen and to Class B chambers whethe1- they a1·e p1·essurized
(3) Batteries shall be of a sealerl type that does not off-gas with oxygen 01· with air.
during normal use.
( 4) Batteries or hattery-operaterl equipment shall not 14.2.9.6.1 Electrical equipment inside chambers shall be
unde1·go cha1·ging while located in the chambe1·. 1·esu·icted to communications functions and patient physiologi
(5) Batteries shall not be changerl on in-chambe1· equipment cal monit01·ing leads.
while the chamber is in use. 14.2.9.6.1.l* Each circuit shall be designed to limit the electri
(G) The equipment elecu-ical rating shall not exceed 12 V cal energy to wi1·e !earls into the chambe1· under n01·mal 01·
and 48 \'\'. fault conditions to not more than 28 V anrl 4.0 \, V This 1·equire
14.2.9.3.16.5 Cord-Connected Devices. Cord-connected devi ment shall not exclurle more stringent requirement� imposerl
ces shall meet the following requirements: by other codes governing electromedical apparatus.
( l) A.II portable, cm·d-connected equipment shall have an 14.2.9.6.1.2 Communications wires shall be protected from
on/off power switch. physical damage and from coming into contact with flammable
(2) The equipment electt·ical rating shall not exceed 120 V materials in the chamber by baLTiers or conduit.
and 2 A. unless the electrical portions of the equipment
are inert-gas purged. 14.2.9.6.1.3 Patient monitoring !earls shall be pan of
The plug of cord-connected rlevices shall not be used to approved elecu·omedical apparatus meeting the requirement5
(3)
inteLTupt power to the device. in 14.2.9.3.lG.
14.2.9.3.17* Gas Purging. Gas pmging of AC anrl DC equip 14.2.9.6.2 Lighting insirle the chamber shall be supplied from
ment used inside the chamber shall be permitterl using inert external sources.
gas or air. 14.2.9.6.3 No materials shall be permitterl in a chamber whose
14.2.9.4 Grounding and Ground-Fault Protection. temperature exceeds 50"C ( l 22"F), nor shall any elecu·ical
ci1·cuit inside a chamber operate at a temperature exceeding
14.2.9.4.1 All chambe1· hulls shall be grounded to an electrical 50'C (122'F).
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 as
1·equirerl by Part III of Anicle 250 of 1\/I-PA 70.
2021 Edition
14.2.10 Communications and Monitoring. 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
14-2.10.I General. tion within the chambe1·.
14.2.10.1.1 Electt·ical monitoring equipment used inside the 14.2.10.5 Carbon Dioxide Monitoring. The chamber atmos
chamber shall comply with the applicable requirement� of phere shall be monitorerl for carbon rlioxirle levels during satu
14.2.9. rntion operntions whenever ventilation is not userl.
14.2.10.1.2 Detectors, sensors, trnnsducers, and communica 14.2.10.6* Chamber Gas Supply Monitoring.
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 14.2.10.6.1* As a minimum, the air supplied from compres
for Class B chambet·s. sm·s to all classes of chambet·s shall meet the requi1·ements for
CGA Gracie E with the arlrlerl requirement that conrlensed
14.2.10.1.3 Wiring methods in the chamber shall meet the
hyrlrocarbons and particulates shall be less than 0.1 mg/m3
applicable 1·equirement� in 14.2.9.3.
14.2.10.6.2 W'hen ait· cylindet·s are used to prnvirle breathing
14.2.10.1.4 The following equipment shall be installed outside
air in chambers, the breathing air shall be merlical air USP.
the chamber or shall meet the requirements of 14.2.9.3.15:
( 1) Control equipment 14.2.10.6.3 When cylinders are userl to provide oxygen m
(2) Powe1· amplifiet·s chambern, the ga� shall be oxygen USP.
(3) Output transformers 14.2.11 Other Equipment and Fixtures.
(4) Monitors associated with communications and monitor-
ing equipment 14.2.1 I.I All furnitu1·e permanently installerl m the hyper
baric chamber shall be grounded.
14.2.10.2* Intercommuni cations.
14.2.11.2* Exhaust from all classes of chambe1·s shall be piped
14.2.10.2.1* A...11 intet·communications syi;tem shall connect all out�ide of the building.
pe1·s01111el companment� (locks) and the chamber operntor's
control console. 14.2.11.2.1 Each Class B and Class C chamber shall have an
independent exhaust line.
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 14.2.11.2.2 The point of exhaust shall not create a hazard.
not have direct visual contact with the chamber interior from
14.2.I 1.2.3 The point of exhaust shall not allow reentry of
their normal operating location.
gases into the building.
14.2.10.2.3 Oxygen mask microphones shall be inu·insically
14.2.11.2.4 The point of exhaust shall be protecterl by the
safe at the maximum proposed pressure and 95 :t 5 percent
prnvision of a minimum of 0.3 cm (0.12 in.) mesh SCl'een and
m..-ygen.
situated to p1·event the intrusion of rain, snow, or airborne
14.2.10.3 Combustible Gas Detection. debt·is.
14.2.10.3.1 The chamber atmosphere shall be continuously 14.2.I 1.2.5* The point of exhaust shall be irlentified as an
monitored for combustible gas concentrations wheneve1· any oxygen exhaust by a sign prohibiting smoking or open flame
volatile agent� are userl in the chambet·. and the sign shall include a pictograph indicating "no smok
ing'· and "no open flame - flame" in accorrlance with
14.2.10.3.1.1 The monitor shall be set to prmirle audible anrl NFPA 170.
visual alarms at 10 percent lowe1· explosive limit (LEL) for the
particular gas used. 14.3 Administration and Maintenance.
14.2.10.4 Oxygen Monitoring. 14.3.I General.
14.2.10.4.1 Oxygen levels shall be continuously monitorerl in 14.3.1.1 Purpose. Section 14.3 contains requi1·ements for
any chamber in which nitrogen is adderl to the chambet· or to administration and maintenance that shall be followed as an
reduce the volumetric concentration of m.. -ygenin the atmos a�junct to physical precautions specifierl in Section 14.2.
phere.
14.3.1.2* Recognition of Hazards. The natm·e anrl 1·ecogni
14.2.10.4.1.1 Oxygen monitors shall be equipped with audible tion of hyperbaric hazards at·e outlinerl in Annex B of this
and visual alarms. rlocument and shall be 1·eviewerl by the safety rlirector.
14.2.10.4.1.2 Sample 1·esponse time, at all treatment levels, 14.3.1.3 Responsibility.
shall be no more than 30 seconrls.
14.3.1.3.1 Pet·sonnel ha\ing 1·esponsibility for the hyperbat·ic
14.2.10.4.2* Oxygen levels shall be continuously monitored in facility, and those responsible for licensing, accrediting, or
Oass A chambet·s when breathing mixtm·es containing in apprnving institutions or other facilities in which hyperba1·ic
excess of 21 pet"Cent OJ,,.")'gen by volume are being bt·eathed by installations at·e employerl, shall establish anrl enfot·ce
patient� or attendant5, when any flammable agents are present programs to fulfill the provisions of this chapter.
in the chamber, 01· when both conrlitions exist.
14.3.1.3.2* Each hypet·baric facility shall rlesignate an on-site
f
14.2.10.4.2.1 Audible and visual alarms shall indicate volumet hyperbaric safety directot· to be in cha1·ge o all hyperbat·ic
ric oxygen concenu·ations i n excess of 23.5 percent range for equipment and the operntional safety requirement� of this
Class A chambet·s. chapter.
2021 Edition
14.3.1.3.2.1 1l1e safety di1·ector shall participate with facility 14.3.1.5.2* All personnel shall be traineci in emergency proce
management personnel and the hyperbaric physician(s) in dures.
developing procedtu-es for operation anci maintenance of the
hyperba1·ic facility 14.3.1.5.3 Personnel shall be trained to conu·ol the chambe1·
and decompress occupants when all powereci equipment has
14.3.1.3.2.2 The safety director shall make recommendations been renciered inoperative.
fo1· departmental safety policies and procedures.
14.3.1.5.4* Eme1·gency proceciures anci fi1·e training drills
14.3.1.3.2.3 The safety direct01· shall have the authmity to shall be conducted at least annually anci documented by the
restrict or remove any potentially hazardous supply or equip sal"ety director.
ment items from the chambe1·.
14.3.1.5.4 .1 The time requi1·eci to evacuate all persons from a
14.3.1.3.3* The governing boa1·ci shall be responsible fix the hype1·baric area with a full complement of chamber occupant�
care and safety of patient� and personnel. all at treatment pressure shall be measureci annually.
14.3.1.3.4* By virtue of it� responsibility for the professional 14.3.1.5.4.2 The occupanl� for the timeci evacuation drill shall
f
conduct of membe1·s of the medical staf of the health ca1·e be permitteci to be simulated.
facility, the organizeci medical staff shall adopt anci enforce
1·egulations with respect to the use of hype1·baric facilities loca 14.3.1.6 General.
ted in health care facilities. 14.3.1.6.1 Potential Ignition Sources.
14.3.1.3.4.1 1l1e safety director shall participate in the cievel 14.3.1.6.1.1 * The following shall be prohibited from inside
opment of these regulations. the chamber and the immediate \�cinity out�ide the chamber:
14.3.1.3.5* The safety director shall ensu1-e that electrical, (1) Smoking
monitoring, life-support, protection, and ventilating arrange (2) Open flames
ment� in the hype1·baric chamber are inspected and testeci a� (3) Hot objecL�
part of the routine maintenance program of the facility.
14.3.1.6.1.2 The following shall be prohibited from inside the
14.3.1.4 Rules and Regulations. chamber:
14.3.1.4.1* General. The aciministrative, technical, anci (1) Personal warming de,ices (e.g., therapeutic chemical
professional staffs shall jointly develop policies for manage heating pads, hand warmers, pocket v.,armers)
ment of the hyperbaric facility. (2) Personal electrically powered devices (e.g., laptops, elec-
tronic tablets, cell phones, pagers)
14.3.1.4.1.1 Upon acioption, the management policies shall be (3) Sparking toyli
available in the facility. ( 4) Personal entertainment devices
14.3.1.4.2 The meciical directm· of hypedJaric medicine anci 14.3.1.6.1.3* P1·ior to each hyperbaric treatment, a p1·etreat
the safety di1·ector shall jointly cievelop the minimum staff qual ment safety check to identify and remove prohibited items shall
ifications, experience, and complement based on the following: be perfonned and ciocumenteci by a qualified pe1·son.
(I) Number and type of hype1·baric chambers in use 14.3.1.6.2 Flammable Gases and Liquids.
(2) Maximum treatment capacity
(3) Type of hyperbaric therapy normally provicieci 14.3.1.6.2.1 Flammable agents, including cievices such as labo
ratory burners employing bottleci or natural gas and cigarette
14.3.1.4.3 1\ll personnel, including those involved in mainte lighters, shall be prohibiteci insicie the chamber anci from the
nance and repai1· of the hype1·baric facility, shall be trained on proximity of the comp1·ess01· intake.
the purpose, application, operation, and limitations of emer
gency equipment. 14.3.1.6.2.2 For Class A chambers, flammable agents used for
patient care, such a.� alcohol swabs, parenteral alcohol-ba�ed
14.3.1.4.4 When an inspection, test, or maintenance proce pha1-maceuticals, anci topical c1·eams, shall be pe1·mitted in the
cim·e of the fire suppression system results in the system being chamber if the following conditions a1·e met:
placed out of service, a protocol shall be followed that notifies
approp1·iate personnel anci agencies of the planned 01· emer (1) Such use is approved by the safety di1·ector or othe1·
gency impairn1ent. autho1·ity ha\ing jurisdiction.
(2)* 1l1e quantities of such agenl� are limited so that they are
14.3.1.4.5 A sign indicating the fire suppression system is out incapable of releasing sufficient flammable vapor into the
of service shall be conspicuously pl.aced on the operating chambe1· atmosphe1·e to exceed the LEL for the material.
console until the fire supp1·ession system is 1·estoreci to service. (3) A safety factor is includeci to account for the localizeci
14.3.1.4.6* During chamber operations with an occupant(s) concentrations, stratification, and the absence of ventila
in a chamber, the ope1·ator shall be phys ically present anci shall tion.
maintain visual or audible contact with the control panel or the (4) The oxygen monitm·ing requirement of 14.2.10.4.2 is
chamber occupant(s). obsen·eci.
14.3.1.5 Emergency Procedures. 14.3.1.6.2.3 Flammable liquids, gases, or vapors shall not be
pe1·mitted insicie any c:Ja�s B chamber.
14.3.1.5.1 Eme1·gency procedures specific to the hyperba1·ic
facility shall be e stabl ishe rt.
2021 Edition
14.3.1.6.3* Personnel. (2) The total heat released by the single upholstered furni
ture item <luring the first 10 minutes of the test shall not
14-3.1.6.3.1 An tistatic procedures, as di1·ectetl by the safety exceerl 25 MJ.
di1·ector, shall be employed wheneve1· atmosphe1·es containing
mm·e than 23.5 percent m..·ygen hy volume are used. 14.3.1.6.4.6 Mattresses.
14.3.1.6.3.2 In Class A and Class B chambe1·s with atmos (A) Mattress componenl� shall have a cha1· length not exceerl
pheres containing more than 23.5 percent oxygen by volume, ing 2 in. (51 mm) when tested in acco1·rlance with 16 CFR
electrical grounrling of the patient shall be ensured by the 1632, "Standa1·d for the Flammabilitv of Mattt·esses and
provision of a high-impedance conductive pathway in contact Mattress Pads (FF 4-72) ," or NFPA 260.
\\1th the patient's skin.
(B) Mattresses shall have limited rates of heat relea�e when
14.3.1.6.3.3 Shoes having ferrous nails that make contact with tested in accorrlance \\1th ASTM El 590, Standard Test Method for
the floor shall not be permitterl to be worn in Class A cham Fire 1;,sting of Mattre.tses, or California Technical Bulletin 129,
be1·s. Flammability Test Pmredure for MattTl'SSl'S for Use in Publir Buildings.
a5 follows:
14.3.1.6.4* Textiles.
(1) 1l1e peak rate of heat relea5e for the mattress shall not
14.3.1.6.4.1 Except where permitted in 14.3.1.6.4.3, silk, wool, exceed 100 kW.
or synthetic textile materials, or any combination thereof, shall (2) The total heat 1·eleased by the mattress <luring the first
he prnhibiterl in Cla�s A or Class B chambers. 10 minutes of the test shall not exceed 25 MJ.
14.3.1.6.4.2* Garment� permitted insirle of chambers shall be 14.3.1.6.4.7 Fill mate1·ials contained within upholsterer! furni
as follows: tm·e anrl mattt·esses shall comply \�th the open flame test in
( l) Ga rment� fabricated of 100 percent cotton or a blend of Section A-1 of the 2000 erlition of California Technical Bulletin
cotton anrl polyeste1· fabric shall be permitterl in Class A 11 7, Requimnmts, 'll'st Pmadim and Apparatus for TPsting the
chambe1·s. Rmne RetardanrP of RPsilimt Filling lvl.ate-rials U�Pd in UphoMered
(2) Ga rment� falxicated of 100 percent cotton, 01· a blend of Furniture.
cotton and polyester fabric containing no more than 14.3.1.6.4.8 For materials with fire-retardant coatings, the
50 percent polyeste1·, shall be pe1·mitted in Cla�s B cham mate1·ial shall be maintained in accordance \�th the manufac
be1·s. tm·er's instructions to retain the fi1·e-retardant properties.
14.3.1.6.4.3* The physician in charge, with the concurrence 14.3.1.6.4.9 Exposed foamed plastic materials shall he prohibi
of the safety director, shall be pe1·mitted to approve the use of ted.
the follm�ng prohibiter! items in the chamber :
( l) Suture material 14.3.1.6.5 The use of flammable hair sprays, hair oils, anrl skin
(2) Alloplastic devices oils shall be prohibited for all chamber occupant5/patienrn as
(3) Bae te1·ial haITiers well a� personnel.
(4) Surgical d1·essings 14.3.1.6.5.1 Wheneve1· possible, patient� shall be stripped of
(5) Biological interfaces all clothing, particularly if it is contaminaterl by dirt, grease, or
(6) Synthetic textiles solvents, a.nrl then 1·eclotherl. (SeeA.14.3.1.6.4.)
14.3.1.6.4.4 Physician and safety di1·ector approval to use 14.3.1.6.5.2 All cosmetics, lotions, anrl oils shall be removed
prohibited items shall be stated in writing for all prohibiter! from the patient ·s borly and hair.
materials employer!. (See A..14.3.1.3.2.)
14.3.1.6.6 All othe1· fah1·ics used in the chambe1·, such as
14.3.1.6.4.5 Upholstered Furniture. sheets, pillow ca5es, and blankets, shall conform to 14.3.1.6.4. l
(A) Upholste1·ed furniture (fixed or portable) shall be 1·esist anrl 14.3.1.6.4.2.
ant to smolde1·ing (or cigarette) ignition in acc01·dance with 14.3.1.6.7 Drapes user! within the chamhe1· shall meet the
one of the following: flame propagation perfo1·mance criteria contained in Test l or
( l) The components of the upholstered furniture shall meet Test 2, as appropriate, ofNFPA 701.
the 1·egui1·ements for Class l when tested in accm·rlance 14.3.1.6.8 Clothing worn by patient� in Class A or Class B
withNFPA 260. chambers and personnel in Class A chambers shall, prior to
(2) Mocked-up composites of the upholstered furniture shall each treatment, conform to the follo\\1ng:
have a char length not exceeding 38 mm ( l 1/., in.) when
tested in accm·rlance withNFPA 261. ( l) They shall be issued by the hyp erbaric facility or specifi
cally approver! by the safety rli1·ector fo1· hyperbaric use.
(B) Upholsterer! forniture shall have limited rates of heat (2) They shall be uncontaminaterl.
release when tested in accorrlance with ASTM El537, Standard ( 3) They shall be devoid of prohibiter! anicles prior to cham
1Pst Nlfthod for Fire 1Psting of Upholstered Furniture, m \\1th Califm ber pressurization.
nia Technical Bulletin 133, Rmnmaliility 1Pst Pmad1ae for Seating
Furniture for Use in Publir, Ocrupanries, a� follows: 14.3.1.6.9* Paper brought into the chamber shall be storer! in
a closed metal container.
( l) The peak rnte of heat 1·elease for the single upholsterer!
furniture item shall not exceed 80 k\,I,'_ 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:
2021 Edition
( l) All electrical and mechanical eguipment necessary for 14.3.3 Handling of Gases.
the operation and maintenance of the h)'perbaric facilicy
(2) Any medical devices an<l instrument� used in the facility 14.3.3.1 The institution's adminisu·ative personnel shall
develop policies for safe handling of gases in the hype1·baric
14.3.2.1.1 Use of unapproved eguipment shall be prohibited . facility. (SN 14.3.1.6.2.)
14.3.2.1.2 The following <levices shall not be operated in the 14.3.3.2 Ox-ygen and other gases shall not be introduced into
hyperba1·ic chamhe1· unless approved fo1· such use by the safecy the chamber in the liguid state.
director and medical director of hype1·baric medicine:
14.3.3.3 Flammable gases shall not be used or store<l in the
( l) Portable x-ray <levices chamber or in the hyp erba1·ic facility.
(2) Electrncaute1·y eguipment
(3) High-ene1·gy- de\ices 14.3.3.4* P1·essm·ized containe1·s of gas shall be permitted to
be introduced into the hyperbaric chamber, provided that the
14.3.2.1.3 Photog1·aphic eguipment employing the following container and its content� are approved fo1· such use by the
shall not 1·emain in the chamber when the chamber is p1·essur safecy direct01·.
ize<l:
14.3.4 Inspection, Testing, and Maintenance.
( l) Photoflash
(2) Flood lamps 14.3.4.1 General.
14.3.2.1.4 The use of Class l or Cla�s 2 lasers a� define<l by 14.3.4.1 .1 The hyperbaric safecy di1·ector shall ensme that all
ANSI Z136.3, American Natinnal Standard fm- SafP U�P of La.wrs in valves, regulators, meters, an<l similar eguipment use<l in the
Hmlth Care, shall be permitted. hype1·baric chambe1· are compensated fo1· use un<le1· hype1·baric
conditions and tested as part of the 1·outine maintenance
14.3.2.1.5 Eguipment known to be, or suspecte<l of being, program of the facilicy.
defective shall not he introduced into any hyperbaric chamber
01· used in conjunction with the opei-ation of such chamber 14.3.4.1.1.1 P1·essure 1·elief valves shall he teste<l an<l calibra
until repai1·ect, tested, an<l accepted by gualifie<l pe1·sonnel and ted as part of the routine maintenance program of the facility.
approved by the safecy <lirector. (SI¥ 14.3.1.3.2.)
14.3.4.1.2 The hyperharic safecy director shall ensure that all
14.3.2.2* The following shall be all-metal to the extent possi gas oullets are labeled 01· stenciled in accordance with CGA
ble: C-7, GuidP tn Cla�sijiration and Labeling of Cmnpressed Gases.
( l) Oxygen containers 14.3.4_1.3 The reguirements set forth in Section 5.1 and
(2) Valves NFPA 55 concen1ing the stoi-age, location, an<l special p1·ecau
(3) Fittings tions 1·e(]uire<l for me<lical gases shall be followe<l.
(4) Interconnecting eguipment
14.3.4.1 .4 Storage areas for hazardous materials shall not be
14.3.2.3 1l1e following shall be compatible with oxygen under located in the room housing the hyperbaric chambe1·. (See
senice conditions: 14.2.1.)
(1) Valve seat� 14.3.4.1.4.1 Flammable gases, except as provided in
(2) Ga�kets 14 .3 .1.6.2.2(1), shall not he use<l 01· stored in the hype1·baric
(3) Hose room.
(4) Lub1·icants
14.3.4.1 .5 All replacement part� an<l component� shall
14.3.2.4 Eguipment use<l insi<le the chamber reguiring lub1·i conform to original design specification.
cation shall he lubricated with oxygen-compatible mate1-ial.
14_3.4_}.6* ..\i1· from compressors shall be sampled at least
14.3.2.4.1 Factory-sealed antifriction bearings shall he permit every 6 months an<l after major repair or mo<lification of the
r
ted to be use<l with standa d hydrocarbon lulxicants in Cla�s A comp1·esso1·(s).
chambers that do not employ atmospheres of inc1·ease<l oxygen
concentration. 14.3.4.2 Maintenance Logs.
14.3.2.5* Eguipment made of the following shall be prohibi 14.3.4.2-1 Installation, repairs, an<l modifications of eguip
ted from the chamber inte1·i01·: ment 1·elated to a chamber shall be evaluated bv engineering
(1) Cerium pe1·so1111el, tested under pressm·e, and approve<l by the safety
(2) Magnesium director.
(3) Magnesium alloys 14.3.4.2.1.1 Logs of all test� shall he maintained .
14.3.2.6* In the event that radiation e<Juipment is inu·oduced 14.3.4.2.2 Operating eguipment logs shall be maintaine<l hy
into a hyperbaric chamber, hydrocarbon detectors shall he enginee1·ing personnel.
installed.
14.3.4.2.2.1 Opei-ating eguipment logs shall be signe<l before
14.3.2.6.1 In the event that flammable ga�es are detecte<l in chamber operation hy the person in charge. (SI¥ ,4.14.3.1.3.2.)
excess of 1000 ppm. radiation e(]uipment shall not be ope1·ated
until the chamber atmosphere is cleare<l. 14-3.4.2.3 Operating e<Juipment logs shall not be taken inside
the chamber.
2021 Edition
14.3.4.3 Fire Protection Equipment for Class A Hyperbaric 14.3.4.5 Furniture and Grounding.
Chambers.
14.3.4.5.1 Conrluctive de,ices on furniture and equipment
14.3.4.3.1 Electrical switches, valves, and elect1·ical monitot·ing shall be inspecterl to ensu1·e that they a1·e free of wax, lint, or
eguipment associaterl ,v:ith fire prntection shall be ,is ually other extraneous material that could insulate them and defeat
inspecterl before each chamber pressurization. the conductive properties.
14.3.4.3.1.1 \'\'he1·e provirlerl, wate1· level indicat01·s shall be 14.3.4.5.2* Casters or furniture leg tips shall not be capable of
visually inspected before each chamber pr·essurization. impact sparking.
14.3.4.3.1.2 Whe1·e provided, air p1·essure gauges shall be visu 14.3.4.5.3 Casters shall not be lulxicated with oils or other
ally inspected before each chambe1· pressut·ization. flammable materials.
14.3.4.3.2 Fire detection eguipment, if installed, shall be 14.3.4.5.4 Lubricants shall be oxygen compatible.
testerl each week.
14.3.4.5.5 Wheelchai1·s and gurneys with bea1·ings lubricated
14.3.4.3.2.1 Testing shall include activation of trnuble circuil� anrl sealed by the manufacturer shall be pe1·mitted in Class A
and signals. chambers where conditions prescriberl in 14.2.10.4 are met.
14.3.4.3.3 Full testing, including discha1·ge of extinbruishing 14.3.4.6* FJectrostatic Safeguards.
media, shall be conrlucted annually.
14.3.4.6.1 Conductive accessories shall meet conrluctivity and
14.3.4.3.4 Inspection, testing, anrl maintenance of the water antistatic reguiremen L�.
storage tanks fot· Cla�s A chambe1·s shall be in accordance with
applicable sections of Chapte1· 9 of NFPA 25. 14.3.4.6.2* Patient ground shall be verifierl in Class B cham
be1·s p1·i01· to each chambe1· operation.
14.3.4.3.5* Fire extinguishing systems shall be functionally
tested at least semiannually as follows: 14.3.4.6.3* Patient grounrl shall be verified in Class A cham
be1·s p1·i01· to chamber operation wheneve1· atmosphe1·es
(I) For deluge systems, in accordance with the reguiremenl� containing more than 2,\.5 percent oxygen by volume are userl.
of 14.2.6.2.5 and 14.2.6.2.7
(2) For handline systems. in accotTlance with the reguire- 14.3.4.6.4 Chambe1· grounrl shall be verifierl to be in accord
menl� of 14.2.6.3.7.l 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.
14.3.4.3.5.1 Following the test, all valves shall be placed in
their ba�eline position. 14.3.4.6.5* Materials containing rubber shall be inspected as
part of the routine maintenance program of the facility, espe
14.3.4.3.5.2 If a bypass system is used, it shall not 1·emain 111 cially at poinl� of kinking.
the test mode after completion of the test.
14.3.4.7* Housekeeping. A housekeeping program shall be
14.3.4.3.5.3 During initial construction, or wheneve1· changes implemented, whether or not the facility is in regula1· use.
ar·e marle to the installed deluge system that will affect the
spray pattern, testing of spray coverage to demonstrate 14.3.4.7.1 The persons assigned to the ta�k of housekeeping
conformance to the reguiremenl� of 14.2.6.2.6 shall be shall be u·ainerl in the following:
pedonnerl at surface pressure anrl at maximum opernting pres (l) Potential rlamage to the eguipment from cleaning proce-
sure. dures
14.3.4.3.5.4 A detailerl 1·ecorrl of the test 1·esult5 shall be main (2) Potential personal injury
tainerl and a copy sent to the hypet·baric facility safety rlirector. (3) Specific cleaning procerlures
(4) Eguipment not to be cleaned
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. Chapter 15 Dental Gas and Vacuum Systems
14.3.4.4 FJectrical Safe guards. 15.1 Applicability. This chapter shall apply to rlental health
care facilities that gualify to install dental ga� and vacuum
14.3.4.4.1 All electrical ci1·cuits shall be testerl in acc01·rlance piping systems.
with the routine maintenance program of the facility.
15.1.1 Category l dental piped gas and piped vacuum system
14.3.4.4.1.1 Electrical circuit test� shall include the following: r·eguiremenl� shall be applied in facilities whe1·e general anes
(l) Ground-fault check to ve1·ify that no conrluct01·s are thesia and deep sedation is pel"formed, as defined in 3.3.68.1
grounded to the chamber and 3.3.68.2.
(2) Test of normal functioning (sfe 14.2. 9.2.3.2)
15.1.2 Category 2 rlental piped gas and piped vacuum system
14.3.4.4.1.2 In the event of fire, all nonessential elect1·ical reguiremenl� shall be applied in facili ties whe1·e only modernte
eguipment within the chamber shall be de-energizerl before and minimal sedation is performerl, as definerl in 3.3.68.3 and
extinguishing the fire. :\.3.68.4.
(A) Smolrlering, burning electrical eguipment shall be rle 15.1.3 Category 3 rlental piped gas anrl piperl vacuum system
energized before extinguishing a localizerl fire involving only reguiremenl� shall be applied in facilities where minimal or no
the eguipment. (See 14.2.6.) sedation is performect, as definect in 3.3.68.4.
2021 Edition
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
(a) One or m01·e cylinders of nitrogen NF, sufRcient for 15.3.3.4* Dental Air.
at least one average day's supply
(h) A manifokl, if p1·imar y and secondary cylinders are 15.3.3.4.1 General.
prmided 15.3.3.4.1.1 Dental ai1· shall be used as a support ga� for driv
(c) A lin e pressure regulating valve ing dental tools and shall be permitted to be used to supply air
(d) A check valve downstream from the pressure regu d1·iven eguipment. Dental compressed air shall not he used for
lating valve respiration.
(e) A presstll"e relief valve set at 50 pe1·cent above the
normal line pressure and located downstream from 15.3.3.4.1.2 Dental air outlet5 shall not be interchangeahle
the check valve with any other gas outlet�, including oxygen, nitrous oxide,
(f) A pressure relief valve discha1·ge piped to the medical ai1·, instrument air, and nitrogen.
outdoors at a point that will not create a probahle 15.3.3.4.2 Dental Air Compres.sor Units.
hazard and that is turned down to prevent the ent ry
of rain 01· snow 15.3.3.4.2.1 Dental ai1· compressor units shall include dental
air compressors, vibration isolation, air receive1·s, coalescent air
15.3.2.12 Medical Gas and Vacuum Operation and Manage filters, adsorption dryers, exhaust silencer/filters, moisture
ment. Category I systems shall comply with 5.1.14. indicators, and senice access manifolds. electt·ical disconnecL�.
15.3.3 Categor y I Dental Air and Vacuum Piping Systems. 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
15.3.3.7 Piping for Dental Air and Vacuum Systems. (A) Copper Tube. Coppe1· tubing shall comply with the
following:
15.3.3.7.1 General.
( 1)ASTM B88, Standard Spffijirntion for SPmnlP.�� CoppPr Wat Pr
15.3.3.7.1.1 Piping for dental comp1·essed att· systems shall TubP, Type L01· K
comply with 15.3.3.7.2. (2) ASTM B819, Standard SpPcifimtion for Smmll's.1 Copper fobp
15.3.3.7.1.2 Piping for dental vacuum systems and scavenging for 111.Pdir.al Gas .�vste111s, Type Lor K
systems shall comply with 15.3.3.7.3. (3) ASTM B280, Standard Sperification for SeamlPs.1 Coppn J1.t!Je
for A.ir Conditioning and Refrigeration Fidd Snvi,:e, ACR tube
15.3.3.7.2 Piping for Dental Air Systems. (O.D. size)
15.3.3.7.2.1 General. Pipe. fittings, and joint� in piping for (B) Copper tube shall be hard temper or atrnealed (soft
dental compressed air systems shall be in accordance with temper).
15.3.3.7.2.2 through 15.3.3.7.2.5.
(C) Copper Fittings. Coppe1· fittings shall comply with the
15.3.3.7.2.2 Pipe. Pipe under 15.3.3.7.2 shall comply with the following:
following: Brazed or soldered fittings conforming to ASME Bl6.22,
(1)
( 1) ASlM B88. Standard SpPcifiration Jar SmmlPss CoppPr Watl'r Wrought CoppPr and CoppPr A. lloy SoldPrfoint PrPssim Fittings
Ti1be, T)pe L m K (2) Brazed fittings conforming to ANSI/ASME BlG.50,
(2) ASlM B819, Standard SpPrifi,:atfon for SmmlP.�� CoppPr Tube Wrought Copper and CoppM Alloy Braz.!'-joint PressurP Fittings
for MPdiral Gas Systnm, Type Lor K (3 ) Brazed fittings conforming to ASME BlG.22 with socket
(3) ASlM B280, Standa rd Spfl'ijiration for Smmlm CoppPr Tub!' depths equal to or greater than braze-:ioint pressure
for Air Conditioning and RPfrigmllion Field Snuir.e, ACR tube fittings conforming to ANSI/ASME Bl6.50
(O.D. size) (4) Flared fittings conforming to ASME Bl6.26, Cast Coppl'r
Alloy Fittings for Hared Coppl'r 111bl's
15.3.3.7.2.3 Coppe1· tube shall be hard temper 01· annealed Compression fittings (1/, in. maximum size)
(5)
( soft tern pet·) .
(D) Joints for Copper Piping. Joints in copper tubing shall be
15.3.3.7.2.4 Fittin gs. Fittings for piping under 15.3.3.7.2 shall in accordance with the following:
be permitted to be any of the following acceptable joining
methods: ( 1) Joint� shall he brazed, soldered, tlu-eaded, flared, 01· the
compression type.
(1) Brazed or soldered fittings conforming to ASME Bl6.22, (2) ,.vnere joints are brazed, they shall comply with the
Wrought CoppPr and CoppPr Alloy SoldPr-joint PrPssurP Fittings 1·equireme11t� of 15.4.6.
(2) Brazed fittings conforming to ANSI/ASME Bl6.50,
(3) Solde1·edjoints shall be made in accordance with ASTM
l-Vmught CoppPr and Coppl'r Alloy Braze-Joint Pressure Fittings B828, Standard Prartire for Making Capillary joints by Sol,lfr
(3) Brazed fittings conforming to ASME Bl6.22 with socket ing of Copper and CoppPr Alloy Tube and Fittings, using a
depths equal to 01· g1·eate1· than braze:joint p1·essu1·e "lead-free" solde1· filler metal containing not more that1
fittings in compliance with ANSI/ASME B1650 0.2 pet"Cent lead by volume that complies with ASlM B32,
( 4) Flared fittings conforming to ASME BlG.26, Cast Copper Standard Sperification for SoldPr MPtal.
Alloy Fittin� for HarPd Coppn· TubPs
(5) Compression fittings (1/, in. maximum size) 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:
15.3.3.7.2.5 Joints. Joints for piping under 15.3.3.7.2 shall
comply with the following: (1) PVC plastic pipe shall be Schedule 40 or Schedule 80,
conforming to ASlM Dl785, Standard Sperifiration for
( 1) Joint� shall be brazed, solde1·ed, threaded, flared, 01· the P"Zv(Vinyl ChloridP) (PVC) Plastic PipP, S,:hedulPs 40, 80, and
compression type. 120.
(2) Where joint� are brazed, they shall comply with the (2) PVC plastic fittings shall be Schedule 40 m Schedule 80
requirements of 15.4.6. to match the pipe, confonning to ASTM D2466, Standard
(3) Solde1·ed joints shall be made in acc01·dance with ASTM Specification for Poly (Vinyl ChloridP) (PVC) Plastir. PipP
B828, Standard Practia for Alailing Capillary joints IY)' Sol.d!'r Fittings, Srhedule 40. or ASTM D2467, Standard Spff ijiration
ing of Copp" and Coppn Allny Tube and Fittings, using a Poly (Finyl Chlo·ride) (PVC) Plastir Pifr Fittings, Srhedull' 80.
"lead-free" solde1· fillet· metal containing not mot·e than
(3) Joint� in PVC pla�tic piping shall be solvent-cemented in
0.2 percent lead by volume that complies with ASTM B32, accordat1ce with ASTM D2672, Standard Spedfiration far
Standard SpPrifiration far Solder Metal. joint1for JPS PVC PipP U�ing Solvmt Cnnmt.
15.3.3.7.3 Piping for Dental Vacuum Systems and Scavenging 15.3.3.7.3.4 CPVC Plastic Piping. CPVC plastic piping unde1·
Systems. 15.3.3.7.3 shall be in accordance with Lhe following:
15.3.3.7.3.1 General. Piping fot· dental vacuum systems and (1) CPVC IPS pla�tic pipe shall be Schedule 40 or Schedule
scavenging systems shall be copper, PVC plastic, or CPVC plas 80, confmming to ASTM F441/F441M, Standard Sper.ifira
tic . tfon for ChlorinatPd Poly(Vinyl Chloride) ( CPVCj Pia.stir Pipe,
15.3.3.7.3.2 Copper Piping. Coppet· piping unde1· 15.3.3.7.3 Schfdules 40 and 80.
shall he m accordance with 15.3.3.7.3.2(A) through (2) CPVC IPS plastic fittings shall be Schedule 40 or Sched
153.3.7.3.2(D) . 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
F439, St andard SpPcifiration far Ch1nrinattd Poly(Vinyl Chlar men tation 1·equired by 15.4.6. l for the qualifications of the
ide) (CPVCJ Plastit PipP Fittings, Srhtdule 80. brazing procedures and in<livi<lual brazers.
(3) CPVC CTS pla�tic pipe and fittings ½ in. through 2 in.
size shall be SDR 11, confmming to ASTM D2846/ 15.4.2.2 Central Supply System Identification and Labeling
D2846M, Standard SpPtijiratinn for ChlnrinatPd Poly (Vinyl (Oxygen and Nitrous Oxide).
ChlaridPJ (CPVC) Plastir Hot- and Cold-tt½tt'r Distribution 15.4.2.2.1 Cylin<le1·s, containers. and tanks shall be designe<l,
Sys tnns. fab1·icate<l, teste<l, and marke<l (stampe<l) in accor<lance with
( 4) Solvent cement fm joint� in CPVC plastic piping shall regulations of DOT, Transpon Canada (TC) Trans portation of
comply with ASTM F493, Standard SpPdjiration for Solvmt Dangerous (',nod� Rfgu lations, or the ASME BnilPr and Pressure
Cem1ml.1 for ChlorinatPd Poly/Vi nyl ChlaridP)(CPVC) Plas tir \fasel Code, ·'Rules fo1· the Constrnction of Unfire<l Pr·essure
PipP and Fittings. Vessels," Section VIII. f 55:7.1.5. ll
15.4 Categor y 2 Dental Gas and Vacuum Systems. 15.4.2.2.2 Cylin<ler content� shall be i<lentified by attached
15.4.1 General. labels or stencils naming the contents in acc01·dance \\�th the
mandatmy 1·equirements of CGA C-7, GuidP tn Cla�sijiratinn and
15.4.1.1 Category 2 <lental ga� an<l vacuum system shall be LabPling nf Cmnpmwd (',ases.
limite<l to facilities that, at most, provide moderate and mini
mal sedation. 15.4.2.2.3 Liqui<l containers shall have additional product
i<lentification ,isible from all directions with a minimum of
15.4.1.2 lhe me<lical gases shall be limited to oxygen an<l 51 mm (2 in.) high letters such as a 360-degree wraparound
nitrous oxide. tape for medical liqui<l containers.
15.4.1.3 ll1e dental suppon gases shall be provided from a 15.4.2.2.4 Cryogenic liquid containe1·s shall be provided with
dental air source system. gas-specific out.let connections in accor<lance with the manda
tory requirement� of CGA V-5, DiamPtl'T Index Sapty Svstem
15.4.1.4 The vacuum systems shall be <lental vacuum and (NonintPrrhangmblP Low Pres.mre ConnPrtions far Afrdiwl (',as A.ppli
nitrnus oxide scavenging. mtinns), or CGA V-1, Standard far CmnprPssPd Gas CylindPr Valve
15.4.1.5 All connections within Catego1y 2 me<lical gas Outltt and InlPt Connections.
(oxygen an<l nitrnus oxide) shall be gas-specific to prevent 15.4.2.2.5 Cylin<le1· and Cl'yogenic liquid container outlet
cross-connections with othe1· piping systems, including vacuum, connections shall be afRxe<l in such a manne1· as to be integral
water, an<l dental air. to the valve(s), unremovahle with ordina1y tools, or so
15.4.1.6 Station outlet� and pipe<l outlet� for Category 2 me<li designed as to ren<ler the attachment point unusable ,vhen
cal gas an<l dental air having nonstandar<l operating pressures r·emove<l.
shall comply with the following a<lditional requirement�: 15.4.2.2.6 The contents of cylin<lers and cryogenic liquid
( l) Be gas-specific. containe1·s shall be verified prior to use.
(2) Be pressure-specific whe1·e a single gas is piped at more
than one operating pressure. 15.4.2.2.7 Labels shall not be defaced, altered, 01· remove<l,
(3) Be a D.I.S.S connection if operated at a gauge pressure in and connecting fittings shall not be modified.
excess of 550 kPa (80 psi). 15.4.2.2.8 Locations containing positive-p1·essure gases other
( 4) Be <lesigned to pr·event the removal of the adapte1- until than oxygen and me<lical ai1· shall have their door(s) labeled as
the pressure has been relieved, if operated at a gauge follows:
p1·essure between 1380 kPa and 2070 kPa (200 psi and
300 psi). Positive-Pressure Gases
NO Smoking or Open Flame
15.4.I. 7 Requirement� for Catego1y 2 dental gas and vacuum Room May Have Insufficient Oxygen
systems relating to the ope1·ation, management, an<l mainte Open Door and Allow Room to Ventilate Before Entering
nance of oxygen an<l nitrnus oxide piping sptems shall apply
both new an<l existing facilities as specifie<l in 15.1.7. 15.4.2.2.9 Locations containing central supply systems or
cylinders containing only oxygen or medical air shall have their
15.4.2 Medical Gas Systems (Oxygen and Nit rous Oxide). dom(s) labele<l as follows:
15.4.2.1 Installer Qualificatious (Oxygen and Nitrous Oxide). Medical Gases
15.4.2.1.1 Installers of medical gas systems shall be certifie<l in NO Smoking or Open Flame
accordance with ASSE 6010 , Pmpssional Qualifir:ation Standard 15.4.2.3 Central Supply System Operatious (Oxygen and
for MPdiral Ga1 Systnm Instnlln,, regardless of the capacity of the Nitrous Oxide).
source equipment.
15.4.2.3.1 The use of adapters or conversion fittings to a<lapt
15.4.2.1.2 Installe1·s of medical gas systems shall not use thei1· one gas-specific fitting to another shall be prohibited.
cenification to oversee installation by noncenified pe1·so1111el.
15.4.2.3.2 Cylinde1·s an<l containe1·s shall be handled in strict
15.4.2.1.3 Brazing of me<lical ga� piping systems shall be accordance with 11.6.2.
pedorme<l by indivi<luals who are gualifie<l in accordance "�th
15.4.6.1. 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
15.4.2.1.4 Prior to any installation work involving brazing, the containing central supply systems 01· ga� cylinders.
installer of the medical ga� piping systems shall prnvide docu-
2021 Edition
15.4. 2.3.4 No flammable mate1·ials. cylinde1·s containing flam 15.4.2.4.7 Cylinders in use and in storage shall be pt·evented
mable gases, or containers containing flammable liquirls shall from reaching temperatures in excess of 52'C (125'F). Nitrous
be stored in rooms with gas cylinde1·s. oxirle cylinders shall be prevented from reaching temperatures
lower than -7'C (20'F).
15.4.2.3.5 If cylinde1·s are wrapperl when receiverl, the wrap
pers shall be removed prior to storage. 15.4.2.4.8 Only gas cylinders, reusable shipping containers,
anrl thei1· access01·ies shall be permitted to be storerl in rooms
15.4.2.3.6 Cylinrle1·s without correct markings or whose mark containing central sup ply systems or ga� cylinde1·s.
ings and gas-specific fittings do not match shall not be used.
15.4.2.4.9 No flammable materials, cylinders containing flam
15.4.2.3. 7 C1yogenic liquirl sto1·age units intended to supply mable gases, or containers containing flammable liquirls shall
gas to the facilitv shall not be userl to transfill other liquirl stor be sto1·ed in rooms with gas cylinde1·s.
age vessels.
15.4.2.4.10 Inrloor enclosures shall not communicate directly
15.4.2.3.8 Ca1·e shall be exerciserl when hanrlling cylinrlers with medical gas (oxygen and nitrous oxirle) use points 01· stor
that have been exposed to freezing tempei-atures 01· containe1·s age locations for oxidize1·s.
that contain ctyogenic liquids to prevent injuty to the skin.
15.4.2.4.11 Outdoor enclosures that are adjacent to a builrling
15.4. 2.3.9 Cylinde1·s containing compressed gases and wall shall be located such that the distance to any window 01·
containers fot· volatile liquids shall be kept away from rndiat01·s, rloor of the adjacent builrling is g1·eater than 3.05 m (1() ft).
steam piping, anrl like sources of heat.
15.4.2.4.12 Enclosures for merlical gas (oxygen anrl nitrous
15.4.2.3.10 \'\'here cylinder valve protection caps are supplierl, oxide) som·ce equipment shall be prmirlerl with do01·s 01- gates.
they shall be secu1·ed tightly in place unless the cylinrler is
connected for use. 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
15.4.2.3.11 Containers shall not be sto1·erl in a tightly closed over.
space.
15.4.2.5 Medical Gas Source Equipment (Oxygen and Nitrous
15.4.2.3.12 Cylinders in use and in storage shall be prevented Oxide).
° °
from 1·eaching tempe1-atures in excess of 52 C ( 125 F).
15.4.2.5.1 Mechanical means shall be providerl to ensure that
15.4.2.3.13 Centt·al supply systems for nitrous oxirle and the medical gas sout-ce equipment is connected to the correct
carbon dioxide using cylinrlers or portable containers shall be medical gas distribution piping system.
p1·evented from reaching tempe1·atures lower than the recom
menrlations of the centi-al supply system's manufacturer but 15.4.2.5.2 Cylinder valve outlets fot· oxygen anrl nitrous oxide
shall never be lower than -7'C (200 F) 01· g1·eater than 52"C shall comply with CGA V-1, Standardfnr CmnprPs.vd Gas Cylinder
(125'F). l-alvP Outlft and InlPt Connections.
15.4.2.4 Locations of Medical Gas Source Equipment (Oxygen 15.4.2.5.3 Threaded connections to manifolds shall comply
and Nitrous Oxide). with CGA V-5, DiamPll'r lndl'x Sajl'ty Systmn (NonintPrrhangmblP
Low Pre.�surP Connl'l:tions for i1hdiml Gas Applimtions).
15.4.2.4.1 Gas stmage locations in facilities with Catego1y
2 medical ga� systems with a total of all gases in cylinde1·s or 15.4.2.5.4 A check valve shall be prnvirled downstream of each
containe1·s, except nitrogen, connecterl and in storage at one pressure 1·egulator.
time that rloes not exceerl 85 m 1 (;\000 h:3) at standa1·d temper
15.4.2.5.5 A pressut·e relief valve set at 50 pet-cent above the
ature and pressure (STP), m 142 m� (5000 ftR) (STP) if oxygen normal line pt·essure shall be locaterl downstream of the check
is stored in a DOT specification 4 L (cryogenic liquirl) valve in 15.4.2.5.4.
container shall comply with 15.4.2.4.3 through 15.4.2.4.13.
15.4.2.5.6 Pressure relief valves shall be brass. bronze. or stain
15.4.2.4.2* Gas storage locations in facilities with Category less steel anrl designed for oxygen senice.
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 15.4.2.5.7 Hose and flexible connectors shall have a gauge
with .'",.1.3.3. pressure rating not less than 6895 kPa ( 1000 psi).
15.4.2.4.3 Enclosut·es shall serve no put-pose other than to 15.4.2.5.8 Materials used in central supply systems shall meet
contain the merlical gas source equipment (oxygen anrl nitrous the following requirement�:
oxide), except that nitrogen sout-ce equipment and (1) In those portions of systems intended to hanrlle oxygen at
compressed ai1· cylinrle1·s shall be pe1·mitted in the enclosure. gauge pt·essut·es equal to 01· g1·eater than 2413 kPa
15.4.2.4.4 Storage of full or empty gas cylinders, or both. shall ( 3 50 psi). interconnecting hose shall contain no poly
be pe1·mitted in the same enclosu1·e. meric materials.
(2) In those portions of systems intenderl to handle oxygen
15.4.2.4.5 Ai1· compressors, vacuum pumps, anrl othe1· equip or nitrous oxirle matei-ial, construction shall be compati
ment shall not be located in enclosures for merlical ga� cylin ble with oxygen under the temperatures and pressures to
rlers ( O>..)'gen anrl nitrous oxide source equipment). which the components can be exposed.
15.4.2.4.6* If enclosures are outdo01·s or 1·emote from the (3 ) If potentially exposed to cryogenic temperatures, materi
treatment facilities that they serve, they shall be kept locked. 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
15.4.2.5.9 Nonmetallic hoses and flexible connectors shall not 15.4.2.7.5 Factory-installed copper inlet tubes on station
exceed 1.52 m (5 ft) in length and shall not be concealed or outlets extending no further than 205 mm (8 in.) from the
penetrate walls, flom·s, ceilings. or partitions. 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.
15.4.2.5.9.1 Sou1·ce equipment shall not be connected to the
piping svstem through flexible connectors. 15.4.2.8 Manufactured As.semblies (Oxygen and Nitrous
Oxide). Category 2 systems shall comply with 5.1.6.
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 15.4.2.9 Pressure and Vacuum Indicators (O xygen and Nitrous
cylinders of oxygen and (if used) two banks of one or more Oxide). Categmy 2 systems shall comply with 5.1.8.
cylinders of nitrous oxygen, each bank containing at least one
average day's supplv. 15.4.2.10 Warning Systems (Oxygen and Nitrous Oxide).
Category 2 warning systems shall comply \\�th 5.2.9, except as
15.4.2.5.11 The two banks of each meciical gas source shall be follows:
manifolded so that either bank can supply its distribution
(1) Warning systems shall he permitteci to he a single alarm
piping system.
panel.
15.4.2.5.12 Where the source equipment is remote from a (2) 1l1e ala1·m panel shall be located in an area of continuous
single tt·eatment facility anci an in use bank is unable to supply surveillance while the facility is in operation.
the system, the manifold shall automatically switch to the (:!) Pressure and vacuum switches/sensors shall be mounted
secondary bank. at the smu-ce equipment with a pressut·e inciicatm· at the
master ala1·m panel.
15. 4.2.5.13 '\,\There the source equipment series multiple treat ( 4) Warning systems for medical gas systems shall provide the
ment facilities and an in use bank is unable to supply the following alarms:
system, the manifold shall automatically switch to the secon
da1y bank. (a) Oxygen main line pt·essure low
(b) Oxygen main line pressure high
15.4.2.5.14 Whe1·e the source equipment is not 1·emote and is (c) Oxygen changeove1- to secondar y bank or about to
accessible from a single treatment facility serveci and an in use changeover (if. automatic)
bank is unable to supply the system, the manifolci shall be (d) Nitrous oxicie main line pressm·e low
manually or automatically switched to the secondary bank. (e) Nitrous oxide main line pressure high
( f) Nitrous oxide changeove1- to secondary bank or
15.4.2.6 Emer gency Shutoff Valves (O xygen and Nitrous about to changeover (if automatic)
Oxide). (5) Auciible and noncancelable alarm visual signals shall indi
15.4.2.6.1* All Categoq• 2 medical gas systems shall have an cate if the pressure in the main line increases or decrea
f
emergency shutof valve accessible from all use-point locations ses 20 pe1·cent from the nm·mal operating pressure.
in an emergency. (6) Visual indications shall remain until the situation that
causeci the alarm is resolveci.
15. 4.2.6.2 'Where a central medical gas supply system supplies ( 7) Pressure switches/sensm·s shall he installeci ciownstream
two treatment facilities, each facility shall be provided with an of any eme1·gency shutoff valves and any other shutoff
emergency shutoff valve locateci in that treatment facility so as valves in the system and shall cause an ala1·m fot· the medi
to be accessible from all use-point locations in an emergency. cal g-,is if the pressure decreases or increases 20 percent
f
15.4.2.6.3 Emergency shutof valves shall be labeleci to indi from the nm·mal operating pre��ure.
cate the gas controlled by the shutoff valve anci shall shut off (8) A cancelable audible indication of each alarm condition
only the gas to the treatment facility that they serve. that produces a sounci at the alarm panel shall reinitiate
the audible signal if another ala1·m condition occm·s while
15.4.2.6.4 A remotely activated shutoff valve at a gas supply the audible signal is silenced.
manifold shall not be used for emergency shutoff.
15.4.2.1I Labeling and Identificati on. Category 2 systems
15.4.2.6.4.1 For clinical put-poses, such a remote valve actua shall comply with 5.1.11.
tor shall not fail-close in the event of loss of electric power.
15.4.3 Category 2 Dental Air and Vacuum Piping Systems.
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. 15.4.3.1.1 Dental air and vacuum piping systems shall inclucie
15.4.2. 7 Station Outlets and Risers (Oxygen and Nitrous dental support gases and dental vacuum systems.
Oxide). 15.4.3.1.2 Dental vacuum systems shall include dental vacuum
15.4.2. 7.1 Each gas outlet shall be gas-specific. anci nitrous oxide scavenging.
15.4.2. 7.2 Gas outlets shall consist of a primary and a secon 15.4.3.2 Equipment Locations for Dental Air and Vacuum
dary valve or assembly. Systems.
15.4.2. 7.3 Each gas outlet shall be legibly identified. 15.4.3.2.1 General. Any of the following systems shall be
permitted to be located together in the same room:
15.4.2.7.4 1l1readed outlet� shall be noninterchangeable Dental air comp1·ess01· sout·ces and reserve heaciei-s
(1)
connections complying with the manciatoty requirement� of
(2) Dental-surgical vacuum sources
CGA V-5, Dimnfter IndPx SafPty Systnn (Nonintm:hangeahle Low
(3) Dental vacuum sources
PmHurP Connn:tions frrr MPdiral ('-.as Af1>li,:ations ).
2021 Edition
(4) Any other comp1-essor. vacuum pump. or electrically 15.4.3.3.4 Nitrous Oxide Scavenging.
powered machinery
15.4.3.3.4.1 General.
15.4.3.2.2 Cylinders and Containers. Cylinders and containers
fot· gases shall be handled in accordance with Chapter 11. (A) The use of scavenging shall be limited to ponions of
dental facilities where moderate or minimal sedation is admin
15.4.3.2.3 Ventilation for Motor-Driven Equipment. The iste1·ed. WAGD shall be provided whet·e the dental treatment
following source locations shall be adequately ventilated to involves genernl anesthesia 01· deep sedation.
pt·event accumulation of heat:
(B) Active nitrous oxide scavenging shall include the use of a
( l) Medical air sources nasal mask on the patient. TI1e na5al mask shall be connected
(2) Instt·ument ai1· sotJt"ces to a scavenging inlet in the dental vacuum syi,tem through a
(3 ) Dental compressed air sout·ces flow-limiting adapter.
(4) Dental-surgical vacuum sources
(5) Dental \-acuum soutTes (C) Nitrnus oxide scavenging inlets shall not be inte1·changea
(6) WAGD sources ble with any other vacuum inlets, including medical-sm·gical
vacuum, dental vacuum. and "WAGD.
15.4.3.3 Dental Gas and Vacuum Source Equipment .
15.4.3.3.4.2 Connection to Dental Vacuum. Scavenging
15.4.3.3.1 General. connections to the dental vacuum system shall be a direct high
15.4.3.3.1.1 TI1e capacity of source equipment shall be based volume evacuation (HVE) connection to a high-volume
on the design requirement� for the facility, including the vacuum port with a capacity of 45 L/min ( l .G cfm).
f
number o gas outlets , vacuum inlet5, and other connections, 15.4.3.4 Category 2 Warning Systems (Oxygen and Nitrous
and their individual capacities. Oxide).
15.4.3.3.1.2 TI1e svMem design requirement5 shall be included 15.4.3.4.1 General.
in the data used for testing and vet·ifying the operation of the
gas and vacuum piping systems. 15.4.3.4.1.1 The warning systems in Category 2 dental gas and
vacuum syi,tems shall comply with applicable requirements of
15.4.3.3.2 Dental Air. 5.2.9 and 15.4.3.4.2 through 15.4.3.4.4.
15.4.3.3.2. 1 General. 15.4.3.4.1.2 The mastet·, area, and local alarm functions shall
(A) Dental air shall be used as a support gas for driving dental be permitted to be provided by a single alarm panel, as indica
tools and shall be permitted to be used to supply air-dt·iven ted in 5.2.9.
equipment. Dental compt·essed air shall not be used for respi 15.4.3.4.2 Master Alarm Panels.
ration.
15.4.3.4.2.1 A master alarm panel shall be located in the
(B) Dental air outlet� shall not be intet·changeable with any facility at a point of continuous surveillance when the facility is
other ga� outlets, including m,·ygen. nitrous oxide, medical air, in operation.
instrument air, and nitrogen.
15.4.3.4.2.2 The master alarm panel shall indicate the follow
15.4.3.3.2.2 Dental Air Compressor Units. ing:
(A) Dental air compressor units shall include dental air ( 1) Oxygen supply pressut·e :t:20 percent from normal
compressors, vibration isolation. air receivers, coalescent air (2) Nitrous oxide supply pressure ±20 percent from normal
filte.-s. adsm·ption dryers. exhaust silencet/filters. moistut·e (3) Changeover of oxygen supply source
f
indicatm·s. service access mani olds, electrical disconnect�. (4) Changeover of nitrous oxide supply som·ce
motor wiring. and controls.
15.4.3.4.3 Area Alarm Panels.
(B) Air compressm·s shall be scroll dental, reciprocating
dental, or the oil-free dental types. 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
15.4.3.3.3 Dental Vacuum. zoned dental gas and vacuum piping.
15.4.3.3.3.1 General. 15.4.3.4.3.2 At·ea alarm panels shall indicate the following:
(A) Dental vacuum shall be used for oral evacuation and ( l) Oxygen supply pressure :t:20 percent from normal
nitrous oxide scavenging. (2) Nitrous oxide supply pressure ±20 percent from normal
(B) Dental vacuum inlet� shall not be interchangeable with 15.4.3.4.4 Local Alarms.
any other vacuum inlets, including dental-surgical v,1cuum. 15.4.3.4.4.1 Local alarms shall be located in source equipment
15.4.3.3.3.2 Dental Vacuum Units. contt·ol panels or separate control panels in the equipment
rooms for sout·ce equipment.
(A) Dental vacuum unit� shall include dental vacuum pumps.
vibration isolation, separation tanks, vacuum inlet, vacuum 15.4.4 Pipi ng for Category 2 Medical Gas, Dental Air, and
exhaust, condensate drain, motot· \,fring, and controls. Vacuum Systems.
(B) Dental vacuum pumps shall be dental d ry vacuum or 15.4.4.1 General.

