NFPA 99: Health care facilities code overview

Here’s a basic overview of the 2012 edition of NFPA 99, along with a review of the information covered in the new chapters.


This article has been peer-reviewed.NFPA 99: Health Care Facilities Code applies to all health care facilities other than home care. The code is intended for professionals involved in the design, construction, maintenance, and inspection of health care facilities, in addition to the design, manufacture, and testing of appliances and equipment used in patient care rooms of the health care facilities.

The 2012 edition of the code has undergone a complete restructuring from the previous edition. The laboratory requirements; manufacturers’ requirements on electrical equipment; Annexes B, C, and D; and all the occupancy chapters have been deleted. These requirements have been replaced by chapters on risk instead of occupancy and new chapters added for IT and communication systems, HVAC, plumbing, security, emergency management, and fire protection unique to health care facilities.

The 2012 edition of the NFPA 99 directs the user to first determine the level of system category depending on the risks to the caregivers and patients present in the facilities. The system categories are determined by following and documenting a defined risk assessment procedure. NFPA 99 recommends following procedures such as those found in ISO/IEC 31010: Risk Management-Risk Assessment Techniques, NFPA 551: Guide for the Evaluation of Fire Risk Assessments, and SEMI S10-0307E: Safety Guideline for Risk Assessment and Risk Evaluation Process. Depending on the risk assessment findings, and subsequently the system category classification of the health care facility, the other minimum criteria for gas vacuum and gas electrical system, electrical systems and electrical equipment, IT and communication systems, plumbing, HVAC, gas equipment, emergency management, security management, and fire protection features are then determined.

Updated chapters

Chapter 1: This chapter provides the scope of the code and fundamentals, and summarizes the contents of each chapter. It also gives a list of areas that are not addressed in this code but are referenced as part of other NFPA codes and standards. These areas include:

  • Special requirements of installation and wiring, covered in NFPA 70.

  • Requirements for illumination and identification for means of egress, covered in NFPA 101.

  • Requirements for installation, testing, and maintenance of fire alarm systems, covered in NFPA 72.

  • Requirements for installation of fire pumps, covered in NFPA 20, except that the alternate source of power is specifically allowed to be the essential electrical system.

  • Requirements for installation of stationery engines and gas turbines, covered in NFPA 37.

Chapter 1 also covers the purpose, application, equivalency, and code adoption requirements.

Chapter 2: This chapter provides the referenced NFPA standards based on their current editions. The chapter also lists the referenced non-NFPA publications, which are: American National Standards Institute (ANSI); ASHRAE; American Society of Mechanical Engineers (ASME); American Society of Sanitary Engineers (ASSE); American Welding Society (AWS); Building Industry Consulting Service International (BICSI); Copper Development Association (CDA); Compressed Gas Association (CGA); Canadian Standards Association (CSA); International Electrotechnical Commission (IEC); Instrumentation, Systems, and Automation Society (ISA); Manufacturer’s Standardization Society of the Valve and Fittings Industry Inc. (MSS); Transport Canada (TC); Telecommunication Industry Association (TIA); UL; and U.S. government publications.

Chapter 3: The chapter defines a number of terms that will be used in the subsequent chapters of the code. Any terms that are not defined in this code will have their ordinarily accepted meanings as in Webster’s dictionary.

Chapter 4: This chapter lists and defines four building system categories. Building systems in health care facilities are now required to be classified into one of the system categories and the various applicable sections of the code need to be applied. There are four system categories:

Category 1: Facility systems in which failure of such equipment or system is likely to cause major injury to patients or caregivers shall be designed to meet Category 1 system requirements.

Category 2: Facility systems in which failure of such equipment or system is likely to cause minor injury to patients or caregivers shall be designed to meet Category 2 system requirements.

Category 3: Facility systems in which failure of such equipment or system is not likely to cause injury or death to patients or caregivers, but can cause patient discomfort shall be designed to meet Category 3 system requirements.

Category 4: Facility systems in which failure of such equipment or system would have no impact on patient care shall be designed to meet Category 4 system requirements.

