# How to use NFPA 99

06/17/2013

Steps to complying with NFPA 99

1. Start by stressing that this is not an engineering responsibility.

As engineers, we are traditionally “the smartest person in the room,” and as such, we are big targets for logical analysis and ultimately complicated math projects like this, usually without compensation. The engineer most likely has a role in the risk assessment process, but the effort is fruitless until a risk assessment team, including the folks mentioned in NFPA 99, is assembled.

NFPA specifically lists clinicians, biomedical engineering, staff, and facility safety engineering staff as required to be on the team. This group is going to be the source of the data that you’ll use to calculate the risk probabilities. I kept the group that I worked for accountable for supplying the data that I used in the calculations. Why is it necessary that the engineer perform the calculations? Reference the first sentence in the previous paragraph.

In my experience, this is an iterative process. The clinicians, biomedical engineers, etc., that I’ve worked with are normally confused as to why they are even participating in this process. As such, they will not arrive at the first meeting with suitable information that you need to perform the calculations. Set up a weekly conference call that lets the team get used to running down the data that you will need.

3. Explain why it’s different this time.

Participants often say, “It’s a general operating room! What else do you need to know?’’ Explain why we are doing the assessment and how much of the risk is driven by the number/types of medical procedures that will be performed in the room. The nursing/scheduling staff normally can give you a comprehensive list of the procedures with relative frequencies for an operating room (it is their business).

4. It’s all about fluid dynamics.

The biggest unknown and ultimately the largest risk factor is directly proportional to the quantity of fluid that can end up on the floor. Understand the fluid impact for every procedure. Questions to ask include:

• How much (measured in milliliters) fluid do you use when you irrigate a cysto procedure?
• When fluid is spilled, how much is spilled?
• Do you have a special irrigation table?
• Do you use special draping?

Are there inherent advantages/disadvantages to the electrical system the engineer has designed? Are there any cords on the floor? Have any of the cords been altered or require adapters? (These are all past reasons for reported microshock incidents.)

5. Give the team homework assignments.

Everyone is programmed to fill out forms. Table 1 is an example of the worksheet used recently. This helped the staff understand the needed information in an easy format.

6. Crunch the numbers.

Once the team has provided the basic information for the operating room procedures, it’s time to convert the data into something useful for the actual risk assessment portion of the exercise. The actual risk is directly proportional to the “pool” size on the floor. Using a linked Microsoft Excel sheet, it is easy to develop the information in Table 2.

7. Develop a fault tree.

The culmination of all this work is expressed in a fault tree. Table 3 shows an example.

8. Calculate risk results.

Table 1: Risk worksheet

Table 2: Risk assessment (calculating event per year)

Table 3: Risk assessment (calculating event per year)

Finally, combine all the information into an aggregate risk probability that is suitable for the published results of the risk assessment team that can be included in the final published report (by the facility) that will be reviewed by the hospital executive board as, eventually, the authority having jurisdiction.

Reviewing the results in Table 3, it looks like the chance of having an undesirable electrical result for either an arthroscopic or C-section procedure over a 30-year period is far less than a person’s chance of getting hit by lightning any given year. However, using the risk assessment, there is s a better chance of having an undesirable event (i.e., microshock) with a cysto procedure (over a 30-year period) than getting hit by lightning. This result isn’t surprising because a cysto procedure is a known “wet” procedure and often is considered the benchmark for when to install an isolated power system.

Interpreting and applying the code will be unique for each situation. It’s always better to err on the conservative side when lives are at stake; but realize that the code writers appear to be  evolving away from a prescriptive solution for many high-risk installations. As engineers, we often speak to the client about the relative costs, lead-time, installation method, on-going maintenance, etc. for a proposed engineered system. We will be compelled to address the associated risk in that conversation wherever NFPA 99-2012 has been adopted.

Gerald Versluys is a senior electrical engineer and principal at TLC Engineering for Architecture. His areas of expertise include sustainable health care design and campus distribution systems. He is a member of Consulting-Specifying Engineer's editorial advisory board.

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