dental liquid (wet) ring pumps. Pumps shall be oil-free or oil 15.4.4.1.1 Piping for the following systems shall comply with
lubricated and suitable for nitrous oxide scavenging. 15.4.4.2:
2021 Edition
(1) Oxygen ( 1) Flared an<l comp1·ession connections, including connec

(2) Nitrous oxi<le tions to station out let�, alarm devices, and other compo
nent�
15.4.4.1.2 Piping for dental air systems shall comply with (2) Push-lock connections
15.4.4.3. (3) Straight-threaded con nections, including unions
15.4.4.1.3 Piping fix dental vacuum systems and scavenging (4) Pipe crimping tools used to permanently stop the flow of
systems shall complv with 15.4.4.4. medical gas and vacuum piping
15.4.4.2 Piping for Oxygen and Nitrous Oxide Systems_ 15.4.4.3 Piping for Dental Air Systeiru.
15.4.4.2.1 Cleaning for Oxygen Service. Fm oxygen an<l 15.4.4.3.1 General. Pipe, fittings, and joints in piping for
nitrous oxide, the pipe, fittings, valves, ga�/vacuum outlet�/ dental compressed a.it· systems shall be in accordance with
inlets, and other piping components shall be cleaned for 1:,.4.4.3.2 through 15.4.4.3.4.
oxygen by the manufacturer prior to installation in accm·<lance 15.4.4.3.2 Pipe. Pipe un<ler 15.4.4.3 shall complv with the
with CGA Cr-4.1, Clmning .Equipmmt for Oxygen SRrvia. Fittings following:
shall be permitted to be cleaned by a supplie1· or agency other
than the manufacturer. (1) ASTM B88, Standard Specijiration for SeamlP.t� CnppPr Water
Tube, Type Lor K
15.4.4.2.2 Pipe. Pipe shall be ha1·d-<lrawn seamless coppe1· (2) ASTM B8l 9, Standard Spedfiration for SPllmlPss CoppPr 111/Jp
tube conforming to ASTM B819, Standard SpPcifir:atinn for Seam for Mediral (',as Systems, Type Lm K
lf.t� Cnppl'r Tube for Mediral GrL� Systmis, Type Lor K. (3) ASTM B280, Standard Specifiration for Smmless Coppl'r '.fobe
15.4.4.2. 3 Fittings. for Air Conditioning and Refrigeration Ffrld Servire, ACR tube
(O.D. size).
15.4.4.2.3.1 Fittings shall be brazed, memo1y metal, or axially
swaged. 15.4.4.3.2.1 Copper tube shall he hard temper or annealed
( soft tern per) .
15.4.4.2.3.2 Brazed fittings shall be the wrought coppe1· capil
lary type complying wilh the following: 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
( 1) ASME Bl 6.22. Wrought Copper and Coppl'T Alloy Soldl'r-joint ods:
Pressure Fittings
(2) ANSI/ASME B1650, Wmuglit Copper and Coppr Alloy (1) Brazed or soldered fittin� confmming to ASME Bl6.22.
Bm:u-joint PrPs.rnrP Fittings Wrought Cof1per and Coppfr Alloy SoldPr-joint Pmsurf fzttings
(3) ASME Bl 6.22 with socket depths equal tom greate1· than (2) Brazed fittin� confo1·ming to ANSI/ASME Bl6.50,
brazed joint pt·essut·e fittings in accordance with ANSI/ Wmug:ht Copper and Copper Alloy Brau-joint Press1m Fittings
ASME B1650 (3) Brazed fittin� conforming to ASME Bl 6.22 with socket
depths equal to or greater than braze-joint pressure
15.4.4.2.3.3 Cast copper alloy fittings shall not he used with fittings in compliance with ANSI/ASME Bl6.50
field-braze<l joint�. (4) Flared fittinb.-s conforming to ASME B l6.26, Cast Coppl'T
,1lloy Fittings for Flared C',npper 'Jlibes
15.4.4.2.3.4 Memmy metal fittings shall be rate<l for not less (5) Comp1·essio11 fittings (Y, in. maximum size)
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 15.4.4.3.4 Joints. Joints fot· piping un<ler 15.4.4.3 shall comply
facturer's instructions. with 15.4.4.3.4.1 through 15.4.4.3.4.3.
15.4.4.2.3.5 Axially swaged couplin� shall include metal-to 15.4.4.3.4.1 Joint� shall he hraze<l, soldered, tlu-ea<le<l, fla1·e<l,
metal seats, shall be rated for not less than 538'C ( lO0O'F) an<l or the compression type.
2070 kPa (300 psi), and shall provide permanent, nonseparable
joint�. Fittings shall be installed by qualified technicians 111 15.4.4.3.4.2 \Vhe1·e joints are braze<l, they shall comply with
accor<lance with the manufacture1·'s instructions. the requirements of 15.4.6.
15.4.4. 2.4 Join ts. 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
15.4.4.2.4.1 Brazed. Brazing of coppe1· joint� shall be 111 ing of Copper and Copt>Pr A.Uoy Tube and Fittings, using a ''lead
accordance with 15.4.6. free" solder filler met al containing not more than 0.2 pe1·cent
lead by volume that complies with ASTM B32, Standard Spedfi
15.4.4.2.4.2 Threaded. Threaded joint� shall be limited to ration for SolrlPr Metal.
connections to pressut·e in<licators, alarm devices, and source
equipment and shall com ply with the following: 15.4.4.4 Piping for Dental Vacuum Systems and Scavenging
(1) Threads shall be tapered complying with ASME Bl .20.1, Systems.
Pipe Thread�, Genl'Tal Purpose, Inrh. 15.4.4.4.1 General. Piping for <lental vacuum systems and
(2) Th1·ea<ls shall be ma<le up with polytetrafluoroethylene scavenging systems shall be coppe1·, PVC plastic, 01· CPVC pla�
(PTFE) tape or other thread sealant recommended for tic.
oxygen sen,ice, with the sealant applied to the male
th1·eacb only. 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.
15.4.4.2.4.3 Prohibited Joints. The following joint� shall be
prohibited un<ler 15.4.4.2.4:
2021 Edition
15.4.4.4.2.1 Copper Tube. Copper tubing shall be hard F439, Standard Sperification for Ch1arina1Pd Poly(\!inyl Chlnr
temper or annealed (soft temper) and shall comply with the ide) (CPFC) Plastir Pipe Fitt in�, Srhedule 80.
follov.fog: (3) CPVC CTS plastic pipe and fittings ½ in. through 2 in.
ASTM B88, Standard Sppr,iji,ration Jar Seamless Copper Water size shall he SDR 11, confo1·ming to ASTM D2846/
( l)
Tube, Type L or K D284fiM, Standard Sperifiration Jar Chlarinated Poly(Vinyl
ASTM B819, Standard Specijiration for Seamless Copper Tube Chlaride) (CPVC) Plastir Hot- and Cald-H'izter D istribution
(2)
for Atediral Ga� Systl'ln�, Type L or K Systl'lns.
ASTM B280, Standard Sperijiration for Seamless Copper Tube (4) Solvent cement for joint� in CPVC plastic piping shall
(3)
for Air Conditioni ng and Rffrigl'mtion Field Service, ACR tube comply with ASTM F493, Standard Sperifimtion for Solven t
(O.D. size) t.R111ml.1 for Chlnrinated Poly(Viny l ChlrrridP) (CPVC) Plastir
PipI' and Fittings.
15.4.4.4.2.2 Copper Fttlings. Coppe1· fittings shall comply
with the following: 15.4.4.5 Piping for Nitrogen. Nitrogen piping in dental facili
ties shall comply with 15.4.4.2, including cleaning for oxygen
(1) Brazed m soldered fittings conforming to ASME Bl 6.22, service.
Wrought Copper and Capper Alloy SoldPr-joint Pn,ssure Fittings
(2) Brazed fittings conforming to ANSI/A';ME Bl 6.50, 15.4.5 Installation of Medical Gas, Dental Air, and Vacuum
Wrought Copper and Capper Allryr Brau-Joi n t PressurP Fittings Piping.
(3) Brazed fittings conforming to ASME Blfi.22 with socket 15.4.5.1 General.
depths equal to or greater than hraze:ioi11t pressure
fittings conforming to ANSI/ASME B1650 15.4.5.1.1 Gas and vacuum piping systems shall be as listed in
(4) Flared fittings conforming to ASME Blfi.26, Cm/ Copper Section 15.4.
A.lloy Fit tings for Hared Capper Tubes
(5) Compression fittings (Vi in. maximum size) 15.4.5.1.2 Piping materials shall be as listed in 15.4.4.
15.4.4.4.2.3 Joints for Copper Piping. Joint� in coppe1· tubing 15.4.5.2 Pipe Sizing. Piping systems shall be designed and
shall be in accordance with the following: sized to delive1· the 1·equi1·erl flow rates at the utilization pres
sures.
(1) Joint5 shall be brazed, soldered, threaded, flared, or the
compression type. 15.4.5.3 Minimum Pipe Sizes. The minimum size of the
(2) Whe1·e joint5 a1·e brazed, they shall comply with the following piping shall be a� follows:
requirement� of 15.4.6. (1) Category 2 oxygen piping shall he not less than DN 10
(3) Solde1·ed joint5 shall be made in accoi·dance with ASTM (NPS ¾ in.) (½ in. O.D.) size.
B828, Standard Pmrti,:e Jar Making Capillary JoinL� 1,y Solder (2) Category 2 nitrous oxide piping shall be not less than
ing of Capper and Capper Allny Tube and Fittin�, using a DN8 (NPS Vi in.) (% in. O.D.) size.
''Iearl-free·· solder filler metal containing not more than (3) Category 2 oxygen piping shall be at least l size larger
0.2 percent lead by volume that complies with ASTM B32, than piping for nitrous oxide.
Standard Sperifiration Jar Solder Mdal.
15.4.5.4 Location of Piping. Piping shall not be located where
15.4.4.4.3 PVC Plastic Piping. PVC plastic piping under subject to contact with oil.
15.4.4.4 shall be in accoi·dance with the follov.�ng:
15.4.5.5 Protection of Piping.
(l) PVC pla�tic pipe shall b e Schedule 4 0 m Schedule 80,
conforming to ASTM D1785, Standard Spedfiration for 15.4.5.5.1 Piping shall be protected against freezing, corro
Poly(Vinyl Chloride) (PVC) Plastic Pip, Si:heduvs 40, 80 , and sion, and physical damage.
120.
(2) PVC pla5tic fittings shall be Schedule 40 or Schedule 80 15.4.5.5.2 Piping exposed in con-irlors anrl other locations
to match the pipe, conforming to ASTM D2466, Standard where subject to physical damage from the movement of equip
Specifimtinn for PoZv(Finyl Chlnride) (PVC) Plmtii: Pipe ment shall be protected.
Fittin�, Schedule 40, m ASTM D2467. Standard Sperifiration 15.4.5.6 Pipe Support .
for Poly(Vinyl Ch laride) (PVCj Plmtir Pipe Fittings, Srhedule
80. 15.4.5.6.1 Piping shall be supported from the building struc
( 3) Joint5 in PVC plastic piping shall be solvent-cemented in ture.
accordance with ASTM D2672, Standard Sprifimtion for 15.4.5.6.2 Hangers and supports shall comply with anrl be
joint� for JPS PVC PipP U�ing Solvent Cnnmt. installed in accordance with MSS SP-58, Pipe Hangers and
15.4.4.4.4 CPVC Plastic Piping. CPVC pla5tic piping under Supports - Alaten·al�, Design, Manufacture, Selertion, A.pplimtinn ,
15.4.4.4 shall be in accm·dance with the follov.1ng: and Jnstallatian.
(1) CPVC IPS plastic pipe shall be Schedule 40 or Scherlule 15.4.5.6.3 Hangers and supporrn shall be sized fo1· the tube or
80, conforming to ASTM F441/F441M, Standard Spncifim pipe being supported.
tion for Chlnrinall'd Poly (Vinyl ChloridP) (CPVC) Plastic Pip,
Schedu/J,s 40 and 80. 15.4.5.6.4 In potentially damp locations, copper tuhe hangers
(2) CPVC IPS plastic fittings shall be Schedule 40 or Sched anrl supports that are in contact with the tube shall he plastic
ule 80 to match the pipe, conforming to ASTM F438, coated 01· othenvise electrically insulated from the tube.
Standard Sperifimtion for So,:kpt-Type ChlnrinatPd PoMViny l 15.4.5.6.5 The maximum support spacing for copper tube
ChloridP) (CPVC) Pla�ti,: Pipe Fittin�, Srhedule 40, or ASTM shall be in accordance with Table 15.4.5.6.5.
2021 Edition
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
15.4.6.1.3 1l1e bi-azing procedm·e specification shall addt·ess 15.4.6.3.2 The cutting wheels on tubing cutters shall be free
cleaning.joint clearance, overlap, internal purge gas, purge gas from grease, oil, or other lubricant5 not recommenrlerl for
flow rate, anrl fillet· metal. oxygen service.
15.4.6.1.4 The brazing procedure qualification 1·eco1·d and the 15.4.6.3.3 The cut enrls of the tube shall be rolled smooth 01·
recorrl of brazer performance qualification shall rlocument the rleburred with a sharp, clean deburring tool, taking care to
filler metal userl, cleaning, joint cleai-ance, ovedap, internal prevent chips from entering the tube.
pm·ge ga.� and flow rate during brazing of the coupon, and the
absence of internal oxirlation in the completerl coupon. 15.4.6.4 Cleaning Joints for Brazing.
15.4.6.1.5 Brazing procerlures qualified by a technically 15.4.6.4.1 The interior surfaces of tubes, fittings, anrl othe1-
competent group or agency shall be permitterl unde1· the components that a1·e deaned for oxygen se1·vice shall be stored
following conrlitions: and handlerl to avoirl contamination prior to assembly and
brazing.
(l ) The brazing procerlure specification and the procedu1·e
qualification recorrl meet the requirements of this code. 15.4.6.4.2 The exterior sudaces of tube ends shall be cleanerl
(2) The employer obtains a copy of both the brazing proce prim· to brazing to remove any oxides anrl surface dirt anrl to
dure specification anrl the supporting qualification roughen the surfaces to prepare them for brazing.
rec01·d from the group or agency and signs anrl rlates 15.4.6.4.3 Nonabrnsive p ads shall be used to clean the exte1·i01·
these reconls, thereby accepting 1·esponsibility for the surfaces of tube enrls.
qualifications that were performerl by the group or
agency. 15.4.6.4.4 The use of steel wool, sand cloth, or wire brushes
(3) The employe1· qualifies at least one hi-aze1· following each shall be prohibited.
brazing procedure specification userl.
15.4.6.4.5 The cleaning process shall not result in grooving
15.4.6.1.6 An employer shall be permitted to accept bt·azer the sud"aces to he joined.
qualification 1·ecords of a pt·evious employer unde1· the follow
ing conditions: 15.4.6.4.6 A.fte1· being abrnded, the surfaces shall be wiperl
using a dean, lint-free white cloth.
(l ) The brazer has been qualified following the same proce
dure that the new employer uses or an equivalent p1·oce 15.4.6.4.7 Tubes, fittin�. valves, and other component� shall
dure. be visually examined internally befo1·e being joinerl to ve1·ify
(2) The new employer obtains a copy of the record of brazer that they have not become contaminated for oxygen service
performance qualification tests from the previous and that they a1·e free of obstructions or debris.
employer and signs and rlates these 1·ecords, thereby 15.4.6.4.8 Mate1·ial that has become contaminated internally
accepting responsibility for the gualifications performerl anrl is not clean for oxygen senice shall not be installed.
by the previous employer.
15.4.6.4.9 Joint� shall be brazed within 8 hout·s afte1· being
15.4.6.1.7 Pei-fom1ance gualifications of bi-azers shall remain cleanerl for bi-azing.
in effect indefinitely, unless the brazer rloes not bi-aze with the
qualifierl procedure for a period exceerling 6 months or there 15.4.6.5 Brazing Dis.similar Metals.
is a specific 1·eason to guestion the ability of the bi-aze1·.
15.4.6.5.1 Flux shall only he userl when brazing dissimila1·
15.4.6.2 BrazedJoints. metals, such as coppet· and bronze or brass, using a silve1· hrnz
ing filler metal (i.e., BAg series) .
15.4.6.2.1 Brazed tube joints shall be of the socket type.
15.4.6.5.2 Cast metals shall not be field brazed.
15.4.6.2.2 Brazed joint� shall he marle using a brazing alloy
that exhihirn a melting temperature in excess of 538'C 15.4.6.5.3 Surfaces shall be cleaned for brazing in accordance
(1000 ° F) to retain the integrity of the piping system in the with 15.4.6.4.
event of fi1·e expostu-e.
15.4.6.5.4 Flux shall be applied spat-ingly to minimize contam
15.4.6.2.3 Filler metals shall bonrl with and he metallurgically ination of the insirle of the tube with flux.
compatible with the base metal beingjoined.
15.4.6.5.5 The flux shall be applierl and worked over the
f
15.4.6.2.4 Filler metals shal l comply with ANSI/A\,VS A5.8M/ cleanerl sudaces to be brazed using a stif bristle brnsh to
A5.8, Spffijimtinn for Fzlln I\,fflrrl� for Brazing and Brau HWding. ensure complete coverage anrl wetting of the surfaces with flux.
15.4.6.2.5 Copper-to-copper joints shall be brazed using a 15.4.6.5.6 \.\,'here possible, short sections of coppe1· tube shall
copper-phosphorus or coppet'-phosphorus-silver bi-azing filler be brazed onto the noncopper component, anrl the interior of
metal (i.e., BCuP series) without flux. the subassembly shall he cleanerl of flux prior to installation in
the piping system.
15.4.6.2.6 Joint� to be brazed in place shall he accessible for
necessary preparation, a�semhly, heating, filler application, 15.4.6.5.7 On joint� DN20 (NPS %) (¾ in. O.D.) size anrl
cooling, cleaning, and inspection. smaller, flux-coated brazing rorls s hall be permitted to be used
in lieu of appl)'ing flux to the surfaces to bejoined.
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.
2021 Edition
15.4.6.6 Nitrogen Purge. (l) Flux 01· flux residue (where flux or flux-coated BAg rods
are used with rl.issimilar metals)
15.4.6.6.1 ·while being b1·azed, joint� shall be continuously (2) Base metal melting or erosion
purged with oil-free, nry nitrogen NF to prevent the fot·mation (3) Unmelterl. filler metal
of coppet· oxide on the insirl.e surface of thejoint. (4) Failure of the filler metal to be clearly visible all the way
15.4.6.6.2 The source of the nitrngen purge gas shall be moni around the joint at the interface between the socket and
torerl., anrl. the installer shall be audibly alerterl. when the the tube
content is low. (5) Cracks in the tube 01· component
(G) Cracks in the filler metal
15.4.6.6.3 The nitrogen purge gas flow rate shall not he high (7) Fail111·e of the joint to hold the test press111·e unde1· the
enough to prnduce a positive pt·essure in the piping system. installer-pedormed initial pressure test (.�Pf 15. 4. 7. 4. 4)
15.4.6.6.4 The nitrogen purge gas flow shall be controlled by anrl. standing pressure test (.�PP 15.4. 7.4.6)
the use of both a p1·essure 1·egulator and a flowmeter or a 15.4.6.8.5 Joint� that are irl.entified as defective unrl.er conrl.i
combination the1·eof tions specified in 15.4.6.8.4(2) or 15.4.6.8.4(5) shall be
15.4.6.6.5 Pressure regulators alone shall not be userl. to replaced.
control nitrngen p111·ge gas flow 1·ates. 15.4.6.8.6 Joints that are found to be defective under condi
15.4.6.6.6 During and after installation, openings in the tions specifierl. in 15.4.6.8.4(1), 15.4.G.8.4(3), 15.4.6.8.4(4).
piping system shall be kept capped or plugged to maintain a 15.4.6.8.4(6), 01· 15.4.6.8.4(7) shall be permitted to be
nitrngen atmosphere within the piping and to prevent debris repaired, except that no joint shall be reheated more than
or other contaminant� from ente1·ing the system. once befixe being replaced.
15.4.6.6. 7 While a joint is being brazed, a discharge opening 15.4.7 Performanc e Criteria and Testing (Oxygen and Nitrous
shall be prnvided on the opposite side of thejoint from where Oxide).
the niu·ogen purge gas is being inu·oduced. 15.4.7.1 Testing and Verification.
15.4.6.6.8 1l1e flow of nitrogen purge gas shall be maintained 15.4.7.1.1 General.
until the joint is cool to the touch.
15.4.7.I.I.l Inspection anrl. testing shall be pedormerl. on all
15.4.6.6.9 Afte1· the joint ha.� coolerl., the purge discharge new piperl. oxygen anrl. nitrous oxirl.e systems, adrl.itions, 1·enova
opening shall be plugged or capped to prevent contamination tions, temporary installations, or repairerl. systems to ensure, by
of the inside of the tube and maintain the nitrngen atmos a documented procerl.ure, that the following have been
phere within the piping system. completed:
15.4.6. 7 Assembling and Heating Brazed Joints. (1) All applicable prmisions of this code have been adhered
to.
15.4.6.7.1 Tube ends shall be inserted either folly into the (2) System integ1·ity ha.� been achieverl. or maintainerl..
depth of the fitting socket or to a mechanically limiterl. depth (3) Piping systems are 1·eany fo1· testing and ve1-ification.
that is not less than the minimum cup rl.epth (i.e., overlap) (4) Piping systems are performing in accordance with their
specified in ANSI/ASME BlG.50, Wrought Coppn and Coppfr design requirement�.
A.Uoy BrazPfoint PressurP Fittings.
15.4.7.I.I.2 The inspection and testing 1·epo1·t� shall be
15.4.6. 7.2 \\'here flux is permitted, joints shall be heated submitted directly to the party that contracterl. for the testing,
slowly until the flux has liquefied. who shall submit the 1·eports through channels to the Responsi
15.4.6.7.3 Afte1· flux has liquefied, 01· where flux is not pe1·mit ble Facility Authority and any others that are requi1·ed.
ted to be userl., thejoint shall be beaten quickly to the brazing 15.4.7.I.I.3 Report� shall contain detailerl. listings of all find
temperatu1·e. taking ca1·e not to ove1·heat thejoint. ings and result�.
15.4.6.7.4 Techniques for heatingjoint�, applying the bt·azing 15.4.7.1.1.4 The Responsible Facility Authority shall 1·e,iew
filler metal, and making the horizontal, vertical, and large the inspection anrl. testing records prior to the use of any
diameter joints shall he as desc1·ibed in sections on applying systems to ensu1·e that all findings and result� of the inspection
heat anrl. brazing horizontal anrl. verticaljoint� in Chapte1·VIII, and testing have been successfully completed before use.
"Brazen.Joint�," in the CDA Copper fobe Handbook.
15.4.7.I.I.5 All documentation pertaining to inspections and
15.4.6.8 Inspection of BrazedJoints. testing shall he maintainerl. on-site within the facility.
f
15.4.6.8.1 A te1· brnzing, the outside of all joints shall be 15.4.7.2 Required Testing and Verification.
cleaned by washing with water and a wire brush to remove any
resirl.ue and allow clear visual inspection of thejoint. 15.4.7.2.1 Category 2 Medical Gas Systems (Oxygen and
Nitrous Oxide). All Category 2 oxygen and nitrous oxirl.e
15.4.6.8.2 \'\'he1·e flux has been userl., the wash wate1· shall be piping systems indicated in 15.4.2 shall be initially testerl. in
hot. accordance with 15.4.7.4.
15.4.6.8.3 Each joint shall be visually inspecterl. alter cleaning 15.4.7.2.2 The oxygen and niu·ous oxide piping systems shall
the outsirl.e surfaces. be verified in accordance with 15.4.7.5.
15.4.6.8.4 Joint� exhibiting the following conrl.itions shall not
he permitted:
2021 Edition
15.4. 7.3 Qualification of System Testers and Verifiers (Oxygen 15.4.7.4.3.4 Sources of test gas shall be disconnected from all
and Nitrous Oxide). piping systems except for the one system being tested.
15.4. 7.3.1 Indi"iduals who perfo1·m the initial and final tests of 15.4.7.4.3.5 The system under test shall be charged with oil
the m..·ygen and nitrous oxide piping systems shall be certified free, dry nitrogen NF to a gauge p1·essure of 345 kPa (50 psi).
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. 15.4.7.4.3.6 A:fi.e1· the installation of the individual faceplates
with approp1·iate adapte1·s matching outlet/inlet labels, each
15.4. 7.3.2 Individuals who verify the oxygen and nitrous oxide individual outlet/inlet in each installed medical gas and
piping systems shall be certified to ASSE 6030, ProjP.t1ional Qual vacuum piping system shall be checked to determine that the
ijirations Standard for I\1Pdiral C',a.1 Systems \frijin,. test gas is dispensed only from the piping system tested.
15.4. 7.4 Initial Testing of Piping Systems (Oxygen and Nitrous 15.4.7.4.3.7 The initial cross-connection test in 15.4.7.4.3 shall
Oxide). be repeated for each installed medical gas and vacuum piping
system with coppe1· piping.
15.4.7.4.1 General.
15.4.7.4.3.8 Any cross-connections shall be 1·emoved and the
15.4.7.4.1.1 1l1e initial tests required by 15.4.7.4 shall be a�sociate<l piping repaired and leak tested.
perforn1ed p1·io1· to either the final test� or the verification test�
listed in 15.4.7.5. 15.4.7.4.3.9 The prope1· labeling and identification of system
outlet�/inlet� shall be confirmed <luring these test�.
15.4.7.4.1.2 1l1e test gas for ga� piping systems shall be oil
free, dry nitrogen NF. 15.4.7.4.4 Initial Pres.sure Test.
15.4.7.4.1.3 Where manufactured assemblies are to be in 15.4.7.4.4.1 Each section of the piping in positive-p1·essure gas
stalled, the initial tests required by 15.4.7.4 shall be performed systems and copper vacuum systems shall be pressure tested.
as follows: Plastic vacuum and plastic scavenging piping shall not be pres
(l) Afte1· completion o f the <listrilmtion piping but befo1·e sure tested.
the standing pressure test 15.4.7.4.4.2 Initial pressure test� shall be conducted as follows:
(2) Prior to installation of manufactured assemblies supplied
through flexible hose or flexible tubing (l) After blowdown of the distribution piping
Fm· all station outlet�/inlet� on installed manufactu1·ed (2) After installation of station outlet/inlet rough-in assem
(3)
assemblies supplied through copper tubing blies
(3) Prior to the installation of components of the distribution
15.4.7.4.1.4 Where plastic vacuum and plastic scavenging piping system that would be damaged by the test pressure
piping systems are installed, they shall be visually inspected for (e.g.. pressu1·e/vacuum alarm devices, pressu1·e/,-acuum
cross-connections to positive-pressure systems before applying indicators, and line pressure re lief valves)
positive test pressm·es to the copper piping systems.
15.4.7.4.4.3 The sou1·ce shutoff valve shall 1·emain closed
15.4.7.4.1.5 Where braze<ljoint� in coppe1· tubing are found <luring the pressure test�.
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 15.4.7.4.4.4 The test p1·essme for oxygen and nitrous oxide
shall be repurged if' necessary. piping shall be 1.5 times the system opernting p1·essure but not
less than a gauge p1·essure of 1035 kPa (150 psi).
15.4.7.4.1.6 During the process of initial testing, the identifi
cation and labeling of the medical gas and vacuum piping shall 15.4.7.4.4.5* The test pressure shall be maintained until each
be checked. joint has been examined for leakage by means of a leak detec
tant that is safe fo1· use with oxygen and does not contain
15.4.7.4.2 Initial Piping Blowdown (Oxygen and Nitrous ammonia.
Oxide). Piping in dental air and vacuum distribution syi;tems
shall be blown clear by means of oil-free, dry nitrogen NF after 15.4.7.4.4.6 Any leaks shall be located, 1·epaired (if permit
installation of the distribution piping but before installation of ted), 01· replaced (if' required) by the installer, and retested.
station outlet/inlet rough-in assemblies and other system 15.4.7.4.5 Initial Piping Purge Test.
component� (e.g., pressu1·e/vacuum alarm devices, p1·essm·e/
\-acuum indicatm·s, pressure 1·elief,-alves, manifolds, and source 15.4.7.4.5.1 The outlet� in each oxygen and nitrous oxide
equipment). piping system shall be purged to remove any particulate matter
from the distribution piping.
15.4. 7.4.3 Initial Cros.s-Connection Test for Copper Piping
Systems. 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
15.4.7.4.3.1 Copper piping shall not be tested before any plas the purge produces no discoloration in a clean white cloth.
tic piping.
15.4.7.4.5.3 The pm·ging shall be sta rted at the closest outlet
15.4. 7.4.3.2 It shall be determined that no cross-connections to the piping shutoff \alve and continue to the furthest outlet
exist between the va rious medical gas and vacuum piping from the shutoff valve.
systems.
15.4.7.4.3.3 All ptpmg systems shall be reduced to atmos
pheric pressure.
2021 Edition
15.4.7.4.6 Standing Pressure Test for Oxy gen and Nitrous 15.4.7.5.1.9 During the process of vei-ification, the pt·esence
Oxide Piping. and proper labeling of source equipment, station outlets/
f
inlet�, zone valve boxes, shutof valves, and ala1·ms shall be
15.4.7.4.6.1 1\fte1· successful completion of the initial pressure checked.
test� in 15.4.7.4.4, the gas distribution piping shall be subject to
a standing pressure test. 15.4.7.5.2 Verifier Standing Pressure Test. Oxygen and
nitrous oxide piping systems 1·equiring verification shall be
15.4. 7.4.6.2 Test� shall he conducted after the final installation subjected to a LO-minute standing p1·essu1·e test at operating
of station outlet valve bodies, faceplates, and other distribution line pressure using the following procedure:
system components (e.g., pressure alarm devices, pressure indi
cators, line pressm·e 1·eliefvalves, manufactured assemblies, and (1) .<\fte1· the system is filled ,�th nitrogen 01· the som·ce gas,
hoses). the smu-ce valve shall be closed.
(2) The piping system shall show no decrease in pressure
15.4. 7.4.6.3 The source valve shall be closed during this test. after not less than 10 minutes.
f
15.4. 7.4.6.4 The piping systems shall be subjected to 24-hom (3) Any leaks shall be located, repaired (i permitted). or
standing pressu1·e test� using oil-free, dry nitrogen NF. replaced (if 1·equired) by the installe1·, and 1·etested.
15.4.7.4.6.5 Test pressures shall be 20 percent above the 15.4.7.5.3 Verifier Cross-Connection Test. The piping systems
normal system opernting line pressu1·e. shall be tested fot· cross-connections bel:\veen the systems using
the following procedure:
15.4.7.4.6.6 At the conclusion of the test5, there shall be no (l ) All medical ga� and vacuum piping systems shall be
change in the test pt·essure except that attributed to specific reduced to atmospheric pressm·e.
changes in ambient temperattu-e. (2) All sources of test gas for all of the gas and vacuum
15.4.7.4.6.7 Any leaks shall be located, repaired (if permit systems, with the exception of the one system to be
ted), or 1·eplaced (if required) hy the installer, and retested. checked, shall be disconnected.
f
The piping shall be repurged i necessary. (3) lhe system being checked shall be pressurized to a gauge
pressure of 345 kPa (50 psi) .
15.4. 7.4.6.8 The 24-hour standing pressure tests shall be ( 4) With adapters matching outlet labels, each individual
\\�tnessed by the authority having jurisdiction or it� designee. A station outlet/inlet of all medical gas and "-acuum systems
form indicating that these test� have been performed and installed shall be checked to determine that test gas is
,�tnessed shall be provided to the verifie1· at the start of the dispensed only from the outlet�/inlets of the piping
verification test� in 15.4.7.5. system being tested.
15.4.7.5 Verification of Piping Systems (Oxygen and Nitrous (5) The sou1·ce of test gas shall be disconnected, and the
Oxide). system that was tested reduced to atmospheric pt·essure.
(6) Each additional piping system shall be tested until all gas
15.4. 7. 5. I General. and vacuum piping systems requiring ve1·ific ation are free
of cross-connections.
15.4.7.5.1.1 The oxygen and nitrous oxide piping systems (7) Any cross-<"onnections shall be 1·emoved and the associ-
requiring initial testing and verification shall be as indicated in ated piping repaired and tested for leaks.
15.4.7.2 for the difle1·ent dental facilities.
15.4.7.5.4 Verifier Piping Purge Test.
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 15.4.7.5.4.1 To remove any traces of particulate matter depos
required in 15.4.7.4 have been completed. ited in the oxygen and nitrous oxide piping dtu-ing constrnc
tion, a heavy, inte1·mittent pu1·ging of the piping shall be done.
15.4.7.5.1.3 The test ga� shall be oil-free, dry nitrogen NF 01·
the system gas or vacuum where permitted. 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
15.4. 7.5.1.4 Ve1·ification shall be conducted by a party techni on each outlet.
cally competent and expe1·ienced in the field of medical ga�
and vacuum piping system testing and certified for ASSE 6030, 15.4.7.5.4.3 After each purge is started, it shall be rapidly
Projfssional Qualijirations Standard for MPdiral Gas Systmns Verifiers. inten-upted several times until the pm·ge produces no discolor
ation in a white cloth loosely held ove1· the adapter dut·ing the
15.4. 7.5.1.5 Ve1·ification shall be pedormed by a pa1·ty othe1· purge.
than the installing contractor.
15.4.7.5.4.4 To avoid possible damage to the outlet and it�
15.4.7.5.1.6 All required ve1·ification tests shall he perfo1·med components, this test shall not be conducted using any imple
after installation of any manufactured assemblies supplied ment other than the prnper adapter.
through tubing or flexible hose.
15.4.7.5.4.5 No pronounced or objectionable odor shall be
15.4.7.5.1. 7 \'\IJ1e1·e there are multiple possible connection discernible from any positive presstu-e outlet.
points for tei-minals, each possible position shall be tested inde
pendently. 15.4.7.5.5 Verifier Piping Particulate Test.
15.4.7.5.1.8 Whe1·e brnzedjoint� in copper tubing a1·e found 15.4.7.5.5.1 For each oxygen and nitrous oxide system, the
f
to be defective, they shall be repaired i petmitted by l f>.4.6.8.6 cleanliness of the piping system shall be verified.
or replaced if required by 15.4.6.8.5, and retested. The piping
shall be 1·epm·ged if necessary. 15.4.7.5.5.2 The test shall be performed with the use of oil
free, dry nitrogen NF.
2021 Edition
15.4.7.5.5.3 A muumum of 1000 L (35 ft3) of gas shall be 15.4.7.5.8.2 Tests shall be performed with the gas of system
filtere<l through a clean, white 0.45 micron filte1· at a minimum designation.
flow rnte of 100 NI/min (35 SCFM).
15.4.7.5.8.3 All medical gas outlet� with a gauge p1·essu1·e of
15.4. 7.5.5.4 Twenty five percent of the zones shall be tested at 345 kPa (50 psi), including oxygen an<l nitrous oxide, shall
the outlet most 1·emote from the source. 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
15.4.7.5.5.5 The filter shall accrne no m01·e than 0.001 g (50 psi to :i5 psi).
( l mg) of matter from any outlet teste<l.
15.4.7.5.9 Verifier Gas Concentration Test. After purging
15.4.7.5.5.6 If any outlet fails this test, the most remote outlet each system with the gas of system designation, the follm\�ng
in every zone shall be tested. shall be pedonne<l:
15.4.7.5.6 Verifier Piping Purity Test. ( l) Each pressure gas source an<l outlet shall b e analyzed for
concentration of gas, by volume.
15.4.7.5.6.1 For each oxvgen and nitrous oxide system, the
(2) Analysis shall be conducted with instrnment� designed to
purity of the piping system shall be verified in accordance with
meastlt"e the specific gas dispense<l.
15.4.75.G.
(3) Allowable concentrations shall be as folio�:
15.4.7.5.6.2 These test� shall be ped,xme<l with oil-free, d ry (a) Oxygen 299 pe1·cent
nitrogen NF or the system gas. (b) Nitrous oxide ;>99 percent
15.4. 7.5.6.3 The outlet most remote from the sou1·ce shall be (c) Other gases ±1 percent unless othen\/ise specified
teste<l fo1· total nonmethane hvdrocarbons an<l compare<l to 15.4.8 Performance Criteria and Testing (Dental Air and
the test of the source gas. Vacuum).
15.4. 7.5.6.4 If the system gas is used a� the source ga�. it shall 15.4.8.1 Dental Air and Vacuum SystellLS Testing.
be tested at the source equipment.
15.4.8.1.1 General.
15.4.7.5.6.5 The difference between the two tests shall in no
case excee<l :> ppm of total nonmethane hy<lrocarbons. 15.4.8.1.1.1 Inspection and testing shall be performed on all
new piped dental gas and \·acuum systems, additions, renova
15.4.7.5.6.6 The diffe1·ence between the two tests shall 111 no tions, temporary installations, or repai1·e<l systems to ensm·e, by
case exceed 5 ppm of halogenate<l hydrocarbons. a documented procedure, that the following have been
15.4. 7.5.6.7 1l1e moisture concentration of the outlet test completed:
shall not excee<l :i00 ppm or an equivalent p1·esstll'e dew point ( l) All applicable provisions of this code have been adhere<l
of -12'C ( lO'F) at a gauge pressure of 345 kPa (50 psi). to.
(2) System integrity has been achieve<l or maintained.
15.4.7.5.7 Verifier Final Tie-in Test.
(3) Piping systems are ready for testing and verification.
15.4.7.5.7.1 Prior to the connection of any work or any exten (4) Piping systems a1·e pedo1·ming in accm·dance with thei1·
sion 01· addition to an existing piping system, the verification design requirement�.
tests in l!">.4.7.5 shall be successti.tlly pedormed on the new
15.4.8.1.1.2 The inspection and testing report� shall be
work.
submitte<l directly to the party that contracted for the testing,
15.4.7.5.7.2 Each joint in the final connection bet ween the who shall submit the report� through channels to the Responsi
new work and the existing system shall be leak-teste<l with the ble Facility Authority an<l any others that a1·e 1·equire<l.
gas of system designation at the normal operating pressure by
means of a leak detectant that is safe for use with oxygen an<l
15.4.8.1.1.3 Reports shall contain <letaile<l listings of all find
ings and result�.
noes not contain ammonia.
15.4.8.1.1.4 The Responsible Facility Authority shall review
15.4. 7.5. 7.3 For oxygen an<l niu·ous oxi<le, imme<liately after
the inspection and testing records prior to the use of any
the final brazed connection is made and leak- tested, an outlet
systems to ensure that all findings and results of the inspection
in the new piping and an outlet in the existing piping that a1·e
and testing have been successfully completed befot·e use.
immediately downstream from the point or a1·ea of intrnsion
shall be purged in accordance with the applicable require 15.4.8.1.1.5 All <locumentation pertaining to inspections an<l
ment� of 15.4.75.4. testing shall he maintaine<l on-site within the facility.
15.4.7.5. 7.4 Before the new work is used fo1· patient care, 15.4.8.1.2 Category 2 Dental Air and Vacuwn SystellLS.
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 15.4.8.1.2.1 All Category 2 <lental gas an<l vacuum p1p1ng
15.4.75.9. systems in<licate<l in 15.4.3 shall be initially tested in accord
ance with 15.4.8.1.
15.4.7.5. 7.5 Permanent reconi� of these test� shall be main
taine<l. 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
15.4.7.5.8 Verifier Operational Pressure Test. in accordance with 15.4.8.1.7 and 15.4.8.1.8.
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.
2021 Edition
15.4. 8. I. 3 Initial Testing of Piping Systems. 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
15.4. 8. I. 3. I General. tant that is safe for use with oxygen and <loes not contain
(A) Whe1·e plastic vacuum and pla�tic scavenging p1pmg ammoma.
systems are installe<l, they shall be visually inspected for cross 15.4.8.1.5.6 Any leaks shall he locate<l, repaired (if permit
connections to oxygen an<l nitrous oxide systems before apply f
ted), or replaced (i 1·equi1-ed) by the installe1·, and reteste<l.
ing positive test pressm·es to the coppe1· piping systems.
15.4.8.1.6 Initial Piping Purge Test.
(B) During the process of initial testing, the identification an<l
labeling of the dental gas and vacuum piping shall he checked. 15.4.8.1.6.1 The outlet� in each dental air piping system shall
be purged to remove any particulate matte1· from the dist1·ibu
15.4.8.1.4 Initial Cross-Connection Test for Plastic Vacuum tion piping.
and Plastic Scavenging Piping Systems.
15.4.8.1.6.2 Using appropriate adapters, each outlet shall be
15.4.8.1.4.1 Plastic piping shall be tested before coppe1· pm·ged with an intermittent high-volume flow of test ga, until
p1pmg. the purge produces no discoloration in a clean white cloth.
15.4.8.1.4.2 Tests shall be conducted to determine that no 15.4.8.1.6.3 The purging shall be started at the closest outlet
cross-connections exist between any plastic vacuum piping to the piping shutoff valve and continue to the furthest outlet
systems or pla�tic scavenging piping systems an<l any coppe1- from the shutoff"-alve.
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 Vacuum Piping.
for the vacuum 01· scavenging piping systems shall remain
close<l during the test�. unless thev are heing used for the cross 15.4.8.1.7.1 After successful completion of the initial pressure
connection test vacuum source. 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.
15.4.8.1.4.4 The cross-connection test vacuum shall be a mini
mum of300 mm (12 in.) HgV. 15.4.8.1.7.2 Tests shall be conducted after the final installation
of station outlet valve hoclies, faceplates, and othe1· distribution
15.4.8.1.4.5 1l1e source of test vacuum shall be connected system component, (e.g., p1·essure alarm <levices, p1·essure in<li
only to the vacuum or scavenging piping system being teste<l. cators. line p1·ess111"e relief valves, manufactured a�semblies. and
15.4.8. 1.4.6 All individual gas system outlets an<l vacuum or hoses).
scavenging system inlet� shall be checked to dete1·mine that the 15.4.8.1.7.3 The source '1-alve shall be closed du1·ing this test.
test vacuum is only p1·esent in the vacuum or scavenging piping
system being tested. 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.
15.4.8.1.4.7 The cross-connection test� shall be 1·epeated fo1·
each installed vacuum and scavenging system with pla�tic 15.4.8.1.7.5 Test pressu1-es shall he 20 percent above the
piping. normal system operating line pressure.
15.4.8.1.4.8 Any cross-connections shall he remove<l an<l the 15.4.8.1.7.6 At the conclusion of the test�, there shall be no
associated piping repaired an<l leak tested. change in the test pressure, except that attributed to specific
changes in ambient temperature.
15.4.8.1.4.9 The proper labeling an<l identification of system
outlets/inlet� shall be confirmed during the initial test�. 15.4.8.1.7.7 Any leaks shall be located, repaired (if permit
te<l), or replaced (if requi1·e<l) by the installer, and retested.
15.4.8.1.5 Initial Pressure Test. The piping shall be repurged if necessarv.
15.4.8.1.5.1 Each section of Ll1e piping in dental air systems 15.4.8.1.8 Standing Vacuum Test for Plastic Vacuum Piping.
and coppe1- vacuum systems shall he pressure teste<l. Plastic
vacuum and plastic scavenging piping shall not be pressure 15.4.8.1.8.1 After successful completion of the initial pressure
teste<l. test� in 15.4.8. l, ,-acuum distribution piping, including scaveng
ing, shall be subjected to a standing vacuum test.
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- 15.4.8.1.8.2 Tests shall be con<lucted after instal lation and
blies connection of all component� of the vacuum system.
f
(2) P1·io1· to the installation o component� of the distribution 15.4.8.1.8.3 The piping systems shall he subjecte<l to a 24-hour
piping system that would be damage<l by the test pressure stan<ling vacuum test.
(e.g., pressure/vacuum alarm de"ices, pressure/vacuum
indicatoi-s. and line pressure relief valves) 15.4.8.1.8.4 Test pressure shall be between 300 mm (12 in.)
HgV and full ,-acuum.
15.4.8.1.5.3 The sout"Ce shutoff valve shall remain closed
during the pressure tests. 15.4.8.1.8.5 During the test, the source of test vacuum shall be
disconnected from the piping system.
15.4.8.1.5.4 The test pressm·e fo1· dental ai1· piping and coppe1·
\-acuum piping shall be 15 times the system opernting pressure 15.4.8.1.8.6 At the conclusion of the test, there shall be no
but not less than a gauge pressure of 10:\5 kPa (150 psi). change in the vacuum pressure other than that attributed to
changes of ambient tempei-ature.
2021 Edition
DENTAL (;As AND W.CUllM �YSTEMS 99-149
15.4.8.1.8.7 Any leaks shall be located. repai1·ed (if permit 15.5.3.2 Cylinders and Containers. Cylinders and containers
ted), or replaced (if required) by the installer, anct retested. for gases shall be handled in accordance with Chapter 11.
15.4.9 Operation and Management. 15.5.3.3 Ventilation for Motor-Driven Equipment. The follow
ing source locations shall be adequately ventilated to prevent
15.4.9. 1 System Shutdowns. accumulation of heat:
15.4.9.1.1 Gas anct vacuum piping systems shall be shut down ( l) Dental comp1-essect air sources
at the end of each workday. (2) Dental vacuum sources
15.4.9.1.2 Emergency shutoff valves or remote actuators shall 15.5.4 Dental Gas and Vacuum Source Equipment.
not be used fot· ctaily shutdown of the systems. Cylin<ler gas
valves shall be used fix ctaily shutdowns. 15.5.4.1 General.
15.4.9.2 Prohibi ted Interconnections. Two or more piping 15.5.4.1.1 The capacity of source equipment shall be base ct on
systems for different gases or different vacuums shall not be the design requi1·ement� for the facility. including the numbe1·
inteJ"Connected for testing or any othe1· 1·eason. of gas outlet�, vacuum inlet�, anct other connections, and thei1·
indi,ictual capacities.
15.4.9.3 Manufacturer's Instruct ions.
15.5.4.1.2 The system design 1·equi1·ement� shall be incluctect
15.4.9.3.1 Piping system component� shall be installed, adjus in the <lata used for testing anct verilJ-ing the operntion of the
ted, operated, and maintained in accordance with the manu g-as and vacuum piping systems.
facturer's instructions.
15.5.4.2 Dental Air.
15.4.9.3.2 Copies of the manufacture1·'s instructions shall be
prnvided to the facility anct maintained at the facility. 15.5.4.2.1 General.
15.4.9.4 Maintenance. 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
15.4.9.4.1 Gas and vacuum system equipment shall be main driven equipment. Dental comp1-esse<l ai1· shall not be usect fot·
tainect by a qualifiect person. respiration.
15.4.9.4.2 Eve1·y facility shall establish a prncedure for 15.5.4.2.1.2 Dental ai1· outlet� shall not be interchangeable
manually turning off the gas supply at the cylin<ler valves of wiili any othe1· gas outlet�, including oxygen. nio·ous oxide,
Category 2 ctental g-as and vacuum systems at the end of each medical air, inso·ument air, anct nitrogen.
<lay
15.5.4.2.2 Dental Air Compressor Units.
15.4.9.5 Periodic Testi ng.
15.5.4.2.2.1 Dental air compressor units shall include dental
15.4.9.5.1 Station outlets for oxygen and nio·ous oxide shall air comp1·essorn, vib1·ation isolation, ai1· 1·eceivers. coalescent ai1·
be tested fot· flow and pt·essure on an apprnvect sche<lule. filters, adsorption dryers, exhaust silencer/filte1·s, moisture
15.5 Category 3 Dental Gas and Vacuum Systems. indicators, and service access manifolds, electrical disconnects,
motor wiring, and controls.
15.5.1 General.
15.5.4.2.2.2 Air compressors shall be scroll dental, reciprocat
15.5.1.1 Category 3 dental ga� anct vacuum systems shall be ing <lental, or the oil-free <lental types.
limite<l to facilities that perform minimal or no sedation.
15.5.4.3 Dental Vacuum.
15.5.1.2 1l1e1·e shall be no medical gases.
15.5.4.3.1 General.
15.5.1.3 The <lental support gases shall be provictect from a
<lental ai1· source system. 15.5.4.3.1.1 Dental vacuum shall be used for oral evacuation
and nitrous oxide scavenging.
15.5.1.4 The vacuum system shall be dental vacuum.
15.5.4.3.1.2 Dental vacuum inlet� shall not be interchangeable
15.5.2 Category 3 Dental Air and Vacuum Piping Systems. wiili any other vacuum inlet�, including dental-surgical
vacuum.
15.5.2.1 General. Dental air and vacuum piping systems shall
include <lental support gases and ctental vacuum systems. 15.5.4.3.2 Dental Vacuum Units.
15.5.2.2 Vacuum Systems. Dental vacuum systems shall 15.5.4.3.2.1 Dental vacuum unit� shall include dental vacuum
inclucte dental vacuum and nitrnus oxide scavenging. pumps, vibration isolation, separntion tanks, vacuum inlet,
vacuum exhaust, condensate drnin, motor wiring, anct contt·ols.
15.5.3 Equipment Locations for Dental Air and Vacuum
Systems. 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·
15.5.3.1 General. Any of t he following systems shall be oil-lubricate<l and suitable for nitrous oxide scavenging.
permitted to be located together in the same room:
( l) Dental ai1· compressor sout·ces anct 1·eserve heade1·s 15.5.5 Piping for Category 3 Dental Gas and Vacuum Systems.
(2) Dental vacuum sou1·ces 15.5.5.1 General.
(3) Any other compressor, vacuum pump, or electrically
powered machinery 15.5.5.1.1 Piping for dental air systems shall comply with
15.5.5.2.
2021 Edition
15.5.5.1.2 Piping fot· dental vacuum systems and scavenging (3) ASTM B280, Standard SpPrifir.ation for Sfamless Copper 1iibe
systems shall comply with 15.5.5.3. for Air Conditioning and Refrigeration Field Sm,ire, ACR tube
(O.D. size)
15.5.5.2 Piping for Dental Air Sy.stems.
(B) Copper tube shall be ha1·d tempe1· 01· annealed (soft
15.5.5.2.1 General. Pipe, fittings, and joint� in ptpmg for temper).
dental compressed air systems shall be in acco1·dance with
15.5.5.2.2 thrnugh 15.5.5.2.4. 15.5.5.3.2.2 Cop per Fittings. Copper fittings shall comply
with the following:
15.5.5.2.2 Pipe. Pipe under 15.55 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
( 1)ASTM B88, Standard Sper.ifir.ation for Seamless Copper lVater (2) Brnzed fittings confrll"ming to ANSI/ASME Blfi.50,
Tube, Type L or K Wrought CoppfT and Coppfr Alloy Brau-joint Pressure Fittings
(2) ASTM B819, Standard Sper.ifir.ation for Smmle.�1 Copf"/Pr Tube (3) B1·azed fittings confo1·ming to ASME Bl6.22 with socket
for Ivlfdir.al Gas SystP11ts, Type L or K depths equal to 01· greate1· than braze:joint pr·esstffe
(3) ASTM B280, Standard Sper.ijir.ation for Smmless Copper Tube fittings conforming to ANSI/ASME Bl6.50
for 1tir Conditioning and &frigeration Field Senria, ACR tube (4) Flared fittings conforming to ASME Bl6.26, Cast Copper
(O.D. size) A.flrr;, Fittings for Rared Gipper Tubfs
15.5.5.2.2.1 Copper tube shall be hard tempe1· or annealed (5) Comp1·ession fittings (Yi in. maximum size)
(soft temper). 15.5.5.3.2.3 Joints for Copper Piping. Joint� in copper tubing
15.5.5.2.3 Fittings. Fittings for piping unde1· 15.5.5.2 shall be shall be in accordance with the following:
pe1·mitted to be any of the following acceptable joining meth (1) Joint� shall be brazed, soldered, threaded, flar·ed, or the
ods: compression type.
(1) Brazed or solde1·ed fittings conforming to ASME Blfi.22, (2) Where joints a1·e brazed, they shall comply with the
Wrought Copper and Copper Allo-,• Solder-Joint Pressure Fittings 1·equirement� of 15.4.6.
(2) Brazed fittings conforming to ANSI/ASME Blfi.50, (3) Soldered _joints shall be made in accordance with ASTM
Wrought Copper and Coppfr /illO)• Braze-Joint Pmsure fittings B828, Standard Pradia for A1aking Capillaryjoint1 by Soldn
(3) Brazed fittings conft')l"ming to ASME Bl6.22 with socket ing of Copper and Copper Alloy Tube and Fittings, using a
depths equal to or greater than braze:joint pressure "lead-free" solder fillet· metal containing not more than
fittings in compliance with ANSI/ASME B1650 0.2 percent lead by volume that complies with ASTM B32,
(4) Fla1·ed fittings conft')l"ming to ASME Blfi.26, Cast Copper Standard Sper.ijir.ation for SoldPr Metal.
A.lloy Fittings for flared Copper Tubes 15.5.5.3.3 PVC Plastic Piping. PVC plastic piping under
(5) Compression fittings (1/1 in. maximum size) 15.5.5.3 shall be in accordance with the following:
15.5.5.2.4 Joints. Joints for piping under 15.5.5.2 shall comply (1) PVC plastic pipe shall be Schedule 40 or Schedule 80,
with the following: conforming to ASTM Dl 785, Standard Spei:ijimtion for
(1) Joint� shall be brazed, soldered, threaded, flared, or the Poly(Vinyl Chloride) (PVC) Plastir. Pipe, S,-hedules 40, 80, and
compression type. 120.
(2) Vihere joint� are brazed, they shall comply with the (2) PVC plastic fittings shall be Schedule 40 or Schedule 80
n�qui1·ement� of 15.4.6. to match the pipe, confo1·ming to ASTM D2466, Standard
(3) Soldered joints shall be made in accordance with ASTM Sper.ijir.ation for Poly(Vinyl Chloride J (PVC) Pla stir Pipe
B828, Standard Pmr:tire for Maki ng Capillaryjoints by Solder J-zttings, Sdiedule 40, or ASTM D2467, Standard Specifir.atinn
ing of Copper and Copper A.Uoy Tube and Fittings, using a for Poly(Vinyl Chloride) (PFC) Pla1tir. Pipe J-zttings, Schedule
"lead-free" solder filler metal containing not more than 80.
0.2 percent lead by volume that complies with ASTM B32, (3) Joint� in PVC plastic piping shall be solvent-cemented in
Standard Sf"/Pr.ifir.ationfor Solder Metal. accordance with ASTM D2672, Standard Sper.ijir.ation for
Joints for JPS PVC Pipe U1ing Solvent Cnnent.
15.5.5.3 Piping for Dental Vacuum Systems and Scavenging
Sy.stems. 15.5.5.3.4 CPVC Plastic Piping. CPVC plastic piping under
15.5.5.3 shall be in accordance with the following:
15.5.5.3.1 General. Piping fot· dental vacuum systems and
scavenging systems shall be copper, PVC plastic, or CPVC plas (1) CPVC IPS pla�tic pipe shall be Schedule 40 or Schedule
tic. 80, conforming to ASTM F441/F441M, Standard Sper.ijira
tion for Chlorinated Poly(Vinyl Chloride) (CPVC) Plmtir. Pipe,
15.5.5.3.2 Copper Piping. Coppe1· piping under 15.5.5.3 shall S,:hedules 40 and 80.
be in accordance with 15.5.5.3.2.1 through 15.5.5.3.2.3. (2) CPVC IPS plastic fittings shall be Schedule 40 or Sched
ule 80 to match the pipe, conforming to ASTM F438,
15.5.5.3.2.1 Copper Tube. Standard Sper.ifir.ation for Sor.ket-1),pe ('Jilorinated Poly(Vinyl
(A) Copper tubing shall comply with the following: Chloride) (CPVC) Plastir Pipe Fittings, S,:hedule 40, or ASTM
F439, Standard Sper.ijir.ation for Chl,�rinated Poly(Vinyl Chlnr
(1) ASTM B8l 9, Standard Sper:ifir.ation for Semnle.�1 Copper Tul1e ide J ( CPVC) Plaslil.' Pipe Fittings, Srhedule 80.
for Medir.al Gas SystenL1, Type Lor K (3) CPVC CTS plastic pipe and fittings ½ in. through 2 in.
(2) ASTM B88, Standard Sperifiration for Seamless Copper Water size shall be SDR 11, conforming to ASTM D2846/
Tube, Type Lor K D2846M, Standard Spfrijir.ation for Chlorinated Poly(Vinyl
2021 Edition
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
15.5.6.7 Piping Within Floor Slabs Prohibited. Dental ga� and (2) Prim· to the installation of components of the distribution
vacuum piping shall not be installerl within floor slabs. piping system that woulrl be damaged by the test pressure
(e.g., p1·essure/vacuum alarm devices, pt·essure/vacuum
15.5. 7 Performance Criteria and Testing (Dental air and indicators, and line pressure relief valves)
Vacuum).
(C) TI1e source shutoff valve shall remain closed during the
15.5.7.1 Dental Air and Vacuum Systems Testing. pt·essure tests.
15.5.7.1.1 General. (D) TI1e test p1·esst11"e for dental air piping and copper
15.5.7.1.1.1 Inspection and testing shall he performerl on all vacuum piping shall be 1.5 times the system operating pressure
new piped rlental ga� anrl vacuum systems, additions, renova but not less than a gauge pt·essut·e of 10!)5 kPa (150 psi).
tions, temporary installations, or repai1·ed systems to ensure, by
(E) The test pt·essure shall be maintained until each joint has
a documented procedure, that the following have been
been examinerl for leakage by means of a leak detectant that is
completerl:
safe for use \\�th oxygen anrl rloes not contain ammonia.
( 1) All applicable provisions of this code have been adhererl
to.
(F) Any leaks shall be located, 1·epaired (if pe1·mitterl), or
replaced (if required) by the installer, and retested.
(2) Sys tem integrity has been achieved or maintained.
(!)) Piping systems are ready for testing and verification. 15.5.7.1.3.3 Initial Piping Purge Test.
(4) Piping systems are pel'forming in accordance with thei1·
design requirement�. (A) The outlets in each dental air p1p111g system shall be
pm·ged to 1·emove any particulate matter from the rlistribution
15.5. 7.1.1.2 The inspection anrl testing reports shall be piping.
submitted directly to the party that contracted for the testing,
who shall submit the report� through channels to the Responsi (B) Using appropriate adapters, each outlet shall be purged
ble Facility Authority and any others that a1·e 1·equired. with an inte1·mittent high-volume flow of test gas until the
put·ge prorluces no discoloration in a clean w hite cloth.
15.5. 7.1.1.3 Reports shall contain detailed listings of all find
ings anrl results. (C) The purging shall be started at the closest outlet to the
f
piping shutof valve anrl continue to the furthest outlet from
15.5.7.1.1.4 The Responsible F acility Authority shall review the shutoff valve.
the inspection and testing n�corrls prim· to the use of any
systems to ensure that all finrlings and results of the inspection 15.5.7.1.3.4 Standing Pressure Test for Dental A ir and Copper
and testing have been successfolly completed before use. Vacuum Piping.
15.5.7.1.1.5 All documentation pet'taining to inspections and (A) After successful completion of the initial pt·essut·e test� in
testing shall be maintainerl on-site within the facility. 155.7.1.3.2, the dental air systems anrl copper vacuum systems
shall be subject to a standing p1·essm·e test.
15.5.7.I.2 Required Testing.
(B) Test� shall be conducted afte1· the final installation of
15.5. 7.1.2.1 Categor y 3 Dental Air and Vacuum S�tems. station outlet valve bodies, faceplates, and other disu·ibution
system component� (e.g., pressure alarm rlevices, p1·essure indi
(A) A ll Category 3 dental gas and vacuum piping systems indi
cators, line p1·essu1·e relief valves, manufactured a�semblies, and
cated in 15.5.2 shall be initially tested in accm·dance \\�th
hoses).
15.5.7.1.3.
(B) The support gas systems and vacuum systems (i.e., dental
(C) The source valve shall be closed during this test.
ai1·, dental vacuum, anrl scavenging) shall be final tested in (D) TI1e piping systems shall he subjecterl to 24-hom standing
accordance with 15.5.7.1.3.4 and 15.5.7.1.3.5. pressure test� using oil-free, rlry nitrogen NF.
15.5.7.1.3 Initial Testing of Piping Systems. (E) Test pressures shall be 20 pe1·cent above the normal system
operating line pt·essure.
15.5.7.1.3.1 General.
(A) Whe1·e plastic vacuum anrl pla�tic scavenging p1pmg
(F) At the conclusion of the test�. there shall be no change in
the test presstlt'e except that attributerl to specific changes in
systems a1·e installed, they shall he visually inspected fot· cross
ambient temperature.
connections to oxygen and nitrous oxide systems before apply
ing positive test pressures to the copper piping systems. (G) Any leak.� shall be located, repairerl (if permitted), or
f
1·eplacerl (i 1·equired) by the installer, and retesterl. The piping
(B) Dut·ing the process of initial testing, the irlentification and
shall be repu1·gerl if necessary.
labeling of the dental ga� anrl vacuum piping shall be checked.
15.5. 7.1.3.2 Initial Pressure Test. 15.5.7.1.3.5 Standing Vacuum Test for Plastic Vacuum Piping.
(A) Each section of the piping in dental ai1· systems and