The annexure item for this chapter (Annex A4.1) gives a few examples of health care facilities that would fall into different system categories including:

  • Ambulatory surgical center, two patients with full operating room services: Category 1

  • Reconstructive surgeon’s office with general anesthesia: Category 1

  • Procedural sedation site for outpatient services: Category 2

  • Cooling towers in Houston: Category 2

  • Dental office, no general anesthesia: Category 3

  • Typical doctor’s office/exam room: Category 4.

The building system categories defined above shall be determined by following and documenting the risk assessment procedures. Recommended risk assessment procedures are identified in Annex section A4.2.

Chapter 5: This chapter covers the performance, maintenance, installation, and testing of the following:

  • Nonflammable medical gas systems with operating pressure below a gauge pressure of 2068 300 psi

  • Vacuum systems in health care facilities

  • Waste anesthetic gas disposal (WAGD) systems, also referred to as scavenging

  • Manufactured assemblies that are intended for connection to medical gas, vacuum, or waste anesthetic gas sisposal (WAGD) systems.

Section 5.1 refers to Category 1 piped gas and vacuum systems, Section 5.2 refers to Category 2, and Section 5.3 refers to Category 3 piped gas and vacuum systems.

Various subsections within these sections apply to:

  • New health care facilities or facilities making changes that alter the piping

  • Existing health care facilities.

The hazards presented by various gases are required to be considered and criteria are established for gas and vacuum systems for each category.

Chapter 6: This chapter covers the performance, maintenance, and testing of electrical systems, both normal and essential, in health care facilities. For existing health care facilities, variations to the requirements of this chapter are considered acceptable where wiring arrangements are in accordance with prior editions of NFPA 99, or offer an equivalent degree of performance and reliability.

The nature of hazards for electrical systems is categorized as: fire and explosion hazards, shock hazards, and thermal hazards. Section 6.3 deals with electrical systems, its sources, and distribution to all patient rooms, laboratories, and nonpatient areas.

Chapter 6 also gives criteria for performance and testing, including testing of grounding systems in patient care rooms, voltage measurements, impedance measurements, and receptacle testing. Essential electrical system (EES) requirements for Type 1, Type 2, and Type 3 systems are described in Section 6.4, 6.5, and 6.6, respectively.

Chapter 7: This chapter addresses the performance, maintenance, and testing of IT and communication systems in health care facilities. Apart from the information provided in the chapter, Annex section A.7.1 refers the reader to IEEE602: Recommended Practice for Electrical Systems in Health Care Facilities and FGI Guidelines for Design and Construction of Health Care Facilities for additional information on the systems.

Section 7.3 covers all the Category 1 systems, which includes the following rooms/ enclosures within the health care facilities:

  • Entrance facility (EF): Permitted to be combined with telecommunication equipment room (TER). This location shall require not less than two physically separated entrance pathways. The location restrictions, power requirements, and environmental requirements for the EF are addressed. Also, the EF needs to be provided with automatic sprinklers either covered in cages or recessed to prevent mechanical damage and accidental operation.

  • TER: The TER houses the main networking equipment and shall be permitted to also house application servers and data storage devices that serve the health care facility, provided the TER is being used as a data center. The TER shall be designed as a separate space and shall not be used for any other purposes besides networking and data storage. The location restrictions, power requirements, and environmental requirements are addressed.

  • Telecommunications room (TR): The TR houses telecommunication equipment, cable terminations, and cross connection cabling. A minimum of one TR shall be provided in each floor of the facility, and a TR shall serve a maximum of 20,000 sq ft. The location restrictions, power requirements, and environmental requirements for the TR are addressed.

  • Outside plant infrastructure (OSP): OSP consists of conduits, cables, and other pathways used to connect buildings on a campus.

Chapter 8: This chapter was added by a tentative interim amendment (TIA) and covers performance, maintenance, and testing of plumbing systems in health care facilities. It is applicable to new construction, alterations, or renovated portions of existing systems. The risk category that will be applied to the plumbing system in each space shall be treated independent of the risk category applied to other systems (HVAC, electrical systems, etc.) that serve the same space.

The general and specific requirements for potable water, nonpotable water, water heating, and water conditioning, as well as nonmedical compressed air, grease interceptors, greywater, and clear wastewater is governed by the applicable plumbing codes adopted in the area where the health care facility is being constructed or exists.

Chapter 9: This chapter was added by a TIA and covers performance, maintenance, and testing of HVAC systems in health care facilities applicable to new construction, alterations, or renovated portions of existing systems. The risk category that will be applied to the plumbing system in each space shall be treated independent of the risk category applied to other systems (plumbing, electrical systems, etc.) that serve the same space.

The specific requirements for energy conservation, commissioning, ductwork, piping, acoustics, medical gas storage and refilling, natural and mechanical ventilation, and ventilation during construction are all covered in this chapter.

Chapter 10: This chapter covers performance, maintenance, and testing of electrical systems in health care facilities applicable to new construction, altered, and renovated portions of existing systems. Performance criteria and testing for patient care and nonpatient care related electrical appliances and equipment, and testing requirements for fixed and portable electrical systems are covered within this chapter.

The material in Annex A for this chapter relates to electrical safety and interprets some of the basic criteria by presenting different methodologies and alternative procedures to achieve the level of safety defined by the criteria.

Chapter 11: This chapter covers performance, maintenance, and testing of gas equipment in health care facilities applicable to new construction, and altered or renovated portions of existing systems. Criteria for the use of nonflammable medical gasses, vapors, and aerosols and equipment related to the administration of both at normal atmospheric pressure are provided. The cylinder and container source, storage requirements, performance criteria and testing, as well as administration are covered in this chapter.

Chapter 12: This chapter establishes criteria for emergency management in the development of a program for effective disaster preparedness, response, mitigation, and recovery in health care facilities. Responsibilities of all concerned persons, including the authority having jurisdiction (AHJ), senior management, and an emergency management committee is clearly stated. The categories of health care facilities (Category 1 and 2) are clearly defined, and the emergency management plans for each, including mitigation plans, are also covered within the chapter.

Chapter 13: This chapter covers performance, maintenance, and testing of security equipment and systems in health care facilities. The chapter provides criteria for development of a security management program.

Chapter 14: This chapter covers the recognition of and protection against hazards of an electrical, explosive, or implosive nature. The fire hazards associated with hyperbaric chambers and associated facilities used for medical applications and experimental procedures at gauge pressures of 0 to 100 psi are also addressed.

Chapter 15: This chapter covers the performance, maintenance, and testing of fire protection equipment in new and existing health care facilities. Construction and compartmentalization requirements are deferred to NFPA 101. Special hazard protection requirements shall follow NFPA 30, NFPA 54, or NFPA 58, while laboratory requirements shall comply with NFPA 45 and HVAC equipment with NFPA 90A. Fire alarm system and fire suppression system requirements are also described in this chapter. The fire alarm zones and sprinkler zones should match the smoke compartmentation zones.

Annex items: Annex A provides explanatory information for specific sections within the body of the code. Annex B has additional specific explanatory notes for Chapters 5, 6, 11, 12, and 14. Annex C gives the sample ordinance text adopting NFPA 99, and Annex D contains additional informational references.

Looking ahead

The 2012 edition of NFPA 99 introduced significant changes for the first time since 2005. NFPA 99 in its present form is a risk-based code document, compared to a facility-based document in previous editions. The occupancy approach of chapters related to different types of facilities (nursing home, hospital, etc.) was removed in favor of a categorization of each health care facility system in terms of its risk to patients’ well-being. In addition, new chapters on IT and communication systems (Chapter 7), plumbing (Chapter 8), HVAC (Chapter 9), security management (Chapter 13), and features of fire protection (Chapter 15) were introduced.

Poornabodh Kashyap holds a master’s in mechanical engineering and is an associate consultant with Aon Fire Protection Engineering, where he brings his experience and expertise to health care projects. He has been a team member and lead code consultant in health care projects in the Middle East using NFPA codes and standards extensively.

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