(A) Alter successful completion of the initial pressut·e tests in
15.5. 7.1.3.2, vacuum distribution piping, including scavenging,
copper vacuum systems shall be pressure tested. Plastic vacuum
shall be subjecterl to a standing vacuum test.
and pla�tic scavenging piping shall not be p1·essure tested.
(B) Initial pt·essut·e test� shall be conducted a� follows:

(B) Test� shall be conrlucted afte1· installation and connection
of all com ponenl� of the vacuum sy stem.
( l) After installation o f station outlet/inlet rough-in assem
blies (C) TI1e piping systems shall be subjecterl to a 24-hour stanrl
ing vacuum test.
2021 Edition
FEATURES OF FIRE PROTECTION 99-153
(D) Test pt·essme shall be between 300 mm (12 in.) HgV and 16.5 Utilities.
filll vacuum.
16.5.1 General. Utilities shall comply with the requirement5
(E) During the test, the sout·ce of test vacuum shall be discon of 16.5.1.1 through 16.5.1.4.
nected from the piping system.
16.5.1.1 Gas. Equipment using gas and relaterl gas piping
(F) At the conclusion of the test, there shall be no change in shall be in acc01·dance with NFPA 54 or NFPA 58 unless such
the vacuum pressu1·e other than that attributed to changes of installations are apprnverl existing installations, which shall be
ambient tempernture. pe1·mitted to be continued in service. f J0J:9.1.1 l
(G) Any leaks shall be located, repaired (if permitted), or 16.5.1.2 FJectrical Systems. Electrical wi1-ing and equipment
f
1·eplacerl (i requi1·ed) by the installe1·, anrl 1·etested. shall be in accordance with NI-PA 70 unless such installations
are apprnverl existing installations, which shall be permitted to
15. 5.8 Operation and Management.
be continued in service. l"J0J:9.1.21
15.5.8.1 System Shutdowns. Gas and ,-acuum piping systems 16.5.1.3 Emergency Generators and Standby Power Systems.
shall be shut rlown at the end of each workday. Emergency generntors and standby powe1· systems, where
15.5.8.2 Manufacturer's Instructions. requirerl for compliance with this code, shall be installed,
tested, and maintained in accorrlance with NFPA 110 unless
15.5.8.2.1 P iping system component� shall be installed, adjus mortified by this corle.
terl, operated, and maintained in acc01·dance with the manu
facturer's instructions. 16.5.1.4 Stored FJectrical Energy Systems. Storerl electrical
energy systems shall be installed, tested, and maintainerl 111
15.5.8.2.2 Copies of the manufacture1·'s instructions shall be accorrlance with NFPA 111. f JOJ:9.1.41
prnvided to the facility anrl maintained at the facility.
16.5.2 Heating, Ventilating, and Air-Conditioning. f JOJ:9.21
15.5.8.3 Maintenance. Dental air anrl vacuum system equip
ment shall be maintained by a qualified 1·ep1·esentative of the 16.5.2.1" Heating, Ventilating, and Air Conditioning. Ai1·
equipment manufactu1·el". 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
Chapter 16 Features of Fire Protection pe1·mitted to be continued in se1·vice.
16. 1 Applicability. 16.5.2.2 Ventilating or Heat-Producing Equipment. Ventilat

ing 01· heat-prorlucing equipment shall be in accorrlance with
16.1.1 l11is chapter shall apply to all new and existing health NFPA 91, NFPA 211, NFPA 31, NFPA 54, or NFPA. 70 a� applica
care facilities. ble, unless such installations are approved existing installations,
16.1.2 i\n existing system that is not in stt·ict compliance with which shall be permitterl to be continued in service. f J0J:9.2.21
the prnvisions of this corle shall be pe1·mitted to be continued 16.5.2.3 Commercial Cooking Operations. Commercial cook
in use, unless the authority havingjurisdiction has determined ing operations shall he prntecterl in accorrlance with NFPA 96
that such use constitutes a distinct haza rd to life. unless such installations are approved existing installations,
16.2 Construction and Compartmentation. Buildings or struc which shall be pe1·mitterl to be continued in sen,ice. f J0J:9.2.31
tures housing a health care facility shall meet the minimum 16.5.2.4 Ventilating Systems in Laboratories Using Chemicals.
construction anrl compartmentation requirements of the appli Ventilating systems in laboratories using chemicals shall be in
cable corle. accordance with NFPA 45. f J0J:9.2.4 l
16.3 Special Hazard Protection for Flammable liquids and 16.5.3 FJevators, Escalators, and Conveyors. f JOJ:9.41
Gases.
16.5.3.l Code Compliance. f J0J:9.4.21
16.3.1 Where requirerl by the prnvisions of Chaptei-s 11
thrnugh 43 of NFPA 101, occupancies with storage, use, anrl 16.5.3.1.1 Except as modifierl herein, new elevators, escala
handling of hazardous materials shall comply with the follow t01·s, dumhwaitei-s, and moving walks shall be in acc01·dance
ing codes unless otherwise modified by other prnvisions ofthis with the requirement� of ASME Al7.l/CSA B44, Safety CodP for
CudP. NFPA 30, NFPA 54, NFPA 55, NFPA 58, NFPA 400, anrl fifvatars and E1mlators. f J0J:9.4.2.1 l
NFPA 495. f J0J:8.i.3.1 l
16.5.3.1.2 Except as modifierl herein, existing elevators, esca
16.3.2* No storage, use, 01· hanrlling of hazarrlous materials lators, dumbwaiters, and moving walk.� shall be in accordance
shall he permitted in any location whe1·e such storage, use, or with the requirement� of ASME A l7. 3, SafPty CodP for Exi1ting
handling would jeopardize egress from the structure, unless ElPvatar.1 mid E1mlators. f J0J:9.4.2.21
othenvise pe1·mitted by a document listed in 16.3.1.
16.5.3.2 Fire Fighters' Emergency Operations. f J0J:9.4.31
f JOJ:8.7.3.21
16.5.3.2.1 All new el evatm·s shall conform to the fit-e fighte1·s'
16.4 Laboratories. Laboratories that use chemicals shall
emergency operations requirements ofASME A l7. l/CSA B44,
comply with NFPA 45 unless othenvise modified by other prnvi
Sapty Codt for Elfvatars and Esralaturs. f J0J:9.4.3.1l
sions of this corle. f 101:8. 7.4. ll
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
rescue purposes shall conform to the fit-e fighters' eme1-gency 16.7.2.2 Manual fire alarn1 boxes shall be usen only fot· fit·e
operations requirement5 of ASME A l 7.3, Safety Code for Existing protective signaling purposes.
r
Ell'vators andE�ra!.ntors. J0J:9.4.3.21
16.7.2.2.1 Combination fit·e ala1·m ann guarn's tour stations
16.5.3.3* Elevator Machine Rooms. Elevator machine rooms shall be acceptable.
that contain solin-state equipment for elevators, other than
existing elevators, having a travel distance exceeding 50 fi. 16.7.2.3 A manual fire alarm box shall be prminen in the
(15 m) above the level of exit discharge or exceeding 30 h: natural exit access path near each requiren exit from an area,
(9 150 mm) below the level of exit nischarge shall be provided unless modifien by anothe1· section of this code.
with independent ventilation or air-connitioning systems to 16.7.2.4* Adnitional manual fire ala.rm boxes shall he located
maintain temperature during fire fighters' eme1-gency opera so that, on any given floor in any part of the building, no hm·i
tions for elevator operation (see 9.4.3 af Nf<PA. 101). The operat zontal nistance on that floor exceeding 60 m (200 ft) shall
ing temperature shall be established by the elevator equipment neen to be traversed to reach a manual fire alarm box.
manufacturer's specifications. \'\'hen stannhy powe1· is connec
ted to the elevator, the machine 1·oom ventilation or air
r101:9.6.2.s 1
r
conditioning shall be connected to standby powec J0J:9.4.51 16.7.2.5 For fit·e alarm systems using automatic fit·e detection
or waterflow detection devices, not less than one manual fire
16.5.3.4 Elevator Testing. Elevators shall be subject to peri alarm box shall he prnvinen to initiate a fit·e ala1·m signal.
onic inspections ann tesl� as specified in ASME Al 7.1, Sajfty
Code for 1'.'levatars and Ew:alators. All elevators equippen with fire 16.7.2.5.1 The manual fire alarm box shall be located where
fighters' emergency operations in accordance with 9.4.3 of requiren by the authority having jurisdiction.
NFPA IOI shall be subject to a monthly operation with a written 16.7.2.6 Manual fit·e alarm boxes shall he accessible, rnmb
record of the finnings mane and kept on the premises a�
r
requiren by ASME Al 7.1. 101 :9.4.61
r
structed, and \isible. J0J:9.6.2.Ti
16.7.2.7 Where a sprinkle1· system provides automatic detec
16.6 Waste Chutes, Incinerators, and Linen Chutes. Waste tion and alarm system initiation, it shall be provided with an
chutes, linen chutes, and incineratm·s shall be installen ann approven ala1·m initiation ne\ice that operates when the flow of
maintained in accordance with NFPA 82 unless such installa water is equal to or greater than that from a single automatic
tions are approven existing installations, which shall be pe1·mit sprinkle1·.
ted to be continued in service.
16.7.3 Smoke Alarms.
16.6.1 Any wa.5te chute or linen chute, including pneumatic
rubbish and linen systems, shall be prnvided with automatic 16.7.3.1 Whe1·e requi1-en by the applicable code, single-station
extinguishing protection in acconlance with Section 9.7 of and multiple-station smoke alarms shall be in accordance with
NFPA 101. [J0J:19.5.4.31 NFPA. 72.
16. 7 Fire Detection, Alarm, and Communications Systems. 16.7.3.2 System smoke detectors in accot·dance with NFP.1 72
r J0J:9.6 ann arrangen to function in the same manner as single-11tation
or multiple-station smoke alarms shall be permitted in lieu of
16.7.1* General. [J0J:9.6.ll r
smoke alarms. J0J:9.6.2.10.71
16. 7.1.1 Buildings or structut·es housing a health care facility 16.7.3.3 The ala1·ms shall sounn only within an individual
shall meet the fire detection, ala1-m, ann communications nwelling unit, suite of rooms, or simila1· area and shall not
systems requirements of the applicable code. actuate the building fire alarm system, unless otherwise permit
16.7.1.2 A fire alarm system required for life safety shall be ten by the authority having jurisdiction. Remote annunciation
installen, tested, and maintainen in accordance with the appli shall be permitted.
cable requi1-emenl� of NI-PA. 70 ann NFPA 72. 16.7.4 Occupant Notification. r 101:9.6.31
16.7.1.3 An approved existing installation shall be permitted 16.7.4.1 Whe1·e 1·equiren by the applicable code, occupant
to be continuen in use, prnvinen it is tested and maintained in notification shall he provided to alert occupant� of a fit·e or
accordance with the requirements of NFPA 72. other emergency.
16. 7.1.4 For the purposes of this code, a complete fire alarm 16.7.4.2 Occupant notification shall be in accornance \\':ith
system shall pt·mine functions for initiation, notification, ann 16. 7.4.3 unless otherwise provided in 16.7.4.2. l ann 16. 7.4.2.2.
control, and shall peti'orm as follows: r J0J:9.6.3.21
(l ) The initiation function provides the input signal to the
system. 16.7.4.2.1 * Elevator lobby, hoistway, and associated machine
The notification function anvises that human action is room smoke detectors usen solely for elevatm· recall, ann heat
(2)
1·equi1·en in response to a pat'ticular condition. detectrn·s used solely for elevatm- power shutdown, shall not be
(3) The control function prmides outputs to control huil<ling required to activate the building evacuation alarm if the power
equipment to enhance prntection oflife. supply ann installation wi1·ing to such detectors are monitot·ed
by the building fire ala1·m system, ann if the activation of such
16. 7.2 Signal Initiation. detectrn·s initiates a supervisory signal at a constantly attended
16. 7.2.1 Buildings or structures housing a health care facility
r
location. J0J:9.6.3.2. l I
shall meet the minimum signaling and alarm initiation require 16.7.4.2.2* Smoke detectors used solely for closing dampers
ment5 of the applicable cone. or HVAC system shutnown shall not be 1·equiren to activate the
builning evacuation alarm, provided that the power supply and
2021 Edition
FEATURES OF FIRE PROTECTION 99-155
installation wiring to the detectors are monitorerl by the build the closet does not exceed 6 ft� (0.55 m�) provided the distance
ing fire alarm system, and the activation of the rletectors from the sprinkler in the patient sleeping room to the back
initiates a supervisory signal at a constantly attended location. wall of the closet does not exceed the maximum distance
r101:9.6.3.2.21 r
permitted by NFPA 13. 101:18.3.5. l Ol
16.7.4.3 Defend in Place. For new and existing facilities, 16.10 Manual Extinguishing Equipment.
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 16.10.1 * Portable fire extinguishers shall be selected, in
ance with the facility fire plan. stalled, inspecterl, and maintainer! in accordance with
NFPA 10.
16.7.4.3.1* ''\'here builrlings are requirer! to be subrlivided
into smoke compartment�, fil·e alarm notification zones shall 16.10.1.1 Fi1·e extinguishe1·s shall be provider! in MRI rooms
coincide with one or more smoke compartment boundaries or and a5sociated spaces.
shall be in accordance with the facility fire plan. 16.10.1.1.1 * Fire extinguishers and associated hardware rated
16. 7.4.3.2* The private operating mode, as defined in a� MR conditional or MR safe shall be provided in MRI rooms
NFPA 72, shall be permitted to be used for the placement of and a5sociated spaces.
notification appliances within the health care and ambulatory 16.10.1.2 Class K fa-e extinguishe1·s shall be provided ftx
health ca1-e occupancies of the building. hazards where the1·e is a potential fo1· fil·es invoh,ing combusti
16. 7.4.3.3 TI1e notification signal shall readily identify the ble cooking media (vegetable or animal oils and fat5).
smoke zone or the floor area, floor, and building in need of II 0:6.6.1 l
staff 1·esponse. 16.10.1.3* Class K fire extinguishers shall not be 1·equired
16. 7.4.3.4 The notification signal shall be heard in all loca where residential cooking equipment is user! for foorl \\"drming
tions in accorrlance with the facility fire plan. or limiter! cooking, or where an occupancy prohibit5 deep fat
f1ying.
16. 7.4.3.5* In patient care spaces where ala1·m notification
adversely a ffect� patient care, as determiner! by a risk a5sess 16.10.1.4* Clean agent- or water mist-type fire extinguishers
ment, al.arm notification appliances shall not be 1·equirerl a5 shall be provided in operating rooms.
long as an alternative means of alarm notification is provirlerl. 16.10.1.5 Clean agent-type fa-e extinguishers shall be provi
16. 7.4.3.6 Visible signals shall not be required inside surgical rled in telecommunication entrance facilities and telecommu
operating rooms, patient sleeping rooms, or psychiatric care nication equipment rooms.
areas where their operation would intedere with patient n·eat 16.10.2 ,vhere prmirled, standpipe and hose systems shall be
ment. in accordance with NFPA 14.
16. 7.4.3. 7 Visible signals shall not be required inside exam 16.10.2.1 ,vhere standpipe and hose systems are installed in
1-ooms, special procedure 1·ooms, rh-essing rooms, and nonpub combination with automatic sp1·inkler systems, installation shall
lic toilet rooms where staff is 1·equi1·ed to respond to those areas be in accordance with the appropriate provisions establisher! by
in accordance with the facility fire plan. NFPA 13 and NFPA 14.
16.8* Heliports. 16.10.2.2* Hose 01· hose outlet� shall be pe1·mitterl to be
16.8.1 New heliport5 shall be rlesignerl and consu·ucted in removed from existing stanrlpipe and hose systems that are not
accordance with the requi1·ements ofNFPA 418. requi1·erl by the applicable code.
16.8.2 Heliport5 shall be maintained in acc01·dance with 16.11 * Compact Storage. Compact storage shall be protecterl
NFPA 418. by sprinklers in accorrlance with NFPA 13.
16.9 Automatic Sprinklers and Other Extinguishing Equip 16.12 Compact Mobile Stora ge.
ment. 16.12.1 Rooms with compact mobile storage units greate1·
16.9. I Automatic Sprinklers. than 50 ft� ( 4.65 m2) shall be protected a� a hazarrlous area in
accordance with the applicable code.
16.9.1.1 Buildings 01· structures housing a health ca1·e facility
shall meet the automatic sprinkler system requirements of the 16.12.2 Smoke detection shall be installer! above compact
applicable code. mobile storage units g1·eater than 50 ft2 (4.65 m2 ) in acc01·d
ance with l11rPA. 72.
16.9.1.2 ,vhere provided, automatic sp1·inkle1· systems shall be
installer! in accordance with NFPA 13. 16.12.3* Compact mobile storage units greater than 50 ft�
(465 m�) shall be protected by automatic sprinklers in accord
16.9.1.3* Defend in Place. Fm new and existing facilities,
ance with NFPA 13.
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 16.13 Maintenance and Testing.
building, sprinkler system zones shall coincirle with smoke
compartment bounrlaries or shall be in acc01·dance with the 16.13.1 All wate1·-baserl fiI·e protection systems shall be inspec
faci Iity fire plan. terl. tester!, anrl maintained in acc01·rlance with NFPA 25.
16.9.1.4* Closets. Sprinklers shall not be required in clothes 16.13.2 All non-wate1�baserl fire protection systems shall be
closets of patient sleeping rooms in hospitals whe1-e the area of inspected, tested, anrl maintained in acc01·dance with the appli
cable NFPA standards.
2021 Edition
16.14 Fire Loss Prevention in Operating Rooms. of flammable liquid 01· aerosol ge1·micides or atHiseptics use<l in
anesthetizing locations, as requirer! in 16.14.3.9, whenever the
16.14.1 Haz.ardAssessment. use of electrosu1·gery, caute1y, 01· a laser is contemplated.
16.14.1.1 An evaluation shall be made of haza1·ds that could 16.14.3.9 Emergency Procedures.
be encountered during surgical procedures.
16.14.3.9.1 Procechrres for operating room/surgical suite
16.14.1.2 The evaluation shall include hazards associate<l with eme1·gencies shall be developed.
the propenies of electt·icity, hazar<ls associated with the opera
tion of surgical equipment, and hazards associate<l with the 16.14.3.9.2 Procedures shall include alat rn actuation, evacua
natu1-e of the environment. tion, at1<l equipment shutdown procedures and provisions for
f control of emergencies that could occur in the operating
16.14.1.3 Periodic 1-eviews o surgical operntions an<l proce room, including specific detailed plans for control operations
dures shall be conducte<l with special attention given to any by an emergency control group within the organization or a
change in mate1-ials, ope1·ations, or personnel. public fire department.
16.14.2 Fire Prevention Procedures. Fi1·e p1·evention proce 16.14.3.9.3 Emergency procedures shall be established for
dures shall be established. controlling chemical spills.
16.14.3 Germicides and Antiseptics. 16.14.3.9.4 Emergency procedures shall be estahlishe<l for
16.14.3.I Me<licament� an<l alcohol-based han<l satuttzers, extinguishing <lrapery, clothing, or equipment fit·es.
inclu<ling those <lisperse<l as aerosols. shall be permitted to be 16.14.3.10 Orientation and Training.
use<l in anesthetizing locations.
16.14.3.10.1 New operating room/surgical suite pernonnel,
16.14.3.2* Flammable liquid germici<les or antiseptics used in including physicians and surgeons, shall be taught general
anesthetizing locations, whenever the use of electrosurgery, safety practices for the a1·ea an<l specific safety practices for the
caute1y, or a laser is contemplate<l, shall be packaged to ensure equipment and procedures they will use.
controller! delivery to the patient in unit dose applicators,
swabs, and other similar applicators. 16.14.3.10.2 Continuing safetv education and supenision
f shall be provided, incident� shall be reviewed monthly, at1d
16.14.3.3 ,vheneve1· the application o flammable liquid procedtu-es shall be re,iewed annuallv.
germici<les 01· antiseptics is employed in sut·geries where the
use of electrosurgery, cautery, or a laser is contemplated, time 16.14.3.10.3 Fire exit <lrills shall be conducted annually or
shall be allowed to elapse between application of the germicide mm·e frequently as determined by the applicable code.
or antiseptic an<l the following:
( 1) Application of drapes, to allow complete evaporation an<l Annex A Explanatory Material
dissipation of any flammable vehicle remaining
Use of electrosurgery, cautery, 01· a lase1-, to ensure the A.nnex A is not a part of thP rPq11iremPnts o f this NFPA donmtfnt but is
(2)
solution is completely dry and to allow thorough evapora inrluded for injrmnational purposes only. This annex r:ontains explan
tion an<l dissipation of any flammable vehicle remaining atory 111atMial, nm1tbPrrd to rorrespond with t!u applimblr text para
graphs.
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 A.I.I.IO Because no single model of an emergency manage
remove<l from the patient care vicinity. ment plan is fea�ible for every health care facility. this chapter
is inten<led to provide criteria for the preparation and imple
16.14.3.5 Pooling of flammable liquid germicides or antisep mentation of an in<livi<lual plan. The principles involved are
f
tics shall he avoi<le<l; i pooling occu1·s, excess solution shall he universally applicable; the implementation nee<ls to be tail01·ed
wicked, and the germicide or antiseptic shall be allowed to to the specific facility.
completely dry
A.1.1.12 Hype1·baric chambe1·s are foun<l in a variety of
16.14.3.6 A preoperative "time out" period shall be conducted settings, including but not limited to hospitals, doctor's oflices,
prior to the initiation of at1y surgical proce<lure using flamma private clinics, and business occupancies. Not all hyperharic
ble liquid ge1·micide 01· antiseptic solutions to ve1·ify the follow facilities are <lesigned 01· equippe<l the same. HypedJaric tt·eat
ing: ment an<l facilities are used for a va1-iety of eme1·gent and non
Application site of solution is d1y prior to <lraping an<l eme1·gent conditions, and the acuity of patients ranges from
( 1) f
use of electrosurge1y, cautery, or a lase1·. stable to critical. These variations lead to dif erences in hyper
Pooling of solution has not occurred or has been cotTec ba1·ic equipment, at1cillary support equipment, and facility
(2)
ted. location. This chapter is inten<le<l to prmide minimum safe
f
Any solution-soaked materials have been remove<l from guards for hyperbat-ic patients an<l personnel regardless o the
(3)
the patient ca1-e vicinity. location of the facility.
f
16.14.3.7 Whenever flammable aerosols 01· atltiseptics are A.1.3.1.3 This subsection clarifies that i a prmision of this
employed, sufficient time shall be allowe<l to elapse between co<le becomes applicable due to the installation or use of a
deposition and application of <lrapes to allow complete evapo system, equipment, or a�semhly 1·egulated he1·ein, the facility
ration an<l dissipation of any flammable vehicle 1·emaining. does not automatically become subject to the code in it�
enti1·ety.
16.14.3.8 Health cat·e organizations shall establish policies
and procedut-es outlining safety p1·ecautions related to the use A.1.5 Although it is common practice for medical appliances
to use metric unit� on their dials, gauges, at1<l controls, many
2021 Edition
ANNEX A 99-157
component� of systems within the scope of this document a1·e A.3.3.10 Applicator. In the given sense, an applicat01· is not an
manufactured and used in the United States anrl employ electrode, because it rloes not use a conductive connection to
nonmett·ic dimensions. Since these rlimensions (such a� nomi the patient in order to function. A radio frequency "horn .. of a
nal pipe sizes) are not establisherl by the National Fire Protec rliathermy machine is a typical applicator.
tion Association, the Technical Correlating Committee on
Health Care Facilities cannot independently change them. A.3.3.12 Atmosphere. i\s employerl in this code, the term
Accordingly, this document uses rlimensions that are presently atmnsphPrP can refer to the environment within or outside of a
in common use by the builrling trades in the Uniterl States. hypet·baric facility. iVhen used as a mea�u1·e of pressure, atmos
Trade uniL� vary from SI to lJ .S. customary uniL�. depending on phere is expressed as a fraction of standard air pressure
the equipment devices 01· mate1·ial. [101.4 kPa (14.7 psi)l. (SPP thP first rnlwnn nf Tab!,, D.l in
NJ-PA 99B.)
A.2.1 The documenL� 1·efe1·encerl in this chapte1· 01· ponions
of such document� are referenced within this corle and are A.3.3.12.2 Ahnosphere of Increased Burning Rate. The
consirle1·ed part of the 1·equirement� of this rlocument. degree of fire hazard of an m..ygen-enricherl atmosphere varies
with the concentration of oxygen and diluent gas anrl the total
Documents 1·eferenced in this chapter or portions of such pressure. The definition contained in the cutTent edition of
documenL� are only applicable to the extent called for within NFPA 53 anrl in editions of NFPA 56D prior to 1982 did not
otl1er chapte1·s of this code. necessa1·ily 1·eflect the increased fire haza1·rl of hyperba1·ic and
hypobaric atmosphe1·es.
VVhere the 1·equirements of a 1·eferenced corle or standard
f
rliffer from the requiremenL� o this code, the requiremenL� of The definition of atmnspherP nf inrrMsPd burning ratP used in
this code goven1. 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
A.3.2.1 Approved. l11e National Fi1·e Protection A.ssociation increaserl burning rate of material in the atmosphere. It is
rloes not approve, inspect, or certify any installations, proce based on a 1.2 cm/sec (0.47 in./sec) burning rate (at
rlures, equipment, or materials; not· does it approve 01· evaluate 2,\.5 percent oxygen at l atmosphe1·e absolute) as desct"ibed in
testing laboratories. In dete1·mining the acceptability of installa Figure A.3.3.12.2.
tions, procedures, equipment, or materials, the authority
having jurisdiction may base acceptance on compliance with This rate can be determined as follows:
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 [A.3.3.12.2]
may also 1·efer to the listings or labeling pt·actices of an oq�ani 23.45
zation that is concen1ed with product evaluations anrl is thus in
.JTP,""'"'
a position to dete1·mine compliance with appropi·iate standarrls
for the current production of listerl items. where:
A.3.2.2 Authority Havin g Jurisdiction (AHJ). The phrase TP"'"'"' = total pressure in atmospheres
"authority having jurisdiction," or its acronym AHJ, is used in
A.3.3.19.3 Bulk Oxygen Sy..tem. The oxygen containers can
NFPA document� in a broad manner, since jurisdictions and
be stationary or movable, and the oi..ygen can be stored a� gas
approval agencies vary, as do their 1·esponsibilities. Whe1·e
or liquid. The bulk oxygen system terminates at the point
public safety is primary, the authmity ha\ing jurisdiction may
whe1·e oxygen at senice pt·essm·e first ente1·s the supply line.
be a federal. state, local, or other regional department or indi
virlual such as a fire chief; fire marshal; chief of a fire preven A.3.3.21 Central Supply System. Central supply systems
tion btu-eau, labor department, 01· health rlepartment; building comprise the equipment necessarv to produce, condition,
official; electrical inspector; or others having statutot-y author crn1tt·ol, anrl monito1· the gases or vacuum. They include all
ity. For insurance purposes, an insurance inspection depart equipment from the atmospheric intake on air compressors,
ment, rating bureau, or other insm·ance company exhaust on vdcuum pumps, and cylinders or containers for
1·ep1·esentative may be the auth01·ity having jtu-isrliction. In pressurized gases through to the source valve (SPP 5.1.4.2).
many circumstances, the property owner 01· his or her designa Examples of central supply systems include air comp1·ess01·
ted agent assumes the role of the authority having jurisdiction; sources, vacuum pump sources, cylinrler anrl container heade1·s
at government installations, the commanding ollice1· 01· depart and manifolds, liquid bulk gas systems proportioning systems
mental official may be the authority havingju1·isrliction. anrl combinations the1·eof.
A.3.2.3 Code. The decision to designate a stanrlard as a A.3.3.23 Clin ical IT Network. A clinical IT netwmk comprises
"code" is baserl on such factors as the size and scope of the the servers, switches, routers, and voice and data communica
document, it� intended use and form of adoption, anrl whether tions equipment that are employed to transport patient patient
it contains substantial enforcement and administrative provi critical clinical data, information, anrl staff communications
sions. over a shared interoperable IT network infrastructu1·e.
A.3.2.6 Listed. The means fot· identifying listed equipment A.3.3.25 Combustible liqu id. See NFPA 30 fm further infm
may vat-y for each organization concernerl with prorluct evalua mation on flash point test prncerlu1·es.
tion; some organizations do not 1·ecognize equipment a� listed
unless it is also labeled. The authority having _ju1·isdiction A.3.3.26 Combustion. Combustion is not limited to a chemi
should utilize the system employed by the listing organization cal 1·eaction al ways involving oxygen. Certain metals, such as
to identify a listed product. calcium anrl aluminum, will burn in nitrogen; nitrous oxirle
will support the combustion of phosphorus anrl carbon; and so
2021 Edition
on. Howevec this document deals with the more common numbe1· of casualties resulting from a disaste1· that produces no
process of fuels burning in air. damage or injury to the health care facility and staff, or a
combi nation the1·eof.
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 Such a situation Cl'eates the neerl fot· emergency expansion
Cosmetic Act, 21 USC 32l(g)(l). This inclurles gases recog of facilities, as well as operation of this expanded facility in an
nizerl in the current UnitPrf StatPs Phannar:opfia and Natinnal unfamiliar environment. Unde1· this definition, the recognition
f
Fornmlary (USP-NJ,) or supplement� and gases intended fot· o a disa�te1· situation will vary greatly from one facility to
direct use or a� a component of gases in the rliagnosis, cure, another and from time to time in any given facility. Such recog
mitigation, treatment, or prevention of diseases in man or in nition and concomitant activation of the Health Care Emer
animals that achieves it� intended purpose through chemical gency Preparerlness Plan is dependent on mutual aid
rather than phys ical means. [55, 20201 (PIP) agreements, facility type, geographic location, bed capacity.
bed occupancy at a given time. staff size, staff experience with
A.3.3.35 Defend in Place. The concept of the term dPjfnd in rlisaste1· situations, and other factors. F01· example. the routine
plaa includes. but is not limited to, element� related to moving workloarl of the emergency department of a la1·ge metropolitan
building occupant� from an area of immerliate rlange1· to a safe general hospital would constitute a rlisaster, requiring activa
location in the building and containment of the emergency or tion of the Health Care Emergency Preparedness Plan, were
dangerous condition. this same workload to be suddenly applied to a small commun
A.3.3.41 Direct Electrical Pathway to the Heart. Electrodes, ity hospital.
such as those userl for pacing the heart, anrl catheters filled Disa�ters have a variety of causes, all of which should he
with conrluctive fluids, a1·e examples of direct electrical path considered for effective emergency prepa1·edness planning.
ways to the heart. Among the most common are natural disaste1·s such as earth
A.3.3.42 Disaster. A disaster can be either an event that quakes, hurricanes, tornadoes, and floods; ma�s food poison
causes, or th1·eatens to cause, physical damage and i1tjury to ing; industrial accident� invohing explosion 01· environmental
facility pe1·s01rnel or patient� within the facility, or an event that release of toxic chemicals; transportation accident� involving
requires expansion of facilities to receive and care fot· a large 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
4.5 pied structures; and toxic smogs in u1·ban areas. Arson attempt�
99.6% 02 and bomb threat� have been made on health care facilities and
should, therefore, be considei·ed. Potential admission to the
4.0 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
3.5 30.9%
normal routine will be sufficient to quality it as a disasterlike
situation.
24.9%
3.0 Disa�ter plans should reflect a facility's location from poten
��----, 21.0%
18.0% tial internal and external disasters. As an example, area� subject
to frequent wildland fit·es should invoke countermea�ures for
E 2.5
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 99-159
A.3.3.62 Flash Point. Note that the fla�h point temperattu·e is to fou1· or more pe1-sons should not be classifie<l as home care
heavily dependent on the test use<l to <letermine it. 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
A.3.3.64 Flowmeter. A pressure compensate<l flowmeter pancy or an apanment buil<ling with an oxvgen storage room.
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 A.3.3.81 Hyp erbaric Operations. Such procedures include
nonambient p1·essure. but a1·e not limited to (a) therapy inside a hype1·baric chamber,
(b) changing clothes, (c) vital signs assessments, (d) noninva
A.3.3.65 Frequency. Formerly, the unit of frequency wa� cycles sive transcutaneous oxygen monitoring, (e) clinical and me<li
per second, a terminology no longer preferred. The waveform cal assessment�, a.t1d (f) minor dressing changes. Debridement
can consist of component� having many different frequencies, or othe1· surgical proce<lm·es. application of casting material,
in which case it is calle<l a complex or nonsinusoi<lal waveform. application of skin substitutes, an<l application of bioengi
A.3.3.66 Fume Hood. I.aborato1y fume hoods prevent toxic, neered graft� are not recommended in the chamber room.
flammable, 01· noxious vapors from entering the laborat01y: (HYP)
p1·esent a phrical barrie1· from chemical reactions; an<l sei-ve to A.3.3.86 Impedance. The circuit element can consist of any
contain accidental spills. combination of resistance, capacitance, or inductance.
This <lefinition does not inclu<le canopy hoods 01· reci1·nlla A.3.3.88 Instrument Air. Instrument ai1· is intended fo1· the
tion laminar-flow biological-safety cabinets that are not powering of medical devices um·elate<l to human 1·espiration
designe<l for use with flammable materials. (e.g., to remove excess moisture from instrument� before
A.3.3.68 General A nesthesia and Levels o f Sedation/Analgesia. further processing, 01· to operate me<lical-surgical tools, au-.
It should be noted that these are not static conditions. Minimal driven booms. penda.t1t�. or similar applications).
sedation can easily become moderate sedation, and mo<lerate A.3.3.90 Intrinsically Safe. "Abnormal conditions" ca.t1
sedation can progress to deep sedation 01· genera£ anesthesia. include accidental damage to any pan of the equipment 01·
A.3.3.69 Ground-Fault Circuit Interrupter (GFCI). Class A wiring, <lamage to insulation or other failm·e of electt·ical
ground-fault circuit interrupters trip when the current to component�, application of overvoltage, adjustment a.t1<l main
ground is G mA or higher and do not trip when the current to tenance operations, an<l other similar conditions.
groun<l is less than 4 rrn\. Fo1· further information, see UL 943, A.3.3.93 Isolated Power System. See NJ.PA 70.
Ground-Fault Circ-uit-JntPrruptPrs. f70, 20201
A.3.3.95 Laboratory. l11ese laboratories are not intended to
A.3.3.71 Grounding System. It coordinates with, but can be include isolate<l frozen section laboratm·ies; a1·eas in which
locally more e xtensive than, the groun<ling system described in oxygen is administe1·ed; blood <lon01· rooms in which flamma
Article 250 of 1VFPA. 70. ble, combustible, 01· other wise hazardous materials normally
A.3.3. 73 Health Care Facilities. Health care facilities include, used in laboratory procedures a.t·e not present; a.tHl clinical
but are not limite<l to, hospitals, nm·sing homes, limited ca1·e service a.t·ea� not using hazardous materials.
facilities, clinics, medical and dental oflices, and ambulatory A.3.3.98 Limited-Combustible (Material). Material subject to
health care centers. whether permanent or movable. This defi increase in combustibility or flame spread index beyon<l the
nition applies to normal, 1·egular operations and does not limits he1·ein established through the effect� of age. moisture,
pertain to facilities dm·ing decla1·ed local or national disaste1·s. or other atmospheric condition is conside1·ed combustible.
A health care facility is not a type of occupancy classification a�
defined by NFPA IOI. Therefore, the term hmlth am farility See NFPA 259 and NFPA 220.
should not be confused with the te1·m health rarP oi:tupanry. A.JI
health care occupancies (an<l ambulatory health ca.re occupan A.3.3.100 Liquid. ,\'hen not othe1·wise identified, the term
cies) are considered health care facilities; however, not all liquid includes both flammable and combustible liquids. (.'ifP
health ca1·e facilities are considered health ca1·e occupancies, as al�o B.11.1.1.)
health care facilities also include ambulatory health ca1·e occu A.3.3.101 Local Signal. Examples woul<l inclu<le a gauge, a
pancies and business occupancies. flag, a light, or some other possible ma.t1ifestation that allows a
A.3.3. 74 Health Care Facility's Governing Body. This defini maintenance person to stand at the equipment and know what
tion exclu<les political governmental agencies, such as auth01·i conditions a.t·e p1·esent (e.g., which hea<ler of cylin<le1·s is in
ties having jurisdiction, that exercise local, regional, or national service). The element.� to be displayed are typically those that
legal jurisdiction over the design, construction, inspection, and will also be monitored at the ma.�ter alarm, but the local signal
operation of a particula1· health care facility. is visible at the equipment 1-ather than remotely.
A.3.3. 75 Health Care Microgrid. The health ca.re microg1·id A.3.3.104 Manufactured A ssembly. Examples are headwalls,
can connect and disconnect from the utility to enable it to columns, ceiling columns, ceiling-hung penda.tlts, movable
operate in both g1·id-connected or island mode. (ELS) track systems, a.t1d so on.
A.3.3. 77 Home Care. For the purposes of this <lefinition, homP A.3.3.106 Medical Air. A.ii- supplied from on-site comp1·essorn
rare should not inclu<le commercially-operated facilities hous a.t1d associate<l air treatment systems (as opposed to medical air
ing of four or m01·e occupants not related by blood 01· matTi age USP supplied in cylinders) that complies with the specified
1·eceiving personal care or me<lical services. limit� is considered medical ai1·. Hydroca.t·bon carryover from
the compressor into the pipeline dist1·ibution system coul<l be
Facilities, regardless of occupancy classification, that provi<le detrimental to the safety of the en<l user and to the integrity of
01· facilitate the provision of pe1·sonal Gll"e 01· medical services the pip ing system. Mixing of air an<l oxygen is a common clini-
2021 Edition
cal practice, and the hazards of fire are increased if the air is A3.3.143 Patient Lead. A patient lead can be a surface
thus contaminated. Compliance with these limits is thus consid contact (e.g., an ECG electrode), an invasive connection (e.g.,
e1·ed important to fit-e and patient safety. The (]Uality of local implanted wise or catheter), or an incidental long-te1·m
ambient air should be determined prior to it� selection fot· connection (e.g., conductive tubing).
compressors and air treatment e<J uipment.
It is not intended to include adventitious or ca�ual contact�,
A3.3.ll0 Medical Office. Examples include a dental office/ such as a push button, bed sudace, lamp, hand-held appliance,
clinic, a medical office/clinic, an immediate care facility, and a at1d so forth.
podiatry office. (Alm see 3.3. 92, lrnlated Patient LMd.J
A3.3.125 Nonflammable Medical Gas System. See Chapter 5,
Ga� and Vacuum Systems. 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
A3.3.129 Oxidizing Gas. O:,,.ygen and nitrous oxide are 55 psig). The operating pressure for medical support gases is
examples of oxidizing gases. 1l1ere a1·e many othe1·s, including typically 345 kPa to 1275 kPA ( 160 psig to 18:, psig).
halogens.
A3.3.149.6 Partial Pressure. 1l1e pt·essure contributed by
A3.3.130 Oxygen. Oxygen's outstanding property is it� ability other gases in the mixture is ignored. For example, oxygen is
to sustain life and to support combustion. Although oxygen is one of the constituent� of air; the pat·tial pressure of oxygen in
nonflammable, mate1·ials that burn in air will burn much more standard air, at a stat1da1·d air pt·essure of 14.7 psia, is ,l.Oli psia
vigorously and create higher temperatures in oxygen or in or 0.208 ATA or 158 mm Hg.
o:,,.-ygen-enriched atmospheres.
A3.3.150 Pres.sure-Reducing Regulator. In hospitals, the te1·m
A3.3.130.2 Liquid Oxy gen. If spilled, the li <J uid can cause rPgzilator is fre(]uenlly used to describe a 1·egulator· that incorpo
frostbite on contact with skin. rates a flow-measuring device.
A3.3.132 Oxygen Delivery Equipment. If an enclosme such A3.3.152 Producer. Examples of these produce1·s include
as a ma�k, hood, incubator, canopy, 01· tent is used to contain vacuum pumps, fans, blowers, and venturis.
the o:,,.ygen-enriched atmosphere, that enclosure is considered
to be oxygen-delivery e <J uipment. A3.3_154 psig. Under standard conditions, 0 psig is e<Juiva
lent to 14.7 psia.
A3.3.133 Oxygen Hood. For additional information, see
A.3.3.12.2 and Figure A.3.3.12.2. A3.3.160 Remote. A g-ds storage supply system cat1 be remote
from the single treatment facility, but all use point� must be
A3.3.135 Oxygen Toxicity (Hyperbaric). Unde1· the pressures contiguous within the facility.
and times of exposun� n01·mally encountered in hypet·baric
treatment�. toxicity is a direct function of concentration and A.3.3.169 Single 'Ireatment Facility. ll1e definition of single
time of exposure. treatment facilitv was established to take into consideration
pt-incipally single-level installations or those of a pt·actice that
A3.3.140 Patient Care Space. Business offices, con-ido1·s, could be tw-o-level, but ai·e 1·eached by open stai1·s within the
lounges, day rooms, dining rooms, or similar areas typically are confines of the single treatment facility. (See Figure A. .3.3.169.)
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 Examples ol Single Treatment Facllltles
opernted, patient care-1·elated appliances. Examples include,
u • t Use Use points
but a1·e not limited to, special care patient rooms used fot· ct"iti
··:":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) Reconstrnctive surgeon's office with gene ml anesthesia,
arlrlresses the site of intenrlerl expulsion. Actual expulsion can Category l
occut· at other sites 1·emote from the intenrlerl site rlue to (3) Procerlural serlation site for outpatient services, Category
disconnections, leaks, 01· 1·upture of gas conrluits anrl connec 2
tions. Vigilance on the part of the patient care team is essential ( 4) Cooling Towers in Houston, TX, Category 2
to ensure system integrity. ( 5) Cooling Towers in Seattle, WA, Category 3
(6) Dental office, no general anesthesia, Catego1y 3
For example, fot· a patient receiving oxygen via a nasal Typical doctor"s office/exam room, Category 4
(7)
cannula or face mask, the site of expulsion normally surrounds Lawn sprinkler system, Catego1y 4
(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) Any amputation
tor; for a patient receiving oxygen while on a ventilator, the site Loss of the sight of an eye (whether temporary or perma
(2)
of intentional expulsion no1·mally sutTounrls the venting port nent)
on the ventilat01·.
(3 ) Chemical 01· hot metal burn to the eye or any penetrating
A.3.3.176 Surface-Mounted Medical Gas luil Systems. It is injury to the eye
the intent that smi"ace-mounted medical gas 1·ail systems would (4) Any injm·y that 1·esult5 in electric shock and electric burns
be permitterl in indivirlual patient rooms hut would not he leading to unconsciousness and that 1·equires resuscita
permitted to go di1·ectly through room walls to adjacent patient tion or admittance to a hospital fo1· 24 hou1·s 01· m01·e
rooms. However, it is the intent to permit surface-mounted (5) Any other injurv leading to hypothermia, heat inrlucerl
medical ga� mils to be used in a given Category l space whe1·e illness, or unconsciousness requiring 1·esuscitation 01·
there can be a partition sepamting certain patient ca1·e func admittance to a hospital for 24 hours or more
tions, essentially lea,ing the system within the given Category l (6) Loss of consciousness caused by asphyxia or lack of
space. As an e xample, tw-o acljacent patient rooms out�ide of a oxygen or exposure to a biological agent or ha1·mful
Category l space care unit would not be pe1·mitted to have a substance
sudace-mounted medical gas rail interconnect between the two (7) Absorption of any substance by inhalation, skin, 01· inges
rooms through the wall. However, in a nursery where there tion causing loss of consciousness or acute illness requir
might be one or tw-o seg1·egated areas for isolation, a merlical ing merlical treatment
ga� mil system supplying m01·e than one isolation room, but (8) Acute illness requiring medical tt·eatment where ther·e is
within the nursery area, would be permitted to he interconnec reason to believe the expostffe wa� to biological agents, it�
ted with the nursery system. toxins, or infected materials
A.3.3.181.1 Endotracheal Tube. An endotracheal tube can he A.4.1 .2 A mi1101· injury means no/ sPriom or involving risk of lip.
equipped with an inflatable cuff. A.4.1.5 In some situations, it might be desirable to rlesign to a
A.3.3.187 Wet Procedure Locations. Routine housekeeping higher risk category. Fot· example, it might only be 1·equi1·erl to
f
procerlm·es anrl incidental spill age o liquids do not define a design a system to a Category 4 but it is permissible to design to
wet procedure location. a Category 1, Category 2, or Categ01y 3. The converse is not
allowerl. For example, a requirerl Category l system must be
A.4.1 Fout· levels of systems categories are defined in this designerl to a Catego1y l anrl cannot be designerl to a Catego1y
code, ba�ed on the 1·isks to patient� anrl caregivers in the facili 2, Catego1y 3, or Category 4.
ties. 1l1e categories are as follows:
A.4.2 Risk assessment should follow procedures such as those
( l) Catego1y l: Systems are expecterl to work or be available outlined in ISO/IEC 31010, Risk Managnnn1t - Ri�k i'lsses.,111mt
at all times to support patient needs. Tn:hniq11Ps, NFPA 551; SEMI S l 0.0307E, Safety GuidPline for Rish
(2) Categ01y 2: Systems a1·e expected to provide a high level Assessment and Risk Evaluation Proass; SFPE's EnginePring Guide to
of reliability; however, limiterl short durations of equip Fire Ri�k A..t�e.mnmt; 01· othe1· formal prncess. The 1·esults of the
ment downtime can be toleraterl without significant assessment procerlu1·e should be rlocumenterl anrl 1·ec01·rls
impact on patient care. Catego1y 2 systems support retained. Figu1·e A.4.2 is a sample risk assessment model that
patient need� but are not critical for life support. can be userl to evaluate the categories.
(3 ) Category 3: Normal building system reliabilities a1·e
expecterl. Such systems support patient neerls, hut failu1·e A.4.2.2 Classification of risk categories requires a collaborative
of such equipment woulrl not immediately aflect patient effort between tl1e healtl1 ca1·e facility's governing body and the
care. Such equipment is not critical for life support. authority having jurisdiction.
( 4) Category 4: Such systems have no impact on patient ca1·e
and woulrl not be noticeable to patient� in the event of A.4.4.1 The provisions of 4.4. l do not require inherently
failure. noncombustible materials to be tested in orrle1· to be classified
a, noncombustible materials.
The category definitions apply to equipment operations and
are not intended to consirler intervention by ca1·egive1·s or A.4.4.2 Materials subject to inCI"ease in combustibility 01· flame
others. Potential examples of areas/systems anrl their catego spread index beyonrl the limit� herein establisherl thrnugh the
f
ries o risk follow. A risk a�sessment should be conrlucterl to effect� of age, moisture, or other atmospheric conrlition are
f
evaluate the risk to the patient�, staf , and visito1·s. conside1·erl combustible. (See NFPA. 259 and NFPA 220.)
fJOJ:A.4.6.141
( l) Ambulatory sm·gical center, two patients with full OR serv
ices, Category l
2021 Edition
(3) 1l1rnugh 1·isk analysis. the Responsible Facility Authority

Patient Patient has Patient has No impact
dies minor injury discomfort on patien t 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
Category 1 under 5. l.12, the entire system can then be considered an
System Yes "existing system" for t he put·poses of this code.
loss Category 2 (5) The decisions and result� of the risk analysis and final
Yes
Category 3 testing, if required. should be made pa rt of the perma
No Yes nent records of the facility for future reference.
No
Category 4 A.5.1.3 See Figm·e A.5.1.3. Category I source drnwings in this
No 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
Sample Risk Assessment. arrangement�. Alternative arrangements are permitted if they
FIGURE A.4.2
meet the intent of the text. Listed paragraphs might not be the
only paragraphs that apply
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
A.5.1.3.1.1 Regulations of the U.S. Department of Transporta
tion (formerly U.S. Inte1·state Comme1·ce Commission) outline
systems; and Section 5.3 covers Category 3 piped gas and
specifications for transportation of explosives and dangerous
vacuum systems.
articles (49 CFR 171-190). In Canada, the regulations of the
The health care facility's governing bodv should designate a Canadian Transport Commission, Union Station, Ottawa,
catego1y in accordance with Chapter 4 for each patient care Onta rio. apply
space in the facility. This process should include a1·eas being
used fot· medical support (e.g., decontamination 01· ste1·iliza
A5.l.3.l.2 CGA documents contain both mandatory and
nonmandatory language. Enforceable Language uses the word
tion, lab work, post mortem) that are not strictly patient care
"shall"; nonmandatory language uses the word ·'should."' This
spaces themselves (i.e., there are no patients there) but share
section indicates that this code is making refe1·ence onlv to the
utilities such a� medical gases or medical support gases with
mandatory requirement� in the CGA document.
such spaces. Because it is not 1·ealistic to create separate supply
systems for each category, it is desirable that one supply system A5.l.3.2.5 Wrappe1·s (or ove1·packs) a1·e intended to prnvide
be used for spaces of all categories to supply medical gases, an outer package for transpon, such as a ca1·dboard box, and
medical support gases, and vacuums to terminals. typically present a significant combustible fire load. Cylinders
should not be stored in health care facilities in overpacks when
The principle is set out at the start of the requirement� for
the overpack is made of a combustible material ,,>ith a signifi
each category in Chapter 5 (.�PP 5.1.1, 5.2.1, and 5.3.1) that a
cant fire load. Valve shrink wraps used to seal valve connec
higher categ01·y sou1·ce and piping system is pe1·mitted to
tions, and outer netting applied to cylinders that does not
supply terminals in any lowe1· Categmy space; a Categ01·y 1
cove1· more than 50 pet-cent of the cylinder sudace and is only
system can supply terminals in Category 2 and Category 3
intended to prntect the cylinder paint coatings and side wall
spaces, but a Category 2 system cannot supply terminals in a
labels from damage, are not considered wrappers.
Categmy 1 space.
A5.l.l.3 1l1ese requirement� do not restrict the distribution
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
of other inert gases through piping systems.
or CGA G-8.1, Standard far 1'v'itmm Oxidf Systnns al CustmnN SitPs.
A5.l.l.4 1l1e intent is that an existing system built in acco1·d A storage unit(s). reserve, pressure regulation, and a signal
ance with an earlier edition of this code is permitted to be actuating switch (es) a1·e component� of the supply system.
continued in use as long as no element is disturbed. For this Shutoff valves, piping from the site, and electric wiring from a
purpose, ''disturbed" includes 1·eplacing or changing of signal switch(es) to the master signal panels are components of
element� (except simple like-for-like exchange as part of a the piping system.
repair or normal maintenance), portions added to or removed
The hulk supply system is normally installed on the site by
from the system in a manner that requi1·es system shutdown,
the owner of this equipment. The owner or the organization
and opening of any pan of the system to the atmosphe1·e.
1·esponsible for the ope1·ation and maintenance of the bulk
\\'hen any element(s) of the system is disturbed, the follow supply system is 1·esponsible fot· ensuring that all components
ing should occu1·: of the supply system - main supply, reserve supply. supply
system signal-actuating switch(es), and delivery pressure regula
(1) The specific element(s) that wa� disturbed should be
tion equipment - function properly hefo1·e the system is put in
brought into compliance with the most recent edition of
service.
this code.
(2) An evaluation should be conducted and documented fot· In the locating of cenu·al supply systems, consideration
any portions of the system affected by the change. should he given to ensuring the 1·esilience of the facility under
2021 Edition
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 A.5.1.3.3.2.1 (7) Electrical devices shoulrl be physically protec
the central supply systems and thei1· utility connections. 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
A.5.1.3.3.1.1(4) Examples include the concentrator unit, the avoirl causing physical damage to the cylinders or containers.
oxygen reservoir, anrl regulating devices. For example, the rle'1ice coulrl be located at or above 1.5 m
A.5.1.3.3.1.2(5) Examples include the concentrator unit, the (5 ft) above finished f1001· 01· othe1· location that will not allow
m..-ygen resetvoir, and 1·egulating devices. the possi bility of the cylinders or containe1·s to come into
contact with the electrical device as required by this section.
A.5.1.3.3.1.3(6) This includes indivirlual components on the
air side of concentrators. 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 check valve. The valve flows in the direction
of the point.
A quarter turn ball valve. The type
shown is used for ease of recognition. A high-pressure valve. The technology of the
but other configurations are permissible. 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
A.5.1.3.3.2.1(11) Chapte1· fl specifies medical gas equipment Similarly. mate1·ials that can be ignited in ai1· have lowe1· igni
that should be powered by the essential electrical systems. Elec tion energies in oxygen. Many such materials can be ignited by
trical equipment that is not essential for the operation of the friction at a valve seat or stem packing or by adiabatic comp1·es
supply system can be powe1·erl. by nonessential powe1· (e.g., te sion produced when oxygen at high pressure is rnpidly intro
lemetry, site lighting). duced into a system initially at low pressure.
A.5.1.3.3.2.1(14) Considerations for this access inclurl.e prox A.5.1.3.5.5.1 The intent of 5.1.3.5.5.1 is to ensure that the
imity to loading docks, access to elevators, anrl. passage of cylin p1·essu1·e at the station outlet is steady and maintainerl. safely
f
ders through public areas. within the limit� o Table 5.1.11. Trarl.itionally, line pressure
regulators were requirerl. here as the only allowed control-of
A.5.1.3.3.4.2 Exhaust fan motors, fan-coil motors, or similar p1·essu1·e devices. Other methods of control are becoming
small motors userl. for ventilation put-poses a1·e not intenrl.erl. to possible (e.g., variable speed conu·olled on pt·essure). The
be prohibited from the storage enclosure. present wording is intenderl. to achieve the performance
A.5.1.3.5 See Fig111·e A.5.1.3.5. A fout--valve bypass atTange requireme nt (sn' TablP 5.1.11) and to allow not only traditional
ment is illustrnted. Three-way valves a1·e permitterl. in lieu of the p1·essu1·e regulatm-s but other control methods as well.
four valves shown. A.5.1.3.5.9 See Figure A.5. l .3.5.9(a) and Figure
A.5.1.3.5.4 Component� include, but are not limiterl. to, A.5. l .3.5.9(b). Connection to the gas outlet connection is illus
containe1·s, valves, valve seat�. lub1·icant�, fittings, gasket�, anrl. trnted. If the liquirl. outlet connection were userl., an external
interconnecting equipment, including hose. Easily ignitable vaporizer coulrl. be requi1·ed.
materials should be avoided. A.5.1.3.5.9(1) The appropriate number of cylindel'S should be
Compatibility involves both combustibility and ease of igni rl.etermined afte1· consirl.erntion of rl.elivery scherl.ules, proximity
tion. Materials that burn in air will burn "iolently in pure of the facility to alternate supplies, and the eme1·gency plan.
oJi.-ygen at normal pressure anrl. explosively in pressurizerl. A.5.1.3.5.10 See Figure A.5.1.3.5.10.
oxygen. Also. many materials that do not burn in air will do so
in pure oxygen, panicularly unrl.er pressure. Metals fix contain A.5.1.3.5.11 See Figure A.5.1.3.5.11.
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· Intermediate
resistance to ignition anrl. lower rate of combustion. 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 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
check valve 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.
Header valve
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
Cylinders medical air is the following:
(1 ) Test at the intake and at the sample connection valve.
FIGURE A.5.l.3.5.9(b) Header for Cryogenic Gas in (2) If the two purities ag1·ee within the limit� of accurncy of
Containers. the test, the compressor system can be accepted.
(3) If the air is found to exceerl the values for medical
A.5.1.3.5.13 See Figure A.5.1.3.5.13. compressed ai1· as rlefined in 5.1.3.G. l, the facilitv can
elect to install purification apparatus for the contami
If the relief valve on the emergency oxygen supply connec nants in guestion.
tion is moved downstt·eam from the check valve in the emer
gency oxygen line, it shoulrl be connected to the system with a A.5.1.3.6.2 It is the intent that the medical air piping rlistribu
demanrl check fitting. tion system support only the intended need for breathable air
for such items a� intermittent positive pressure breathing
The eme1·gency oxygen supply connection (EOSC) can be (IPPB) anrl long-term respirator)' assistance needs. anesthesia
used a� a part of the emergency operation plan (EOP) fot· an machines, and so forth. The system is not intended to be used
unplanned loss of oxygen supply. However, a risk assessment to provide engineering, maintenance, and eguipment needs
shoulrl be conducted by the facility to rletermine the contin for gene1·al hospital support use. It is the i ntent that the life
gency plan fot· vital life support and Category l space. 1l1ei-e sal·ety natu1·e of the medical air be prntecterl by a system dedi
might neerl to be interim mea�ures for dealing with the loss of cated solely for its specific use.
oxygen (e.g., high-pressure m..ygen cylinrlers available for back
feeding Category l space). As a comp1·essed air supply source, a medical air compresso1·
should not be used to supply ai1· fot· othe1· purposes, because
A.5.1.3.5.13.2(8) Monitot-ing tempornry supply in use is essen such use could ino·ease setvice inte1n1ptions, 1·educe service
tial to patient safety. The facility"s emergency operations plan life, and introduce additional opportunities for contamination.
(EOP) should addt·ess how the facility will monitor the tempo
rnry supply while in use. The length of time the EOSC will be A.5.1.3.6.3 See Figu1·e A.5.1.3.6.
f
in use, the availability o staff to monitor temporary supply, and A.5.l.3.6.3.4(A) Examples of 5. l.3.6.3.4(A)( l) are liguid ring
the tvpe of temporaty supply shoulrl all be considered when and permanently sealed bearing comp1·ess01·s.
rletermining the means to accomplish this item.
An example of 5. l.3.G.3.4(A)(2) is an extenrled head 1·ecip
A.5.1.3.6 Air supplied from on-site compressor anrl associated rocating compressor with an atmospheric vent between the
air treatment systems (as opposerl to medical air USP supplied comp1·ession chambe1· and the crankcase.
in cylinders) that complies with the specified limil� is consirl
ered medical air. Hydrncarbon carryover from the compressor An example of 5. l .3.G.3.4(A)(3) is a rotating element
into the pipeline distribution system could be detrimental to compressor with the compression chamber being nonlubrica
the safety of the end user and to the i11teg1·ity of the piping ted and separated from the lub1·icated gea1·s by at least one
system. Mixing of air and oxygen is a common clinical practice, shaft seal \\>ith an atmospheric vent on both sides. The vent on
and the hazards of fire are inCt"eased if the air is contaminate cl. the lubt·icated side is provided with a gravity drain to atmos
Compliance with these limits is thus considererl important to phere.
fit·e and patient safety. The guality of local ambient air should
2021 Edition
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
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. 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
FIGURE A.5.1.3.5.13 Emergency Oxygen Supply supply in use
Connection. (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
Bypass operation using Bypass operation using sm·es, both high anrl low, anrl for the medical air
3 two-port valves 1 two-port valve
oxygen concentration, both high and low, based
1 three-port valve
upon USP specifications. A process upset can be
FIGURE A.5.I .3.6.3.9(D) Receiver Valving Arran gement. 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.5.l.3.6.3.9(D) A typical example of valving the receive1· ts A means to detect excursion from these p1·ocess
shown in Figure A.5. l.3.6.3.9(D). limit� and power failure should be provided.
(c) At lea�t one dedicated valve or other control should
A.5.l.3.6.3.9(F) The two configtll'ations are equally accepta
he installed in the proponioning system and/or the
ble. The components can be atTangerl in either of the atTange
line(s) between the o:i--ygen and/01· nitrogen supply
menl� shown in Figure A.5.l.3.fi.3.9(F).
system(s) and proportioning system. The pm-pose
A.5.1.3.6.3.10 The intent of 5.1.3.6.3.10 is to ensure that the of the dedicated control (s) is to prevent the cross
pressu1·e at the station outlet is steady and maintainerl safely contamination of the oxygen anrl nitrogen lines rlue
within the limit� of Table 5.1.11. Trnditionally, line pressure to product backflow a� follows:
regulators were required here as the only allowed control-of'. i. The control (s) shoulrl he separate from the
pressun· rlevices. Other methods of control a1·e becoming valve(s) or other device(s) used to control
possible (e.g., va1·iahle speerl controlled on pressure). The oxygen flow and nitrogen flow 111 normal
present worrling is intended to achieve the performance operation .
requirement (sf¥ ]hble 5.1.11) anrl to allow not only trarlitional ii. The control(s) shoulrl not cycle in normal
pressu1·e 1·egulat01·s but other control methorls as well. operation .
A.5.l.3.6.3.14(A)(I) The proportioning system might require 111. If installerl in the line(s) between the oxygen
approval from regulatory bodies that have medical de,ice or nitrogen supply system(s), or both, and
authority, such as the FDA in the Uniterl States. 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 A.5.l.3.6.3.14(C)(9) The proportioning system should be
via the use of check valves. monitored for conditions that can affect air quality during use
(d) In the event of a process upset, the rlerlicated or in the event of failure, based on the type of proportioning
contrnl (s) should e ithe1· positively isolate the supply system rlesign used in the system, including the following situa
of oxygen or nitrogen. or both. from the mixer. or tions:
the rlerlicaterl control(s) should reduce the mixer (1) Where proportioning systems that are confi gured with a
p1·essure to less than half of the minimum final line p1·imary proportioning system and a resenre medical ai1·
p1·essure values, each, fo1· the oxygen anrl nitrogen manifold per 5.1.3.5.10 a1·e userl
lines. In the event of a process upset, the control (s) (2) ,.vnere proportioning systems that are confi gured with a
should operate. Manual 1·eset should be required to pt·imary proportioning system and a reserve proportion
1·estart the proportioning system. ing system are used
2021 Edition
Dryers Filters Regulators
Either Either Either
Dryers Filters Regulators
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 station inlet perfom1ance test� outlined in 5.1.12.4.10 a1·e
primary proportioning system and a reserve medical air extremely important in maintaining the integrity of the medi
compressor pet· 5.1.3.5.10 are userl cal-sm·gical vacuum system, and they shoulrl be made at more
(4 ) When proportioning systems a1·e configured to ala1·m at a frequent intervals ifWAGD is includerl in the vacuum system.
prerletermined set point before the reserve supply begins
to supply the system, indicating reserve supply in use A.5.1.3.8.1 Interfaces are provirled ,�th overpressure, under
(5) When proportioning systems a1·e configured to ala1·m at a p1·essure, overflow, and unrlerflow compensat ion to ensure the
pt·edeterminerl set point befo1·e the reserve supply breathing ci1·cuit is isolated from the \'\'AGD system.
contents fall to one average clay's supply, indicating A.5.1.3.9 See Figure A.5.l.3.9(a), Figure A.5.l.3.9(b), and
1·eserve low Figme A.5.l.3.9(c).
Water-in-receive1· alarms a1·e not requirerl for proportioning A.5.1.3.9.1 See Figure A.5.1.3.9.1.
systems.
A.5.1.3.9.2(2) Oxygen concentt·ators have inherent risks
A. 5. I.3. 7 See Figme A.5.1. 3. 7. because they might not be able to instantaneously begin
A.5.1.3.8 A functioning ·wAGD system allows the facility to producing oxygen of the necessary concentration anti quantity
comply with occupational safety requirements by preventing from a "cold start."' For these reasons, cylinder header(s) are
the accumulation of waste anesthetic gases in the work environ often preferable as one 01· m01·e of the tht·ee sources. The cylin
ment. rlers ,�II supply the sys tem while the concentrntor presstll"izes
and purges itself to the desirerl concentration of oxygen. Cylin
VI/AGD using an HVAC (heating, ventilation, and air ders are also independent of electricity and can provide a
conditioning) system a1·e not \\1thin the scope of Chaplet· 5. supply of oxygen in the event of power interruption.
Flammable and nonflammable g-dses are known to be incom A.5.1.3.9.2(5) The method used elsewhere in this rlocument
patible with some seals and piping used in medical-surgical to pro\1de these characteristics will be found in the final line
vacuum systems. If WAGD is to be included as pan of the medi regulator 1·equiremenl� unrler 5.1.3.5.5. This method woulrl be
cal-sut·gical vacuum system, it should be recognized that this suitable for oxygen supply systems using concentrntor(s) as
activity might cause deterioration of the vacuum system. The well. However, the pressure differential between the output of
2021 Edition
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 all components of the supply system - main supply, reserve
small, making the use of regulators problematic. In this case, supply, supply system signal-actuating switch(es), an<l delive1y
alternate control arrangements (e.g., pressure control through pressure regulation equipment - function properly before the
variable speed drives) might be more effective. system is put in sen-ice. 1"55:A.17.1.1 l
A.5.1.3.10 For bulk oxygen systems. see NFPA 55. Two possible A.5.1.3.10.8.3 For example. 2400 psi (16,550 kPa) rated cylin
choices of reserves are illustrate<l in Figure A.5.1.3. lO(a) and ders are not connected to the same manifol<l as 2015 psi
Figure A.5.1.3.lO(b). Both are not require<l. (13,890 kPa) rnted cylinders unless all cylin<lers. including the
2400 psi (16,550 kPa) cylin<lers, are filled no greater than
A.5.1.3.10.1.1 The cryogenic fluid centrnl supply system 2015 psi (13,890 kPa). 1"55:A.17.8.31
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 A.5.1.3.10.1 l.4(A) A typical alternate material is stainless steel.
sut·e n·gulation, and signal actuating switch(es) a1·e compo 1"55:A.17.11.4. l l
nents of the supply system. Shutoff valves, piping from the site, f
and electt·ic wiring from a signal switch(es) to the master signal A.5.1.3.10.12 TI1e local signal arose from the simple nee<l o a
panels a1·e componenl� of the piping system. f55:A. l 7. l .l] 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
The ctyogenic fluid central supply system is normally in sense of a local or master alarm. It is simply an indicator, which
f
stalled on the site by the owner o the equipment. The owner might be a gauge, a flag, a light, or some other possible mani
or the m·ganization responsible fot· the operation and mainte festation that allows a maintenance person to stan<l at the
nance of the bulk supply system is responsible fot· ensu1·ing that equipment an<l know what conditions are present (e.g., which
2021 Edition
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 (e.g., opernting rooms and delivery rooms). Refer to rlefini
are typically those that will also be monitored at the maste1· tions for these areas.
alarm, b ut the local signal is visible at the equipment rather f
than remotely. [55:A.17.121 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
A.5.1.4 See Figure A.5.1.4. 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,
Area alarms are required in critical care locations (e.g., the1·efore, there woulrl be no great distance separating the two
intensive care unit�. coronary care unit�. angiography labornto valves. A source that was physically separate from the b uilding
ries, cardiac cathete1·ization laboratories, post-anesthesia recov woulrl requi1·e both valves to enstu-e the intervening piping
ery rooms, and emergency rooms) and anesthetizing locations 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 A.5.1.6 Manufacturerl a�sembly examples include headwalls,
average-height individual standing with their feet on the floor columns, ceiling columns, ceiling-hung pendant�, movable
in front of the zone valve. track systems, and so fonh. See Figure A.5.1.6.
A.5.1.4.6.1(3) Wheelen equipment, such as what is permitted A.5.1.7 It is the intent that surface-mounted medical gas rail
to be located in a corrido1· in acconlance with 18.2.3.4 and systems would be pennitted in inrli�dual patient rooms but
19.2.3.4 of NFPA 101, does not 1·ender zone valves inaccessible woulrl not be pe1·mitted to go rlirectly through room walls to
if located in front of the zone valve. Those sections permit a�acent patient rooms. However. it is the intent to permit
wheelerl equipment and eme1·gency equipment in use, merlical surface-mounterl merlical gas rails to be used in a given Cate
emergency equipment not in use, anrl patient lifi: anrl transport gory l space where the1·e can be a partition separating certain
equipment. The zone valve needs to remain visible. patient care functions, essentially lea\ing the system within the
given Category l space. A� an example, two adjacent patient
A.5.1.5 Station outlets and inlet� should be locaterl at an rooms out�ide of a Categm·y l space care unit would not be
apprnp1·iate height above the floor to prevent physical damage pe1·mitted to have a surface-mounted merlical gas rail intercon
to equipment attached to the outlet. The minimum number of nect between the two rooms through the wall. However, in a
station outlet� anrl inlet� for each system that is installed should nursery where there might be one or two segregated areas for
be pro\�ded pet· the applicable volume of FGI guirlelines or isolation, a medical ga� rail system suppl�ng more than one
other federal, state. or local codes. isolation room, but within the nu1·se1·y a1·ea. would be permit
terl to be interconnected with the nursery system.
2021 Edition
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
&
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 A.5.1.10.4.5.12 1l1is is to enstn-e a quality joint and to p1·event
fittings imprnves the quali ty of the brazement without decreas the formation of copper oxide on the inside and out�ide suti"a
ing its strength, particularly in larger sizes, which are difficult ces of thejoint.
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 A5.I.I0.5.l.5 Gas mixtures are commonly used in GTA¼'
fittings (if available) or have the socket� on ASME Bl6.22 autogenous fusion welding. The identification of a gas mixttlt"e
fitting� cut down to ANSI/ASME B16.50 depths. Where a� "75He 25Ar" is a common industry term to define a commer
shallow-5ocket fittings a1·e used for the medical gas piping, care cially available grade from gas suppliers. If test welding result�
should be taken to avoid their use in other piping sy�tems lead to questions about the mixtut·e pet-centage or gas quality,
wherejoints could be soldered instead of brazed. 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
A.5.1.12.2.3.5 Ammonia is known to cause stress cracking in
{User} copper and it5 alloys.
Primary
gas-specific
adapter
check 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
{User} : ,
indicators. line pressure relief valves, manufactures assemblies,
gas -specific � and hose.
adapter
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
FIGURE A.5.1.6 Terminals in Manufactured Assemblies. (Pia) times the final absolute temperature (T2a), divided by
the initial absolute temperature (Tla). The relationship is the
A.5.1. 10.11.4.4 CMT is coate<l with a nonmetallic jacket with same for nitrogen, nitrous oxide. oxygen, and compresse<l air.
an O.D. equal to a la1·ger copper tube size than CMT. The CMT Absolute p1·essure is the gauge p1·essure 1·eading plus the
manufacturer's installation instructions should identify accepta absolute atmospheric p1·essure. See Table A5. l.12.2.6.5 for the
ble solutions. absolute atmospheric pressures for elevations at and above sea
A.5.1.11 It is recommended that the facility's normal operat level.
ing pressure of nitrous oxide be initially set and continually Absolute temperatm·e K ( 0 R) is the temperature gauge 1·earl
maintaine<l at least 34.5 kPag (5 psig) below the normal operat ing ° C ( ° F) plus the absolute zero temperature 273 ° C (460 0 F).
ing pressm·es of the oxygen and medical air·.
Examples of pressure test data at sea level in SI and IP units
Piping systems that ar·e connected through blending devices follow.
are in effect cross-connected through the device. In the rare
event of a faihu-e of the safeties inside the equipment, the The initial test pressure is 41!'> kP ag (60 psig) at 27 ° C (80 ° F).
possibility of having the gases flow across the device exists. A temperature decrease to l 8'C (65'F) will cause the test pres
When the device is an anesthesia machine, and one of the sure to drop to 400 kPag (57.9 psig).
gases is nitrous oxide, a pressure in the nitrous oxide pipeline Pig= 415 kPag, Tlg = 27 ° C. T2g= 18 ° C, Pig= 60 psig. Tlg
greater than the p1·essm·e in the medical ai1· 01· oxygen system = 80 0 F. T2g = 65'F
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 Pla=415+ lOl =5l6 kPa Pla = 60 + 14.7 = 74.7 psia
ox-ygen outlet . Adjusting the pressure as 1·ecommended c:.111 Tla = 27 + 273 = 300K Tla = 80 + 460 = 540 ° R
reduce the likelihood of the causative equipment failure and T'2a=18 + 273 = 291K T2a =65 + 460 = 525 ° R
also reduce the severity of the problem in the event it does P2a= 516 x 291/300= P2a = 74.7 x 525/540=72.6 psia
occur. 501 kPa
A.5.1.11.2.3 It is not intended that all valves on a medical P2g= 501- l0l= 400 kPag P2g= 72.6- 14.7 = 57.9 psig
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
2021 Edition
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
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 ( 1) Inlets and outlets 1·emoved and tuhing capped
gases (e.g., hydrogen, acetylene, natural gas) are outside the (2) Inlets and outlet� plugged and prm-ided with a hlank-off
scope of this chapter. plate
(3) Inlets and outlets remain accessihle for· maintenance and
A.5.1.14.3.3 Vacuum systems from station inlets to the exhaust testing
discha1·ge should be considered contaminated unless proven Other means deemed appropt·iate by the AHJ
(4 )
othenvise. Methods exist to disinfect the system or portions
thereof. Prope1· decom missioning of systems should include identify
ing them as not in senice. The a�sociated zone valve box and
Clogging of regulators, for example, with lint, dehris, or alarm panels should be kept up-to-date with the changes made
dried body fluids, reduces vacuum system performance. to rooms no longer served.
A.5.1.14.3.4 Other examples of prohibited use of medical A.5.1.14.4.1 The facility should retain a w1·itten or an elec
sut·gical vacuum would be scope cleaning, decontamination, tronic copy of all findings and any con-ections pedormed.
and laser p lume.
A.5.1.14.4.2.2 In addition to the minimum inspection and
A.5.1.14.3.5 ,vhen spaces a1·e converted, the inlets and outlets testing in 5.1.14, facilities should considn annually inspecting
should be addt·essed in one of the following v,•,iys: eguipment and procedures and correcting any deficiencies.
2021 Edition
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
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 99-185
A.6.2.4 Facilities in which the normal sout-ce of power is potential <lifferences benveen the grounding pins of 1·ecepta
supplied by two or more separate central station-fed services cles in one area by bringing the grounding con<luctors to a
experience g1·eate1· than normal electrical sen-ice reliability common point. A specific reason is to simplify maintenance by
than those with onlv a single feed. Such a <lual source of making it easier to fin<l the sout-ce fix the receptacles in a
normal power consists of two or more electrical services fed room. 1l1is is particularly a problem in hospitals where emer
from separate generato1· sets or a utility diso·ibution netwnrk gency conditions might require rapid restoration of power.
that has multiple power input sources an<l is arrange<l to
prov'ide mechanical an<l electrical separation so that a fault A.6.3.2.5.1.5 The 1·equirement for grounding interconnection
bet\veen the facility and the generating sources is not likely to between the normal and essential power systems follows the
cause an intern1ption of mot·e than one of the facility service principle of minimizing possible potential differences between
feede1·s. the grounding pins of receptacles in one area by lxinging the
g1·ounding conductm·s to a common point.
A.6.3.2.1 Assignment of degree of reliability of electrical
systems in health care facilities <lepends on the ca1·eful e\-alua A.6.3.2.5.3 Special grounding methods could be required in
tion of the vat-iables at each particular installation. For further patient vicinities immediately adjacent to rooms containing
information, see ANSI/IEEE 493, RP,:mmnPndPd Pmdice for the high-powe1· 01· high-frequency equipment that causes electrical
Design of Reliable Industrial and (',nmmerrial Power Systems. interference with monitors or other electromedical devices. In
extreme cases, electt·omagnetic induction can cause the voltage
A.6.3.2.2.1 It is best, if possible, to employ only one type of limits of 6.3.3.1 to he excee<le<l.
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 Electromagne tic interference problems can be due to a vari
ity to connect life-support equipment in emergencies. The ety of causes, some simple, othe1·s complex. Such problems are
straight-blade, tht·ee-prong receptacle is now pe1·mitte<l in all best solve<l one at a time. In some locations. groun<ling of
locations in a hospital. Pre\iously, special receptacles were stretchers, examining tables, or be<l frames will be helpful.
specified in ope1·ating room locations and caused compatibility Where necessary, a patient equipment grounding point shoul<l
problems. be installed. This can usually be accomplishe<l even afte1·
completion of construction by installing a 1·eceptacle faceplate
Hospital grade requirements are in addition to the basic fitted with grounding posts. Special grounding wires should
constrnction and perfo1·mance 1·equirements for gene1·al not be used unless they a1·e found to be essential fo1· a particu
putpose 1·eceptacles. These requirements enhance the safety of la1· location, because they can interfere with patient care proce
patient� who might be more susceptible to stray current�. evalu dures or present trip hazar<ls.
ate the integrity of the receptacle's groun<ling path where
subjected to the conditions encountered in health care facili A.6.3.2.8.4 Within the const1·ainL� of the equipment p1-mided.
ties, and apply to receptacles that are non-locking-q,pe, 125- considerntion should be given to coordinating circuit breakers,
volt, 15- or 20-ampere grounding receptacles of NEMA fuses, an<l other overcutTent pt·otective devices so that powe1·
configmations S-15R, :>-20R, 5-20RA, 6-15R, 6-20R, and 6-20RA. interruption in that part of the circuit that prece<les the inter
For the evaluation requi1·ement� of hospital-grade receptacles , rnpting device closest to a fault is not I ikely to occur.
see lJL 498, Standard for A.ttac/nnent Plug:, and &r.eptarlfs. For A.6.3.2.9 Patient prntection is prov'ided primarily by an
receptacle configuration <limensions, see ANSI/NEMA WD 6, adequate grounding system. 1l1e ungrnunded secondary of the
Wiring Deuires - Dimemional Requirnnents. isolation transformer 1·e<luces the cross-sectional area of
A.6.3.2.2.5 Care should be taken in specifying a system grounding conductors necessary to protect the patient against
containing isolated ground receptacles, because the grounding voltage resulting from fault current by reducing the maximum
impedance is controlle<l only by the grounding wires an<l does current in case of a single probable fault in the grnun<ling
not benefit from any conduit or building strncture in parallel sr,tem. The line isolation monitor is use<l to provi<le warning
wiLh it. when a single fault occurs. Excessive current in the groun<ling
conductors will not result in a hazard to the patient unless a
A.6.3.2.2.7 A clinical laboratory is a space whe1·e diagnostic second fault occtlt's. If Lhe cutTent in the grounding system
test� are perfo1·med as part of patient care. 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
A.6.3.2.3.1 Moisture c an reduce the contact resistance of the 0.2 mV, and the voltage across 3 m (9.84 ft) of No. 18 AWG
bo<ly, an<l electt·ical insulation is mo1·e subject to failure. grnunding conductor in a flexible cord will not excee<l 0.8 mV
A.6.3.2.3.4 In conducting a risk assessment, the health ca1·e Allowing 0.1 mV across each connector, the voltage between
governing body should consult with all relevant parties, includ two pieces of patient-connected equipment will not excee<l
f
ing, but not limite<l to, clinicians, biomedical engineering staf , 2 mV.
and facility safety enginee1·ing staff. 1l1e refe1-ence grounding point is intended to ensure that all
A.6.3.2.3.8 The health c are health care facility's governing electrically conductive surfaces of the building structure, which
body an<l designe1· of 1·ecord should ev-aluate the type of protec coul<l 1·eceive heavy fault cutTent� from ordinary (grounded)
tion to be provided against electrical shock to patient� and ci1n1it�, are grounded in a manne1· to byp ass these hea\y
ca1·egive1·s in wet procedure locations. The application consid currents from the opernting room.
erations should include but not be limite<l to the reliability of A.6.3.2.9.2.1 It is desirable to limit the size of the isolation
powe1· to critical equipment and systems. transfo1·mer to 10 kVA 01· less and to use conductor insulation
A.6.3.2.4 ll1e 1·equirement that branch circuits be fed from with low leakage to meet the impe<lance 1·equi1·ement�. Keep
not more than one <listrihution panel was introduced for ing branch circuits short and using insulation with a <lielectric
several reasons. A gene1·al principle is to minimize possible constant less than 3.5 and insulation 1·esistance constant greate1-
2021 Edition
than 6100 megohmmete.-s at l6° C (20,000 megohm-ft at 60'F) easy to mea�ure accurately. although one can be sure that the
reduces leakage from line to ground. impedance will be less than that of the grounding wire it�elf
because of the additional parallel paths.
To correct milliammete1· reading to line impedance, use the
following equation: 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
[A.6.3.2.9.2.1] point need not be known or measured with great accuracy.
V-LOOO
Line impedance (in ohms)= -- 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
where:
between exposed conductive sutfaces of any electrical applian
F = isolated powe1· system voltage
ces that were grounded to the grounding contact� of the recep
I = milliammeter reading made during :impedance test
tacles that powered them. Similarly, the1·e would be no voltage
A.6.3.2.9.3.1 Protection for the patient is provided pt·ima rily differences between these appliances and any othe1· exposed
by a grnunding s�tem. The ungrounded secondary of the isola metal surface that was also interconnected with the grounding
tion transformer reduces the maximum current in the ground s�tem, provided that no cutTents were flowing in that intercon
ing s�tem in case of a single fault between either isolated nection.
power conducto1· and ground. The line isolation monit01-
Ideal conditions, however, do not prevail, and even when
provides warning when a single fault occurn, 01· when exces
the1·e are no "faults" within an appliance, residual "leakage"
sively low impedance to ground develops, which might expose
current does flow in the grounding conductm· of each of the
the patient to an unsafe condition if an additional fault occurs.
appliances, producing a voltage difference between the cha.�sis
Excessive cutTent in the grounding conduct01·s will not result
of that appliance and the grounding contact of the receptacle
from a first fault. A hazard exists if a second fault occurs before
that feeds it. Furthermore, this cmTent can produce voltage
the first fau It is cl eared.
diffe1·ences among othe1· appliances plugged into va1·ious
A.6.3.2.9.3.3 It is desirable to reduce this monitor haza rd receptacles on the system.
current, provided that this reduction result� in an inCl'eased
If, however, a breakdown of insulation bel:\\leen the high side
"not alarm" threshold value for the fault hazard current.
of the line a11d the chassis of a11 appliance occut·s, the leakage
A.6.3.2.9.3.4 It is desirnble to locate the ammeter such that it condition becomes a fault condition, the magnitude of which is
is conspicuously visible to pe1·sons in the anesthetizing location. 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
The line isolation monitm· can be a composite unit, with a cutTent is limited only by the 1·esidual 1·esistance of the appli
sensing section cabled to a separate display panel section on ance power cord conductors and that of the power distribution
which the ala1·m and test functions a1·e located, if the l:\vo s�tem. In the event of such a short circuit, the impedance of
sections are within the same electric enclosure. the grounding circuit, as measut·ed between the grounding
A.6.3.3.1.1 In a conventional grounded powe1- distribution contact of the receptacle that feeds the defective appliance a11d
system, one of the line conductm·s is deliberately grounded, the remote ground point where the neutral and grounding
usually at some distribution panel or the service entrance. This conductorn are joined, should be so small that a large enough
grounded conduct01· is identified as the neutral conductor. fault current will flow to ensure a rapid breaking of the ci1·cuit
The other line conductor(s) is the high side of the line. The by the overcurrent protective device that serves that receptacle.
loads to be served by this distribution sy stem are fed by the Fm· a 20-A branch ci1·cuit, a fault cmTent of 40 A or mm·e
high and neutral comlucto1·s. would he requi1·ed to ensut·e a rapid opening of the branch
In addition to the high and neutral conduct01·s, a grounding circuit overcurrent protective device. This corresponds to a
conductor is provided. One end is connected to the neutral at circuit impedance of :I ohms or less, of which the grounding
the point whe1·e the neutral is grounded, and the other end system should contt·ibute 1 ohm 01· less.
leads out to the connected loads. For put-poses he1·e, the load During the time this large fault current flows in the ground
connection point will be considered to be a convenience 1·ecep ing system, the chassis of the defective appliance is 1·aised many
tacle, with the grounding conductor terminating at the ground volt� above othe1- grounded surfaces in the same vicinity. The
ing terminal of that 1-eceptacle. hazard represented by this condition is minimized by the fact
This grounding conduct01· can be a separate wire running that it exist� for only a short time, a11d, unless a patient simulta
from the receptacle back to the remote grounding connection neously contacts both the defective appliance and some other
(where it joins the neutral conductor). If that separate conduc grounded surface during this short time inter.•al, the1·e is no
tor does not make any inte1·mediate ground contact� between hazard. Furthermore, the magnitude of an applied voltage
the receptacle and the remote ground, then the impedance of 1·eguired to produce a serious shock hazard increases as it�
the connection bel:\veen the receptacle and the remote ground duration dect'eases, so the rapidity with which the ci1·cuit is
is prima1·ily the 1·esistance of the grounding conductor itself interrupted helps reduce shock hazard even if such a patient
and is, the1·efore, pt·edictable. contact occurs.
If, however, the receptacle is also interconnected with the If, however, the defect in the appliance is not such as to
remote ground point by metallic conduit or othe1· metallic cause an immediate circuit intetTuption, then the effect of this
building stn1ctures, the impedance of the ci1·cuit between the intermediate level of fault current on the voltages appeai·ing on
receptacle and remote ground is not easily predictable; nor is it
2021 Edition
ANNEX A 99-187
various expose<l con<luctive sui-faces in the patient ca re vicinity ship; and using some techniques that are not found in these
should be considered. documents.
Because all of this fault cuITent flows in the grounding The pedormance of the grounding system is ma<le eflective
con<luctor of the <lefective appliance's power cord, the first through the existence of the g1·een grounding wire, the metal
effect is to raise the potential of this appliance above that of the raceway, an<l all of the other buil<ling metal. Measurements
1-eceptacle that feeds it by an amount proportional to the have shown that it is the metal raceway and building steel that
powe1· cord grounding conductor resistance. This 1·esistance is provide most of the eflective groun<ling path of less than
reguire<l to be less than 0.15 ohm, so fault currenL� of20 A or 10 milliohms at the receptacle, inclu<ling plug-to-receptacle
less, which will not t1·ip the branch-circuit overcurrent protec impe<lance. 1l1e green grounding wire becomes a backup, not
tive device, will rnise the potential of the defective appliance a p1-imary grounding path pedormer.
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�. Goo<l practice calls for each receptacle to have a good
jumper grounding connection to the metal raceway at the
The fault cutTent that enters the grounding system at the receptacle location in addition to having the green groun<ling
groun<ling contact of any 1·eceptacle in the patient ca1·e vicinity wire connecting these point� to the grounding bus in the distri
could affect the potential at the grounding contacL� of all the bution panel. Good workmanship includes seeing that these
other receptacles, and, more importantly, it could produce grounding connections are tight at each 1·eceptacle and that all
significant voltage diffe1·ences between them and othe1· groun metal rnceway joints are secut·e and tight.
ded sudaces, such as exposed piping and building structures.
The voltage <lifference measurement� listed in G.3.3.1.3 in
If one grounde<l point is picke<l as a reference (a plumbing connection with power <listt·ihution groun<ling systems shoul<l
fixture in 01· neat· the patient care vicinity, for example), and ideally be made with an oscilloscope or spectrum analyzer in
the voltage diffe1·ence is then measure<l between that reference or<le1· to observe an<l measm·e component� of leakage current
and the grounding contact of a receptacle, pro<luce<l by <lriving and voltage <lifferences at all frequencies.
some known cuITent into that contact, a direct measure of the
effectiveness of the grounding system within the patient ca1-e For 1·outine testing, such instrument� coul<l he inconvenient.
vicinity is obtaine<l. The "figure of merit" can be stated a5 so An alternative is to use a metering system that weighs the
many volL� per ampere of fault cun-ent. The ratio volt� per contt·ihution to the meter reading of the various component�
ampe1·e is, of course, impe<lance; but because the exact path of the signal being measu1·ed in acc01·dance with their probable
taken by the fault cuITent is not known, and because the way in physiological eflect.
which the reference point is interconnecte<l with the groun<l A meter specifically designe<l for this purpose would have an
ing system is not known, it cannot be stated that this value is impe<lance of approximately 1000 ohms, and a frequency char
the impedance between the 1·eceptacle and some specific point, acte1·istic that wa5 flat to l kHz, <lroppe<l at the rate of 20 deci
such a� the joining of the neutral an<l grounding conductors. bels per <lecade to 100 kHz, and then remaining flat to l MHz
However, it can be stated that this mea�ured \alue of "effective or highe1·. This freguency response cha1·acteristic could be
impedance" is indicative of the effectiveness with which the achieve<l hy proper design of the internal circuit� of the ampli
groun<ling system minimizes voltage diffe1·ences between fie1· that probably precedes tl1e indicating instrument or by
supposedly grounded object� in the patient care vicinity that appropriate choice of a feedback network around the ampli
are produce<l by ground faults in appliances used in that vicin fie1·. These details are, of course, left to the instrument
ity. This impe<lance, which charncte1·izes the ability of the designer.
groun<ling system to maintain nearly eguipotential conditions
within the patient care vicinity, is of prime importance in a�s ess If a meter specifically designed for these mea�urement� is
ing shock hazard; but this impedance is not necessa1·ily the not av-ailahle, a general-purpose laboratory millivoltmete1· can
same as the impedance between 1·eceptacle an<l 1·emote g1·ound be adapted fot· the purpose by adding a frequency response
point, which controls the magnitu<le of the short-circuit shaping network ahea<l of the meter. One such suggeste<l
CutTent involved in tripping the b1-anch-ci1-cuit ove1·cu1Tent netw-ork is shown in Figure A.G.3.3.l .3(a).
protective device. The ci1·cuit shown Fi gu re A.G.3.3.l.3(a) in is especially appli
Fault current� on the grounding system can also come from cable to measurements of leakage current, where tl1e current
neutral-to-groun<l faults, which allow some cmTent to flow in being mea�ured is derive<l from a ci1·cuit whose source impe
the neutral an<l some in the ground. This type of fault is often dance is high compa1·ed to 1000 ohms. Unde1· these con<litions,
the cause of interference on EEG and ECG eguipment. It is the voltage developed across the millivoltmete1· will be propor
often not recognized easily because, except for 60 Hz interfer tional to the impe<lance of the network. The network impe
ence, the equipment work.5 perfectly propedy. It is most easily dance will be 1000 ohms at low frequencies and 10 ohms at
found by causing a substantial change in the line-to-line load high frequencies, an<l the transition between these two values
an<l noting changes in the ground-to-reference voltage. will occur in the freguency range between l kHz and 100 kHz.
A.6_3.3.1.1.4 The grounding system (1·efe1-ence groun<l and The basic low-frequency sensitivity will be l mV of mete1·
con<luit) is to be teste<l as an integral system. Lifting of grounds 1-eading fo1- each l m.A of leakage cutTent.
from receptacles an<l fixe<l equipment is not required or 1l1e millivoltmeter's own input impedance needs to be vety
recommen<le<l fo1· the performance of this test. la1·ge compared to 1000 ohms (100 kilohms), and tl1e mete1·
A.6.3.3.1.3 Effective grounding to safely han<lle both fault and shoul<l have a flat frequency response to well beyon<l 100 kHz.
leakage currents requires following the requirements of both (If the mete1· impedance is lower than 100 kilohms, then the
Chapter 6 and Article 250 of NFPA. 70; having good workman- 1000 ohm resistor can be raise<l to a higher value, such that the
2021 Edition
impetiance of that resist01· in parnllel with the meter will still be testing. The 10 percent random testing shoulti include a
1000 ohms.) mixture of both normal anti emergency receptacles.
The cit-cuit in Figure A.6.3.:l.l .3(a) can be used fot· the volt A.6.3.4.1.1 Although several approaches to documentation
age difference mea�urement� requi1·ed in Section 6.5, but, exist in hospitals. the minimum acceptable documentation
because the source impedance will be very low compareti to shoulti itientify what was testeti, when it was testeti, and
1000 ohms, the frequency 1·esponse of the measurement system whethe1· it performed successfully. Adopting a sy;tem of excep
will 1·emain flat. If any high-frequency component� produced, tion reporting can be tl1e most eflicient form of record keeping
for example, by pickup from nearby radio frequency transmit for routine rechecks of equipment or systems, thereby minimiz
ters appear on the circuit being measured, then they will not ing technicians' time in recortiing the value of each measure
be attenuated, and the mete1· reading will be highe1· than it ment taken. Fm· example. once a test protocol is established,
should be. which simply means testing the equipment 01· system consistent
with Chapter 6, the only item (value) that needs to be recorded
For meter reatiings below any prescribeti limit�, this possible is the failut·e 01· the tieviation from the requi1·ement� of the
error is of no consequence. Fm· bot·dedine cases, it could be chapte1· tl1at was tietected when a con-ective action (repair) was
significant. To avoid this uncertainty when making voltage untiertaken. This approach can serve to eliminate, for exam
difference measurements, a slightly more elaborate version of a ple, the need to keep intiivitiual room sheet� to record mea�
frequency response-shaping network is given 111 Figure ured result� on each 1·eceptacle or to recorti measut·ement
A.6.3.3.l.3(b). values of all types of leakage cutTent test�.
Here the source being measureti is separated from the A6.7 Requirement� found in 6.7. 1 through 6.7.4 are general
frequency response-shaping nel:lvork by the combination of 1·equirement� fot· both T)pe 1 anti Typ e 2 EES.
the 900 ohm and 100 ohm resist01·s. The frequency 1·esponse
charncteristic is now indepentient of the circuit being tested. A6.7.I.I Cnnnedinn tn Dual Snurre nf Nnnnal PnwPr. For the
greatest assurance of continuity of electrical senice, the normal
The millivoltmete1· shoulti have an input impedance of 15 0 sout·ce should consist of l:lvo separate foll-capacity services, each
kilohms and a frequency response that is flat to well beyonti independent of the othe1·. Such services should be selected and
100 kHz. installed with full recognition of local haza rds of interruption,
This intiependence is achieveti, however, at a loss in signal such as icing and flootiing. Whe1·e more than one full-capacity
delive1·ed to the millivoltmeter. TI1e basic low-frequency sensi service is installeti, they should be connecteti in such a manner
tivity of this metering circuit is 1 mV of meter 1·eading for 10A that one will pick up the load automatically upon loss of the
of leakage current or, on a voltage basis, 1 mV of meter reacting other, and should be so arrangeti that the load of the emer
for 10 rnV at the input te1·minals of the netwot-k. gency and equipment systems will be trnnsfetTed to the alter
nate source (generntor set) only when both utility services a1·e
Fm· either of the suggested netwo1·ks, the 1·esistors anti capac de-energized, unless this arrangement is impractical and
itors should be mounteti in a metal container close to the milli waived by the authority having jurisdiction. Such services
voltmeter to avoid stray pickup by the leatis going to the meter. should be intedocked in such a manner a� to prevent parnlle
A.6.3.3.1.4 It is not the intent that each receptacle be tested. It ling of utility services on either primarv 01· seconda r y voltage
is intentieti that compliance be demonstrated through rantiom 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
ilkg-o-------t..- --------<.,_-----<C>---, tive to consult the powe1· companies affecteti as to problems of
0.15 synchronization. Facilities whose normal source of power is
µF supplied by two or m01·e separate central station-fed services
Input (dual sources of normal power) expe1·ience greate1· 1·eliability
of 1000 Q
than those with only a single feed.
test load
10 Q Millivoltmeter Installation of (',('neratnr Sets. Fo1· additional mate1·ial on tiiesel
- 0-------1..------------------C>----' engines, see National Research Council Publication 1132. DiPsel
i1kg = Leakage current being measured .Engines Jnr Use with (',f'neratars to Supply .t.'JMrgmr.y and Short TPrm
ElPt:trir Power.
FIGURE A.6.3.3.1.3(a) Circuit Used to Measure Leakage A.6.7.1.2.1 A Class X system is intended to give the facility the
Current with High Source Impedance. flexibility to provitie the appropriate duration before refueling
ope1·ations a1·e needed. TI1e hospital should determine the
900Q 1400Q appropriate run time for the EES and size the fuel tanks
i lkg- accordingly. Careful considerntion should be given to the
0.10 potential types of outages anticipated and the availability of
µF fuel. It should be noted that in some situations it might be
Input
of 100 Q permissible to size the fuel system to accommotiate less than
test load 48 hours of fuel. If life safety systems are includeti on the EES,
15 Q Millivoltmeter other coties anti standards might have minimum durations of
- 0-------1----------------<D---' required operntion.
i 1k9 = Leakage current being measured A.6.7.1.2.2.2 Some sources, such a� photovoltaic cells, operate
intermittently. The systems should be able to operate with sou1·
FIGURE A.6.3.3.I.3(b) Circuit Used to Measure Leakage ces out of service and still be able to provitie this 1·eduntiancy.
Current with Low Source Impedance.
2021 Edition
ANNEX A 99-189
A.6.7.1.2.2.3 1l1e intent of 6.7.1.2.2.3 is as follows: (3) Section 5.5 for 1·equirement� on energy converters - fuel
(l ) Contiguous or same-site nonhospital builrlings can be supply
se1·ved by the generating equipment. H oweve1·, such loads (4) Subsections 5.fl. l through 5.fl.4.7 fo1· requirement� on
should not compromise the integrity of the system serv rotating equipment
ing the hospital. Thus, any such contiguous or same-site A.6.7.2 It shoulrl be emphasized that the type of system selec
nonhospital buildin� can be served by the generating ted and its area anrl type of coverage should be appropriate to
equipment only if the u·ansfer means operates in accord the medical procedures being performed in the facility. Fm·
ance with fl. 7.1.2.2.3. example, a battery-operated emergency light that switches ·'on"
(2) Within a hospital builrling, 6. 75.1.3.2( l 0) permits "arldi when nm·mal power is interrupted anrl an alternate power
tional" loarls on the CL"itical branch and fl.7.5.1.4.4(9) source for suction equipment, along with the immediate availa
permit� "other equipment"' on the equipment system in bility of some portable handheld lighting, would be advisable
order to provide limited flexibility to a facility to arld one where oral and maxillofacial surgery (e.g.. extraction of impac
or tw-o loads not otherwise listed in fi.7.5.1.3.2(1) through terl teeth) is pe.-formerl. On the other hanrl, in rlental offices
fl.7.5.U.2(10), 6.7.5. 1.4.3, or fl.7.5.1.4.4(1) through where simple exu·action, restorntive, prosthetic, or hygienic
fl.7.5.1.4.4(9) to a critical branch panel or an equipment procedures are pel"formed, remote corrirlm· lighting for purpo
system panel. This is permitted to prevent the neerl for an ses of egress only woulrl be sufficient. Emergency power for
additional panel to se1·ve a small numbe1· of selecterl equipment would not be necessaq;. As with oral surgery loca
ci1·cuits in a particula1· area. These sections are not inten tions. a s111·gical clinic requiring use of life-support 01· emer
ded to permit large blocks of loads not listed in these gency rlevices, such as suction machines, ventilators,
sections to be on the critical branch or equipment system. caute1·ize1·s, or defib1·illato1·s, would requi1·e both eme1·gency
The intent of the division of the essential system loads light anrl powe1·.
into systems anrl brnnches is to ensm·e maximum 1·eliabil
ity of service to loads consirlered essential. Evet)' addi Distribution system arrangement� should be designerl to
tional load placed onto a system somewhat inct·eases the minimize interruptions to the elect1·ical systems due to internal
probability of a failure on the system that threatens the failures by the use of adequately raterl equipment.
integrity of senice to the balance of loarls served by the TI1e following factors should be considered in the design of
system. Therefore, while "additional" loads and "other the rlistribution system:
equipment"" are pe1·mitterl to be placed onto the CL"itical
branch anrl equipment sys tem in veq; limiterl situations, (l ) Abnormal voltages, such as single phasing of tlu·ee-phase
where a facility wants to put large blocks of loads not utilization equipment; switching or lightning surges, or
listed in 6.7.5.1.3.2(1) through 6.7.5.1.3.2(10), 6.7.5.1.4.3, both; anrl voltage rerluctions
or fl.7.5.1.4.4(1) through 6.7.5.1.4.4(9) onto the generat (2) Capability of achieving the fastest possible restoration of
ing equipment, the facility is pe1·mitted to do so, but only any given circuit(s) after clearing a fault
by designating these large blocks of loarls as ·'optional (3) Effects of future changes, such as increased loading or
loads" and by complying with fl. 7.1.2.2.3. supply capacity, or both
(4) Stability and power capability of the pt·ime mover during
A.6.7.1.2.4 Paragraph 12.5.3.3.5 inclurles the 1·equi1·ement� and after abnormal conditions
anrl components for an emergency operations plan. For addi (5) Sequence reconnection of loads to avoirl large current
tional loads to be considererl, see 6.7.1.2.2. l . inrushes that u·ip overcurrent rlevices or overload the
A.6.7.I.2.7.2(B) A� a supplement to ha1·rl-wi1·ed alarm annun generator(s)
ciations, it is permissible to have Level l and Level 2 EPS anrl (6) Byp ass arrangements to allow testing and maintenance of
ATS functions monitored off-site. Monitm·ing stations can system component� that coulrl not othetwise be main
include page1·s, cell phones, and Internet-connected devices. tained without disruption of important hospital functions
(7) Effects of any harmonic current� on neutral conrluctors
A.6.7.1.2.7.2(H) An example of a centralized computer system and equipment
is a building automation system.
Careful consideration should be given to the location of the
A.6.7.1.3.4 During operation. EPS and related equipment spaces housing the component� of the essential electt·ical
reject consirlerable heat that needs to be removerl by proper system (EES) to minimize interruptions causerl by natural
ventilation 01· air-cooling. In some cases, outdom· installations fot·ces common to the area (e.g., storms, floods, or eanh
1·ely on natural air circulation, but enclosed installations need quakes; <ll" hazards ct"eated by adjoining structtu-es or activities).
properly sizerl, properly positione d ventilation facilities, to
prevent recirculation of cooling ai1·. The optimum position of Consideration should also be given to the possible interrup
ai1�supply louvern and radiator air discha1·ge is on opposite tion of nm·mal electt·ical services 1·esulting from similar causes
walls, both to the outdoors. r110:A.7.7. ll as well as possible disruption of normal electrical se1·vice rlue to
internal wiring anrl equipment failures. Consideration should
A.6.7.1.3.4.2 See l 10.3(b) of NFPA 70 for more information be given to the physical separation of the main feerlers of the
on the manufactm·e1·'s installation inst1·uctions. EES from the normal wiring of the facility to pt·event possible
simultaneous destruction as a 1·esult of a local catastrophe.
A.6.7.1.3.5 Refer to the following sections in NFPA 110 for
specific requirements: In selecting electrical rlistribution aITangement� anrl compo
(l ) Section 5.3 for 1·equirement� on energy conveners nents for the EES, high priority should be given to achieving
temperatu1·e maintenance maximum continuity of the elect1·ical supply to the load.
(2) Section 5.4 for requirement� on energy converters Higher consideration should be given to achieving maximum
capacity reliability of the alternate powe1· source anrl its feede1·s 1·athe1·
than protection of such equipment, provided that the protec-
2021 Edition
tion is not reguiretl to p1·event a g1·eate1· tlu·eat to human life. A.6.7.4.l.l.5(A) When event,;, such as the issuance of storm
such as fire, explosion, and electrocution, than would be warnings, indicate that power outages might be likely, good
caused by the lack of an essential electt·ical supply. practice recommends the wa1·ming up of generator set.<; by a
1·egular exe1·cise period. Operation of generatm· sel<; for short
A.6. 7.2.I.I It is important that the various ovei-cutTent de,ices intervals should be avoided, particularly with compression igni
be coordinated, as far a,; practicable, to isolate faulted circuits tion engines, since it is harmful to the engines.
and to protect against cascading operation on short-circuit
faults. In many systems, howeve1·, foll coordination could Recm·ds of changes to the essential electrical system should
compromise safety and system reliability. Primary consideration be maintained so that the actual demand likely to be produced
also should be given to prevent overloading of eguipment by by the connected load will be within the available capacity.
limiting the possibilities of la1·ge cutTent inrushes due to instan
taneous re-establishment of connections to heavy loads. The A.6.7.4.1.2.l Main and feede1· circuit breakers should be pe1·i
terms coordination and coordinated as used in 6.i.2.1.l do not odically tested under simulated overload trip conditions to
cover the full 1·ange of ove1-cu1Tent conditions. ensure reliability.
A.6.7.2.1.2.l(A) Where special loads require more rapid A.6.7.5 General requirement,; from 6.7.1 through 6.7.4 a1·e
detection of power loss, underfrequency monitoring also might also applicable to Type l EES.
be provided. Upon frequency decay below the lowe1· limit A.6.7.5.l Type l essential elect1·ical systems are comp1·ised of
necessary for prope1· operation of the loads, the transfe1· switch th1·ee separate branches capable of supplying a limited amount
should automaticallv initiate transfer to the alternate source. of lighting and power service that is considered essential for
(SPeA.6.2.15 of NI-PA 110.) r110:A.6.2.2.l] life safety and effective facilitv operation during the time the
A.6.7.2.I.2.l(A)(2) See 6.2.5 and 6.2.7 of NFPA 110. normal electrical se1·vice is intetTupted fo1· any 1·eason. These
r110:A.6.2.2.1(2) l tlu·ee separate branches are the life safet)'; CI"itical, and equip
ment branches.
A.6. 7.2.1.2.3 Authorized pe1·so1rnel should be available and
familiar v.�th manual operation of the transfer sMtch and A.6.7.5.1.2.4(3) Departmental installations such as digital dial
should be capable of determining the adequacy of the alter ing systems used for intradepartmental communications could
nate power source prior to manual transfer. rno:A.6.2.4 l have impaired use during a failure of electrical se1vice to the
area. In the event of such failure, those systems that have ligh
A.6.7.2.1.2.4 Fm· most applications, a nominal delay of ted selector buttons in the base of the telephone instrument or
l second is adequate. The time delay should be shoi-t enough in the desk unit� known as "director sets" \,ill be out of service
so that the generator can start and be on the line within the to the extent that the lights will not function and that the
time specified for the type cla,;sification. r110:A.6.2.5l buzzer used to indicate incoming calls will be silenced. The
lack of electt·ical energy ,,ill not prevent the use of telephones
A.6.7.2.1.2.7 It is 1·ecommended that the timer for delay on for outgoing calls, but incoming calls v.ill not be signaled, nor
rett·ansfer to the primary source be set for 30 minutes. The 30- will inte1·communicating calls be signaled. This communication
minute recommendation is to establish a "normalized"' engine failm·e should be taken into consideration in planning essential
temperatu1·e, when it is beneficial fo1· the engine. NFPA 70 electt·ical systems.
establishes a minimum time requirement of 15 minutes.
r110:A.6.2.s1 A.6.7.5.1.3 It is recommended that facility authorities give
consideration to providing and propedy maintaining automatic
A.6.7.2.1.2.11 Fm· maintenance purposes, consideration battery-powered lighting unit� or systems to provide minimal
should be given to a transfer switch counter. r110:A.6.2.13l task illumination in operating rooms, delivery rooms, and
A.6. 7.2.1.2.13 Automatic transfer switches (ATS) can be provi certain special-procedure radiology rooms, whe1·e the loss of
ded with accessory controls that provide a signal to operate lighting due to failure of the essential elect1·ical system could
remote motor controls that disconnect motors prior to transfer, cause severe and immediate danger to a patient undergoing
and to 1·econnect them aft.et· t1·ansfe1· when the residual voltage surgery 01· an invasive radiographic procedure.
has been substantially reduced. Anothe1· method is to provide A.6.7.5.1.3.2(6) Departmental installations such as digital dial
inphase monitors within the ATS in order to prevent 1·etransfe1· ing systems used for intradepartmental communications could
to the primary source until both sources are nearly synchron f
have impaired use during a failure o electrical service to the
ized. A third method is to use a programmed neutral position area. In the event of such failure, those systems that have ligh
transfer switch. See Section 230.95(8) of NI-PA 70. ted selector buttons in the base of the telephone instrument or
fl IO:A.6.2.151 in the desk unil� known as "director set�" will be out of service
A.6.7.2. 1.2. I7 Standards for nonautomatic transfe1· switches to the extent that the lights will not function and that the
are simila1· to those for automatic transfe1· switches, as defined buzzer used to indicate incoming calls will be silenced. The
in 3.3.7.l and 3.3.7.3 of NFPA 110 with the omission of auto lack of electrical energy will not prevent the use of telephones
matic controls. r110:A..6.2.16l for outgoing calls, but incoming calls will not be signaled, nor
will inte1·communicating calls be signaled. This communication
A.6.7.2. 1.5.3 Conside1·ation should be given to the effect that failtu-e should be taken into consideration in planning essential
load interruption could have on the load dm·ing maintenance electrical systems.
and se1vice of the transfer switch.
A.6.7.5.1.4.3 The equipment in 6.7.5. l .4.3(A)(l ) through
A.6. 7.2.2.5(B) If colm· is used to identify these 1-eceptacles, the 6. i.5.l .4.3(A) (3) can be arranged for sequential delayed
same color should be used throughout the facility. automatic connection to the alternate power source to prevent
overloading the gene1·ator where engineering studies indicate
that it is necessa1y
2021 Edition
ANNEX A 99-191
A.6. 7.5.1.4.4 For elevator cab lighting control and signal A.6.7.6.2.l.6(E)(l)(a) The out�ide design temperature is
system require men t�, see 6.7.5.1.2.4 ( 5) . based on the 971/2 percent design value, as shown in Chapter 24
of the ASHRA..E Handbook - Fundammtak
In instances where inteITuption of normal power would
1·esult in other elevatm·s stopping between floors. throw-over A.6.7.6.2.l.6(E)(2) For elevator cab lighting, control, anrl
facilities shoulrl be prmirlerl to allow the temporary operation signal svstem requirements, see 6.7.6.2.l.5(C) ( 6).
of any elevatm- for the 1-elease of patient� 01- other pe1·sons who
are confined between floors. A.6.7.6.3.1 See NFP./i 70for installation n�qui1·ement�.
A.6. 7.5.1.4.4(2) The out�ide design temperature is based on A.6.7.6.3.2 If color is userl to identify these receptacles, the
same color should be used throughout the facility.
the 9 7½ percent design value, as shown in Chapter 24 of the
A.SHRAE Handbook - Fundanumtak A.6.8.1 The intent of these tests is to a�sure that all electrical
A.6. 7.5.1.4.4( 9) Consideration shoulrl be given to selected equipment is operational ,vithin industry-recognized standards
and the manufactm·e1·'s tolerances and that equipment is in
equipment in kitchens, laundries, aml radiology rooms and to
selected central 1·efrigeration. stalled anrl functioning in the system in the manne1· intended.
The test� and inspections should determine suitability for
It is desirable that, where hea\-y interrnption current.� can be initial and continued reliable operation and provide a baseline
anticipated, the transfer load be rerlucerl by the use of multiple fot· the ongoing electrical p1·eventive maintenance (EPM)
transfe1· devices. Elevato1· feeders, fix instance, might be less program.
hazardous to electrical continuity if they are fed through an
A.6.8.2 The intent of this requirement is that the components
individual transfer device.
of the elect1·ical system frerling Category l and Category 2
A.6. 7.5.2.1 See 1VFPA. 70 fm installation 1·equirement�. spaces a1·e tested to ensu1·e that the complete system operates
in the manner anticipated and continues operating reliably.
A.6. 7.6 General 1·equi1·ement� from 6.7.1 through 6.7.4 a1·e This requires testing of the individual electrical component� of
also applicable to Type 2 EES. the system. as well as the development of functional perform
A.6. 7.6.2.1 Type 2 essential electt·ical systems are comp1·ised of ance tests to confirm proper operation of the system as a
tw·o separate branches capable of suppl)'ing a limited amount whole. Examples of industry-recognized standards for the
of lighting anrl power service that is considered essential for development of site acceptance test procedut·es include ANSI/
the protection of life anrl safety and effective ope1·ation of the NETA ATS, Standard for A.rcl'filana ];,sting SpPrijirations for Eln:t,i
f
institution rlu1·ing the time normal electt·ical senice is inten-up wl Power Equip,,nmt and Systems, and Chapter 31 o NFPA 70B.
ted for any reason. These two separate branches a1·e the life A.6.9.1.1 The purpose of any elecu·ical preventive mainte
safety and equipment branches. nance (EPM) program is to establish the condition of equip
The numbe1· of transfer switches to be used should be based ment, determine what work shoulrl be done, anrl verif)' the
upon reliability, rlesign, and loarl considerations. Each branch equipment will continue to function until the next scherluled
of the essential electrical system shoulrl have one or more trans servicing occm·s. Inspection anrl testing are best <lone in
fe1· switches. One transfe1· switch should be pern1itted to sen·e conjunction ,vith routine maintenance. In this way. many
one or mm·e branches in a facility with a maximum demand on minor items that require no special tools, training. or equip
the essential electrical system of 150 kVA ( 120 kW). ment can be corrected as they are founrl. The inspection anrl
testing program is probably the most important function of a
A.6. 7.6.2.l.5(C)(4) Departmental installations such as digital maintenance department because it establishes what shoulrl be
dialing svstems userl fot· intradepartmental communications <lone to keep the system in service performing the function for
could have impaired use during a failure of electrical service to which it is requi1·ed.
the area. In the event of such failure, those systems that have
lighted selecto1· buttons in the base of the telephone instru A.6.9.3.1 Approp1·iate con-ective measures can inclurle. but
ment or in the desk unit� known as "directm· set�" will be out of are not limited to, repair, replacement, and adjustment. Follow
senice to the extent that the light� will not function and that through with necessary repairs. replacement. and adjustment is
the buzzer used to indicate incoming calls will be silenced. The the end purpose of an effective EPM program.
lack of electrical ene1·gy w ill not pt·event the use of telephones A.6.9.4.1 See Table A.6.9.4.l for sources ,vith recommenrlerl
fot· outgoing calls, but incoming calls will not be signaled, nor maintenance acti\ities.
will intercommunicating calls be signaled. This communication
fa.ilu1·e should be taken into consideration in planning essential A.6.9.4.2 Health ca1·e facilities that choose to establish alte1·
electt·ical systems. nate equipment maintenance (AEM) activities and/or sched
ules must develop, implement, and maintain a documented
A.6. 7.6.2.l.6(E) Other selected equipment can be served by AEM program to minimize risk to patients and others in the
the equipment branch. Note that consideration shoulrl be facility associated with the use of electrical utility equipment.
given to selected equipment in kitchens and launrl1·ies anrl to Generally, multiple factors must be considered because diHer
selected central refrigeration. ent types of equipment pt·esent different combinations of
It is rlesirnble that, where heavy interrnption cun-ents can be seve1·it:v of potential harm anrl likelihood of failm·e.
anticipated. the transfer load be 1·educed by the use of multiple A.6.9.4.2.2(1) Stanrla1·rl examples for physical plant equip
transfer rle\ices. Elevator feeders, for instance, might be less ment maintenance can be found in the Ame1·ican Society fot·
hazardous to electrical continuity if they are feel through an Healthca1·e Enginee1·ing (ASHE) document, Maintmanre
individual transfer device. l\ianagnnent fo-r Health Care Farilities, and in NFPA 70B.
2021 Edition
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 99-193
the intended use as a stand-alone wi1·eless communication Part 2: ('_,nllateml standard : ElPl'tmmagnPtit: dislurban,·es - Require
system. ment\ and tests; 60601-1�. Mediral flectrii:al NJuipmmt - Part 8:
01llateral standard: A.lann systems - General requirPments, tests and
The requi1·ement� in ANSI/IEC/ISO 80001-1-1, App!ir:atirm nf
guidan,:e fnr alarm .rystnm in 11/.Pdiral eln:triral Pquipment and medii:al
Risk lvlanagnnimt fnr IT ;\'Ptwurks Inrnrpomting A-Jniii:al Devi,:Ps -
fiPrtrical systnns; and so forth).
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 TI1e 1·esponsible organization can also contract with a
Netwmks Inrnrpnrating A1edi,:al Devias - Part 2-5: A.ppliratinn provider of communication equipment to integrnte a wireless
Guidanre - Guidanre frrr Distn'/mted Alarm Systmis, shoul<l he communication sy stem with nurse call s�tem or with the clini
followed whenever a nurse call system is integrate<l with a cal IT netw01·k for the purposes of enhanced clinical staff
supplemental communication system. communications. Howeve1·. such an integrntion would not be
listed to any governing standard.
A. 7.3.3.1.2.1 Patient care spaces and nursing unit support
areas can contain many types of call stations \\�th varying Therefore, where a wireless communication system 1s rnte
combinations of call initiation functions (e.g., code call, staff grnte<l with the clinical IT netwo1·k and used as a clinical ala rm
emergency; medical <levice alarm, help, assistance). A single notification 01· enhance<l communicati on system, it is necessary
call station can be equipped an<l configured to activate a single for the responsihle organization to follow and enact the risk
call type or a number of <liffe1·ent call types, an<l can have bi management requiremenl� estahlished in ANSI/AAMI/IEC
<lirectional voice communication capability. 80001-1, Appliratirrn nf Risk Jv!anagrment fnr IT Jlietwrrrks lnr.orporat
ing Medir:al Devices - Part 1: Rnles, &sprmsi/Jilities and Artivities.
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 Furthe1· in this context, the end-to-en<l system integration
as liste<l wi1·e<l 01· w i1·eless pillow speakers, pendant controls call and il� management nee<l to also conform to the guidelines
cor<ls, and patient- or staff-worn personal pendanl� a re permit established in ANSI/AAMI/IEC 80001-2-5, Af1plir:atinn nf Risk
te<l to initiate patient or staff calls. A call station that serves two 1vfanagnnmt for IT Netwnrks Inrorprrrating 1vfedii:al Devias -
beds is pe1·mitte<l when beds are locate<l adjacent to each othe1·. Part 2-5: ,4pplir:ation Guidani·e - Guidana fnr DistributPd Alarm
Systems.
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 A.7.3.3.7.1 As the clinical emironment becomes more an<l
1·egulatory standat·d, and is beyond the scope of this code. more automated, integrnted and evolved there is a need to
enslu-e that the serve1·s and networking equipment that trnns
A. 7.3.3.1.3.1 'When tw·o or more call stations are located in the
port interoperable clinical data an<l communications over a
same a r e a and all a re visible from any call location, the alarm
clinical IT network a1·e properly institute<l and sufficiently
should be capable of being cancele<l at any of these locations.
manage<l. ANSI/AAMI/IEC 80001-1, ,4pf1liratian nf Risk ManagP
This method of call cancelation can be applied to all call
ment for IT Netwrrrks Incorprrrating Iviedical Devias - Part 1: Rnles,
station types.
RPspnnsi/Jilities and ,4i:tivities, is the governing stan<lar<l hy which
A. 7.3.3.1.4 A code call can also be refetTed to as an emer the clinical IT netwo1·k needs to he manage<l.
gency 1·esuscitation alarm. A. 7.3.3.7.2 While all nu1·se call s�tems need to be listed to
A. 7.3.3.1.4.1 \Vhen two or more call stations are locate<l in the UL 1069, Standard fnr Hospital Signaling and Nurse Call E quifr
same are a an<l all a re "isihle from any call location, the ala1·m mmt, not all ntu-se call systems can be identified for use on a
should be capahle of being canceled at any of these locations. s ha1·ed clinical IT network. Only those nut·se call s�tems that
This method of call cancelation can be applied to all call are liste<l for use on a shared network are permitted to use the
station types. clinical IT network infrastructure.
f
A. 7.3.3.5.2 Cun-ently, no standanl exists for the certification A.7.3.3.7.3 To ensure an ef ective, reliable, and 1·esilient clini
of a wireless communication system having the specific inten cal IT network, two indepen<lent physical pathways pro"i<ling
<le<l use as a clinical alarm communication and notification netw-ork communications nee<l to be provided. Both paths
system. While <lesirable fot· enhancing clinical communications need to be at operational 1·eadiness at all times. Operational
and optimizing clinical workflow, these types of communica re adiness can be ensured by continuous self�monitot·ing of
tion systems have inherent reliability limitations. For example, each path. All equipment items comprising e ach clinical IT
there is no notification at a wireless page1· when it is out of netwrn·k path need to be verified for availability by means of
rnnge fo1· receiving messages and the1·e is no alen at the central communication. En<l-point terminal equipment items (e.g. .
station that the communication device is unreachable or return computers, monitors, disuete medical devices, <liscrete devices
confirmation that a message has been delivered or received. 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
A document with info1·mation on how to manage an<l 1·equi1·e one ph�ical connection to the clinical IT netwot·k.
control risk is ANSI/AAMI/IEC 80001-1, ,4ppli i:atirm of Risk
l\Janagnnent for IT Networks Inr orpnrating I\4.ediral DevirPs - A.7.3.3.7.5 Examples for operational monitoring of the clini
Part 1: RnlPs, Responsibilitie.1 and Artivities. cal IT network inclu<les, but is not limited to, the following:
(1) Environmental changes, including i-isk� associated with
There might be manufacturers of FDA-cleare<l medical
data and system security vulnerahilities
equipment that can have wireless communication capabilities
(2) Operational/perfo rmance feedback from both automa
and that might he FDA cleared for a specific intended use.
te<l measurement an<l use1· fee<lback (e.g., spee<l proh
Such medical equipment would typically be certified to one or
lems, high error rates, equipment failure, malicious
more ANSI/AAMI ES60601 standar<ls (e.g., 60601-1-1, Medii:al
software attacks, and so forth)
e!n:trii:al n1uipment - Part 1: Gmeml requirements fnr basir safety
and essential perfrrrmanrP, 60601-1-2. lHedii:al ell'ctrical NJuipment -
2021 Edition
A.8.2.1 1l1ere are no inteniependencies for each type of mrth mndurtor. A protective earth conductor is relied upon for
system (e.g., medical gas, electrical, potable water, nonpotahle safety and provides one means of protection from electric
water, nonmedical comp1·essed air, heating). A risk a�sessment shock. A functional earth conciuct01· has no safety function and
of each system should be conducted to evaluate the 1·isk to the noes not provicie a means of protection against electric shock.
patient, staff, and visitors. A ciouble-insulated medical product is permitted (but not
1·equired) to have a functional earth conciuctor that is referred
A.9.2.1 1l1e1·e ar·e no inte1·dependencies for each type of to as a funrtional ground mndurtor.
system (e.g., medical gas, electrical, potable water, nonpotable
water, nonmeciical compressed air, plumbing). A risk a�sess A.10.2.3.6 Consideration shoulci be given to certification of
ment of each system should be conducted to evaluate the risk relocatable power taps in accorciance with UL 1363A, Outlinf of
to the patient, staff, and visitors. It is possible when applying Investigation for SpPrial Purpose Relomtable Pm11Pr Taps. which
this section to identify multiple categories of systems serving a acid1·esses the 1·equirement� currently in this code anti addi
single patient. For example, see A.4. 1. tional safety requirements, such as use of hospital-grade recep
tacle outlet� ai1d plugs, integrity of the enclosm·es, ai1d testing
A.9.3.1.3 P1·e,ious editions haci 1·equired smoke purge systems for grounciing and leakage current.
f
in these locations. The elimination o flammable anesthetics
anti limited use of combustible material in modern ORs makes AI0.2.3.6(1) Tape, adhesive, anti hook-and-loop fasteners are
this requirement obsolete. not considered to be secure means of attachment. A clamp or
bracket that has been hand or tool tighteneci is conside1·ed
A.9.3.3.2 ASHRAE Guideline 0, Tiu Cmmnissioning Pmass, securely attacheci.
ASHRAE Guicieline I .I, HVAC&R Tffhniral RPquirnnmtsfor thf
Cmnmissinning Pmre.��. and ASHR.AE Stanciarci 202, Commiss ion AI0.2.3.6(2) A means of meeting the requirement is through
ing Pmr.f.�� for Buildings and Systnns. while not mandatory. can summation of nameplate ampacity of connected equipment
provide guidance for this requirement. and proactive administrative actions (e.g., education, signs). A
circuit protective device (e. g., circuit breaker, surge protector,
A.9.3.6.3 Paragraph 9.3.6.3 only covers fluids that are storeci supplementai·y protect01·), alone, is not considereci sufficient.
in enclosed spaces.
AI0.2.4.3(2) The disconnection meai1s is permitteci only to
A.9.3.6.5.1 See Table A.11.3.5. facilitate replacement; as such, ceiling drop cords cannot be
A.9.3.8.1 Inlet� can be of any design suitable for the plume disconnected for alternative usage. See Chapte1· 6 f(')l' crite1·ia of
capture device in use, provicieci the design noes not permit 1·eceptades.
interconnection to any medical vacuum, WAGD, or housekeep AI0.3.1 Visual inspections do not have to be formal or ciocu
ing vacuum systems. menteci by any particula1· staff member. All staff a1·e expected to
Flow control for the inlets shoulci be as appropriate for the be observant of the condition of the equipment they use,
plume capture cievice in use. including power cord assemblies.
A wan1ing system, such a� one that uses a builciing automa AI0.3.2 The1·e a1·e several methocis for measm·ing ground
tion system, that monitorn the operation of the sou1·ce equip w:i1·e resistance accurately. Three examples a1·e described as
ment should be provicieci. follows and shown in Figure A. l 0.,>.2(a) through Figure
A.10.3. 2(c):
A.9.3.8.1(1) A dedicated medical plume evacuation system can
senre multiple locations. The discl1a1·ge of a dedicateci system (l ) 1wo-lVire RPsistanre Tn:hniqill'. A kn own cutTent is fed
can be filtereci or unfiltered. through the unknown resistai1ce. A high-input
impedance voltmeter mea�m·es the voltage drop across
A.IO.I An appliance that yielcis en-oneous data or functions the resistance, R. anti R is calculated a� voltage divideci by
poorly is potentially ha1·mful. Quality anti assurance of fall impeciance, V/ I. This technique measures the lead resist
appliance performance is not covered, except as it relates to ai1ce in series ·with the unknown resistance. When the
di1·ect electt·ical 01· fit·e injury to patients 01· pe1·sor111el. unknown resistance :is a ground w:i1·e (less thai1
0.15 ohm), the lean 1·esistance is appt·eciable. This is
The matet-ial in this annex, as it relates to electrical safety, accounted for by shorting the lead w:i1·es together and
f
interpret� some of the ba�ic criteria by presenting dif erent "zeroing" the voltmeter. The actual resistance, in effect,
methodologies and alten1ative proceciures to achieve the level subu·act� out the lead wire 1·esistance. In orde1· ft')!' this
of safety defined by the ct"iteria. technique to be reasonably accurate for measu1·ing
A.10.1.3 Risk categorization is not appropriate for this chap ground wires, an active high-impedance millivoltmeter
ter. Much of the chapter deals with electt·ical safety issues. Any has to be used.
line-powe1·ed device that does not meet these requirement� (2) Four-VVirP RP.,istanrP 1Prhnique. This technique is vety simi
poses the risk of electric shock to patient� or personnel, 1·ega1·d la1· to the l:\Vo-wi1·e resistance technique. The diffe1·ence is
less of where it is useci or the clinical application of the device. that the known current is fed to the resistai1ce to be mea�
Shock and fire 1·isk is not ciependent on the required 1·eliability ured through a pair of leans separate from the pai1· of
of the device or the extent to which patient diagnosis and treat leads to t he voltmete1·. The voltmeter is measuring the
ment depends on the cievice. Even categorization regarding true voltage across the resistance to be measureci, regai·ci
clit·ect cardiac connection 01· patient contact are not 1·elevant as less of the resistai1ce of the mea�uring leads. This method
death or i1tjury can occur in any case. eliminates the need for zeroing out the measuring lead
resistance.
A. I 0.2.3.2.4 ANSI/ AAMI ES60601-1, Medir:al Plei:tn'ral equipwnt (3) A,C CurrPnt Method. This technique utilizes a step-<lown
- Part 1: t,fnl"l'lll rPquirmu>nt� for basic safety and essmtial perform transfonne1· of known voltage output to feed cuITent
anr.P, defines the te1·ms protft:tive mrth r.ondurtor and functional through the ground wire and measm·e the cun-ent that
2021 Edition
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 0.05 microfarad Millivol tmeter
1000ohms
ha� to be es tablished with the test leads shorted. This value
needs to be subtracted from the test measurement. 100 ohms
A.10.3.3 For complex leak age cut-rent waveforms, a single
1·eading from an appropriate mete1·ing system can represent FIGURE A.10.3.3 Leakage Cw-rent Measw-ements (1.0
the physiologically effective value of the composite waveform, Millivoltmeter Reading Corresponds to Input Current of 1.0
provided that the contt·ibution of each component to the total Microampere).
1·eading is weighted in accordance with 10.3.3.
This weighting can be achieved by a frequency response A.10.3.3.3 This test is not valid when perfo1·med on the load
shaping network that precedes a flat-response meter, 01· by a side of an isolation trnnsformer or an isolated power system,
mete1· whose own frequency response charncte1·istic matches because the values ob tained will be falsely low.
that of 10.3.3.
A.10.3.5.4 Whe1·e existing equipment exceeds 500 µ.<\, meth
If the requi1·ed pe1·fo1·mai1ce is obtained by a meter with inte ods to 1·educe leakage cut-rent, such as the addition of small
gral 1·esponse-shaping properties, then that mete1· should have isolation transformers to that equipment, or methods that
a constant input resistance of IO00 ohms. (A high-input provide equivalent safety by adding 1·edundant equipment
impedance meter can be used by shunting a 1000 ohm resis tor ground, are pe1·missible.
across the mete1·'s input terminals.)
A.10.3.6 Although the touch current value is 500 µ.'\, the
If, however, the required frequency response is obtained by a patient lead leakage cutTent limit ft,.- nonisolated input has
net\vork that precedes an otherwise flat-response meter, then been intentionally limited to 100 µA. This decision is in 1·ecog
the input impedance of the network should be 1000 ohms nition of the need fot· a greater level of electrical safety fot·
± 10 pe1·cent, over the frequency range from 0 to l MHz, and those portions of devices that make direct electrical patient
the frequency response of the net\vork-meter combination connection.
should be subs tantially independent of the impedat1ce of the
A.10.5.2.2 The refe1·ence to ANSI/AAMI ES60G0l-l , Mediral
signal source.
elei:triral NJuipmmt - Part I: (',mf'fal rPrJuimnmt1 fm- basir sapty
For maximum chassis leakage current permitted (i.e., and fssential f!Prfrmnanre, is the U.S. version and incl udes devia
300 µi\) below l kHz, this net\vot·k will yield the limiting tions for use in the United States. Other countt·ies often use
cut-rent of 10 mA above 30 kHz. the IEC ve1·sion or other versions with deviations.
A suggested input net\vork is shown in Figure A.10.3.3. 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
2021 Edition
advises manufacturers, and A.10.5.4.5 advises use1·s, of precau A.I 1.1.2 Respiratory therapy is an allied health specialty
tions to take to reduce the fire hazard. Paragraph 10.5.4 !isl� employed with medical direction in the treatment, manage
four \Nays of attacking the problem. Note that an OE A can be ment, control, rliagnostic evaluation, and ca1·e of patient� with
created not only in a ventilato1· or oxygen tubing, but also in an rleficiencies and abnormalities of the carrliopulmonary system.
oxygen tent or incubator. Special precautions should be taken. (Courtesy of the American Association for Respiratory Therapy,
1720 Regal Row, Dallas, TX 75235.)
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� Respiratmy therapy includes the thernpeutic use of the
locaterl within 30.5 cm (12 in.) of the exhaust port, because, in following: merlical gases and administration apparatus, e1ni
most instances, dilution to ambient levels occurs within a few ronmental control systems, humirlification, aerosols, medica
inches of the port; 30.5 cm (12 in.) provides an adequate safety tions, ventilatory support, bronchopulmonary rlrainage,
fact01·. Paragraph 10.5.4.1 provirles guirlance to minimize this pulmonary rehabilitation, cardiopulmonaty 1·esuscitation, and
hazarrl by requiring that only those parts of the apparatus that airway management. (Courtesy of the American Association for
are intenrled to be within the SIE are to he of concern. Even Respiratory The1·apy, 1720 Regal Row, Dallas, TX 7:>235.)
these components, such as nu1·se call buttons, leads, and so
forth, do not necessarily need to be listed for use in OE A, The1·e is a continual neerl for human diligence in the estab
because they usually conform to provisions of 10.5.4.1 ( 4); that lishment and maintenance of safe practices for respirato1y ther
is, they do not have hot surfaces, and they meet the require apy. It is essential for pe1·sonnel having responsibility for
ment� of Figure 105.4.l(a) through Figure 10.5.4.l(f). 1·espiratory therapy to establish and enfo1·ce appropriate
programs to fulfill the provisions of this chapter.
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· It is the 1·esponsibility of the arlministrative anrl professional
hut not to overspecify whe1·e the hazard is minimal. Thus, as staff of a hospital, or safety di1·ector, if one is appointed, to
they are orrlinarily userl, nurse call buttons, pillow speakers, arlopt and enforce appropriate 1·egulations for a hospital. In
anrl so forth, do not need to be listed for use in oxygen other health care facilities, responsibility could be assignerl to a
enriched atmospheres. sal·ety rlirecto1·, or othe1· 1·esponsihle pe1·son, who is, in tun1,
responsible to the administration.
Note, however, that these requirements apply only to the
intended use. The user shoulrl exercise vigilance to guard In institutions having a respiratory therapy service, it is
against an unintended use or an accidental failm·e, which can 1·ecommenrlerl that this se1·vice be di1·ectly 1·esponsible for the
vastly increa�e the hazard. arlministration of Chapter 1 1. Haza1·ds can be mitigated only
when there is continual recognition anrl understanding.
AI0.5.4.6 ·where possible, combustible mate1-ials such as hair,
fabric, and pape1· shoulrl be 1·emoverl from the vicinity where A.II.IA See Chapte1· 14.
the energy is delive1-erl. Wate1·--soluble surgical jelly has been A.I1.1.5 Risk categorization is not appropriate fo1· this chap
shown to dramatically rerluce the combustibility of such materi ter. Much of the chapter deals with ga� equipment safety issues.
als. 1\ny storage 01· use of ga� equipment in a health care facility
AI0.5.5.I Most laboratory fir·es involve biomedical or othe1- pt·esenl� 1·isks that the requirement� of this chapter 1·educe. Any
electronic equipment failures. The most common ignition gas-related rlevice that does not meet these requirements poses
factm·s are short circuits or grouml faults. Electt-ical wi1·e 01- the same 1·isk to patients or pe1·sonnel, 1-egardless of whe1·e it is
cable insulation is the mate1·ial most likely to first ignite in a used or its clinical application.
clinical laboratory fire. (Si¥' HnPltgP, G.A., AlillPr, A., Kll'in, /1.R., A.I1.2.7 It is particularly important that the intermixing of
Hamlin, a'.JJ., '�4,aidmtal Fires in Clinical Labomtnries. ") oxidizing anrl flammable gases unrle1- p1·essure be scrupulously
A 10.5.6.2 1\lthough several approaches to documentation avoided. Such mixing can 1·esult in a violent explosion.
exist in hospitals, the minimum acceptable documentation A.I1.3.5 Electric wiring anrl equipment are not required to be
should irlentify what was tested, when it wa� testerl, anrl explosionproof. See Table A.11.3.5.
whethe1· it pedormerl successfully. Adopting a system of excep
tion 1·eponing can be the most efficient fo1·m of 1·ecm·rl keeping A.I 1.3.5.2(5) The fit·e 1-esistance rating for walls and floors is
for routine rechecks of equipment or systems, thereby minimiz determinerl in accordance with ASTM El 19, Standard TPst Meth
ing technicians' time in recording the value of each measure ods fnr FirP Test� of Building Construction and MatPrial�, or UL 263,
ment taken. For example, once a test protocol is established, Jim &sistancP Rlltin�. The fi1·e protection rating fo1· rloors is
which simply means testing the equipment or system consistent determinerl in accm·dance with NFPA 252.
with Chapter 10, the only item (value) that needs to be recor A.I1.3.5.2(6) Elect1·ical devices should he physically protected,
rlerl is the failure or the deviation from the requirements of the such as by use of a protective barrie1· around the electt-ical de,i
chaplet· that was detected when a cm-rective action (1·epai1·) was ces, 01· by location of the electrical device such that it will avoid
undertaken. This approach can serve to eliminate, for exam causing physical rlamage to the cylinders or containers. For
ple, the neerl to keep indivirlual room sheet� to recorrl meas example, the device could be located at 01· above 1.5 m (5 ft)
urerl results on each receptacle or to recm·rl measurement above finished floor or othe1· location that will not allow the
values of all types ofleakage cun-ent tests. possibility of the cylinrlers or containers to come into contact
AI0.5.8.I "Personnel" includes physicians, n111·ses, nursing with the electrical device as requi1·erl by this section.
assistant�, enginee1·s, anrl technicians. A.I1.3.5.2(7) Examples of indi1·ect heating inclurle steam, hot
AI0.5.8.3 Qualification for equipment servicing rloes not water, anrl electric heating.
always include manufacturer t1·aining, as requirerl knowledge
anrl skills can be ohtainerl hy other means.
2021 Edition
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 All.3.6 When determining the volume of stm·age, do not
ted, such as by use of a prntective b aITiet· arnunrl the electrical consider cylinders and containet·s that at-e in use. Only the
devices, or by location of the electri cal rle,ice such that it will volume of stored gas that is in excess of 8.5 m� (300 ft�) is
avoid causing physical damage to the cylinders or containers. requi1·ed to be located in an enclosure, since 11.3.7 already
For example, the device could be located at <ll" above 1.5 m pet·mits up to 8.5 m� (300 ft�) without any special storage
(5 ft) above finished floor 01- other location that will not allow requiremenL�.
the possibility of the cylindet·s 01· containers to come into
contact with the electrical device as required by this section. A.11.3.B Limited quantities of combustibles applicable to the
cylinde1·s, such as cylinder labels, gauges, posted safety signs,
All.3.5.2(13) Considerntions for this access include prnxim anrl similar, are permitted.
ity to loading <locks, access to elevators, and passage of cylin f
ders through public areas. 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-
2021 Edition
de1·s attached di1·ectly to, and supported by. the device (such as Al 1.5.1.1.3 Patient� and hospital pe1-sonnel in the area of
a gas anesthesia apparatus) used to administer these gases, it is administration should be advised of respiratory therapy hazards
recommended that two cylinders of each gas be attached to the and 1·egulations.
administe1·ing device.
Visito1·s should be cautioned of these haza1·ds through the
A.11.4.1.2 The Pin-Index Safety Svstem consists of a combina prominent posting of signs. (Sff 11. 3.12.)
tion of two pins projecting from the yoke assembly of the appa
ratus and so positioned a� to fit into matching holes dt·illed A.I 1.5.1.1.4 Solid fuel-burning appliances include wood
into the cylinder valves. It is intended to protect against the bun1ing fireplaces, wood stoves, and simila1· appliances. These
possibility of error in attaching the flush-type valves, with which pose a greater risk in locations where oxygen is being provided
gas cylinde1-s and othe1· sou1·ces of gas supply are equipped. to than gas-fueled appliances, in pan due to thei1· ability to emit
gas apparatus having yoke connections. embe1·s into the environment.
A.11.4.1.4 Fabrication specifications are contained in CGA V-1 A.I 1.5.1.1.5 Such toys have been associated with fire incidents
(ANSI B57.l), Standard for ComprPssPd Gas Cylindi'r ValvP Out/J>t in health ca1·e facilities.
and Inlft Conntrtions. Connection No. 860, shown in that docu A suggested text fot· precautionary signs for oxygen tent
ment, illustrates the system. Connection No. 870 (Oxygen, canopies and oxygen hoods used in pediatric nursing units is
Medical), Connection No. 880 (Oxygen-Carbon Dioxide the following:
Mixture), Connection No. 890 (Oxygen-Helium Mixture),
Connection No. 900 (Ethylene), Connection No. 910 (Nitrous CAUTION: OXYGEN IN USE
Oxide), Connection No. 920 (Cyclopropane), Connection ONLY TOYS APPROVED BY
No. 930 (Helium), and Connection No. 940 (Ca1·bon Dioxide)
are for specific medical ga.�es and ga.� mixttu-es and utilize the NURSES MAY BE GIVEN TO CHILD
ba�ic dimensions of Connection 860.
A.I 1.5.1.3.3 Service manuals, instructions, and procedures
A.11.5.1.1.2 Out�ide of a patient ca.re room, 11.5.1.1.2 prohib provided by the manufacttu-e1· should be considered in the
its sout-ces of open flames within the site of intentional expul development of a progrnm fot· maintenance of equipment. The
r
sion l ft (0.3 m) l of a nasal cannula. No sources of open experience accumulated by the facility and others (evidence
r
flame a.re permitted within the area of administ1·ation 15 ft baserl maintenance) shoulrl be userl to adjust manufacture1·'s
(4.3 m) l for othe1· types of oxygen delivery equipment or in recommendations whenever and wherever appt·opriate, even if
patient ca1·e spaces (�ff 11.5.1.1.3). they indicate no maintenance program is required.
The amount of oxygen delivered by a na.�al cannula is limi Al 1.5.2.1.1 "Personnel" typicallv includes physicians. nurses,
ted. One ft (0.3 m) is sufficient separation from an oxygen nursing assistant�, 1·espiratory therapist�, enginee1·s, techni
enriched atmosphe1-e produced by a nasal cannula, which is cians, and others.
oxygen delivery equipment used outside of patient care spaces.
In the open air, dilution goes to ambient levels (not oxygen A.I 1.5.2.2.2 CGA P-2.5. Tmnsfilling of High PrP.rnm Gaw't.JU�
enriched atmosphere) within a few inches of the cannula open Oxygm U�td for &spimtion, contains both mandatory and
ings, but 12 in. (300 mm) provides an adequate safety factor. nonmandatoty language. Enfot-ceable language uses the te1-m
Other oxygen delivery equipment, such a� masks, are not inclu shall; nonmandato1y language uses the term should. This
ded since ma.�ks would not t ypically be associated with mobile section indicates that this code is making refe1·ence only to the
patient� in health ca1·e facilities and can deliver greater quanti mandatoty requi1·ement� in that document.
ties of oxygen than nasal cannula. A.11.5.2.3.2 CGA P-2.6, Tmnsfilling of Liquid Oxygen U.�Pd for
The household-style nursing homes that include kitchens RPspimtion. describes the recommended pt·ecautions and safety
intended for 1·esidents' use and enclosed gas fit·eplaces pt·esent procedtu-es when transfilling liquid oxygen used fot· respira
a source of flame ignition to which residents will be exposed. tion. Mishandling of oxygen present� potential hazards to both
Resident� utilizing a na.�al cannula would potentially not be trained and untrained persons. Organizations engaged in the
allowed to participate in the cooking because it would place ti-ansfilling of liquid oxygen should ensu1·e that personnel are
the cooking flame within the site of intentional expulsion. familiar with the hazards of nyogenic liquid oxygen and that
However. they would be allowed in the kitchen area to assist in they comply with applicable regulations and safety practices.
preparing the food and to socialize with othe1· 1·esident� and A.I 1.5.2.4 Oxygen concentrat01· filling systems are FDA
staff in the kitchen similar to what happens in the kitchens of approved and have been in use for many yea1·s with excellent
residential emironment�. safety records. 1l1e inherent risks a.�sociated with typical trans
The primary concern is that flame-producing equipment filling do not apply to oxygen concentrator filling compressors.
exists in many places in a nursing home and that it would be Limitations were placed on these systems in orde1· to pt·event
impractical to maintain a resident with a nasal cannula a mini the risks associated with larger, higher flow, or higher pressure
mum of 15 ft (4.3 m) (Area of Administration) away from the systems being introduced into the patient em,ironment. The
flame-producing equipment. Typical flame-producing equip cylinder size was limited to cylinde1·s normally used for patient
ment found in a nursing home includes the following: ambulation. The filling rate was limited to pt·event excessive
( l) Candles in chapels heating of the cvlinder content�. The filling pressure wa� limi
(2) Open kitchens using gas cooking equipment ted based on the existing indust1·y pi-actice.
(3) Fi1·e places A.I 1.5.3.2 P1·ecautiona1y signs should be at least 21 cm x
(4) Fuel-fired heating equipment 28 cm (8 in. x 11 in.).
(5) P1·ivate family dining rooms using fuel-fit·ed equipment
(6) Canned cooking fuel (e.g.. used unde1· chafing dishes)
2021 Edition
ANNEX A 99-199
Any material that can bun1 in air will bun1 more rapidly in A..11.7.3.3 Two point� of contact can be provided by using
the presence of oxygen. 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,
Special signs and ad<litional precautionaty measu1·es should such as a table 01· a desk.
be employed whenever fru·eign languages pt·esent a communi
cation problem. (See Figim A.11.5. 3.2.) 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,
No electt·ical equipment is pe1·mitted within an o:i--ygen desct·ibes the 1·ecommended precautions and safety procedures
enclosm·e or ,,�thin 1.5 m (5 ft) of the enclosure. to be followed when liquid oxygen systems are used "ithin
A..11.6.5.5 For furthe1· guidance, refrr to CGA P-50, Site Secur health ca re facilities, such as a 1.5 m (5 ft) separation from
ity Standard. electrical appliances dut·ing filling and use.
A..11.7.3.1 The seller has a responsibility to provide written Mishandling of oxygen presents potential hazarcts to both
instructions to the user in accordance with 11.7.2. In fulfilling trained anct untrained persons. It is therefore important that
this responsibility, the seller should explain to the uset· the use pe1·s01rnel who assume responsibility for oxygen equipment
of the equipment being <lelivered and pt·ecautions that are to anct it� use he familiar \�th the hazar<ls of oxygen, the opera
be taken. The seller's written instructions are intenctect to make tional characteristic of the equipment, anct the precautions to
the uset· awase of the haza1·cts of the matet-ial and to provide be obse1ved while using it.
1·ecommen<lations that ,�II a<ldt·ess the location, restraint, A.11.7.3.6.I.I Drip pans or simila1· containment devices are
f
movement, and refill o portable containers when these used in or<ler to protect against liquid oxygen spillage coming
containers are to be refillect by the user. However, the user has into contact \,�th combustible surfaces, inducting asphalt,
the responsibility to 1·eceive, react, and understand the w1·itten which would elevate the potential for ignition.
mate1·ial rega rding storage and use of liquict oxygen and the
containers anct equipment that are fornished by the seller. In A.12.1 Such facilities include, but are not limited to, hospitals,
ad<lition to specific info1·mation or instructions provided by the convalescent 01· nursing homes, and eme1·gency 1·eceivi11g
seller or equipment manufacturet· rega rding the storage or use stations. A government auth01·ity could fot·mally designate such
of the equipment anct of the liquict oxygen or the containers facilities as ctisa�ter treatment centers. Such facilities woulct not
used, the user remains responsible to see that the containers normally include doctors' or ctentist�' offices, me<lical laborato-
are used or maintained in accordance with the seller's instruc 1-ies, or school nurseries, unless such facilities at·e usect for treat
tions to ensure that they a1·e as follows: ment of disaster victims. National hioterrorism preparedness
Located and maintained i n accorctance with the require effort� call for the use of schools and other large public facili
(l)
ment� of 11.7.3.2 ties to provi<le facilities fix mass immunization.
(2) Restraine<l in accor<lance mth the 1·equirements of A.12.1.1 Throughout this chapter, wherever the term hospital
11.7.3.3 is usect, the term should also apply to other types of health care
(3) Handlect or transported in accordance with the requi1·e facilities. Applicable facilities inclu<le, hut a1·e not limited to,
ment� of 11.7.3.4 hospitals, convalescent or nursing homes, and eme1·gency
(4) Refilled in accordance with the 1·equi1·ement� of 11.7.3.6 receiving stations. A government authority coulct fixmally
and the manufacturer's instructions when liquid oxygen designate such facilities as disaster treatment centers. Such
portable containet·s are to be 1·efilled by the uset· facilities would not normally include doct01·s' or <lentist�• offi
CGA P-2.7, Guide for the Safe Stomge, Handling; and u�e of Small ces, medical laboratories, 01· school nu1·se1·ies, unless such facili
Portable Liquid Oxygen Systnm in Health Care Farilities. ctescribes ties are usect for treatment of <lisaster victims. National
f
the 1·ecommended pt·ecautions and safety proce<lures to he bioterrorism preparedness ef ort� call for the use of schools
followed when liquid oxygen systems are used within health and othet· large public facilities to provide facilities fot· mass
ca1·e facilities. Mishandling of oxygen present� potential immunization. An eme1·gency management progrnm (formerly
hazarcts to both trained and untrained persons. Therefore, it is known as a ctisaster plan or internal/external plan) encom
impot·tant that pe1·so1mel who assume 1·esponsibility fo1· o:i-')'gen pa�ses activities across fout· phases: mitigation, preparedness,
equipment and it� use be familiar ,�th the hazards of oxygen, response, anct 1·ecove1-y. Mitigation activities are those designed
the operational characteristic of the equipment, and the to reduce 01· eliminate the impact of hazat·ds. Prepare<lness
pt·ecautions to he observed while using it. 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.
CAUTION NI-P,1 16()() is an internationally accepte<l framew01·k fot· an
OXYGEN IN USE emergency program. Chapter 12 of this code recognizes this
NO SMOKING 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
NO OPEN FLAMES stances. The eme1·gency operations plans written by a health
care facility should be reviewed and coordinate<l with such
FIGURE A.I 1.5.3.2 Suggested Minimum Text for autho1·ities so a� to prevent confusion. Such authorities
Precautionary Si gns.
2021 Edition
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 9�201
compliant. aml. therefore. many hospitals use this model, sharing, and other collaborative effort�. Participation in other
either as developed or with some customization. HICS can be types of collaborative groups can also be beneficial.
customized and adapted to other types of health care facilities.
A.12.5.3.1.2 By ba�ing the planning of health care emergency
HICS is led by an incident commander and assisted by management on realistic conceptual event�, the pt·ogram
command staff consisting of the public information officer, reflects those issues or event� that are predictable for the envi
safety officer·, and liaison officer, and those medical/technical ronment in which the 01·ganization operates. Thus, such
specialist� who a1·e appropt·iate to Lhe event. Section chiefs a1·e conceptual planning should focus on issues, such a� severe
responsible for each of the following sections: weather typical in the locale, situations that can occur due to
Ope1·ations Section: Conduct� the tactical ope1·ations to close proximity of industrial, government, or transportation
(l )
caITy out the incident action plan using defined objec complexes. 01· earthquake possibilities due to locaf seismic
tives and directing all necessary 1·esou1·ces activity. Planning should also incorporate knowlerlge available
Planning Section: Collect� and evaluates information for in the emergency management research about how individuals,
(2)
decision support, maintains resource status info1·mation, small groups, 01·ganizations, communities, and societies behave
prepares the Incirlent Action Plan, and maintains rlocu during eme1·gencies.
mentation A.12.5.3.1.3(1) Continuity of operations can inclurle, but is
(3) Logistics Section: Pro,irles suppm·t. resources. and other not limited to, maintaining staffing levels, resources and a�set�,
se1·vices to meet the operntional objectives ability to obtain support from the out�ide environment, and
(4) Finance/Administration: Monitors cost� related to the leade1·ship sustainability. At a minimum, plans shoulrl inclurle
incirlent anrl prmirles accounting services, time recorrl the following:
ing, and cost analyses
(1) Learlershi p succession
f
Each section is composed of subm·dinate positions that a1·e (2) Delegation o legal authority
rlivided into branches or unit�. (3 ) Restoration of critical systems
Features of HICS inclurle the following: A.12.5.3.2.3(7) T his should include additional information on
Clear chain of commanrl the rlevelopment, maintenance, anrl evaluation of hazardous
( l)
materials first receivers rlecontamination programs.
(2) Manageable span of control
(3) Common te1·minology A.12.5.3.3.6.1(5) Emergency internal and external communi
(4) Arlaptabilit:y to unifierl command cations systems shoulrl be established to facilitate communica
HICS tools inclurle the following: tion with security forces and other authorities having
jurisdiction, as well as internal patient care anrl service unit� in
( l) Job action sheets detailing position responsibilities the event normal communications methorls are renrle1·erl inop
(2) Fm·ms to rlocument the event erative. 1l1e basic form of communication in a disaster is the
HICS was intenderl to be userl not only for eme1·gencies but telephone system. A� part of the contingency plan to maintain
also fot· plannerl event�. Complete HICS rlocumentation is free communication, a plan fot· 1·estoring telephone systems 01·
anrl available for rlownloarl at www.emsa.ca.gov. using alternate svstems is necessaty. Tvpicafly, the first line of
internal defense for a system outage is strategically placed
A.12.4.1 Conside1·ation should be given to all sites affiliated power-failure telephones that are designed to continue to func
with the 01·ganization. Each component of the health ca1·e tion in the event of system failtll'e (e.g., dedicated lines, fax
01·ganization should either have their own emergency manage lines). Plans for external outages and load control shoulrl
ment program and plan or be part of the overall organization's inclurle the use of pay phones, where available, that have first
emergency management program and plan. prim·ity status in external system 1·estoration. Facilities should
preplan restoration activities and pt·ioritization with their tele
A.12.4.1.1 01·ganizations that are part of an integrated heafth phone service prmiders. A review with the state anrl other
care system can choose to develop an emergency operations communications agencies (Goven1ment Emergency Telecom
plan (EOP) using a system approach, rnther than individual munications Service, ,vi1·eless Prim·ity Se1vice, Health anrl
facility EOPs. Homeland .,\Jert Network) shoulrl be conducted.
A.12.4.2 The A�sistant Secretary of Preparedness and Contingency plans should also contain strategies for the use
Response (ASPR ) defines the te1·m health rare rnalitinn (HCC) in of rarlio frequency communications to supplement landline
201 7-2022 Hmlth Carp PrP/xmdnPss and &sponse Capabilitifs as "A usage. The plan should include a means to distt·ibute and use
group of indi\irlual health care anrl response organizations two-way radio communication throughout Lhe facility. A plan
[e.g., hospitals, emergency medical services (EMS), emergency fot· the incm-poration and use of amateur rarlio operatorn
management organizations, public health agencies l in a should also be considet'erl.
rlefined geographic location. HCCs play a critical role in rlevel
oping health care delivety system preparerlness anrl response It should be recognized that single-channel radio communi
capabilities. HCCs senre as multiagency coorrlinating groups cation is less desirable than telephone system restoration due
f
that support and integrate with [Emergency Support to the limiterl numbe1· o messages that can be managed. Cellu
Function-Bl ESF-8 [health anrl medical services l activities in lar telephones. although useful in some disa�ter situations,
the context of incident command system (ICS) responsibili should not be considered a contingency that has high reliabil
ties." ity due to thei1· vulnerability to the load control schemes of tele
phone companies. Text messaging has been proven to be more
Health care facilities should participate in health care coali reliable than cellular phone calls. Social merlia can be an
tions to improve community emergency planning, resource important tool for emergency communication, but it must be
managerl so that responses to inquiries can be prnvirlerl. Porta-
2021 Edition
ble email devices, satellite telephones. and audio- an<l video levels appropt·iate for patients an<l supply storage. This could
conferencing services are useful tools to link key staff an<l be done by provi<ling HVAC on emergency power, by reloca
organizations. tion of patient� an<l supplies to an appropt-iately heated or
coole<l a1·ea of the facility, or evacuation.
A.12.5.3.3.6.3 Prim· to a disaster, facilities should formally
coordinate their security nee<ls with local law enforcement Al2.5.3.3.6.8(1) The command structure should also follow
agencies. The health care institution will find it necessary to the National Incident Management System (NIMS) as provided
share it� eme1·gency operations plans with local law enforce in NI.PA 1600.
ment agencies or, better still, involve them in the process of
planning for security support during disasters. The information A.12.5.3.3.8 Experiences show the importance of drills to
should at least include availability of parking for staff, patient�. rehearse the implementation of all element� of a specific
an<l visitors, and nm·mal vehicula1·, emergency vehicula1·, an<l 1·esponse, including the entity's role in the community, space
pedestrian tral'fic flow patterns in an<l aroun<l the facility. The management. staff management, and patient management
extent of the security and traffic control problems for any given activities. To document an exercise, the following a�pect� a1·e
health ca1·e facility will depend upon its geogrnphical location, typically incorporated. A general overview of the scenario,
f
physical arrangement, availability o visitor pat·king area�. <locumente<l activation of the eme1·gency operations plan,
number of entrances, and so forth. reports from an i<lentified evaluator(s), evaluation of all
involved participants (ciepartments) and any obse1·ver(s), a
Cmwrl Cnntml Visito1·s can he expected to inCl'ease in written n·itique following the <l1-ill, an<l any identifie<l follow-up
number with the severity of the disaster. They should not be tt·aining m· improvement action(s) to correct or manage any
allowed to disrupt the functioning of the facility disa�ter plan. <leficiencies.
I<leally, a visitor reception cente1· shoul<l be established away
from the main facility it�elf, particularly in the case of majm· A.12.5.3.3.9.8 \\!hen improvement� requi1·e substantive 1·eso1Jt'
<lisasters. Volunteer personnel such as community emergency ces that cannot be accomplishe<l by the next planne<l exercise,
response teams (CERT), Red Cross, Explorer Scouts, 01· othe1- interim improvement� should he put in place until final resolu
helpe1·s can be utilized as liaisons between the visitors and the tion.
health care facility it�elf. A.12.5.3.4.l In emergency situations that occm· without warn
Vehicular Tmffir Control. AtTangement for vehicula r trnffic ing an<l impact the facility, staff at the scene of the problem are
control into and on the facility premises shoul<l be ma<le in the expected to follow establishe<l protocols to protect life, notify
disaster planning pe1·iod. It will be necessary to di1·ect ambulan othe1·s, and conse1·ve pt·openy. Senior management can estab
ces and other emergency vehicles carrying casualties to triage lish a hospital comman<l center (HCC) or participate in
a1·eas or the emergency room entrance, and to <li1·ect incoming unified command \\1th othe1· responding agencies at a designa
an<l outgoing vehicles canying people, supplies, an<l equip te<l eme1·gency operations center (EOC). In emergency situa
ment. Charm showing traffic flow an<l indicating entrances to tions with warning 01· whose impact� requi1·e extended pe1·iods
be used, evacuation routes to be followed, and so forth, should to resolve. <lesignate<l lea<lership report� to the HCC. Not all
be prepared and included in the eme1·gency operations plan. incidents 1·equire an HCC.
Pa1·king arrangements should not be overlooked. 1l1e HCC provides centralize<l locations fot· information
Intfrnal Sn:urity and Tmffir Cnntml. Internal security and traf'. collection, display, coordination, documentation, an<l dissemi
fie control are best conducte<l by facility-traine<l personnel nation.
(i.e., regula r health ca1·e facility security forces) v,1th reinforce Al2.5.3.4.5 Note that ca1·e should be taken to ensu1·e that
ments a� necessary. Potential additional a�sistance from the i<lentification cards are recalle<l whenever personnel terminate
local law enforcement agencies shoul<l be coon:linate<l in the a�sociation \\ith the health care facility. Members of the news
disaster planning phase. Upon activation of the eme1-gency me<lia should be asked to wea1· some means of identification,
operations plan, security guards should be st.atione<l at all such as a press card, on their out�ide ga rment� so that they are
unlocked entrances and exits to the extent possible. Entrance 1·ea<lily i<lentifiable by security guarcis controlling access to the
to the facility shoul<l be 1·estricted to pe1·sm111el bearing staff facility or cenain areas the1·ein. Cle1·gy also \,ill frequently
identification ca1·ds and to ca�ualties. In the case of majm accompany casualties or arrive later fot· visitations and require
access corri<lors between key areas of the facility, pedestrian some means of identification. ,-vater storage systems should be
traffic shoul<l be restricte<l to one side of the con-idor, keeping inventorie<l and protecte<l to the greatest extent pos�ible.
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 A.12.5.3.4.9 For additional infot·mation, see the 2012 Institute
in the planning phase, as is the case with external tral"fic of Medicine (IOM) Report, Crisi� Standards nf Care: A Systnns
control. FrmnPwnrk fnr rntastmphii· Dimstfr Respnnse.
A.12.5.3.3.6.5 Consideration should be given to preemptively Al2.5.3.4.10.l Based on the facility's haza1·d vulnerahility
installing parallel component� such that maintenance can be analysis (HVA), consi<leration shoul<l inclu<le, but not he limi
pel'formed on operating equipment. This will necessitate the ted to, preparation to <lo the following:
installation of additional valves, ci1·cuits, or controls to isolate (1) Provide services to i1tjure<l respon<lei-s and disa�ter
those part� to he removed and replaced, such as air or foe! \ictims
filters. 1l1is work should not violate any other code, stan<lard, (2) Receive large numbe1·s of victims from a mass casualty
or safety <levice. The desire<l outcome is system 1·esiliency incident (trauma or me<lical)
despite part failure. (3) Be a 1-ecei"ing facility for a health ca1·e facility evacuation
\Vhen planning for emergency utility systems, consideration (4) Handle uncontrolled increased census (e.g., <lue to a flu
should be given for maintaining tempernture an<l humi<lity outh1-eak)
2021 Edition
ANNEX A 9�203
A.12.5.3.5 Recoveqr measures could involve a simple reposi A.13.6.3_1 There can be times where full or partial facility
tioning of staff, equipment, supplies, aml information services; access or egress is not rlesirable. Planning for these event�
or 1·ecovery could demand extensive cleanup and repair. It can, should be conrlucterl in coordination with local eme1·gency
unrle1· cenain circumstances, be a means to identify opponuni agencies, such as police, fire. and public health agencies.
ties for structural and nonstructural mitigation efforts. Filing of
loss claims might require special approaches. Health care facili A.13.7 Patient� that generate media interest should be su�ect
ties should have access to cash 01· negotiable i nstruments to to special security procedures. VIP or media rep1·esentatives
procure immerliately needed supplies. present the need fo1· a unique set of secu1·ity requi1·ement�.
Protection of VIPs is normally accomplished by restricting the
A.13.1 This chapter is the sou1·ce for security management in use of names on chart� anrl rooms and by assigning a rlerlicaterl
health care facilities anrl is based on the foundations of security watch.
NFPA 730.
Admission of a high-profile person to a health care facility
A.13.2 A health care facility security plan can be formulated creates two set� of problems that might require partial activa
from security-sensitive a1·ea� that neerl the highest level of tion of the health care emergency management plan . These
protection outv,ard to the perimete1· of the health care facility problems are security and the reception of news merlia.
campus in concentric rings. Viewed from the outside, security
is thus open and welcoming to patients and visitors. A� an indi Provision of security forces in this situation might be provi
virlual proceeds into the inte1·i01·, public spaces might have rlerl by a governmental agency 01· private security fot·ces.
minimal surveillance, but those sensitive areas that cannot be However, activation of facility security forces might be 1·equired
entered are layered with protections and countermeasures. to prevent hordes of curious onlookers from entering facility
wo1·k a1·eas anrl intedering with routine facility functioning.
A.13.2.2 The security plan should be re,iewerl annually or Routine visiting privileges and rnutine visiting hours might
more frequently if new challenges present themselves. need to be suspenrlerl in parts of the facility.
A.13.3.1 For general information 1·egarding the SVA and A.13.7.I.l The marketing department of the hospital might
p1-emises security, see NFPA 730. be best suited to a�sist security personnel with media control.
A.13.4.2(3)(c) The emergency potential inherent in the tele A.13.7.2 Irleally, news media personnel should be prnvirlerl
f
phoned bomb th1·eat watTant� inclusion o this contingencv in with a media briefing a1·ea or a merlia staging area, or both,
the health ca1·e eme1·gency operntions plan. Expe1·ience has with access to telephone communication and, if possible, an
shown that facility personnel have to accompany police 01· mili expediter who, though not permitted to act as a spokesperson
tary bomb demolition personnel in searching for the suspected for news releases, coulrl provide other assistance to such
bomb, because speed is of the essence, and only individuals pe1·s01rnel. News media pe1·sonnel should not be allowerl into
familia1· with a given area can rnpidly spot unfamilia1· or suspi the health care facility \\�thout proper irlentification. Media
cious object� or conditions in the area. This is particularly true representatives should be requested to wear some means of
in health ca1·e facilities. The facility switchboard operator irlentification ftx secm·ity purposes. Members of the news
shoulrl have a checklist, to be kept available at all times, in media shoulrl be askerl to wear some means of irlentification,
01·de1· to obtain as much in formation as possible from the caller such as a press card, on their out�ide garment� so that they are
concerning the location of the s upposed bomb, time of detona readily identifiable by security guards controlling access to the
tion, and other essential rlata, which should be consirle1·erl in facility or certain areas therein.
decirling whethe1· 01· not to evdcuate all 01· pan of the facility.
A.13.B Crowrl control of persons rlemanding access to care
A.13.5.2(1) A visible presence is normally accomplished by the will create additional demands on securitv. Because of the
placement ofa secut·ity officer at the ambulance entrance. This intense public interest in disaster casualties. news media repre
serves the rlual put-pose of monitoring the secu1·ity cameras sentatives should be given as much considerntion as the situa
throughout the emergency rlepartment as well as the activity at tion will allow. To alert off-<luty health care stalf and to rea%ure
the ambulance entrance. the public, use of broarlcast merlia shoulrl be plannerl.
A.13.5.3(5) The facility-wide alening system shoulrl be activa Whe1·e feasible, photo identification or other means to
ted for all report� of pediatric or infant abduction. The use of a ensure positive identification should be userl. Visitor anrl crowrl
f
stanrlarrlizerl "code alert"' system can facilitate the announce control create the problem of rlistinguishing staf from visitors.
ment; for example, "code pink" fot· an infant abduction or Such identification should be issuerl to all facility personnel,
"code purple" fot· a pediatric abduction. inclurling voluntee1· personnel who might be utilizerl in disaster
functions. Note that care should be taken to ensure that irlenti
A.13.5.4 Video surveillance and motion detection can be userl fication cards are 1·ecallerl whenever personnel te1·minate asso
as additional protection for these areas. Some conu·olled rlrngs ciation with the health care facility. Cle1·gy also will frequently
should be stored in safes. accompany casualties 01· aLTi\·e later for visitations anrl 1·equire
A.13.5.6(3) Reasons for a contrahaml check procedure would some means of identification.
be to control items such as tobacco, drngs. or tools that coulrl A.13.9.4 Key ca1·ds are p1·efrrable tof trarlitional ke)'ll because
cause harm to the patient or staff they can be immediately rleactiv-ated i lost or not returned by a
A.13.5.7(1) Law enfo1·cement personnel should have orienta terminated employee.
tion on the eme1·gency procedut·es and layout of the facility. Facility ke)'ll should not be identified in any manner such
There should be good communication between law enfo1-ce that a person finding a lost key coulrl trace it back to the
ment and health care facility security staff. facility. A policy should be established to resu·ict duplication of
keys without written pe1·mission. A..11 keys should be ma1·kerl
2021 Edition
"DO NOT DUPLICATE" to deter the unauthmize<l copying of schedules, so that all personnel are familiar ,,'ith the plan. Prac
keys. ticing the plan helps personnel react as nee<led <luring a secur
ity i ncident.
The1·e should be a log of keys issued to empl oyees an<l
vendo1·s maintained at the facility. A responsible individual Al4.I Chapter 14 does not apply to respiratory therapy
should be in charge of issuing keys an<l maintaining complete, employing o:i..)'gen-enriche<l atmospheres at ambient pressures.
up-to-<late 1·ecords of the disposition of keys, including copies. (SPP ChaptPr 11.)
The records should show the issuance and return of keys,
including the name of the person to whom the key wa� issued, Al4.2.l.l.l For gui<lance on minimum construction requi1-e
as well as the date an<l time. Records of key issuance should be ments, depending on occupancv classification, see NFPA 101.
secured an<l kept separate from keys. Al4.2.l.l.6 Characte1·istics of building construction housing
Kevs should be restricte<l to those who need them, and extra hyp erba1·ic chambers an<l ancillaty facilities a1·e no less impm·
copies of keys shoul<l be kept locked in a secure cabinet with tant to safety from fire hazar<ls than are the characteristics of
access control. the hyperbaric chambern themselves. It is conceivable that a
fit·e eme1·gency occuITing imme<liately oul�ide a chambe1·,
Proce<lures should be establisher! for collecting keys from given sufficient fuel, coul<l seriously endanger the life or lives
f
terminate<l employees, employees on vacation, an<l \'3.Cate<l o those insi<le the chamber. Since the service facilities, such as
tenant�. Lost keys should be 1·eported immediately and proce compressors, cooling equipment, reserve ai1· supply, oxygen,
dures establisher! fot· the 1·ekeying or replacement of the affec and so forth, will, in all probabilitv, be within the same build
ter! locks. ing, these facilities will also need protection while in themselves
supplying life-maintaining service to those inside.
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 Al4.2.l.2 In addition to the fi.mctions of buil<ling protection,
the facility. A master key system is used to limit the number of the chamber room sprinkler system should be designed to
keys catTie<l by pe1·srn111el 1·equiring access to multiple areas of ensure a <leg1·ee of protection to chambe1· operato1·s who likely
the building. It is important that such a system not be <lesigne<l will not be able to immediately evacuate the pt·emises in the
so that the loss of a single key coul<l provi<le an unauthorize<l event of a fire.
in<lividual unrestricted access to all areas of the buil<ling. The
sophistication of the master key system should depend upon an Al4.2.l.2(1) Where the area to be cove1·ed is small (six sprin
assessment of employees· or tenants' nee<ls an<l the ffiticality, klers or less), 9.7.1.2 ofNFPA 101 pe1·mits fire sprinkle1· systems
risk, an<l sensitivity of restricte<l areas. 1·equired to be installed in accordance with NFPA 13 to be
supplier! from the local <lomestic water system, provi<led that
The number of grandmaster keys should be limited to the the local domestic wate1· system ha� sufficient pt·essut·e and flow
lea�t numbe1· necessary for operation of the health care facility. capacity.
Master key distribution shoul<l be limited to the personnel
requiring access to multiple restricted area�. A log should be Al4.2.l.2(3) When selecting a clean agent fire protection
maintainer! sho\\'ing who is in possession of ma�ter keys. system, careful consi<leration should be given to the selection
of agent based on pe1·missible exposure levels.
A.13_10 Background checks shoul<l include criminal recor<l
checks, employment histories, and 1-eferences. This function is A.14.2.1.3.1 Hyperbaric chamber systems often require piping
typically managed by the human 1·esou1·ces department. mate1·ials, pressut·e ratings, an<ljoining techniques that are not
permitted by Chapter 5 of this code.
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 A.14.2.2.1 Other chapters in this code contain many require
the cuITent 1·isk factm·s. Many states have laws that require ments that could appear to relate to hyperbaric facilities but
background checks and specific training for secu1·ity personnel. coul<l be inappropriate. The requi1·ements of othe1· chaptern in
especially armer! personnel. It is essential that facilities using this code should be applied to hyperbaric facilities only where
secu1·ity personnel train them in the legal and practical applica specifically invoked by this chapter.
tions of thei1· employment. Training must reflect changes in A.14.2.2.4 A <lefinition for the term vil'U!port can be found in
regulations and the enactment of new laws. ASME PVHO-1, Sajfty Standmd far PrP.mm l,;,ssd� for Human
A.13.1 I .I Post orders should contain a list of the duties of the Orcupanry.
security office1· and instrnctions to cover all foreseeable events Al4.2.2.6.I In past e<litions of this code, "high quality epo:i..)'''
the security officer can encounter. Post orders shoul<l list the was specifier! as interior finish in these chambers, without a
name of the facility, the date issued, the eflective date, and the specific fit·e pedormance. Although not the only option, this
purpose. Duties of security pe.-sonnel should be listed, includ type of matet-ial ofle1·s suitable physical properties. The interior
ing job cla�sification, uniforms, caITying of firearms, reporting finish of a Class A c hamber shoul<l be smooth, impermeable,
f
times, watch tours, hours o coverage, an<l other <luties to be durable, provide corrosion resistance, and be compatible with
assigned. Instrnctions should be lawful an<l protect the safety of i nfection control procedures.
the security ollice1· and those they encounter. Reviews of post
orders should be conducted regularly ,,'ith facility management A.14.2.2.6.2 One common hazard of paint fires in ships is rela
and security officers. Post orders should be updater! regularly ter! to welding or burning operations on one side of a metal
and at least annually. A proce<lure should be established to bulkhead that heal� the metal to a point whe1·e the paint on the
info1·m secu1-ity officers of changes in post 01·<le1·s. opposite si<le ignites. Most paint� are not flammable when
installed as thin layers over a substantial heat sink, such as the
A.13.12.1 The effectiveness of the security plan is tested by thick steel walls of a hyperbaric chamber, unless the walls are
pedorming <lrills. Drills should be con<lucted on all work heated first. The same paint�, when ground into a powde1· or
2021 Edition
ANNEX A 9�205
installed ove1· a very thin metal substrate, can burn readily. The increased 1·esistance to water droplet movement in the denser
paint selected for use in the interior walls of a h)perbaric atmosphere. This is so, even though the water pressure difler
chamber should be selected both fix suitability to the 1·equi1·e ential is maintained above chambe1· pressure. Therefot·e, it is
ments of the application and fot· its combustibility properties. necessary to compensate by inc1·easing the numhe1· of sprinkle1·
The hazard of a fire increa�es as the amount of heat sink is heads. It is recommended that spray coverage tesrn be conduc
1·educed. Therefore, combustion is easier to achieve when paint ted at maximum chamber pressure.
is applied over thin mate1·ials and when the1·e are multiple
layern of paint. On thin section materials that are easily heated, Some chamber confi gu rntions, such as small-diameter hori
care should be exercised in selecting the flammability charac zontal cylinders, could have a very tiny floor, or even no floor at
te1·istics of the paint and the amount of paint applied. all. For horizontal cylinder chambers and spherical chambers,
the term floor lPvPl should be taken to mean the level at 1/, diam
A.14.2.2.6.4 Many comme1·cial sound-deadening materials ete1· below the chambe1· centedine or actual floor level, which
that might be nonflammable are porous and will absorb water ever yields the larger floor area.
from activation of the fit·e.;;uppression system and retain odo1·.
Metallic panels that contain a la1·ge quantity of small holes or A.14.2.6.4.2 Additional detectors are 1·ecommended to avoid
are made of wire mesh and are installed about 2.5 cm (1 in.) "blind" a1·eas if the chambe1· contains compart.mentation.
away from the chamber wall can be used to form an acoustic A.14.2.9.2.1 A backup generator or backup power system fo1·
baffle. These panels should be made from cotTosive-resistant the hyperbaric facility might not be necessary, but certain elec
mate1·ials. such a� stainless steel 01· aluminum. and are permit trically driven feattlt"es of hypet·baric facilities should have some
ted to be painted in accordance with 14.2.2.6.3. type of backup. This could be addressed with a single backup
A.14.2.2.7 Prudent design considerations suggest that at least power system 01· with multiple, smaller powe1· sou1·ces. The
50 pe1·cent excess pass-through capacity he provided, for futu1·e source for such backup power and eme1·gency lighting can be
use, given the difficulty of adding pass-throughs to the chamber battery supplied.
afte1· it is constructed and tested. A.14.2.9.2.1(1) Chamber room emergency lighting should be
A.14.2.4.1.2 Expe1·ience and practice can dictate the need for provided and does not requi1·e a unique type of eme1·gency
a threshold ventilation rate in excess of the minimum specified lighting because it is a hyperbaric facility.
fo1· sanitary 1·ea�ons. It is recommended that consideration he A.14.2.9.2.1(2) Chamber emergency lighting 1·equirements
given, if necessa1y, to the use of odo1· filte1·s in the chamber vary. Fm· chambe1·s with a large acrylic window, found in most
circulation system as a means of keeping sanitary ventilation Class B chambe1·s, the room emergency lighting is sufficient to
rate requirement� to a minimum. meet this requirement. For chambers made primarily of steel,
A.14.2.4.2.1 If intakes are located where it could be possible with a small window(s), lighting dedicated to the chamber inte
fot· maintenance to be conducted in the immediate vicinity, a rim· might be necessary. In this case. at least on light should be
warning sign should be posted. provided with backup power.
A.14.2.4.4.1 Ventilation is permitted to be provided hy closed- A.14.2.9.2.1(3) Chamber intercommunication powe1· 1·equire
01· open-cit"Cuit systems. menL� vary. The duration of backup power fot· communications
depends on the type of hyperbaric treatments performed but
A.14.2.5.4 The risk assessment should be documented. \,Vhen should not have to exceed the duration of a hype1·haric treat
perftxming a 1·isk assessment, consider using available internal ment conducted in the facility.
1·esou1Tes (e.g., safety officer, risk management, public safety).
Risk a�sessmenL� should include, but not be limited to, the A.14.2.9.2.l (4) Class A chambers might employ flame detec
following factors: torn. If employed, these detectors should have backup power.
Flame detectors are typically not employed in Class B cham
(1) The time required to evacuate to a safe a1·ea (as 1·equi1·ed bers.
hy 14.3.15.4.1)
(2) Building and room a1·chitectu1·e (e.g., egress ve1·sus A.14.2.9.2.1(5) Class A chambe1·s are 1·equi1·ed to have a fire
defend-in-place architectut·e) suppt·ession system. All electrical controls related to activation
(3) Accessible means of egress and perfo1·mance of the fire suppt·ession system should have
(4) Room layout, number, and configuration of the chambers backup power. Fire suppression systems are not typically
(5) Possible need fo1· slow decompression or decompression employed in Class B chambers.
stops A.14.2.9.2.1(6) Some Class A and Class B chambers employ
(G) Response time of internal and external emergency electrical controls as part of the pressurization and ventilation
responde1·s system of the chamber. These controls should have backup
A.14.2.6.1.5 Expe1·ience has shown that fit·e blankets, portable power.
carbon dioxide extingu ishers, and other methodology inten A.14.2.9.3 This subsection contains requiremenL� for the safe
ded to "snuff out"' fires by excluding air a1·e not effective in use of electrical equipment in the hyperba1·ic, oxygen-enriched
controlling fires in oxygen-enriched atmos phe1·es. Valuable environment of the Class A chamber.
time can be lost in attempting to use such devices.
A.14.2.9.3.9 It should be recognized that interruption of any
A.14.2.6.2.4 More than one control station could be 1·equi1·ed powered circuit, even of ve1·y low voltage, could produce a
in a compartment (lock), depending on iL� size. spark sufficient to ignite a flammable agent.
A.14.2.6.2.6 Experience has shown that, when water is A.14.2.9.3.10.1 It is recommended that all control switching
discha1·ged t hrough conventional sprinkle1· heads into a hyper functions inside the chamber he accomplished using intrinsi-
baric atmosphere, the sprny angle is reduced because of
2021 Edition
cally safe cit-cuit� that conu·ol power and control circuit� loca the chamber. an<l the chambe1· should be eguippe<l with an
ted out�i<le of the chamber. oxygen monitor for each sample port.
A.14.2.9.3.11 It is the intention of 14.2.9.3.11 that eguipment Chamber atmosphe1·es a1·e l:)pically not homogenous.
used in the chamber he incapable of igniting , hy heating, any Oxygen can accumulate in pools or pocket� around patient�
material or fabric that coul<l come into contact with the surface with levels that are <langerouslv high. A single oxvgen sample
of the eguipment. pon inside the chambe1· might not be sufficient to detect
inct"eased oxygen levels in another area of the chamber. In this
A.14.2.9.3.13 It is 1·ecommended that electric motors not be case, a serious increase of oxygen, well above the allowed level
located inside the chamber. This recommendation is not inten of 2 3.5 percent, can go undetected. Providing at least two
ded to apply to a mot01· that is within a piece of portable medi sample po1·t� allows for bette1- assessment of the oxygen levels
cal eguipment. insi<le the chambe1·. The size of the vessel shoul<l be fact01·ed
A.14.2.9.3.14 It is strongly recommended that high-intensity into determining how many port� are necessary.
local task lighting be accomplishe<l using through-hull fiber A dedicated oxygen analyzer on each line p1·events false
optic light�. Many high-intensity light� will not meet the 1·ea<lings from t wo or more sample lines feeding into one
temperature reguirement� specified in 14.2.9.3.11. oxygen sensor.
A.14.2.9.3.15.1 The 1·eguirement for isolation from main F01· example, one sample line might come from an area of
supplv in 14.2.9.3.15.1 is not the same as the reguirement in 21 percent, and the other line might come from an area of
14.2.9.4.2 that circuits supplying power to portable utilization 50 percent or more. When both lines come together, they will
eguipment inside the chamber be isolated, monitored, and mix an<l give a false low oxygen rea<ling. Having a de<licated
alarme<l. oxygen monitor for each sample line will avoid this unsafe
lt is recommen<led that intrinsically safe sensors and situation.
controls be used wheneve1· possible. Al4.2.I0.4.2.2 1l1e ability to spot check for oxygen leaks and
A.14.2.9.3.16 These reguirements are only the nmumum oxygen pooling is essential fot· the safe management of oxygen
reguirement� for electrical safety. There are many other safety levels. If the minimum 30-second 1·esponse time is not compro
concerns that should be a<ldressed on a case-by-case basis. mised, the extension or "snooping wand'' can remain connec
Meeting the 1·egui1·ement� of 14.2.9.3.16 does not in<licate that te<l for easy use.
proper device perfo1·mance will occut· in the hyperbaric envi Al4.2.I0.6 ll1e purity of the various ga� supplies should be
ronment and that the device will he safe for use with patient5. ensure<l. A purity statement for any cryogenic or high pressure
A.14.2.9.3.17 The intent of this section is to mitigate the risks cylinder gas should be supplied by the vendo1·. Gas cylinder
of fit-e when an electrical device is placed inside the chambe1· purity statement� should be cross-reference<l. where possible.
and put un<ler pressure. with the delivere<l gas.
f
The 1·eguirement� o this section are not inten<le<l for things F01· additional ve1·ification, some facilities have installed
such as approved wristwatches an<l similar approved small sampling port� for monitoring oxygen an<l other gases.
battery-powered devices. See B.145 for additional information A.14.2.10.6.l CGA Grade E permit� guantities of hydrocar
on ine1·t gas or ai1· pm·ging. bons an<l water in air. In piping systems whe1·e air and oxygen
A.14.2.9.5.2 It is necessa1·y that these circuit� be protecte<l might be used inte1·changeahly, hydrocarbon buildup can
from exposure to water from the room sprinkler system occur and increase the risk of fire when oxygen is used. There
protecting the chamber housing in the event of a fire in the is also a concern about pneumatic components being fouled
vicinity of the chamber while it is in operation. and functionally impaired by hydroca1·bons 01· wate1· from
compresse<l air. Ideally. there should be no condensed hydro
A.14.2.9.6.1.l Limiting current using a suitable current sens carbons in an oxygen system and no liquid water in pneumatic
ing device (e.g., a .-apid acting fuse or circuit breaker, located co11t1·ol systems.
out�ide the chamhet") would provide appropriate protection
and prevent circuit� from excee<ling the 4.0 Vv power limit. Al4.2.ll.2 Exhaust piping exten<ling from the building can
create a lightning risk. Lightning protection shoul<l he consid
A.14.2.10.2 Intercommunications equipment is mandatory fot· ered.
safe operation of a hypet·baric facility.
Al4.2.l1.2.5 ll1e facility should consider bilingual signage
A.14.2.10.2.l It is recommended that multiple-compartment that is appropriate to the location. The hyperbaric safety direc
f
(lock) Cla�s A chamhe1·s be eguipped with multiple channel tor shoul<l be aware o any work perfo1·med on the roof near
systems and that, in addition, a sound-powered telephone 01· exhaust vent.
surveillance microphone be furnishe<l.
See Figure A.14.2.11.2.5 for examples of the pictographs
A.14.2.10.2.2 It is 1·ecommended that info1·mation about the 1·equired by NFPA I 70.
status of an anesthetize<l or otherwise monitored patient be
transmitted to the inside chamber attendant� via the intercom Al4.3.l.2 The haza1·ds involved in the use of hyperbaric facili
munications system. A� an alternative, the monitor indicators ties can be miti ga ted successfully only when all of the areas of
can be place<l a�acent to a chamber ,ie,\port (01· viewp01·t�) hazard are fully recognize<l by all personnel and when the phys
for direct observation by inside personnel. ical protection prmi<le<l is complete an<l is augmente<l hy
attention to detail hy all personnel of administration and main
A.14.2.10.4.2 Oxygen levels in Class A chambers should be tenance ha,ing any responsibility for the functioning of the
sample<l from at least two sample port� at <lisparate locations in hyperba1·ic facility. Since Section 14.3 is expected to be use<l as
2021 Edition
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.
2021 Edition
Positive mea�u1·es a1·e necessary to acguaint all personnel Alcohol vapor density at LEL = 0.02 x 2.1 x 0.0i5
with the rules and regulations establishe<l an<l to ensure <i :i
= 0.00315 lb/h (0.05 kg/m )
enftxcement. Trnining and discipline a1·e necessary. 3 3
= 1.43 g/ft (0.05 kg/m )
A.14.3.1.4.6 The complexity of hype1·baric chambers is such
that one person should be <lesignated chamber operator, such Fm· a relatively small 500 ft3 (14.2 m3 ) chamber, this implies:
as a person in a position of 1·esponsible authority. Before start
ing a hype1·baric operation, this person should record, in an 1.43 x 500 = 715 g (1.58 lb) alcohol vapor at LEL
appropriate log, the purpose of the operation or test, the
Using a safety factm· of 10 to account fo1· uneven vapor
duties of all personnel involved, an<l a statement that he or she
concentrations gives 715 g = 91 mL (3 oz) alcohol.
is satisfied with the condition of all eguipment. Exceptions
should be itemize<l in the statement. One could conclude that even 90 mL (3 oz) of alcohol is
mm·e than would be needed for almost any medical procedm·e.
A.14.3.1.5.2 All foll- and part-time personnel should receive The preceding calculation also <loes not account for the miti
trnining in eme1·gency management appropriate to thei1· job
gating effect of ventilation.
<lesc1·iptions.
Many "inen'' halogenated compounds have been found to
A.14.3.1.5.4 A calm reaction (without
f
panic) to an emergency
act explosively in the presence of metals, even under normal
situation can be expected only i the 1·ecommendations are
atmospheric conditions, despite the fact that the halogen
familiar to and rehea1·sed by all concerned.
compound it�elf does not ignite in oxygen or, in the case of
A suggested outline for emergency action in the case of fire solids such as polytetrnfluoroethylene, is sell�extinguishing.
is containe<l in B.14.2. Apparently these materials are strong oxidizers, whether gases.
liguids (solvent�, greases), 01· solicl.s (electrical insulation,
A.14.3.1.6.1.l Oxygen-filled chambers dump oxygen into the fab1·ic, or coatings). Some halogenated hydrocarbons that will
room each time the door is opened at the en<l of a treatment. not burn in the presence of low pressure oxygen will ignite and
Oxygen could also be dumped into the room by the chambe1- continue to burn in high pressure oxygen. Customarily, Cla�s A
pressu1·e 1·elief device. Ai1°filled chambe1·s could leak oxygen chambe1·s maintain inten1al o)<-ygen concentration that does
into the room from the breathing gas piping. This oxygen not exceed 23.5 percent.
e111·ichment lowers the ignition temperntu1·e of combustible
materials. 1l1erefore, extra caution shoul<l be used in the area Parts of Chapter 14 <leal with the elements reguire<l to he
around the chamber as well as inside the chambe1·. incorpornted into the structm·e of the chambe1· to 1·e<luce the
possibility of electrostatic spark discha1·ges, which are a possible
A.14.3.1.6.1.3 Precautions should be in place for monitoring cause of ignition in hyperbaric atmospheres. The elimination
items used to p1·epa1-e a patient 01- staff member fo1· entry into of static cha1-ges is cl.ependent on the vigilance of administrative
the hyp erbaric chamber to prevent the entry of prohibite<l activities in m ate1-ials, pm·chase, maintenance supervision, and
items into the hyperbaric chamber. periodic inspection an<l testing. It cannot be emphasize<l too
In addition to monit01-ing prohibited items, the following strongly that an incomplete chain of precautions generally will
items shoul<l be verifie<l: increase the electrostatic haza1·d. For example, concl.uctive
flooring can contribute to the hazard unless all pe1·s01111el wear
( l) Patient i<lentity con<luctive shoes, all object� in the room are electrically contin
(2) Prett·eatment orders uous with the floor, and humidity is maintained.
(3) Appropriate safety measures
(4) Appropriate staffing The limitations in 14.3.1.6.2.2 on the use in the chambe1· of
(5) Appropriate textiles alcohol an<l other agent� that emit flammable vapors should be
(6) Patient grounding strictly observed, and such restrictions should be prominently
posted.
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, A.14.3.1.6.3 The number of occupant� of the chamber should
flammable agent vapor density, and lower explosive limit be kept to the minimum number necessa1y to carry out the
(LEL). Experience has shown that increased pressure has little p1·ocedtu-e.
f
ef ect on LEL for a given flammable ga� and oxygen concentra Al4.3.l.6.4 It is recommended that all chamber personnel
tion. A safety factor of 10 is recommen<led. Flammable liguids
shoukl wear garment� of the overall 01· jumpsuit type that
shoul<l be confine<l to nonb1·eakable, nonspill containers. completely cover all skin areas to the extent possible and that
Sample Detmninalion. An example of limiting guantity of a1·e as tight-fitting as possible. It can be impractical to clothe
flammable agent substance: some patient� (depen<ling upon their disease or the site of any
surge1y) in such garments. Hospital gowns can be employed in
Isopropyl alcohol (2-propanol) such a case.
LEL= 2%/vol. (irrespective of chamber pressure) A.14.3.1.6.4.2 Selection of textiles for the hyperbaric chamber
Vapor density= 2.1 1·elative to air should be basecl. on a variety of factm·s, including comfort, lint
pro<luction, ignition temperatu1·e, static-producing properties,
Ligui<l density= i86 g/L (49. l lb/ft3 ) 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
Air <lensity= 0.075 lb/ft'l (1.2 kg/m3 ) at STP
factors.
The limiting case occurs at the lowest ambient pressure, that
Histm·ically, all synthetic fabrics were prohibited from the
is, l atmosphere:
chamber. Previous ed itions of this code allowe<l an "antistatic
2021 Edition
ANNEX A 9�209
blend of cotton and polyeste1·" because of one specific fabric - should not be <listurbed (e.g.. in the case of a new skin
a blend of cotton an<l polyester with steel fibers to make it graft); some dressings are designed to stay in place for
con<luctive. This blended fab1·ic was intende <l for sm·gical several days; some <lressings are very expensive; and it can
scrnbs, but its con<lucti\·e properties ma<le it a goo<l choice for be detrimental fix the woun<l to 1·emain und1·esse<l
hyperbaric garment�. The polyester in the fabric was acceptable during the treatment. If there is a suitable alternative to
because the con<luctive properties of the fabric actually affor using this dressing, the rest of the decision process can be
<le<l some protection from static production that cotton fabric eliminate cl.
did not. This particular fabric is no longe1· made. Selection of (2) Does this dressing pro<luce heat in the chambe1·? D1·ess
textiles has always been about balancing various safety ings are ma<le from a la rge variety of materials. The
concerns; primarily fire-resistance an<l static pro<luction. For concern is that materials in a d1·essing can 1·apidly oxidize
fi.Jrther gui<lance on selecting approp1·iate textiles, see an<l produce heat (i.e., cause an exothermic 1·eaction)
A.14.3.1.6.4.3. when expose<l to additional oxygen. Fm· example, air
activate<l heat patches (commonly used for pain relief)
A..14.3.1.6.4.3 The textiles <lefinitions an<l risk assessment have been tested in hyperbaric environments. The ave1·
process fo1· hyperbaric wound dressings are as follows: age operating tempei-ature inct·eased from 48.1 'C
Combustion. A chemical process of oxidation that occurs at a (119° F) in normobaric air to 121.S ° C (25l'F) in hvper
1·ate fast enough to produce heat in the form of either a glow ba1·ic oxygen. In this ci1-cumstance, the patient's skin
01· a flame. woul<l be burne<l, an<l the heat coul<l ignite combustible
material in the chamber. Information on oxygen compati
Flammable. Refers to a combustible (soli<l, liquid, or gas) that bility can be foun<l in a product material safety <lata sheet
is capable of easily being ignited an<l rapi<lly consumed by fire. (MSDS).
Hmh Point. The minimum tempernture of a liquid or soli<l at (3) Does this dressing produce too much static electt·icity? All
which it gives off vapor sufficient to form an ignitible mixture common textiles i,vill contribute to static production.
with oxygen under specified environmental con<litions. \Vool and synthetic materials generallv contribute more
to static production than cotton. Although static charge is
Ignition Tn1tpemture. The minimum temperatu1·e 1·equi1·ed to constantly accumulating, it will <lissipate into the environ
initiate or cause self-sustaining combustion un<ler specifie<l ment when humidity is present. At less than 30 percent
e1nironmental conditions. 1·elative humi<lity, static charge can accumulate faste1· than
it can dissipate. At g1·eater than 60 pet-cent relative
Lower 1'.xplosiw Limit (LEL) or Lowl'r Flmmnable Limit (LFL). humidity, static charge is all but completely eliminated.
The minimum concentration of fuel vapor (percent by Use of con<luctive surfaces and electrical grounding will
volume) ove1· which combustion will occur on contact with an allow static charge to <lissipate. Parngi-aph 14.2.9.4.1
ignition source. 1·equires all hype1·baric chambers to be grnundetl. Para
(",enl'fal Risk 11..��e.mnmt Information. This risk assessment proc graph 14.2.11.1 requires any furniture installe<l insi<le a
ess wa.� designe<l to evaluate woun<l dressing products for use in chambe1· to be grnun<le<l. Paragraph 14.3.1.6.3.2 1·equires
f
a hyperbaric chambe1·. However. the same decision process can all occupants o the chamber to be groun<le<l when the
be applied to the evaluation of textiles fo1· hyperbaric use. oxygen percentage in the chamhe1· is above 23.5 percent.
Woun<l dressings are commonly use<l insi<le hyperbaric cham TI1e continuity of electrical groun<ls should be verified
bers. They play an important role in infection control and perio<lically.
patient outcome. Imp01·tant safety concerns include produc (4) Does this dressing have a low ignition tempernture/fla.�h
tion of heat, production of static electricity, production of flam point? ASTM G72/G72M. Standard Test Method for Autoge
mable vapo1·, ignition temperatu1·e, and total fuel load. Many nom Ignition Tm1pm1hm of Li quids and Solid� in a High
wound d1·essings employ fab1-ics and othe1· materials that a1·e Pres.mre Oxygm-Enrirhed Enuimnmml, can be used to
gas-permeable. It is a common misconception that a gauze determine the autogenous ignition temperatu1·es of pro<l
bandage will isolate an un<lesirable product from the chamber ucts entering a hyperbaric chamber. In 2016, ASTM G72/
environment. Gauze is gas-permeable an<l will allow o}..·ygen G72M added a new test fo1· oxygen-enriched environ
from the chambe1· to internet with the pro<luct an<l vapors from ments of less than 300 psi (2068 kPa) of p1·essure. In all
the pro<luct to interact ,vith the chamber environment. Also, hyp erbaric environments, the partial pressure of oxygen
gas-permeable materials exposed to hyperbaric oxygen ,viii is higher than at normal atmospheric con<litions. Increas
hol<l additional oxygen fo1· some perio<l of time afte1· the expo ing the partial pressure of o:,,.)'gen can change the classifi
sm·e. These materials should be kept away from open flames cation of a material from nonflammable to flammable.
for at least 20 minutes after the hyperbaric treatment. Many materials are flammable in a 100 percent oxygen
environment. Any material used in a hyperbaric chambe1·
Risk Asses.wmnt Pro[l'SS (seP Figure A.14. 3. I. 6.4. 3). should have an ignition temperatm·e higher than it can
( 1) Is there a more suitable alternative to this <lressing? The be exposed to. Paragraph 14.2.9.3.11 limits electt·ical
issue of need must first be ad<lressed. There might be a equipment insi<le a Class A (multi-place) chamber to a
substitute dressing that has already been deemed accepta maximum operating surface temperntu1·e of 85 ° C
ble for the hyperbaric environment. The wound <lressing ( 185° F). Parngrnph 14.2. 9.6.3 limiL� electrical circuiL�
orders can be change<l to the more desirable substitute insi<le a Class B (monoplace) chamber to a maximum
(if there is no negative impact on patient outcome). It operating temperature of 50'C ( 122 ° F). A� the oxygen
might be viable to remove the d1·essing befo1·e the hyper percentage inct"eases, it takes less ene1·gy to ignite materi
baric treatment, leave it off during the treatment, an<l als. This leads to more conservative <lecisions in a
replace it after the treatment. Before making this deci 100 percent oxygen environment. A greater margin of
sion, it is important to 1·emember that some dressings safety is achieved when there is a greater diffe1·ence
between the temperatu1·e limit of the equipment inside a
2021 Edition
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
�-------'�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
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 9�215
ca1·bon dioxide fire extinguishe1· sha1·es the electrically noncon and summarized in Table B.5.1. Tests specified in 5.1.12 should
ductive properties of clean agent and water mist fire extin be carried out by an experienced person or persons designated
guishe1·s and, on that basis, could he used in lieu of a clean by the administration of the health care facility. Such a
agent extinguisher. However, it should be noted that carbon pe1·son(s) should cenify the result� of test� to the administra
dioxide fire extinguishers do not have Class A ratings. A clean tion. The designated person(s) should be experienced in medi
agent extinguisher for use in an operating room should have a cal gas testing and verification of piping systems \,1th cross
Cla�s A rating of some fot·m. connection testing. A membe1· of the health ca1·e facility should
be pt·esent to ve1·ify the testing.
A.16.10.2.2 Hose and hose outlet� can be required hy a build
ing code or by the authority having jurisdiction. B.5.2 Retesting an d Maintenance of Nonflammable Medical
Piped Gas Systems (Category 1 Systems).
A.16.11 Compact storage is characte1·ized by shelving unit�
that are manually or electrically moved on fixed track� to B.5.2.1 [5.J.3_5.9) These systems should be checked daily to
provide access aisles. Such systems are also known as mobile ensure that proper pressm·e is maintained and that the change
shelving, track files, compaction files. 01· movable files. over signal has not malfi.mctioned. Pe1·iodic retesting of the
routine changeover signal is not necessary, a� it mll n01·mally be
A floor loading calculation should be petformed. activated on a regular basis.
A.16.12.3 NFPA 13 contains protection c1·ite1-ia fot· limited B.5.2.2 [5.1.3.5.10) These S}'lltems should be checked daily to
configurations of compact mobile storage unit� and materials enstu-e that prope1· presstu-e is maintained and that the change
stored. Storage arrangement� not specifically addressed in over signal has not malfunctioned. Periodic retesting of the
NFPA 13 are outside the scope of the standard (i.e., protection routine changeover signal is not 1·equi1·ed. Annual retesting of
fot· plastic commodities in compact mobile storage units does the operation of the 1·eserve and activation of the 1·eserve-in-use
not simply follow high piled storage protection crite1·ia for signal should be performed.
shelves or racks). Where compact mobile storage configura
tions outside the scope of NFPA 13 a1·e to be utilized, they must B.5.2.3 [5.1.3.5.10] If the S}'lltem has an actuating S\\1tch and
be addt·essed on a case-by-case basis, with consideration given signal to monitot· the content� of the 1·eserve, it should be retes
to the fact that no known sprinkle1· protection criteria is ted annually.
currently available. The storage of paper administrative and
medical records with l imited plastic labels 01· folders is typically B.5.2.4 [5.1.3.5.11) Maintenance and pet-iodic testing of the
a Class III commodity "�th less than 5 percent pla�tics. The bulk S}'lltem is the 1·esponsihility of the owner or the organiza
storage of most office supplies, engineering parts, food prod tion 1·esponsible for the operation and maintenance of that
ucts. garments. and othe1· general supplies is typically a Cla�s IV system.
commodity with 5 pe1·cent to 25 pe1·cent plastics. 1l1e storage of The staff of the facility should check the supply system daily
x-rays. medicines. and plastic-based medical supplies is typically to ensure that medical ga� is ordered when the content's gauge
a Group A plastics commodity with greater than 25 percent drops to the reorder level designated by the supplier. Piping
plastics. sy,tem pressm·e gauges and othe1· gauges designated by the
A.16.14.3.2 Some tinctures and solutions of disinfecting supplie1· should he checked regularly, and gradual variation,
agent� provide significant clinical benefits in reducing the risk either increa�es or decreases, from the normal range should be
of surgical infections. However, they can be flammable and can rep01-tecl to the supplier. These variations might inclicate the
be used improperly during sm·gical procedures. Tipping need for con-ective action.
containers, accidental spillage, and the pouring of excessive Periodic testing of the master signal panel system, other than
amount� of such flammable agents on patient� expose them to the routine changeover signal, should be perforn1ed. Assis
injury in the event of accidental ignition of the flammable tance should be requested from the supplie1· or detailed
solvent. To control this risk, flammable germicides 01· antisep instrnction if 1·eadjustment of bulk supply controls is necessary
tics that are used when electrosurgery, cautery, or a laser is to complete these test�.
contemplated should be packaged to ensure controlled deliv
ery to the patient (e.g., unit dose applicator, swab) in small B.5.2.5 [5.1.8.2.3] The main line pressure gauge should be
volumes appropt·iate for single application. checked daily to ensu1·e the continued p1-esence of the desired
pressure. Variation, either increases or decreases, should be
investigated and con-ected.
Annex B Additional Explanatory Notes
B.5.2.6 [5.1.3.6.3.14) Quanerly rechecking of the location of
171i� annex is not 11 part of thP m1uirnnmts of this NFP./1 document the air intake should be made to ensure that it continues to be
but is indudfd for informational pu-rposfs only. a satisfactory sou1·ce fot· medical compressed air.
B.l Reserved. B.5.2. 7 [5.1.3.6.3.14) Prope1· fi.mctioning of the pressure
B.2 Reserved. gauge and high water level sensor should be checked at least
annually. The 1·eceiver drain should be checked daily to deter
B.3 Reserved. mine if an excessive quantity of condensed wate1· has accumula
B.4 Reserved. ted in the receiver.
B.5 Additional Information on Chapter 5. Numbers in brack B.5.2.8 [5.1.3.6) An impo1·tant item t·equired for ope1·ation of
ets refer to paragraphs in Chapte1· 5. any medical compressed ai1· supply system is a comp1·el1ensive
preventive maintenance program. ''\'orn part� on reciprocating
B.5.1 General. This section sets out a minimum recommen compressors can cause high discharge temperatures, resulting
ded guide for testing. Testing requi1-ements a1·e listed in 5.1.12 in an increase of contaminants in the discharge ga�. Adso1·be1-
2021 Edition
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 B.5.2.11 [5.1.9.2.4] Reserve-In-Use Warning Signal. All
saturated and lose their effectiveness. It is important that all component� of this warning signal system should be retested
components of the system be maintained in accordance with annually. Audible and visual signals should be tested periodi
the manufacuu·ers' 1·ecommendations. It is important that any cally during the yea1· (monthly).
instrnmentation, including analytical equipment, be calibrated
routinely and maintained in operating order. Proper function B.5.2.12 [5.1.9.2.4] Reserve Supply Low (Down to an Average
ing of the dew point sensor should be checked at least annu One-Day Supply) High Pressure Cylinder or Liquid Reserve.
ally. All component� of these signal warning systems should be
retested annually. If test buttons are provided, audible and
B.5.2_9 [5.L9] \\'hen test buttons are provided with signal visual signals should be periodically tested throughout the year
f
panels, activation o the audible and visual signals should be (monthly).
pedonned on a 1·egular ba�is (monthly).
B.5.2.13 [5.1.9.2.4] The medical comp1·essed ai1· system
B.5.2.10 [5.1.9.2.4] Changeover Warning Signals. As these are alarms in 5.1.3.6.3.12 should be checked at least annually.
routine signals that are activated and deactivated at frequent
intervals, there is no need fo1· retesting unless they fail. If the B.5-2.14 [5.I.8.2.2(1)] This pressure gauge should he
reserve-in-use signal is activated because both unit� of the ope1· checked on a daily basis to ensure proper piping system pres
ating supply are depleted without the prior activation of the sure. A change, inCI"ea�e or deCI"ease. if noted, could he
changeove1· signal, it should be repai1-ed and retested. 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 B.6.3 Suggested F ormat for Listing Functions to Be Served by
ing systems, if it can be done without changing piping system the Essential Electrical System in a Hospital. It might be
line p1·essu1·e, should be performed. advantageous in listing the specific functions for a given
construction project or builrling 1·eview to list them, at the
B.5.2.16 [5.1.9] If test buttons are provided, the retesting of
outset, by geographical location within the project in orrler to
audible and visual alarm inrlicators should be performed ensure comprehensive coverage. Every room or space should
monthly. be 1·eviewed for possible inclusion of the follov.�ng:
B.5.2.17 [5.1.4] Shutoff valves should be periodically checked (l ) Lighting (partial or all)
for external leakage by means of a test solution or other equally (2) Receptacles (some or all)
effective means of leak detection that is safe for use with (3 ) Permanently ,virerl electrical apparatus
m..-ygen.
l11e fot·mat suggesterl he1·ein is offered as a convenient tool,
B.5.2.18 [5.1.5] Station outlet� shoulrl be periodically not only for identifying all functions to be served and their
checked for leakage anrl flow. Manufactut·e1· insu·uctions respective time intervals for being re-energized by the alternate
should be followed in making this examination. electric source, but also for rlocumenting othe1· functions that
B.5.3 Oxyge n Service-Related Documents. The following were considered, rliscussed, anrl excluded a� nonessential. The
publications can be used fot· technical refe1·ence: 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
(I) ASTM G63, Standard GuidP for Evaluating }llnmnNallir Mate revie,ving authority will ,vish to keep on file a final copy of the
rial� f()r Oxygen Servia list, which would be the ba�is for the elecu-ical engineer's
(2) ASTM G88, Standard GuidP far Designing ,\)'stems far Oxygrn rletailed enginee1·ing design.
Servi,·e
(3) ASTM G93, Standard Prartia f()r Clmning Methnds and Although this suggested format is intenrled for use by a
Cleanline.t1 Level1 fnr Material and Equipment U1ed in Oxygen hospital, it might, \,�th suitable changes, be useful for other
Enrirhed Envimnmmts health care facilities.
( 4) ASTM G94, Standard Guide fnr Evaluating Metal1 f()r Oxygen B. 7 Reserved.
Si'rvire
B.8 Reserved.
B.6 Additional Information on Ch.apter 6.
B. 9 Reserved.
B.6.1 T)pical Hospital Wiring Arrangement. See Figme B.6.1.
Separate transfer s,vitches for each branch, as shown, are B. l O Reserved.
1·equired only if rlictated by load considerntions. Smalle1· facili
B. 11 Additional Information on OJ.apter 11.
ties can be se1·ved by a single transfe1· switch.
B.6.2 Maintenance Guide for an Essential Electrical System. B.11.1 Medical Safeguards - Respiratory Therapy.
This genernlizerl maintenance guirle is provided to assist B.11.1.1 General.
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.
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
MAINTENANCE GUIDE
Monthly Engine Compressed Air Starting System:

.J Air compressor operating properly
( 1) Testing of generator sets and transfer switches under .J Air compressor lubricating oil level
load and operating temperature conditions at least .J Spare compressed air tanks full
every 30 days. A 30-minute exercise period is an
absolute minimum, or the engine manufacturer's .J Main compressed air tanks full
recommendations should be followed. .J Drain water from compressed air tanks
(2) Permanently record all available instrument readings Engine Exhaust System:
during the monthly test.
.J Condensate trap drained
(3) During the monthly test, check the following system
or systems applicable to your installation: .J No exhaust leaks
.J Exhaust not restricted
Natural Gas or Liquid Petroleum Gas System:
.J All connections tight
.J Operation of solenoids and regulators
.J Condition of all hoses and pipes Transfer Switch:
.J Fuel quantity .J Inside clean and free of foreign matter
.J No unusual sounds
Gasoline Fuel System:
.J Terminals and connectors normal color
.J Main tank fuel level
.J Condition of all wiring insulation
.J Operation of system
.J All covers tight
Diesel Fuel System: .J Doors securely closed
.J Main tank fuel level
.J Day tank fuel level General:
.J Operation of fuel supply pump and controls .J Any unusual condition of vibration, deterioration,
leakage, or high surface temperatures or noise
Turbine Prime Movers: .J Maintenance manuals, service log, basic service
.J Follow manufacturer's recommended maintenance tools,jumpers, and supplies readily available
procedure .J Check and record the time intervals of the
various increments of the automatic start-up
Engine Cooling System:
and shutdown sequences
.J Coolant level
.J Rust inhibitor in coolant .J Overall cleanliness of room
.J No unnecessary items in room
.J Antifreeze in coolant (if applicable)
.J Adequate cooling water to heat exchangers (4) After the monthly test: Take prompt action to correct
.J Adequate fresh air to engine and radiators all improper conditions indicated during test. Check
that the standby system is set for automatic start and
.J Condition of fan and alternator belts load transfer.
.J Squeeze and check condition of hose and
connections Quarterly
.J Functioning of coolant heater (if installed)
Engine Lubricating System: (1) Generator Sets:
.J Lubricating oil level
Engine Electrical Starting System:
.J Crankcase breather not restricted
.J Check battery electrolyte specific gravity
.J Appearance of lubricating oil
.J Check battery cap vents
.J Correct lubricating oil available to replenish
or change Engine Lubricating System:
.J Operation of lubricating oil heater (if installed) .J Check lubricating oil (or have analyzed if part of
an engineered lube oil program)
.J Oil pressure correct
Engine Electrical Starting System: (2) FuelSystem:
.J Battery terminals clean and tight .J Drain water from fuel filters (if applicable)
.J Add distilled water to maintain proper electrolyte .J Drain water from day tank (if applicable l
level .J Check fuel gauges and drain water from main
.J Battery charging rate fuel tanks
.J Battery trickle charging circuit operating properly .J Inspect all main fuel tank vents
.J Spare batteries charged (if provided)
© 2020 National Fire Protection Association (NFPA 99, 1 of 2)
FIGURE B.6.2 Maintenance Guide for Essential Electrical System.
2021 Edition
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
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 9�221
( b) Close the dooi-s leading to the site of the fire. B.11.3.5.2 The large quantities of noxious gases produced
(c) Attempt to extinguish or contain the fire (see constitute a threat to life from asphyxia, beyond the thermal
B.11.3.4). burn problem.
(d) Direct fit·e fighte1·s to the site of the fire.
B.11.3.5.2.1 Pe1·s01rnel are cautioned not to remain in the fire
(e) Take whatever steps necessary to protect or evacuate
patient� in adjacent area�. area after patient5 are evacuated if quantities of gaseous
comhustion product� are present.
B.l 1.3.3 Closing Off of O xygen Sup ply.
B.11.3.6 Indoctrination of Personnel. It is highly desirable
B.l 1.3.3.1 In the event of a fire involving respiratory therapy that personnel involved in the care of patients, including
equipment connected to an oxygen station outlet, the zone nurses, aides, wa.tTI sec1·eta1·ies, and phyi;icians, in-espective of
valve supplying that station is to be closed. whethe1· or not they are involved in 1·espiratory therapy practi
ces. be thoroughly indoctrinated in all aspect5 of fire safety.
B.l 1.3.3.1.1 All personnel are cautioned to be aware of the including the following:
hazard of the step specified in B.11.3.3. l to othe1· patient�
1·eceiving oxygen supplied through the same zone valve. Steps (l ) Location of zone valves of nonflammable medical gas
should he taken to minimize such hazards, realizing that clos systems whe1·e employed, and the station outlets control
ing the valve is of foremost importance. led by each valve
(2 ) Location of electt·ical service boxes and the areas served
B.11.3.3.2 In the case of oxygen therapy apparatus supplied the1·eby
by a cylinder or container of oxygen, it is desirable to close the (3 ) Location of fire extinguishers, indications for their use,
valve of the cylinder or container, provided that such closure and techniques fo1· thei1· application
can be accomplished without irtjury to pe1·sonnel. (4 ) Recommended methods of evacuating patients and
Note that metallic component� of regulators and valves can routes by which such evacuation is accomplished most
f
become exceedingly hot i exposed to flame. Personnel are expeditiously, with reference made to the facility's fire
cautioned not to use their bare hamls to effect closure. plan
(S) Steps involved in carrying out the fire plan of the hospital
B.l 1.3.4 Extinguishment or Containment of Fire. (6) Location of fire alarm boxes, or knowledge of other
methods, for summoning the local fire department
B.l 1.3.4.1 Fi1·e 01·iginating in or involving respiratory therapy
apparatus generally involves combustibles such as ruhbe1·, plas B.11.4 Typical Gas Cylinders. See Table A.11.3.5.
tic, linen, blanket�, and the like. \,Vater or Wdter-based extin
guishing agents are most effective in such fires. B.12 Additional Information on Chapter 12.
B.11.3.4.1.1 P1·ecautions should be observed if electrical B.12.1 Emergency Mana gement Program Development. The
equipment is adjacent to, or involved in, the fire because of the program development process illustrated in Figure B.12. l is an
danger of electrocution of personnel if streams of water example of a tool that can be used to develop an emergency
contact live l lS-V circuits. management program; othe1· tools or processes a1·e acceptable
f
a� long a� the task.� o identification, planning, education, eval
B.11.3.4.1.2 Before attempting to fight the fire with water or a uation, and improvement are addressed.
wate1�based extinguishing agent, electrical appa1·atus should be
disconnected from the supply outlet. or the supply ci1-cuit B.12.1.1 Program Development Steps and Activities.
should be de-energized at the circuit panel. B. 12.1.1.1 Review the Hazard Vulnerability Analysis (HVA) and
B.l 1.3.4.1.3 If de-energization at the circuit panel cannot be Determine Priorities f or Developing Standard Operating
accomplished. wate1· should not be employed. (See B.11. 3. 4. 2.) Procedures (SOPs). Using the input submitted by operating
unit manage1·s, the Emergency Management Committee
B.l 1.3.4.2 Fires invohing or a<ljacent to electrical equipment (EMC) must prioritize threats/event� and develop a list of
with live circuits can he fought with extinguishers suitahle for SOPs that must be developed to address those hazards. Figure
Cla�s C fires in accordance with NFPA 10. B.12. l . l . l displays a sample standard operating procedure
fo1·mat.
Note that chemical extinguishers are not effective against
fires in oxygen-enriched atmosphe1·es unless the source of B. 12.1.1.2 Implement Mitigation and Preparedness Strategies.
oxygen is shut off. See B.11.3.3 for closing off the oxygen Using the SOPs developed for prioritized threal�/evenl�,
supply. develop and implement actions that will eliminate or 1·educe
the impact of adverse evenl� to the facility and build capabili
B.l 1.3.5 Protection of Patients and Personnel. ties to manage them. The committee should review the SOPs to
B.l 1.3.5.1 Because of the intense heat generated, serious and identify resources needed for mitigation and preparedness,
even fatal burns of the skin or of the lungs from inhaling develop cost estimates or resources 1·equired, and submit the
heated ga�es are possihle sequelae to a fire in an oxygen resource request to the director for fonding. The committee is
enriched atmosphere. Thus. it is essential that patient� be responsible for tracking mitigation and preparedness planning
1·emoved from the site of the fire whene\·er practical. activities until completed.
Note that, where a nonamhulatory patient is connected to a B.12.1.1.3 Report Results of Mitigation and Preparedness
burning piece of thernpy equipment, it might be m01·e practi Activities to the Emer gency Management Committee. Opernt
cal, as the initial step, to remove the equipment or extinguish ing unit manage1·s and the emergency program coordinat01-
the fire, or hoth, than to remove the patient. 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
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 B.12.1.1.5 Train Staff on the EOP. See 12 .5.3.5.
or eliminate adverse impact� to the facility operation; an<l
B.12.1.1.6 Delegate the Emergency Management Committee
recommendations for mitigation an<l preparedness activities,
(EMC), Identify Department Roles, and Assi gn Responsibili
bu<lget, an<l timelines.
ties. The EMC is a multidisciplina1·y committee established to
B.12.1.1.4 Develop, Publish, and Distribute the Emergency coordinate and oversee the emergency management program
Operations Plan (EOP). Section 3.6 of NFPA. 1600 desct"ibes and should have a close 1·elationship \,�th the Safety Committee
four types of planning: strategic administrative (preparedness) or Environment of Care Committee, or both.
planning, mitigation planning, recove1y planning, and eme1·
1l1e functions of the EMC include defining the role of the
gency operntions planning.
organization in the communitywide emergency management
The Federal Emergency Management Agency, now part of program; conducting/revie\\1ng a hazar<l vulnerability analysis
the Department of Homeland Security. issues gui<lance on the (HVA). which addresses all hazanls that threaten the facility;
development of emergency operations plans, 01· EOPs. The developing/1·eviewing standar<l operating proce<lut·es (SOPs)
EOP is des igned to address all hazards, and it accomplishes this that address hazar<ls identified in the HVA; developing/review
through it� organization by functions, not department�, ing the emergency operations plan and coor<linating it \\1th
haza1-ds, 01· individuals. Flexibility is a key katme of this type of other health care organizations in the communitywide eme1·
format, as only the functions n eeded to address the problems gency management program; assigning mies and responsibili
are activated, not the entire plan. This type of EOP format (a ties of operating unit managers an<l key operators/managers;
ba.�ic plan an<l functional annexes) is that used by communi ove1·seeing the development an<l maintenance of the EMP;
ties. states. an<l the Fe<leral Response Plan. (SPe AnnPx D.) ensuring that all employees have received apprnpriate training;
f
conducting an annual evaluation of the ef ectiveness of the
Hard copies of the EOP need not be widely <listributed.
prngram; an<l ensuring a telephone roster of key personnel
Staff membe1·s need access to incident-specific plans, but not
1·esponsible for Cl'itical operations is kept cutTent.
the entire document. Several copies of the full EOP should be
available in the Hospital Command Cente1·, the adminisu·ative B.12.1.1.7 Test and Evaluate the EOP in Response to a Drill or
offices, and with the chair of the Emergency Management Actual Event. See 12.5.3.3.7.
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.
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
f
B.12.2 Personnel Notification and Recall. Medical staf . key history of high winrls or the HVA. or both. showed that certain
personnel, and other personnel needed will be notified anrl winrlows shoulrl be boarderl and certain doors should be
recallerl as requirerl. In 01·rle1· to 1-elieve switchboarrl conges braced and sa.nrlbaggerl.
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 B.12.3.2.4 Flooding. Flooding into a facility's lower levels
the pyramidal system, an indivirlual who has been notified will where utilities are often housed result� in a disruption of these
notify two other individuals, who, in turn, will each notify two sen.•ices. In a recovery effort, the following procedm·es were
othe1· inrlividuals, and so on. A current copy of the notification helpful:
and recall roster, with current home and on-call telephone (l ) Keep the elecu-ical service turned off until the electrical
numbers, will be maintainerl at the hospital switchboard at all rle\�ce completely dries.
times. In case the pyrnmidal system is to be utilized, each inrli (2) Secure environmental waste containe1·s anrl ponable
\irlual invoh·ed in the system ha� to maintain a current copy of medical gas containers.
the roster at all times, in order that each knows who they are to
notify and the telephone numbers concerned. It is essential One contract01· dealing with the hospitals of the Gulf states
that key pe1·s01111el roste1·s be kept cutTent. stated that, based on its experience with floorls, it would never
again use "fail return" elevators to a basement level. Many times
B.12.3 Special Considerations and Protocols. elevators returned to the basement level upon loss of power,
resulting in the wires that a1·e locaterl in the cab flom·ing being
B.12.3.1 Fire and Explosion. In the event that the health care soaked, rendering the elevat01- useless.
facility does not need to be completely evacuated immediately,
the actions staff should take when they are alerted to a fire are B.12.3.2.5 Power Loss. Power is lost typically as a result of
detailed in Sections 18.7, 19.7, 20.7, and 21.7 ofNFPA 101. high winds and floorling. Generators and transfer switches have
been lost due to their location below the high wate1· mark.
B.12.3.2 During the past rlecade, the health care industry ha� Another problem surfacing with generators is that they often
been struck by numerous natural disasters. A study of these we1·e not powerful enough to provide HVAC services to the
disastern ha� prmiderl a set-ies of "lessons learnerl." Examples facility. In some of the Gull" states, this alone forced evdcuation
follow. of the hospital or long-term care facility. Another problem
B.12.3.2.l Alert. Alerting is often provided through the local encountered was fuel, designed for another type of generator
Office of Eme1·gency Management and the National Oceanic (such a� military). contaminating the unit. When otTle1·ing
and Atmosphe1·ic Administrntion. Based on the facility's backup generat01·s, it is important to know the size neerlerl and
geographical location, these alerts often come in the form of a the method to be used to connect the generator to the facility.
"watch," which inrlicates the strong possibility of a natu1·al disas Services, in p1·i01·ity, which shoulrl be up and rnnning for the
ter, or a "warning," which indicates the immediate threat of a facility to be operational, are a� follows:
disaster. A haza rd vulnernbility analysis (HVA) of the a rea
would result in actions that should be taken at different stages (1) Clinical care:
of the alert. Such actions could indicate monitoring 1·epo1·t� by (a) Life-support systems
f
a liaison with the Office o Eme1·gency Management; the lnte1· (b) Life safety (exit� and fit·e ala rm and fire suppt·es-
nal Incirlent Commanrl of a facility would assess exis ting staff'. sion)
ing and supply issues and make decisions to activate staff call (c) Lab sen,ices
back. plans and augment critical supplies. Some facilities have (d) Pharmaceutical services
also inrlicaterl they have found it useful to complete a pre (e) Diagnostic services
storm patient census reduction to discharge, where possible, or (2) Infrastructure:
to move preselected high-acuity patient�. such as neonatal
intensive care patients, bariatt·ic patient�. or patient� with (a) Heating, ventilation. and ait0conrlitioning
seve1·e 1·espiratory complications, or a combination the1·eof. (b) \'Vater supply and 1·emoval systems
Also, during this pre-storm patient relocation, selecterl patient� (c) Information technology
could be moverl to what are conside1·ed to be safer a1·eas within (d) Food and liquids
the facility. (e) Elevators
Some natural disa�ters provirle absolutely no warning, such B.12.3.2.6 Loss of Communications. Loss of communications
as an earthquake. During such a situation, staff woulrl have to is one of the maj01· problems rlm·ing a disaster. There have
assume immediate operations plan procedures. been many suggesterl solutions, inclurling satellite phones and
websites to communicate to staff and responsible parties. A
B.12.3.2.2 Isolation Survival for up to 96 Hours. Recent disas successful solution has been communications conducted
ters have shown it coulrl be 96 hours (in some cases, longe1·) through Amateut· Radio Emergency Services (ARES). Health
before outside help is able to reach the facility. Those facilities care facilities have also reporterl that it was important to have
with sufficient resources in-house for critical areas fared the either a liaison to, or a liaison position within, the community
best during disa�te1·s. Facilities that had cot-porate strnctures 01- eme1·gency ope1·ations center.
associations with out-of-area 01·ganizations also 1·eceived help in
a timelv manner. 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
B.12.3.2.3 Wmd. ·when wind knocked down communications tion cooling systems, sterilization. dialysis services, liquid
antennas, the result was severe rlifRculties in facility communi consumption, laundry, dishwashing, staff and patient hygiene,
f
cation with staf , other health ca1·e facilities, and so forth. One and fit·e suppression. It is recommended that hospitals perfo1·m
solution was construction of antennas with hinges so they coulrl risk. assessment� in these areas anrl prepa re themselves for
be laid down during a pre-storm warning. In other cases, the
2021 Edition
ANNEX B
96 hours of isolation. without out�ide water delivery. If this is (1) Move to predesignated a1·ea�. whethe1· in the facility,
not possible, evacuation might have to be considered. nearby, or in remote zones. Evacuation directives will
no1·mally indicate destinations. Note that it is 1·ecommen
B.12.3.2.8 Staff Issues. The following staff issues were found ded to predesign a mutual aid evacuation plan with othe1·
to be important to address: health care facilities in the community. (SPP AnnPx D, U.S.
(1) Transportation, including knowledge of which roads are (',<JvPrnmPnt Publication 3152, Hospital� and Community Emer
f
open and actually trnnsporting staf to the facility. The gPnry RPsponse - What fou NPPd to Know, on thP subjN:t of
health cat·e organization should wo1·k with the state and hPalth rarP r01111nunity mutual aid and euar.uation planning.)
local agencies to identify qualified volunteer groups or Receiving facilities can also be designated ba�ed on the
othe1· oi·ganizations that could provide tt·ansportation scope of the event, activation of state or federal 1·eso111-ces,
services to staff. or by local emergency medical senices (EMS), based on
f
(2) Addressing the sa ety of families of staff. availability.
(3) Provision of food, liquids, and lodging for staff and family (2) Ensure movement of equipment, supplies, and medical
f
members. 1·ecords to accompany rn· meet patients and staf in the
new location.
B.12.3.2.9 Civil Disturbance. Civil disturbance resulted mostly (3) Execute predetermined staffing plans. Some staff will
from members of the disa�te1°struck community seeking drugs, accompany patient�; other·s will 1·endezvous in the new
food, and shelter. Dm-ing such disturbances, facilities initiate f
location. Maintenance of shi t� is more complex than
lock.down procedures and 1·equest local police a�sistance to not·mal, especially when some ha1·d-to-move patienl� stay
protect the facility. It was noted that police department� were behind in the threatened location, and when staff might
often ove1·bunlened dut·ing disasters that involved civil disturb be separated from their own 1·elocated families.
ance, and facilities had to 1·ely on pt·ivate secut·ity 01· the (4) Protect patients and staff (during and afi:e1· movement)
Nationa1 Gua1·d, or both. against the threatening environment.
B.12.3.2.10 Influx of Patients. Even though the facility is (5) \Vhen planning, consider transportation arrangement�
tq,ing to keep it� patients alive and safe, it must be 1·ecognized and patient tracking.
that some outside patients might come to the facility due to B.12.3.3.l The Emergency Management Committee oversees
serious ir�uries that occur during the disaster or other medical the HVA process to ensure that all major threat5 to the facility
needs. Othe1·s might have power at home or home health ca1·e are accounted fo1· and assessed. Input to the HVA by operating
provide1·s to assist them with special needs and may not need to unit managers is very important. Once a list of priority hazards,
go to the health care facility. Community members might come threat�, and evenrn has been compiled, managers should
to the facility simply to seek shelter or medications in the event complete an operating unit template for their particula1· service
thei1· normal pharmacy is shut down. Some patients might or department. Some thr·eat� to individual operating units are
come from an e\'acuating facility. so severe that they might inten-upt the continuity of critical
Recognizing these situations, facilities might be able to redi- operations in the facility. The operating unit template is a unit
1·ect the special needs population to a special needs shelte1· if level contingency plan, useful in staff education, drills, and
the community has set up such provisions. It was found helpful actual evenl�. Figure B.12.3.3.l(a) illustrntes a sample HVA
to establish an oul�ide (under cover) pre-emergency/triage format. Figure B.12.3.,\.1 (b) shows a sample operating unit
1·oom to relieve stt·ess from the critical care emer·gency room template.
within the hospital. B.12.3.4 Activation of Emergency Utility Resources. Loss of
B.12.3.2.11 Evacuation. Often evacuation wa� accomplished utility resources can occur at any time due to a natural disaster,
in twu phases. Pha�e I was a pre-storm evacuation. It \'\"dS found an internal sy.,tem failure, or even a supply shortage. Redun
f
that, i this was going to be undertaken, it had to begin early dancy in system design and suppon is fi.mdamental to avoiding
enough to avoid traffic congestion to get patienl� to their ulti loss of utilities. Critical points of failure in systems and supply
mate destination in an acceptable length of time; otherwise, chains should be identified, and their malfunction, disruption,
Pha�e II, or full hospital evacuation, could not take place until or loss mitigated.
the disa�ter had subsided and trnnsportation was once again The key to a successful 1·esponse to a loss of utilities is plan
available to move patienl�. Additional problems occurred with ning. Assessment of the organization's utilitv systems is an
tracking patienl� and moving their medical 1·ecords. Medical excellent starting point and should consist of identifying essen
1·ecords that were on the Electronic Health Recot·ds System tial utility sy.,tems, such as electricity, wate1/sewe1·, piped medi
we1·e at times unattainable if they could not be accessed from a cal ga� and Vdcuum systems, HVAC systems, and vertical and
remote site. Hard copy records, in some cases, were lost during horizonta1 transporl�. Once the sy.,tems are identified, they
transport. should be broken down to the component level and evaluated
B.12.3.3 Evacuation. Evacuation can be partial or total. It fo1· importance. This allows the organization to establish priori
might involve moving from one story to another, from one ties and the capabilities of the systems and their component�.
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:
2021 Edition
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.
2021 Edition
Organizations shoul<l evaluate their self-sufficiency for at Volcanic ash is actually finely pulverized rock blown out of
lea�t 96 hours. This evaluation will assist in establishing gaps in the volcano. Out5i<le the area of direct damage, the ash varies
the utility systems. For example, if a facility loses electricity an<l from a fine powde1· to a coarse sand. General housekeeping
has backup generators, the 01·ganization must establish how measures can exclude much ash. It shoul<l be note<l, howeve1·,
f
long it can operate on those generators. By looking at dif erent that people move about freely during and after ash fall.
components of the generator system, the organization might
determine that only enough fuel fot· 24 hours is maintaine<l. If i\sh fall pt·esents the following fotu- problems fot· health care
the same generator is coole<l by water an<l the water supplv is fac iii ties:
disrupted, that is an ad<litional limitation. This concept should ( l) People require cleanup (brushing, vacuuming) before
be applied to all systems and key components of each utility. entering the building.
(2) Electromechanical and automotive equipment an<l air
By establishing the limitations of the utility systems an<l filtering systems 1·equire special ca1·e because of the highly
component5, an organization can i<lentify the nee<l to mitigate abrasive and fine-penetration nature of the ash.
v.'ith alternative means, such as extra equipment, generators, (3) Increa�ed flow of patients with respiratory complaint5 can
bottle<l medical gas, bottled water, 01· formal documente<l be ex pee te<l.
agreements and understan<lings ,,'ith other organizations. (4) Eye protection is require<l for people who have to be out
Contingency plans should be establishe<l an<l tested for effec in the dust. (No contact lenses should be won1; goggles
tiveness on a regular basis. It is essential that an 01·ganization a re suggested.) Dust ma�b are available that are
understands its limitations and uses this information to <lete1· approve<l by the National Institute fot· Occupational
mine if it can sustain itseu· for 96 hours or if it is appropriate to Safety and Health (NIOSH) and a.re marked TC-21 plus
stop or limit services. other digit�.
B.12.3.5 Civil Disturbance. Large-scale civil distut·bances have f
B.12.3.8 Weapons of Mass Destruction. V{eapons o mass
shown that health care facilities and their personnel are not destruction, or V11MD, are <lefined as any weapon or device that
immune to the direct eflects of human violence during such is intended to cause, or ha� the capability to cause, <leath or
distu1·bances. Hospitals in la1·ge urban area.5 have to make serious bodily i1tjury to a significant numbe1· of people through
special provisions in thei1· disaste1· plans to ens1u-e the physical the release, dissemination, or impact of toxic or poisonous
safety of their employees in transit from the hospital exit to an<l chemicals or their precu1·sors; a <lisease organism; or 1·adiation
from a secure means of transportation to thei1· homes. In or rndioactivity. Many frdernl department� and agencies a1·e
extt·eme cases, it might be necessaty to house employees within involved in supponing \,VMD preparedness an<l 1·esponse activi
the health care facility it�elf during such civil disturbances. ties at the state and local level. The Department of Health and
A.nother aspect of ci,il <listurbances not to be ovedooke<l in Human Services manages two cooperative grant programs
facility security planning is the possibility that a given health a<lministet"ed by the Cente1·s fot· Disea�e Control and Preven
care facilitv might have to admit and treat la1·ge numbers of tion (CDC) and the A5sistant Sec1·etary for P1·epa1·edness and
prisoners during such emergencies; however, security guards Response (ASPR). These programs are aimed at enhancing the
for such patient� will normally be provi.<led by the local police 1·eadiness of the public health and hospital system.
depanment.
1l1e Department of Justice maintains a help line
B.12.3.6 Hazardous Materials. There are at least three major ( l-800-368-6498) offering technical assistance in nonemer
sources of concern v.'ith 1·egard to nonradioactive haza1·dous gency cases an<l provides info1·mation on the following subject�:
materials mu-elated to the intentional use of chemical agents to detection equipment; pe 1·sonal protective equipment; decon
ha rm people (sPe B.12.3.8). The first is the possibility of a la rge tamination systems and metho<ls; physical properties of WMD
spill or venting of hazar<lous materials near the facility; this is materials; signs and symptoms of \'\'MD exposm·e; tt·eatment of
especially likely near major rnil or truck shipping routes, nea r expostu-e to V\'MD materials; toxicology information; fe<lernl
pipelines, 01· neat· heavy manufactut·ing pla.nK Second, every response asset�; an<l applicable laws and 1·egulations. For
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facilitv contains \\'ithin its boundaries v-atying amount5 o such reporting actual or potential act� of terrorism, health care
materials, especially in the labo1·ato1y and custodial a1·eas. A facilities shoul<l contact their local 01· state health department�.
spill of a highly volatile chemical can quickly contaminate an The National Response Cente1· ( l-800-424-8802) can link call
entire stntctm·e by way of the ai1· <luct�. Finally, contaminate<l ers to technical experts.
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patients can pose a risk to staf , though on a more localize<l
ba5is. Usually, removal of their clothing \,'ill reduce the risk See i\nnex D for publications relating to \'\'MD p1·eparedness
materially. In any case, stall has to be pt·epared to seek ad"ice for health systems.
on unlmown hazards. This type of a<lvice is not usually available
B.12.4 Continuing Operations Plan and Recovery. It has been
from poison centers, but rather from a central referral, such as
CHEMTREC, and it� toll-free emergency inforniation senice well documented that a community cannot recove1· without the
number (800-424-9300). health care facilities recovering simultaneously or befo1·ehan<l.
If at all possible, a health care facility nee<ls to remain opera
See A,.nnex D for publications concerning hazardous materi tional throughout a disaster to care fo1· it� patients, as well as
als regulations and repo1·t� on va rious types of chemical protec for those who are ittjure<l <lut·ing the disaste1·.
tive equipment.
It is important to advertise that the facility is open for busi
B.12.3.7 Volcanic Eruptions. Although most of the direct ness as soon a.5 it is able to operate.
effect� of a volcanic eruption are covered in othe1· protocols fot·
disasters (e.g., fire, explosion), it is necessary· to make special A5 part of disaste1· recove1y, health ca1·e facilities should
provisions for functioning in areas of heavy to moderate ash consider the following:
fall. This hazar<l can exist hundreds of miles downwind from
the eruption.
2021 Edition
ANNEX B 9�229
( l) Know the sout-ces of funding, such a� msui-ance and their ignition but that burn ,igornusly in 100 pet-cent oxygen
FEM A, and request loans from those sources to initiate include, but are not necessarily limited to, the following: tri
cash flow as soon as possible. cresyl phosphate (lub1-icant); certain types of flame-1·esistant
(2) Activate lines of credit with vendors and banks. fabrics; silicone rnbhe1·; polyvinyl chl01·ide; ashestos-<:ontaining
(3) Use stock and other investment5 as collateral for loans paint; gla�s fiber-sheathed silicone rubber-insulated wire; poly
and lines of credit. vinyl chloride-insulated asbestos-covered wire and sheet; poly
(4) Have the finance section chief of the Incident Command amides; epoxy compounds; and certain a5bestos blankets.
System work with othe1· section chiefs to keep p1·ecise
records of disaster-related expenses for reimbursement Note that flammable lubricant� are used widely in equip
follmving the disaste1·. ment designed for conventional use, including shafts, gear
(5) Ensure that doctors' offices open simultaneously with the boxes, pulleys and eastern, and tlu-eaded joint�. which are
opening of the hospital to provide senices to patients. coupled and uncoupled.
Provide office support as soon as possible for physicians, B.14.1.1.3.2 The flammability of certain volatile liquids and
with the p1·iority being eme1·gency department physicians, gases containing carbon and hydrogen is well known. Haza1·ds
genei-al practitioners, orthopedic surgeons, and ca1-dio and safeguards for thei1· use in oxygen-enriched atmospheres at
vascular surgeons. ambient pressure are well-documented in the NFPA Firf Proter
(6) Activate billing and payroll a� soon as possible. tion Guidf to Hazardous Material� and NFPA 53.
(7) Consider setting up a bank ,vi thin the hospital fo1· staff.
B.14.1.1.3.3 Human tissues will burn in an atmosphe1·e of
Credits: 100 percent oxygen. Body oils and fat�, as well as hair, will burn
Educational Fact Finding and On-site Resea1·ch in Houston, readily unde1· such circumstances.
Texa�. following Tropical Storm Allison, 2001. B.14.1.1.3.4 When a conventional loose cotton oute1· garn1ent,
National Fire Protection Association. such a� scrub suit�. dresses, and gowns employed in hospital
operating suites, is ignited in an atmosphere of pure oxygen,
Russell Phillips & Associates, LLC. the garment will become engulfed in flame i-apidly and ,viii he
totally destroved \vi thin 20 seconds 01· less.
Also see "Atmospheric Pressure,"' Firf journal, July/August,
2002. If such a garment is ignited in a comp1·essed ai1· atmosphere,
the flame spread is increased. When oxygen concentration
Educational Fact Finding and On-site Resea1·ch for HuITi exceeds 23.5 percent at elnated total pressure, flame spread is
cane Katrina, Louisiana, Mississippi, 2005. much more rapid, and at 6 ATA, is comparable to 95
Ame1·ican Society of Healthcare Engineers: Dale ''\'oodin. ± 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
Russell Phillips & A�sociates, LLC: Russell Phillips & Scott ± 5 percent at l ATA.
Aronson.
Combustible falxics have tiny ai1· spaces that become filled
B.13 Reserved. \vith oxygen when exposed to oxygen-enriched environment�.
B.14 Additional Information on Chap ter 14. 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
B.14.1 Nature of Hazards. 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
B.14.1.1 Fire and Explosion. time to diffuse out and be replaced by air.
B.14.1.1.1 The occut-rence of a fire requires the presence of B.14.1.1.3.5 Oil-based 01· volatile cosmetics (facial creams,
combustible or flammable materials, an atmosphere containing body oils, hair spi-ays, and the like) constitute a sou1-ce of fuel
m..-ygen or other oxidizing agent(s), and heat or energy source that is highly flammable in an oll.-ygen-enriched atmosphere.
of ignition.
B.14.1.1.4 Sources ofl gnition.
Note that ce1·tain substances such a� acetylenic hydrocarbons
can propagate flame in the absence of oxygen. 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
B.14.1.1.2 Under h)pedJaric conditions utilizing compressed to, the following: defective electrical equipment, including fail
air, the partial p1·esstu-e of oxygen is increased. Leakage of ure of high-voltage component� of radiological 01· monitoring
m,-ygen into the atmosphere of the chamber (for example, equipment; heated surfaces in broken vacuum tubes or broken
from improper application of respirato1-y therapy apparatus) lamps used for general illumination, spot illumination, or illu
can further inci·ease markedly the oxygen partial p1·essure. mination of diagnostic instrnment�; the hot-wi1·e caute1·y 01·
B.14.1.1.2.1 The flammability or combustibility of materials high-frequency electrocautery: open or arcing switches, includ
generally increases as the partial p1·essure of oxygen inCt"eases, ing motor s,vitches; bare defibrillator paddles; overheated
even when the percentage of m,-ygen in the gas mixtm·e motors; and electrical the1·mostat�.
1-emains constant. Materials that are nonflammable 01- noncom B.14.1.1.4.2 Sources of ignition that should not be encoun
bustible under normal atmospheric conditions can become tered in a hyp erharic facility, but that might be introduced by
flammable 01· combustible under such ci1·cumstances. inept practice, include the following: lighted matches 01-
B.14.1.1.3 Sources of Fuel. tobacco, static sparks from improper use of personal attire,
electrical wiring not complying mth 14.2.9, cigarette lighters,
B.14.1.1.3.1 Mate1-ials that might not ignite in air at atmos and any oil-contaminated mate1·ials that present a spontaneous
phe1·ic pressut·e 01· require relatively high tempei-atures for heating haza1·d.
2021 Edition
B.14.1.1.4.3 In oxygen-enriche<l atmospheres. the minimum stan<lard flowmeters, presstlt"e gauges. and pressure-re<lucing
energy necessary to ignite flammable or combustible materials regulators.
is 1·e<luce<l in most instances below the ene1·gy 1·egui1·e<l in
atmosphe1·es of ambient air. Note that illuminating lamps 01· vacuum tubes, which
implode. or ovedoaded fans, a1·e sources of ignition.
B.14.1.2 Mechanical Hazards.
B.14.1.3 Pathophysiological, Medical, and Other Related
B.14.1.2.l General. Hazards.
B.14.1.2.1.l A large amount of potential energy is stored in B.14.1.3.l Exposure of pregnant chamber occupant5 to hyp er
even a small volume of compressed gas. In hyperba1·ic cham ha1·ic atmospheres might result in fetal 1·isk.
bern of moderate or la1·ge size, the potential energy of the
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chambe1·'s compressed atmosphere, i released su<ldenly, can B.14.1.3.2 Medical hazar<ls that can he encounte1·ed routinely
produce devastating destruction to adjacent structures an<l include compression problems, niu·ogen narcosis, oxygen
pe1·sonnel, as well as to structures and personnel remote from toxicity, and the <lirect effects of sudden pressure changes.
the site of the chambe1·. Such sudden release coul<l 1·esult from B.14.1.3.2.l Inability to egualize pressme <lifferentials
failure of the vessel structure, it� part�, or its piping. between nasophary nx (nose) an<l nasal sinuses or the middle
B.14.1.2.1.2 A panicular hazard can be CL"eated if individuals ear can result in excruciating pain and might cause rupture of
attempt to d1·ill, cut, or wel<l the vessel in a manne1· contrary to the eardrum 01· hemotThage into the ear ca\ity 01· nasal sinus .
ASME BoilPr and PrP.mm l-',,sifl CodP. B.14.1.3.2.2 The breathing of air (78 percent nitrogen) un<ler
B.14.1.2.2 The restt·iction on escape an<l the impedance to significant pressu1·es (as by chamber personnel hreathing
rescue and fit-e-fighting effort� pose<l by the chamber CL"eate a chambe1· atmosphe1·e) can result in nitrogen na1·cosis, which
significant hazard to life in case of fire or other emergency. r·esembles alcoholic inebriation. The <legree of narcosis is
directly related to the amount of pressurization. Nitrogen
B.14.1.2.2.l A particular haza1·d exist� to chamber personnel narcosis results in impairment of mental f unctions, loss of
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in the event o a fi1·e within the structure housing the chamber. manual dexterity, and interference with alertness an<l ability to
Inability to escape from the chamber and loss of se1vices of the think clearly an<l act quickly and intelligently in an emergency.
chamber operator woul<l pose serious threat� to the lives of all
occupant� of the chambe1·. 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·
B.14.1.2.2.2 All personnel involved in hyperbaric chamber a significant length of time . Oxygen toxicity can affect the
operation an<l therapy, inclu<ling patient� and family, have to lungs (pain in the chest, rapid shallow breathing, coughing).
be made aware of the 1·isks and hazar<ls involved. Fi1·e preven nervous system (impaire<l consciousness an<l convulsions), or
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tion is essential. Extinguishment o a fit·e within a Class B cham other tissues and organs, or combinations thereof.
ber is impossible. Extinguishment of a fire within a Class A
chambe1· is only possible utilizing eguipment alt-eady installe<l B.14.1.3.2.4 Direct eflects of reduction in pressure can
in such a chambei-, and then often only by the effo1·t� of the include inability to egualize pressures between the na�ophar
occupant� of such a chamber or the chamber operator. ynx and sinuses 01· middle ear, expansion of gas pockets in the
gastrointestinal tract, an<l expansion of trappe<l gas in the
B.14.1.2.3 The necessity for restt·icting viewing po1·t� to small lungs.
size limit� the vision of chamber operators and other obse1·vers,
reducing thei1· effectiveness as safety monit01·s. B.14.1.3.2.5 The presence of pe1·sonnel within the cramped
confines of the hyperbaric chamber in close proximity to
B.14.1.2.4 Containers and enclosures can be subjected to grounded metallic structut·es on all si<les ct"eates a definite
collapse 01· ruptm·e as a conseguence of the changing pressures shock hazard if accidental contact is made with a live electrical
of the hyperbaric chamber. Items containing e ntrained gas conductm· or a defective piece of electrical equipment. Such
inclu<le, but are not necessarily limite<l to, the following: accidental contact also could he a source of ignition of flamma
ampuls, partially filled syringes, stoppe1·e<l 01· capped bottles, ble or combustible materials. (SPP B.14.1.1.4.)
cuffed endotracheal tubes. an<l pneumatic cushions employed
for breathing ma�ks or aids in positioning patient�. The B.14.1.3.3 Medical hazar<ls that are not ordinarily encoun
ruptut·e of such containers having combustible or flammable tered during hyperbaric oxygen therapy. but that might arise
liquids would also constitute a severe fit·e 01· explosion hazard. during maUi.mction, fire, or other eme1·gency conditions,
include electric shock and fouling of the atmosphe1·e of the
B.14.1.2.4.l The su<lden collapse of containers from high chamber with oxygen, niu·ous oxi<le. carbon <lioxide, carbon
external pressures will 1·esult in adiabatic heating of the monoxide, pyrolysis product5 from ove1-heated materials, or the
contents. The1·efore the collapse of a container of flammable toxic products of combustion from any fire.
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 B.14.1.3.3.l Increased concentrations of carbon dioxide
11.14.1.1.3.2.) within the chambe1·, as might 1·esult from malfunction of the
systems 1·esponsible fo1· monit01·ing or removal thereof, can be
B.14.1.2.5 Othe1· mechanical hazards relate to the malfunc toxic u nder inct"ea�ed pressures.
tion, disruption, or inoperativeness of many standar<l items
when placed in service unde1· p1·essurized atmosphe1·es. B.14.1.3.3.2 The development of combustion product5 or
Hazar<ls that might be encounte1·ed in this regar<l are implo gases evolved from heated nonmetallics within the close<l space
sion of illuminating lamps and vacuum tubes; overloading of of the hype1·ba1·ic chamber can be extremely toxic to life
fans dri\ing gas at higher <lensity; and inaccurate operation of because of the confining nature of the chamber and the
2021 Edition
ANNEX B 9�231
increased hazarrls of lxeathing such product� under elevated (2) The actions of the chamber operat01· should be as
pressure. follows:
Note that extreme p1·essu1·e rises have accompanied cata ( a) Activate the fire supp1-ession system , if needed.
strophic fit-es in confined atmospheres. These pressures have (b) Switch b1·eathing gas to air.
driven hot, toxic ga�es into the lungs of victims as well as ( c) Decompress the chamber as rapirlly as possible.
exceeding the strnctural limit� of the vessel in at least one case. (d) Deactivate all unnecessary electt·ical equipment.
(3) The actions of the medical personnel (outsirle) should be
B.14.1.3.4 Physiological haza1·ds include exposure to high as follows:
noise levels and decompression sickness. Rapid release of pres
su1·ized gases can produce shock waves and loss of visibility. (a) Di1·ect operations and assist crew members whe1·eve1-
necessary.
B.14.1.3.4.1 During h}perba1·ic therapy, and especially during (b ) Provide merlical support as required.
compression, the noise level within the chamber becomes quite (4) The actions of the other personnel (out�ide) should be as
high. Such a level can be hazardous because it is distractive, follows:
intede1·es with communication, and can prorluce pe1·manent (a) Notif)' the fin� department by activating fit·e signal
sensory-neural rleafness. ing device.
B.14.1.3.4.2 Decompression sickness (benrls, caisson w01·ke1·'s (b) Stand by with a fire extinguishe1·.
disea�e) 1·esult� from the elution into the bloorlstream or ( c) A�sist in unloarling chamber occupant�.
exu·avascular tissues of bubbles of inert gas (mainly nitrogen) B.14.2.2 Fire Outside OJ.amber. For fire outside the chamber,
that becomes dissolved in the blood and tissue fluids while the following procerlures should be perfo1·merl:
b1·eathing air at elevated presstlt' es for a significant period of
time. (1) The actions of the chamber opera tot· shoulrl be as
follows:
Note that rapid decompression of the chamber can occur if
the pressu1·e relief valve is damaged from exposu1·e to a fit·e (a) Notif)i the inside obse1·ve1· to stand by fo1· eme1-gency
external to the chambe1· 01· from the venting of hot product� of retun1 to nonnal atmosphe1·ic pressure.
combustion from within the chamber. (b) Notify the fire rlepartment by activating fire signal
ing device.
f
B.14.1.3.4.3 The use o decomp1·ession procerltlt'es will (c) Switch b1·eathing gas to air.
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p1·event immerliate escape from the Class A chamber by occu (rl) Don the operator's breathing rlevice, i applicable.
pants during emergency situations. (2) The actions of the medical personnel (out�ide) should be
a� follows:
Note that these procedm·es are not followerl if chamber
occupant� are exposed to a "no-decompression exposure"' ( a) Determine whethe1· procedure shoulrl be termina
r compression to Jess than 2 atmospheres absolute (ATA) air l, terl.
01· when comp1·essed to 2 ATA 01· highe1· pressures anrl breath (b) Provide medical suppon as required.
ing 100 pe1·cent oxygen. B.14.3 Suggested Fire Procedures for Facilities with Class B
B.14.1.3.4.4 The sudden release of gas, whether by rupture of OJ.ambers.
a container or operation of a rlevice such as used in fit·e fight B.14.3.1 Fo1· fit·es within the facility not involving the chamber,
ing, will produce noise, possible shock waves, reduced or the following procedure shoulrl be pedormed:
obscurerl 11isibility, anrl temperature changes. The initial effect
might be to cool the air, but resulting pressure rises will cause (1 ) Don the operator's means for respiratory anrl eye protec
adiabatic heating. tion, if applicable (.�ff 14.2.5.4).
(2) Decompress the chambe1·. The urgency of rlecompression
B.14.1.3.5 In summary, the hazarrls of fire and related prob should be determined by the location of the fire.
lems in hyperbaric systems are real. By the very nature of the (3) Remove the patient and evacuate to a sal'e area.
hyperba1·ic atmosphe1·e, increased partial p1·essures of O>,,')'gen ( 4) Turn off the oxygen zone \-alve to the chamber room anrl
are p1·esent routinely. Flammability and combustibility of mate close any smoke/fire batTier doorn. These steps are
rials are increased. Ignition energy is lowered. Both immediate consistent with the rescue anrl confine element� of the
escape and 1·eady entt·y for 1·escue are imperlerl. Finally, attenrl rescue, ala1·m, confine, extinguish (RA.C.E.) procedure.
ants within the chamber, through effect� of the ele\-aterl noise It is assumerl that othe1· personnel will e,-acuate othe1-
level and nitrogen pressur·e, might be unable to responrl to patients anrl visitot·s from the area and acti,-ate a fire
emergencies quickly and accurately. alarm signaling device (if not already activated).
B.14.2 Suggested Procedures to Follow in Event of Fire in B.14.3.2 For fire within the chambe1·, the following procedure
Class A Chambers. should be performerl:
B.14.2.1 Fire Inside OJ.amber. Fo1- fit·e inside the chamber, (1) Stop oxygen from flowing into the chambe1· by switching
f
the following procedures shoulrl be performed: of the chamber ( if the chamber is compressed \\1th
( 1) The actions of the insirle observer should be a� follows: oxygen) or switching the supply gas of a breathing device
from oxygen to air (if the chamber is compressed \\1th
(a) Don breathing air device immerliately air).
( b) Activate fire supp1·ession system anrl/or hanrlheld (2) Decompress the chambe1· as rapirlly as possible in accorrl
hoses. ance with the emergency rlecompression procedures.
( c) Ao.vise outside.
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 \'\'he1·e gas purging is use<l. the following should he consid
ered:
element� of the rescue, alarm, confine, extinguish (R.A.C.E.)
procedure. It is assumed that other pet·sonnel will evacuate (1) Each electrical device should comply with 14.2.9.3.17.
othet- patient� and visitoi·s from the at·ea an<l activate a fire Gas purging is only one element of the essential risk
alarm signaling de\ice (if not already activated). The i1tjure<l a�sessment and management that is critical to safely
patient shoul<l have appropriate me<lical attention imme<liately managing any electrical de\ice that is introduced into
after evacuation to a safe at·ea. Many Class B chambet·s require the chamber. A comprehensive risk assessment with
oxygen supply pressure to opei-ate a rapid decompn�ssion approved safety procedures and mitigation orders needs
f
featut·e. If this is the case, do not turn of the oxygen zone valve to be documented and signed by the medical director,
or any in line oxygen supply shutoff valve until all patients have sal·ecy director and all who are directly involve<l, prior to
been remove<l from the chamher(s). the <levice being used in the chambet·.
(2) Each gas purge device should have it� own dedicated
B-14.4 See Table B.14.4. purgi ng line and flowmeter with each flowmeter clearly
B-14.5 Gas Purging. Inert gas 01· air purging is a means to lahele<l identifying the gas used. Splitting a purge line to
mitigate the risk of fit·e from an electrical <levice brought into supply two or more <le,ices can c t·eate a <lispa1·ity of flow
the chamber. The three main ol�ectives to inert gas 01· air purg between the multiple gas lines depending on the length
ing are to lower the ox ygen level, to purge increase<l heat from and resistance of each line. One <levice might be well
the <le\ice an<l to help pt·event <lust accumulation inside the protecte<l with high flow and the othet· de\ice ina<le
device. quately protected \,�th very little flow. A single line with a
single flowmeter will prevent this and \viii provide a
Fire research has demonstrated that under normal condi measurable way to verify the correct flow to the <levice. A
tions combustion will not take place when the oxygen level is at gas flowmeter can he mistaken fot· an oxygen flowmetet·.
6 pet-cent 01- less. This is t·egardless of the tt·eatment pressure (3) When using an inert ga�. oxygen should be maintained
and is related to the ratio of oxygen to the inert ga�. With an at less than or equal to 6 percent within the electrical
m..-ygen level of 6 pet-cent and the balancing inert gas level of compartment(s) of the device at all treatment levels. For
94 percent, the high percentage of inert ga� will prevent initial testing and, to establish the prnpet· inert gas flow,
combustion. oxygen levels in the electrical compartment.� of the
A cleat· policy an<l prnce<lure should he wt·itten fot· an inert device shoul<l be teste<l at all treatment pressures.
(4) The manufactut·et·'s safe operating temperatm·e range
ga� purging system. It should inc lude the inert gas parametet·s
for each device and instructions fot- the propet· setup of the 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.
system.
For initial testing an<l, to establish the proper inert gas
All testing to detet·mine the propet· inert gas 01· air flow flow, temperatut·e levels in the electrical compartments
should he well documented. At a minimum, approval signa of the <levice should be teste<l at all treatment pt-essures.
tures have to he obtained from the me<lical director and the
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 9�233
(5) Supply pressure for gas purging should be supplied from file an<l are open to inspection by the public in the office of the
a regulator system that will maintain the surface pressure [jurisdfrtinn '.� kfeper nf rerord�] of the [jurisdictinn], are hereby
over the chambe1·'s treatment p1·essm-e, or ove1°bottom adopted an<l incorporated into this 01·dinance a� folly as if set
pressu1·e. Maintaining pm·ge ga� p1·essm·e at all treat out at length herein, an<l from the date on which this ordi
ment levels can be accomplished by means of a tracking nance shall take eflect, the provisions thereof shall he control
type regulator outside the chambe1· or by placing the ling within the limits of the [jurisdil:tinn]. The same are hereby
regulat01· insi<le the chamber with an a<leguate supply a<lopte<l as the code of the [juri�dirtinn] for the purpose of
pressure for all treatment pressm·es. prescribing 1·egulations governing conditions hazardous to life
(6) An au<lio and visual alarm system should activate at the and property from fire or explosion and providing for issuance
operator's console if the1·e is a loss of sufficient p1·essure of permit5 and collection of fees.
to maintain set flowrates to the gas purging system
f
during any pressu1·ization o the chamber. The chamber SECTION 2 Any pe1·son who shall violate any provision of
operator needs to he alerted to a loss of purge gas flow. this code or stan<lar<l hereby adopte<l or fail to comply there
Chamber operations should be aborted if there is a loss \\'ith; or who shall violate or fail to comply with any or<ler made
(7)
of suHicient pressm·e to the gas prn·ging system as noted thereunder; or who shall build in violation of any detaile<l state
in (6). Loss of purge ga� pressure creates risks to ment of specifications or plans submitted and approved there
patient� an<l staff. un<ler; or fail to operate in accordance with any certificate or
\\'hen using inert gas, oxygen monitoring of the cham pe1·mit issue<l the1·eunde1·; an<l from which no appeal has been
(8)
ber's atmosphere shoul<l have a low-level ala1·m limit set taken; 01· who shall fail to comply with such an orde1· as
at no lower than 19.5 percent. Normal gas purging is affirmed or modified by a court of competent jurisdiction,
unlikely to lower the oxygen level of the chamber atmos within the time fixed herein, shall seve1·ally fo1· each an<l every
phere during hyperbaric oxygen treatment�. However, such violation an<l noncompliance, 1·espectively, he guilty of a
because inert ga� is being introduce<l into the chamber, mis<lemean01-, punishable by a fine of not less than$ _ _ _ nor
an oxygen low-level alarm limit of 19.5 percent shoul<l more than$___ or by imprisonment for not less than ____
be set. days nor m01·e than _ _ _ days or by both such fine and
imprisonment. The imposition of one penalty for any \iolation
(9) Electrical devices that a1·e enclose<l, such a� TV monitors
placed in acrylic boxes, should have some means of shall not excuse the violation or permit it to continue; an<l all
extinguishing the de\ice ·with ·wate1· from the <leluge such persons shall be reguire<l to correct or remedy such viola
system or the handheld hose. Acrylic boxes/endosm-es tions or defect� within a rea�onable time; and when not othe1·
are sometimes used to make gas pu1·ging easier. In the \\'ise specifie<l the application of the above penalty shall not be
event of a fire or smoke inside this box there should he held to prevent the enforced removal of prohibited conditions.
some means of <lrenching the device inside with water. Each day that prohibited conditions are maintaine<l shall
The do01-s to chambe1·s with ga� purging systems using constitute a separate offense.
(10)
inert gas should be kept open <luring nonoperational SECTION 3 Addit.ions, insertions, and changes - that the
hours. Chambe1·s are made to be ai1·tight. If the cham her 2021 e<lition of NFPA 99, Health Care Farilities CndP, is amen<le<l
do01·s are c lose<l, (e.g., overnight), and the inert gas is and change<l in the following respect�:
inadvertently left on, the inert gas coul<l potentially
accumulate insi<le the chamber to a dangerous level. List Amen<lment�
This would <leplete the oxygen level and create a hazard SECTION 4 That ordinance No. _ _ _ of [jmisdirtinn]
fo1· anyone entering the chamber. 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
Annex C Sample Ordinance Adopting NFPA 99 conflict he1·ewith are hereby repeale<l.
17ii� annex is nnt a part nf tht m711irnnmts nf this NFP.A. dncum.Mt SECTION 5 That if any section, subsection, sentence, clause,
but i� included frrr infrrrmatinnal purpnses nnly. or phrase of this ordinance is, for any reason, hel<l to be invali<l
or unconstitutional, such <lecision shall not affect the validity
C.l The following sample ordinance is provided to a�sist a or constitutionality of the 1·emaining portions of this or<li
jurisdiction in the adoption of tl1is code and is not part of this nance. The {health care Jarility '.� gnverning hndy] hereby <leclares
code. that it would have passe<l this ordinance. and each section.
ORDINANCE NO. ____ _ subsection, clause, 01· phrase hereof, irrespective of the fact
that any one or more sections, subsections, sentences, clauses,
An ordinance of the [jurisdictinn] a<lopting the 2021 edition an<l phrases be <leclare<l unconstitutional.
of NFPA 99, Health Care Facilities Cnde, and document� listed in
Chapter 2 of that code; presc1·ibing 1·egulations governing SECTION 6 That the [jurisdictinn'.� kwper nf m:ords] is he1·eby
con<litions haza1·dous to life an<l property from fit·e or explo orde1-ed and directed to cause this m·dinance to be published.
sion; providing for the issuance of permit� an<l collection of rNOTE: An a<lditional prmision may be reguired to <lirect the
fees; 1·epealing O1·dinance No. ___ of the ljuri�dii:tinn] and number of times the ordinance is to be publishe<l and to spec
all other ordinances and parts of ordinances in conflict the1·e ify that it is to be in a newspape1· in general ci1nilation. Posting
witl1; providing a penalty; prmiding a severability clause; and may also be reguired. l
providing for publication; and providing an effective date. SECTION i That this onlinance and the rules. regulations.
BE IT ORDAINED BY THE {hmlth mre facility\ gnVl'rning provisions, 1·egui1·ement�, 01·ders, and matte1·s established an<l
hnd,•] OF THE [jurisdictinn]: 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
SECTION I That the Health Crm Fa1:ilitifs CndP and docu adoption.
ment� adopted by Chapter 2. three (3) copies of which are on
2021 Edition
Annex D Informational References D.1.2 Other Publications.
D.I Referenced Publications. T he ciocument� 01· portions D.1.2.I AAMI Publications. A�sociation for the Advancement
the1·eof listed in this annex are refe1·enceci within the informa of Medical Instrumentation, North Glebe Roaci, Suite 300,
tional sections of this code anci are not part of the require Arlington, VA 22203.
ment� of this ciocument unless also listed in Chapter 2 for ANSI/A<\MI ES60601-1, Medir.al elertriral equipmmt - Part 1:
othe1- rea�ons. GenP ml requirements fnr /Jasir sapty and essential pfrfnnnan ,:e, 2012.
D.1.1 NFPA Publications. National Fire Protection A�socia ANSI/AAMI ES60601-2, Medir.al Pier.trim! equipment - Part 2:
tion, I Batte1ymarch Park, Quincy, MA 02169-7471. G.illateml standard: ElNtrmnagnPlir di1turbanr:es - &quiremmts
NFPA W, Standard fm- Pnrtablf Fire .I.-.xtinguishn:,, 2018 edition. and test,, 2014.
NFPA 1 :'I, Standard fnr the Installation nf Sprinfa.ler S)•stnns, 2019 ANSI/AAMI ES60601-8, Mediral elertriral equipment - Part 8:
edition. Cnllaleml standard: lHann systnns - (',eneral requiremmts, tests and
guidance fnr alarm systems in mediral elertriral equipmmt and mediral
NFPA 30. Hmnmable and Cmn/Jmtible Liquid, CnrlP. 2021 electriral systnm. 2006.
edition.
D.1.2.2 ASHE Publications. Ame1·ican Society for Health Care
NFPA 53, Re,-mmnn1.ded Pra,:tia on A1aterial,, Equipmn1.t, and Engineering of the American Hospital Association, 155 N.
Systnn, U,ed in Oxygm-Enrirhed A tnwsph eres. 2016 eciition. Wacker Drive, Suite 400. Chicago, IL 60606.
NFPA 55. G.nnpre.t,ed Gase.1 and C,yngmir Fluid, Code, 2020 J\IIaintmana Management for Health Care Farilities, 2009.
eciition.
D.1.2.3 ASHRAE Publications_ ASHRAE, 1791 Tullie Circle.
NFPA 56D, Standard fnr Hypni!arii: Fiuilitil's, 1982 edition NE, Atlanta, GA 30329-2:'105.
(withdrawn).
ASHRAE Guideline 0, 17ie Cmmnissinning Pmress, 2013.
NFPA f',8, Liquefied Petmlezw1 (',a_, Cnde, 2020 edition.
ASHRAE Guicieline 1.1, HVAC&R Tedmiral &quirnnmt, fm
NFPA 7rfD, NatinnalElertriral Cnd/0, 2020 edition. the Cmnmissinning Pmress, 2007, errata 2012.
NFPA 70B, Rn:mmnended Prar.tire fnr F.!Prtrir.al Equipmmt Main ASHRAE H andbonk - ht ndamental,, 201 7.
tmanre, 2019 e diti on.
ASHRAE Standard 202, Cmmnis,inning Pmcess for Buildings
NFPA 7P, National Fire A.lann and Sign aling Cndl', 2019 and Systnns, 2013.
eciition.
D-1.2.4 ASME Publications. American Society of Mechanical
NFPA 77, Rn:mmnmded Practire nn Statir Elfftrici ty, 2019 Engineers, Two Park Avenue, New York, NY I00IG-5990.
edition.
ASME B16.22, Wmught Capper and Cnpper 1Hloy Solder-Jnint Pres
NFPA 90B, Standard for the Installatinn nf Wann Air Heati ng and sure fzttings, 201 '.l.
Air-Cnnditinning Systnn,. 2021 edition.
ANSI/ASME B16.50, Wrought Cnpper and Capper Allny Braz.e
NFPA 99B. Standard fnr Hypnbarir: Farilities . 2021 edition. Jnint PrPssurP Fittings. 2013.
NFPA 101® . Life Safety Cndifi', 2021 edition. ASME PVHO-1. Safety Standard fnr Pre.mm \!iz,sel, fnr Human
01:rupanr.y, 2016.
NFPA 110, Standard fnr Eme1gmry and Standl,y Pnwer Systems.
2019 edition. Boiler and Pr1,ssure ¼ssel Cnde, 2017.
NFPA 111, Standard ,m Stnred Elfftriral Energy fanergenr.y and D.I.2.5 ASSE Publications. American Society of Sanitaty Engi
Standby Pnwer System.,, 2019 edition. neering, 18927 Hickory C1·eek Drive, Suite 220, Mokena, IL
60448.
NFPA 170. Standard for Firn Sapty and Emergen,:y ,�\•11d)()l,. 2018
eciition. ASSE 6000, Profe.t,innal Qualifirations Standard fnr Mediral l>fL,
Systnns Persnnnel, 2015.
NFPA 220, Standard on Types nf Building Comtrur.tinn, 2021
edition. D.1.2.6 ASTM Publications. ASTM International, 100 Ban
Harbor Drive, P.O. Box C700, \Vest Conshohocken, PA
NFPA 252, Standard Methnds nf Fire 1Psts of Dnor A.tw,mbliPs, 19428-2959.
2017 edition.
ASTM E l19, Standard 1Pst l\1etlwd, fnr Fire Tests nf Building
NFPA 259, Standard Test Methnd fnr Pntmtial Hmt nf Building OJmtrur.tinn and Material,, 2018c e1.
l\.1aterial,, 2018 edition.
ASTM F2213, Standard 1Pst J\.1etlwd fm- MN1.rnremmt nf Magm'li
NFPA 551, Guide fnr the Evalual inn nf Fire Risk Asse.mnenl1, rally lndur.ed Tnrque nn Aiediral Devires in the Maguetir &sonanr.e
2019 eciition. Envimnmmt, 2017.
NFPA 730, Guide for Pmnisf.l Smtrity, 2020 edition. ASTM F250:l, Standa-,d Prar.tir:e fm- Marl1ing Mediral Dfvir:es and
NFPA 160()il, Standard nn Cnntinuity, Emergency, and Cri-i., Other ltnn, for Safety in the 1'v!agm'tir &sonana Envimnmmt, 2013.
Afanagnnm t. 2019 edition. ASTM G6:'I, Standard Guide for Evaluating Nnmnetallir. Maten.al,
Fire Pmte,:tion GuidP tn Haz.rrrdmts J\,fateriafr. 2010 edition. fm- Oxygen Snvire, 201:>.
2021 Edition
ANNEX D 9�235
ASTM G72/G72M, Standard 1;,s1 AlPthod for A.utogenom Igni ANSI/NEMA PB 1.1, General Inslrurtions far Proper Installation,
tion Temperature of Liquid� and Solids in a High-Prl'ssure Oxy gm operatian and Maintenance of Panelboard.1 Rated 6()() F ar Le.ii,
Enrirhed Environment, 2015. 2007.
ASTM G88, Standard Guide far Designing Systnn� for Oxygen ANSI/NEMA WD 6. lViring Droires - Dimensional Require
Si'rViff, 2013. ments, 201G.
ASTM G93, Standard Pm,:tia for Clmning l'vlPthod� and Clmnli NE?v1A ICS 2.3, Instrw:tions far the Handling, Installation, oper
ness Le,ll'ls far l'vlaterial and Equiftmmt Uwd in Oxygrn-Enrirhed ation and Afaintenanr:e of Afotor Control Centen Rated Not Afore than
t:nvironment1, 2003, reapproved 2011. 6()() t-; 1995, revised 2008.
ASTM G94, Standard Guide for J.-.'valuating Mnal1 far Oxygm D.1.2.12 NETA Publications. InterNational Electrical Testing
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D.I.2.7 CGA Publications. Compressed Gas A�sociation,
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CGA G-8.1, Standard for Nitrous Oxide System,1 at Customer Sites,
2013. D.1.2.13 Ocean Systems, Inc., Publications. Ocean Systems,
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2011. A.3.3.12.2 i1 adapted fmm Figure 4 of this mnnarandwn.) \,l,,'ork
CGA P-2.7, Guide for the SafP Storage, Handling, and U1e of Small carried out under U.S. Office of Naval Research, Washington
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2021 Edition
Title 49. Code of Federal Regulations. Subchapte1· C. D.2.3 Other Organizations that Publish Standards or Guide
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D.1.2.19 Other Publications.
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D.2 InfonnalionaJ References. The following documents 01·
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f
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2021 Edition
ANNEX D 9�237
The Joint Commission (lJC), One Renaissance Blvd., Title 49. Code of Federal Regulations. Part 173, "Shippers -
Oakbrook Terrace, IL 60181. General Requirements for Shipment� and Packagings."
National Interagency Fire Centei-, 3833 Development Commercial Standard 223-59, CastPrs, VVhePL�, and Glides for
Avenue, Boise, ID 83705-5354. Hospital Equipmn1f.
Pan American Health Organization, 525 23nl St1·eet, NW, Environmental Protection Agency, Chemical Eme1·gency
Washington, DC 20037. Prepa1·edness anrl Prevention.
Stanrlarrlizerl Emergency Management Sys tem, State of Cali National Research Council Publication 1132, DiPsd Enginfs
fornia Governor·s Office of Emergency Services, 3650 Sclu·iever for U�f with t,fnPrators to Supply EmPrgem:y and Sh(/rf J;,nn Elfrtric
Avenue, Mathe1·, CA 95655-4203. Power. (Also available as Order No. O.P.52870 from University
Microfilms, P.O. Box 1366, Ann Arbor, MI 48106.)
Disaster Research Center (Universitv of Delaware), 166
Graham Hall , 111 Acarle myStreet, Newa1k DE 19716. (The following is available from the U.S. Department of
Health and Human Se1·vices, 200 Inrlependence Avenue, S"\,V,
U.S. Department of Transportation, available from the U.S. Washington. DC 20201.)
Government Publishing Office, 732 North Capitol Street, NW,
Washington. DC 20401-0001. HHS Publication No. 93-8395. fliosajfty in Micmbiologi,ml and
Bimnediral Laboratoril's, Cente1·s fot· Disease Control anrl P1·even
D.2.4.2 Audiovisual Materials. tion.
National Fire Protection A�sociation. l Batterymarch Park, "Public Health Preparedness and Response for BiotetToris m
Quincy, MA 02169-7471. Program," Centers fot· Disease Control and Prevention.
Abbott Laboratm·ies (Corporate Headquarters), 100 Abbott ·'Emergencv Response Resources: Personal Protection Equip
Park Roarl, Abbott Park. IL 60064-6500. ment,'' National Institute for Occupational Safety and Health
Federal Eme1·gency Management Agency, :,00 C Street, SW, (NIOSH).
Washington, DC 20472. "Protecting Building Environments from Airborne Chemi
National Aurlimisual Center, General Senices Arlminist1·a cal, Biologic, 01· Radiologic Attack.�," CDC's M(/rbidity and
tion, 1800 F Stt·eet, NW, Washington, DC 20405. Mortality WPPkly Riprrrt 51, no. 3 (6 September 2002): 9.
Helicopter A�sociation International, 1920 Ballenger (The following is available from the U.S. Department of
Avenue, 4th flom·, Alexandria, VA 22314-2898. Homeland Secmity. 3801 Nebraska Ave N\V. Washington. DC
20016.)
Pyramid Merlia, 3200 Airport Ave, Ste 19, Santa Monica, CA
90405. IS-120.C: An Introrluction to Exercises" (interactive web
based course).
University of Illinois Hospital anrl Health Sciences System,
1740 West Taylor Stt·eet, Chicago, IL 60612. Guidf f(/r All-Hazard EmMgl'rll.Y Opm,tions Plnnning, Septembet·
1996.
D.2.5 Additional U.S. Government Informational Sources.
"National Health Security Strategy," Office of the Assistant
Kidney Community Emergency Response Coalition, 3000 Secretary for P1·eparedness and Response (ASPR).
Bayport Dr.. Suite 300. Tampa. FL 33607.
Health Professional Pre-Disaster Identification (ESAR-VHP),
"'National Response Frnmewot-k." June 2016. Ferleral Emer Office of the A�sistant Secretary fot· Preparedness and
gency Management Agency, 500 C Street, SW, Washington, DC Response (ASPR).
20472.
"Hospital Preparedness Program," Office of the A�sistant
"National Disaster Recovery Frnmewo1·k" January 2017, Secretary for P1·eparerlness and Response (ASPR).
Federal Emergency Management Agency, 500 C Street, SW,
Washington, DC 20472. "National Disaste1· Medical System," Office of the i\.ssistant
Secretary for Preparedness and Response (ASPR).
(The following is available from the U.S. Government
Publishing Office, 725 North Capitol Street, NW, "Washington, "Strategic National Stockpile," Office of the Assistant Secre
DC 20401-000 l.) tary for Preparedness and Response (ASPR).
Title 29, Code of Federal Regulations, Part 1910.1030, Publications Lib1·a1y, Office of Domestic P1·eparerlness, U.S.
f
"Bloodborne Pathogens." Department o Justice.
Title 29, Code of Federal Regulations, Part 1910.1450, (The following is available from the U.S. Department of
"Occupational Exposure to Hazar·rlous Chemicals in Laborato- Labor, 200 Constitution Ave, N\1/, Washington, DC 20210.)
1·ies." Title 29, Corle of Federal Regulations, Part 1910.38, "Emer
Title 49, Code of Ferleral Regulations, Subchapter C and gency Action Plans."
Part 190 (U.S. Dept. ofTrnnspm·tation. Specifications fot· Trnns Title 29, Corle of Federnl Regulations, Subpart H, "Hazard
portation of Explosives and Dangerous Articles). (In Canada, ous Materials," specifically Part 1910.120, "Haza1·dous \'\'aste
the regulations of the Board of Transport Commissioners, Operations and EmergencyResponse" (HAZ\'\'OPER).
Union Station, Ottawa, Canada, apply. )
2021 Edition
Title 29. Code of Federal Regulations. Subpart I. "Pe1·sonal IEEE 3001.5, &rnnmimdPd Prartia for the AfiPliralinn of Power
Protective Equipment," specifically Part 1910.132, "General Distribution Apparatm in Industrial and Cmmnn'r.ial Power Systnn�,
Requi1-ements," Pan 1910.133, "Eye and Face Protection," 2013.
Pan 1910.1,\4, "Respirntory Protection," Pan 1910.136, "Foot
Protection," Part 1910.138, "Hanrl Protection,'' anrl Appendices IEEE 3003.2, Rer.mmmndPd Practire for E' quipment Grounding
A-D. and Bonding in Industrial and Gnnmerrial Power Systnns, 2014.
Title 29, Corle of Ferleral Regulations, Subpan Z, "Toxic and IEEE 3006.2, RecmmnendPd Prartir.e for J.,."valualing the &liability
Hazarrlous Substances," specifically Part 1910.1200, "Hazard of E'fisting Industrial and Cmmnm:ial Power Systnns, 2016.
Communication" (including Appenrlices A-E). IEEE 3006.3, Rerommended Prartire for Determining the. Impa,:t of
Publication 3114, Hazardous H'ilstP Opemtiom and EmPrgmry Prevmtative Maintmanr.e on the Reliability of Industrial and Commer
&sponw. rial Power Systems, 2017.
Publication 3152. Hospital1 and Cmmnunity l.•.'lnPrgpnr:y &spome IEEE 3006.5, RP1:mmnended Prartire fo-r thP u�e of Probability
- H'hat You Need to Know.
Methods fo-r Condurting a &liability A.nalysis of Indmtrial and
Cmnmm:ial Power Systnm. 2014.
D.2.6 Additional Resources for Emergency Management.
IEEE 3006.7. &rmmnmded Prartir.e fo-r Detmnining the &liability
Ba1·bern, J. Emergm.ry I\'Ianagemmt Prinr.iplPs and Pm,:tires for of 7x24 Continzwm PowPr Systems in Industrial and Cmmnerdal
Hmlthrare Systn11s, Institute of Crisis, Disaster anrl Risk Manage Farilitie.\, 2013.
ment, 2010. George Washington University, for the Veterans
Health Administration, ,,Vashington, DC. IEEE 3006.9, Rem111111ended Prm:tice for CollPr.ting Data fo-r u�e in
Reliability, Availability, and Maintainability ilssessment� of Industrial
Ba1·bern, J. A., and A. G. Macintyre. 2007. Ivfrdiral Surge and Cmnmerrial Pm.11er System1, 2013.
Capar.ity and Capability Handbo-ok: A IVlanagnnent S�stem for Inte
grating 1\'Iediral and Health &.rnura.1 During Large-Srale Enwrgen IEEE 3007.1, &rmmnmded. Pmctir.e for the operation and
ries, Contract No. 233-03-0028, Department of Health anrl Management of Indmtrial and CmnmPrr.ial Power Systems, 2010.
Human Services. Washington. DC. IEEE 3007.2, &rmmnended Prartirefo-r the Maintmanre of Indus
NFPA 3000TM (PS). Standard fo-r an A.i:tive Shooter/Hostile Event trial and Cmmnerrial Power Systnns, 2010.
&spnnse (ilSH.l!.R) Program, 2018 edition. IEEE P3007.3, &,wnmended Prai:tice for Hectriral Safety m
D.2.7 Other Publications.
Industrial and Cmmnerr.ial Power Syste,m, 2017.
Ba1·bern, J. anrl A. G. Macinty1·e. 2002. Mediral and Health D.3 References for Extracts in In formational Sections.
Inrident Managnnmt (Afo.HINI) Systnn: A Cm11prehn1sive I-lmr.tional NFPA 55, Compressed (',ases and Cryogmir Fluids Cod.P, 2020
System Desi:riptiom fo-r IVfoss Crmwlty lVIediml and Health Inddmt edition.
f
Nianagnnmt, George ,,vashington University, School o Engi
neering and Applied Sciences, Institute fo1· Crisis, Disaste1· and NJ.PA 7r-P. National Elniriml Cod.I-'. 2020 edition.
Risk Management. NFPA JO?!. Life Safety Cod.�. 2021 edition.
DuPont Safety News.June 14, 1965. NFPA 110. Standard for E'liu,rgenry and Standby Power Systnns.
Da�Iet- anrl Baue1·, Ind. l•.'ng. Chnn. A.nal, Erl. 18, 52 (1964). 2019 edition.
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
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 Category I and Category 2 requiremenL,, 12.3, 12.5, A.12.5.3.1.2
Adminisrration of; 6.3.4, A.6.3.4.1.1 to A.12.5.3.5
Design consideraLions, 6.7.1.1, A.6.7.1.1 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
Disrribution, 6.3.2, A.6.3.2
Isolared power sys rems, see Isolarcd power sysrems Continuing operarions plan and recovery, B.12.4
Defini Lion, 3.3.48
Parient bed locarions, 6.3.2.4, A.6.3.2.4
Emergency plan, 12.5.3.'.l.6.5 ( I) General requirements, 12.4, A.12.4.1 10 A.12.4.2
Equipment branch, 6.7.5.l.1(3), 6.7.5. 1.4, A.6.7.5.1.4.3 10 Medical air, loss ot; 5.2.3.5(2)
A.6.7.5.1.4.4 (9) l\tiLigaLion, 12.5.3.2, A.12.5.3.2.3(7), B.12.1.1.2
Fire protect.ion, 16.5.l.2 to 16.5.1.4 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
Hyperbaric facilities, 14.2.10.1.1
Program development, B.12.1
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 Responsibilities, 12.2
Insrrument air supply sysrems, 5.1.13.3.7.12 Aurhority having jurisdiction, A.12.2.1
Isolared power sysrems, see Isolared power sysrems 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
Medical air systems, 5.1.3.6.3.10
Medical-surgical vacuum supply sysrems, 5.1.3.7.6 Senior management, 12.2.2
Patient care spaces sat·ery and securiry, 12.5.3.3.6.3, A.12S3.3.6.3
Special consideraLions and prorocols, B.12.3
(;rounding systems, (j.3.3.1, A.6.3.3.l.l to A.6.3.3.1.4
Sraff educaLion, I 2.5.3.3.7
Insrruclions for appliances, 10.5.3.1, 10.5.3.2, 10.5.(j_ I
Surge capaciry ofviclims, 12.5.3.3.8.5, 12.5.3.4. IO,
Performance criteria and resLs, 6.3.3, A.6.3.3.1. I to A.6.3.3.1.4
A.12.5.3.4.10.1
Grounding systems in parient care rooms, 6.3.3.1, A.6.3.3.1.1
Wa,te anesthetic gas di,posal (WAGD), loss of; 5.2.3.H (2)
(0 A.6.3.3.1. 4
Emergency operations plan, 12.2.3.3, 12.5.3.3.5, 12.5.3.3.8.
Isolared power systems, 6.3.3.3
A.12.2.3.3, B.12.1.1.4 to B.12.1.1.7
Recepracle tesLing in parient care rooms, 6.3.3.2
Emergency oxygen supply connection (EOSC), 5.1.3.5.13,
Sources of power, 6.3.1, 6.7.I, A.6.7.1.1 to A.6.7.1.3.5 A.5.1.3.5.13
Alrernate, s� Alrernare power sources Definilion, 3.3.49
Failure of, 6.7.3.3 to 6.7.,t7 Emergency power supply systems (EPSSs), 6. I I
Performance criteria and resLs, 6.7.!i.3.l, 6. 7.6.4.l Emergency power system (EPS) room HVAC S)Stems. 9.3.9
Power loss, emergency management of: B.12.3.2. 5 Emergency procedures, see fllso Emergency management
Transfer to, see Transfer switches Hyperbaric faciliLies, 14.3.1.4.3, 14.3.1.5, A.14.3.1.5.2,
Type I essenlial cleCLrical sysrems, 6.7.l, A.6.7.1.l to A.14.3.1.5.4, B.14.2, B.14.3
A.6.7.1.3.!i OperaLing room, 16.14.3.9
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 Emergency recovery, 12.5.3.5, A.12.5.3.5
Waste anesthelic gas disposa l (WAGD) systems, 5.1.3.8.4 Emergency response, 12.5.3.4, A.12.5.3.4.1 to A.12..'i.3.4.IO.l, B.12.3
Flectrica l wiring, B.6.1 Emergency systems, see Critical branch; Equipment branch; Life
EssenLial elecrrical systems, 6.7.5.2. 6.7.6.3, A.6.7.5.2.l, safety branch
A.6.7.6.3.l, A.6.7.6.3.2 Employees
Fire prorecLion, 16.5.1.2 Emergency roles, 12.5.3.3.6.7, 12..'i.3.3. 7, B.12.2, B.12.3.2.8
Hyperbaric faciliries, 14.2.9.3 10 14.2.9.6 (;as equipment cylinders and containers, handling of; 11.5.2.1,
Isolared power systems, 6.3.2.9.2 A.11.5.2.1.l
Flectrocautery equipment, 14.3.2. 1.2 (2), 16.I4.3.2, 16.14.3.3, (;as equipment senicing, 11.5.3.3.5, I 1.6.1.2
A. I 6.14.3.2 Hyperbaric chambers, 14.3.1.3, 14.3.1.6.3, 14.3.1.6.5,
Flectrode, 5.1.14.3.2, 6.3.2.9.3.7 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
Definirion, 3.3.47 to B.14.1.1.3 ..5, B.14.1.2.2, B.14.1.3, B.14.3
Flectrostatic safeguards, hyp erbaric chambers, 14.3.4.6, A.14.3.4.6 Medical gas and vacuum sysrems, 5.l.10.11.10, 5.l .l0.11.11,
to A.14.3.4.6.5 5.l.12.2, 5.1.14.4.2.5, .'i.l .14.7.4, B.5.1
Flectrosurgery, lfi.14.3.2, 16.14.3.3, A.16.14.3.2 Operating rooms, 16.14.3.10
Flevators, 16.5.3, A.16.5.3.3, B. 12.3.2 ..�(2) Protection, 6.3.2.8.5
Alarm systems, 16.7.4.2.1 Respirarory rherapy, B.11.l.l.l , B.11.1.1.2, B.11.3.5, B.l UHi
Essenliaf elecrrical systems, 6.7.5.1.2.4(5), 6.7.,,.1.4.4(3), Responsible facility authoricy, 5.1.14.1, .'i.1.14.2, A..5.1.14.2.1,
6. 7.6.2.l.'i(C) (6) A.5.l.14.2.2(4)
Temporary operarion ot; 6.7.6.2.l.6(E) (2), A.6.7.6.2.l.6(E)(2) Securiry management, 13.4, 13.10, 13.11, A.13.4.2(3) (c),
Emergency care, policies for, 1.3.3 A.13.10, A.13.11
Emergency generators, 16.5.l.3; see alto Generator seL, Training, .�eTraining, employee
Emergency management, l.l.10, Chap. 12. A.1.1.10; see fll<n Enclosures, gas system, 11.3.6. I, 11.4.2.2
Emergency procedures Endotracheal tube, B.14.1.2.4
Adminisrration, 12.5.3.6 Definilion, 3.3.181.1, A.3.3.181.1
Energy converters, 6. 7.1.3.5, A.6.7.1.3.5
2021 Edition
INDEX 99-245
Equipment, see alw Electrical equipment Extinguishers, portable fire, 14.2.6.1.5, 16.10.I, A.14.2.6. 1.5,
Critical A.16.10.1, B.11.3.4.2, B.14.2.1, B.14.3.2
Definition, 3.3.31 E.xtinguishing systems, see Fire exlinguishing systems and
Hyperbaric, 14.2, 14.3.2, A.14.2.1.l.l to A.14.2.1.3.1, A.14.3.2.2 equipment
to A.14.3.2.6
-F-
Portable
Electrical, see Elecu-ical equipment Facility fire plan, B.11.3.2.I (2), B.12.3.1; see alw Emergency
operalions plan
Patient care gas equipment, 11.4.l, A.11.4.1.1 to A.11.4.1.4
Definition, 3.3.55,A.3.3.55
Rack or cart, 11.4.3.1
Failure
Equipment branch, 6.7.6.2.1.2(2), 6.7.fi.2.l.6, 7.3.l.2.2.8(8)
Power sources, 6.7.3.3 to 6.7.3.7
Definition, 3.3..�0
Fault current, 6.3.2.3.2, 6.3.2.9.'.U, 6.7.2.1.1.1, 14.2.9.3.6.4,
Equipment grounding bus, I 0.2.1
A.6.3.2.9.3.1
Definition, :LU; I
Definilion, 3.3.56
Equivalency to standard, 1.4
Fault hazard current, 6.3.2.9.3.2 to fi.3.2.'l.3.5
&calators, 16.5.3
Definilion, 3.3.72.l
&sential electrical systems_, 5.1.3.3.'.U (II),A.5.1.3.3.2(11 ), B.6.2,
Feeders
B.6.3
From alternative source, 6.7.2.2.6
Definition,3.3.52, A.3.3.52
Circuit breakers, inspect.ion ot; 6.7.4.1.2.1, A.!i.7.4.1.2.1
Fuel cell systems, 6.7.1.5
Definition, 3.3.57
Information technology and communicalions systems, see
Informal.ion technology and comni'unicalions Insulation resistance, 6.7.4.1.2.2
systems 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,
Sources, 6.7.l,A.fi.7.l.l to A.fi.7.l.3.5 A.7.1
T}pe I, fi.7.5, A.6.7.5 to A.6.7.5.2.1 Definilion, 3.3.58, A.3.3.58
Administration, 6.7.4, A.6.7.4.l.l.5 (A), A.6.7.4.l.2.l Filters, air
Alternate power sources, 6.7.l.2, 6.7.4.l.l, A.6.7.l.2.l to Instrument air, 5.1.13.3.7.8
A.6.7.l.2.7.2 (H), A.6.7.4.l.1.5(A) Medical air, 5.1.3.6.3.8, 5.l.3.6.3.9(E), !i.l.3.6.3.9(F),
Branches, 6.7.2.2, A.fi.7.2.2.5(8) 5.1.3.6.3.9(1), 5.2.3.5(1), A.5.l.3.6.3.9(F)
Distribution, 6.7.2, A.6.7.2 to A.6.7.2.2.5(B) Final tie-in tests, 5.1.12.4.9, 15.4.7.5.7
Fuel cell systems, 6.7.1.5 Fire alarm systems, see Alarm systems
Generator sets, fi.7.1.3, A.6.7.I.3.4 to A.6.7 .l.3.5 Fire blankets, 14.2.6.1.5, A.14.2.6.1.5
l\faintenance and testing, 6.7.4.1, A.6.7.4.1.l.S(A), Fire dampers or shutters, 6.7.l.3.4.2(C). 6.7.1.3.4.5, 16.7.4.2.2
A.6.7.4.1.'.U Fire detection systems, 16.7; see alrn Alarm systems; Smoke alarms/
Performance criteria and tesLs, 6.7.5.3 detectors
Sources, 6.7.l, A.6.7.l.l to A.6.7.1.3.5 Hyperbaric facililies, 14.2.6.4, 14.2.8.2, A.14.2.6.4.2
Type 2, 6.7, 6. 7.6, A.6.7.6 to A.6.7.6.3.2 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
Distribution, 6. 7.2, A.6.7.2 to A.6.7.2.2.5(8)
nlm Fire protect.ion
Performance criteria and tesLs, 6.7.6.4
Hyperbaric chambers, 14.2.6, B.14.2.1
Sources, 6.7.l, 6.7.6.4.1, A.6.7.1.1 to A.6.7.1.3.5
Respiratory therapy apparatus, B.11.3.4
Evacuation, waste gas, see 'Waste anesthetic gas disposal (WAGD)
Telecommunicalions facililies, 7.3.1.2. 1.8 (D), 7.3. l.2.3.8(8)
systems
Fire fighters' emergency operations (elevator), 16.5.3.2
Evacuation of occupants
Fire hazan:ls
Emergency plan, B.12.3.2.11, B.12.3.3
Dental gas and vacuum piping systems, 15.2
Hyperbaric facilities, B.14.3.1
Electrical systems, 6.2.1, A. 6.2.l
Natural disasters, due to, B.12.3.2.11
Gas systems, 5.1.2, 5.3.2
Oxygen-enriched aunosphere (OEA), B.11.3.2.1
H}perbaric facililies, B.14.l.l
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 Oxygen delivery equipment, 11.5.l.l.6, I1.5. 1.2.2
Emergency systems, 6.7.5.1.4.4(4) Oxygen-enriched aunospheres (OEA�), I 1.5.1.2.1
Hyperbaric facilities, 14.2.l 1.2, A.14.2.11.2, A.14.2.11.2.5 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
Medical gases storage or transfilling areas, 9.3.6.5.3
Fire preventfon
Vacuum or scavenging source, 5.1.3.7.7
Hyperbaric facililies, 14.3.1.6, A.14.3.1.6.1.l, A.14.3.l.fi.1.3
Waste anesthelic gas disposal (WAGD) systems, 5.1.3.8.5
Operating rooms, 16.14,A.16.14.3.2
E.xposed conductive surfaces
Fire protection, 12.5.3.3.!i.5(fi), Chap. 16
Definition, 3.3.54
Construct.ion and compartmental.ion, 16.2
Tesrn, 6.3.3.1.l.2, 6.3.3.1. 1.3
Hyperbaric facililies, 14.2.6 to 14.2.8, B.14
E.!{tension cords, 10.2.4, 10.5.2.3; see alw Power cords
Respiratory therapy, B.11.3
Exterior connections, 12.5.3.3.6.6
Flammable (definition), 3.3.59, A.3.3.59
2021 Edition
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
-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 5.1.12.4.3.I (D),5.1.12.4.3.2 (E), 5.1.12.4.10.

Scope of standard, 1.1,A.l.1.IO, A.1.1.12 :d.12.4.13.5.1.14.7.9, 15.3.2.3, A.5.1.5,
A.5.1.12.4.10.6
Security management, Chap. 13
Category 2, 5.2.5
Access control equipment, 13.9, A.13.9.4
Emergency, 12.5.3.3.6.3, A.12.5.3.3.6.3 Catego11• 3, 5.3.5
Denni Lion, 3.3.17'.l
Information technology and communicaLions
systems, 7.3.1.2.2.6,7.3.1.2.3.6 Station out lets
OperaLions,13.11, A.13.11.A.13.ll.l 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,
Plan, I :l.2, 13.12.'.l to 13.12.5, A.13.2, A.13.2.2
5.1.12. 1.2, 5.1.12.1.10, 5.1.12.2.1.3(3),5.1.12.2.4.6,
Program evaluaLion, 13.12, A.13.12.1 5.1.12.2.6.l, 5.1.12.4.3.1 (D}, 5.l.l 2.4.3.2(E),
Responsible person, 13.4, A.13.4.2 (3) (c) 5.l.12.4.3.2(G), 5.1.12.4.6.1, 5.1.12.4.6.3,
Security"'ensitive areas, 13.5, A.13.5.2(1) to A.13.5.7(1) 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,
Security vulnerability assessment,13.3, A. 13.3.l 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,
Selec ted receptacles (definition), 3.3.164
A.5.1.12.4.6.4, A.5.1.12.4.10.6, B.5.2.18
Self-extinguishing (definition), 3.3.16.�
Category 2, 5.2.5, 15.4.1.6, 15.4.2. 7
Semipermanent connection (definition), 3.3. rn6 Category 3, 5.3.5
Sensors, inside hyperbaric chambers, 14.2.10. 1.2
DefiniLion, 3.3.174
Service inlets, 3.3.20 Storage
Definition, 3.3.167
Compact, sf.If Compact stora!(e
Service outlets Containers, Siie Cont.ainers
Definition, 3.3.168 Cryogenic liquids, venLilaLion for stora!(e of, 9.3.6, A.9.3.6.3.
Service valves, 5.1.4.5, 5.1.11.2. 7 A.9.3.6.5.l
Shall (defini tion), 3.2.7 Cylinders, see Cylinders
Should (definition), 3.2.8 F1ammahle and combustible liquids, 16.3, A.16.3.2
Shutoff valves F1am mable gases, 14.3.3.3, 14.3.4.1.4.l, 16.3, A.16.3.2
Emergency oxygen supply connection (EOSC), 5.1.3.5.13.2(3). Gas equipment, 11.5.3.3
15.4.2.6, A.14.2.6. 1.5 Hyperbaric faciliLies, 14.2.1.6, 14.3.2.2.14.3.3.3, 14.3.4.1.4,
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.14.3.2.2
A.5.l.4.3
Nonflammable gases,11.3.5, 11.3.6, A.11.3.5,A.11.3.6
Hyperbaric facilities, 14.2.1.3.2 Oxy!(en, 5.1.3.l.9,14.3.2.2, A.14.3.2.2
Labeling and idenLitication, 5.l.l 1.2 Ventilation for medical !(as storage, 9.3.6, A.'l.3.6.:l, A.9.3.6.5.1
Vacuum, 5.1.4.l. l Stored electric a l energy systems, 16.5. I. 4
Signs, see Labeling and identification
Supply source, see also Category l piped gas and vacuum systems.
Single treatment facilities, 15.4.2.5.12, 15.4.2.5.14, 15.4.2.6.1 Sources; Category· 3 piped gas and vacuum systems,
Definition, 3.3.169, A.3.3.169 Sources
Si te of intentional expulsion, 10.5.4.1, 10.5.4.2, 11.5.l.l.6, 11.5. 1.2.3 Category• 2 piped gas and vacuum systems, 5.2.3
Definition, 3.3.170, A.3.3.170 Defini lion, 3.3.175
Smoke alarms/de tectors, 16.7.3, rn.7.4.2.1, 16.7.4.2.2, 16.12.2 OperaLing supply, 3.3.161, 5.1.9.2.4,6.7.1.3.8.3
Smoke compartments, 16.7.4.3.1, 16.9.1.3,A.16.9.1.3 Definition, 3.3.175.1
Smoke control, 6.7.5.l.4.3(A)(4), 6.7.6.2.1.6(0)(4) Portable, 11.4.l, A.11.4.1.l to A.11.4.1.4
Smoke zones, 16.7.4./l.3 Primary supply, 5.l.3.6.3.14(C) (6)
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 Definition,3.3.175.2
Sound-deadening materials, 14.2.2.6.4, A.14.2.2.6.4 Reseive supply (definition), 3.3.17.,.3; se,, alrnResenie supply
Source valves, -�.1.4.2, 5. I.I 1.2.3, 5.1.11.2.4,A.5.1.11.2.3 Secondary supply, 5.1.12.4.14.2
Spaces (definition}, 3.3.171; see alrnPatiem care spaces Definition, 3.3.175.4
Sprinklers, automatic, 7.3. l.2.l.8(O), 7.3.1.2.1.H(B},16.9, l(U I, Supply systems, Sf.If also Category I piped ga� and vacuum systems;
16.12.3, A.16.11, A.16.12.3 C'�'ltegory 2 piped gas and vacuum systems; Catego11· 3
Hyperbaric facilities, 14.2.1.2,A.14.2.1.2 to A.14.2.1.2(3) piped gas and vacuum systems; Central supply systems:
Pipe and piping, gas; Piped distribution systems
Staff, s,� Employees
Staff emergency calls, 7.3.3.1.3, A.7.3.3.l.3.l
Hyperharic faciliLies, 14.2.4.1.3.2
Support gases, see alrn Instrument air; Nitrogen
Standard cubic fee t per minute (SCFM} (definition}, 3.3.172
Category l piped gas and vacuum systems, see Category I piped
Standard (defini tion), 3.2.9
gas and vacuum systems
Standby power systems, 16.5.1.3
Category 2 piped gas and vacuum systems, 5.2.13
Standpipe and hose systems, 16.10.2, A.16.10.2.2
CategorJ 3 piped gas and vacuun1 systen1s, 5.3.13
Station inlets
Medical, 5.1.1.3, 5.3.12, A.5.1. l.3
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,
Central supply system,5.1.13.3
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, DefiniLion, 3.3.111
2021 Edition
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 Committee Membership
Develo-pment fucess Classifications1 '2' ' 34
Once the current edition is publi�hed, a Standard i� ofwnedfor The following classifications apply to Committee members
Public In/mt. and represent their principal interest in the activity of the
Committee.
Step 1- Input Stage
• Input accepted from the public or other committees for I. M Manufacturer: A representative of a maker or mar
consideration to develop the First Draft keter of a product, assembly, or system, or portion
• Technical Committee holds First Draft Meeting to revise thereof, that is affected bv the standard.
Standard (23 weeks); Technical Committee(s) with Cor 2. U User: A representative of�n entity that is subject to
relating Committee ( IO weeks) the provisions of the standard or that voluntarily
• Technical Committee ballots on First Draft (12 weeks); uses the standard.
Technical Committee(s) with Correlating Committee 3. IM Installer/Maintainer: A representative of an entity that
(11 weeks) is in the business of installing or maintaining a prod
• Conelating Committee First Draft Meeting (9 weeks) uct, assembly, or system affected by the standard.
• Conelating Committee ballots on First Draft (5 weeks) 4. L Labor: A labor representative or employee concerned
• First Draft Report posted on the document information with safety in the workplace.
page 5. RT Apjilitd Resean:h/Testin{{ Laboratory: A representative
of an independent testing laboratory or indepen
Step 2 - Comment Stage
dent applied research organization that promulgates
• Public Comments accepted on First Draft (IO weeks) fol and/or enforces standards.
lowing posting of First Draft Report 6. E Enforr:ing A. uthority: A representative of an agency or
• If Standard does not receive Public Comment� and the an organization that promulgates and/or enforces
Technical Committee chooses not to hold a Second Draft standards.
meeting, the Standard becomes a Consent Standard and 7. I Imumncf': A representative of an insurance company,
is sent directly to the Standards Council for issuance (see broker, agent, bureau, or inspection agency.
Step 4) or 8. C Consumer: A person who is or represent� the ultimate
• Technical Committee holds Second Draft Meeting purchaser of a product, system, or senice affected by
(2 I weeks); Technical Committee(s) with Correlating the standard, but who is not indL1ded in (2).
Committee (7 weeks) 9. SE SJ)('(:io.l Ex/wr"t: A person not representing (I) through
• Technical Committee ballot� on Second Draft (11 weeks); (8) and who has special expertise in the scope of the
Technical Committee(s) with Correlating Committee standard or portion thereof.
(IO weeks)
• Conelating Committee Second Draft Meeting (9 weeks)
• Conelating Committee ballots on Second Drnft NOTE I: "Standard" connotes code, standard, recom
(8 weeks) mended practice, or guide.
• Second Draft Report posted on the document infonna NOTE 2: A representative includes an employee.
tion page NOTE 3: \-Vhile these classifications will be used by the
Standards Council to achieve a balance for Technical Com
Step 3 - NFPA Technical Meeting
mittees, the Standards Council may determine that new
• Notice oflment to Make a Motion (NITMAM) accepted classifications of mern ber or unique interests need repre
(5 weeks) following the posting of Second Draft Report sentation in order to foster the best possible Committee
• NITMAMs are reviewed and valid motions are certified deliberations on any project. In this connection, the Stan
by the Motions Committee for presentation at the NFPA darci� Council may make such appointments as it deems
Technical Meeting appropriate in the public interest, such a.� the classification
• NFPA membership meet� each.June at the NFPA Techni of "Utilities" in the National Electrical Code Committee.
cal Meeting to act on Standards with "Certified A mend
NOTE 4: Representatives of subsidiaries of any group are
ing Motions" (certified NITMAMs)
generally considered to have the same classification as the
• Comrnittee(s) vote on any successful amendments to the
parent organization.
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
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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
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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
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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
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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.
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NFP�

Health Care Facilities Code

Updating of NFPA Standards

Interpretations of NFPA Standards

Law and Regulations

For Further Information

REMINDER: UPDATING OF NFPA STANDARDS

Health Care Facilities Code

Origin and Development of NFPA 99

Correlating Committee on Health Care Facilities

Richard P. Bielen, NFPA Staff Liaison

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

Technical Committee on Electrical Systems

Richard P. Bielen, NFPA Staff Liaison

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

Technical Committee on Fundamentals

Richard P. Bielen, NFPA Staff Liaison

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

Technical Committee on Health Care Emergency Management and Security

BrianJ. O'Connor, N FPA Staff Liaison

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

Technical Committee on Hyperbaric and Hypobaric Facilities

BrianJ. O'Connor, NFPA Staff Liaison

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

Technical Committee on Mechanical Systems

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

Technical Committee on Medical Equipment

BrianJ. O'Connor, NFPA Staff Liaison

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

Technical Committee on Piping Systems

Richard P. Bielen, NFPA Srnff Liaison

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

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

1.1.9 Gas Equipment. Chapter 11 covers the performance,

1.1.14 Features of Fire Protection. Chapte1· 16 covers the ( l) Category l spaces

Chapter 3 Definitions 3.3 General Definitions.

5.1.3.10* C ryogenic Fluid Central Supply Systems. (1) Fill connection

½ 17 5.1.4.5.3 Service valves shall he placed in the branch piping

(2)* It is 1·eadily operable from a standing position. 5.1.5* Station Outlets/Inlets.

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

Colors Standard Gauge Pressure

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

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

Chapter 6 Electrical Systems 6.3.2.2 Receptacles.

6.3.3.1.3* Voltage Measurements. 6.3.3.2.7 Receptacles not listed as hospital-grnde, at patient

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

6.7.2.2.4.2 Installation of the u·ansfer equipment shall be 6.7.4 Administration.

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

Table 6.9.4.1 Electrical Preventive Maintenance (EPM) Intervals

Item Inspection Period Testing Period Maintenance Period

6.10.3 Reliability. 6.10.6.2 Source Monitoring. (Reserved)

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

7.4.3.10 Archiving Systems. (Reserved) Chapter 8 Plumbing

7.4.4 Security Systems. 8.1 Applicability.

8.3.5 Nonmedical Compres.sed Air.

Chapter 10 FJectrical Equipment 10.2.2.3.7.3 Plugs shall be permitted to be integrally molded

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

This connection is at Appliance power switch

FIGURE 10.3.5.3 Example Test Circuit for Measuring Touch

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

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

(1) Oxygen ( 1) Flared an<l comp1·ession connections, including connec

16. 1 Applicability. 16.5.2.2 Ventilating or Heat-Producing Equipment. Ventilat

J\"itrngl·n main lint :l.l.9.�.4(7)