Computer Modeling Challenges Illustrate the Need for Codes Supported by Science

by Deanna Martin, ASHE senior communications specialist

The American Society for Healthcare Engineering (ASHE) is working with fire protection engineers to collect scientific data that will help the International Code Council (ICC) Ad Hoc Committee on Healthcare determine the appropriateness of potential changes to the I-Codes that would affect hospitals. Committee members want to reduce conflicts caused by overlapping code requirements and use research to back up their suggested changes. But engineers using computer modeling to explore the possible effects of proposed changes have run into some technical challenges. Quick-response sprinklers extinguish virtual hospital fires so rapidly that the differences between various scenarios cannot be assessed. The difficulty in distinguishing the effects of these proposed changes illustrates the need for codes written to make a real difference in protecting lives and property, not simply to pile on unnecessary requirements.

ASHE partnered with Rolf Jensen & Associates (RJA) to do engineering research that would provide the ICC ad hoc committee members with data to help them decide whether proposed changes to the codes make sense. For example, one change the committee is considering would allow an increase in the amount of wall decorations hung in hospitals from 10 percent of wall space to 20 percent. The expansion would not only allow more artwork to be displayed, which can please patients, but also more space for posting important signs like infection control notices, staff information, and the patient bill of rights.

Michael Crowley, SASHE, FSFPE, PE, senior vice president at RJA, said his team pulled data on typical wall decorations found in hospitals, including paper, canvas, and corkboard. Some materials burn quickly and others burn slowly, but the key conclusion seemed to be the same for all types of materials: If sprinklers went off, there was no problem. In fact, the sprinklers put out the fires so quickly that no differences were measured between fires in spaces with 10 percent and 20 percent of the wall covered with decorations. Without sprinklers, of course, conditions were worse. “One of the things we keep coming back to is that if it’s not sprinklered, we have a problem. If it is sprinklered, we don’t have a problem,” Crowley said.

New hospitals and hospitals that undergo major renovations are required by code to use quick- response sprinklers, and ASHE estimates that more than 90 percent of hospital spaces are fully sprinklered. Sprinklers were present in 57 percent of the reported fires in all types of health care properties from 2005 to 2009, according to a 2011 National Fire Protection Association (NFPA) report.

Not only are sprinklers present in most hospitals, but they are reliable. In fact, the NFPA report found that sprinklers operated in 91 percent of all structure fires large enough to activate them from 2005 to 2009. In the 9 percent of fires where sprinklers did not operate, the most common reason (accounting for 65 percent of failures) was that the sprinklers had been shut off before the fire began, as may occur in the course of routine inspection or maintenance.

Crowley points out that hospitals do not face all the problems with sprinklers that other building occupancies have because hospitals use advanced building automation systems that notify staff when a problem arises or if sprinklers are turned off. This practice effectively eliminates the chief concern of depending on sprinklers for fire extinguishment—that a sprinkler may not function for some reason.

ASHE Associate Director for Advocacy Chad Beebe, AIA, SASHE, CHFM, CFPS, CBO, said codes such as the 10 percent limit on wall decorations were understandable when hospitals were not sprinklered, even though there was little scientific evidence to support a limit of 10 percent and not another number.

“When we had unsprinklered hospitals and had 10 percent, it made sense,” Beebe said. “Now that we are adding a sprinkler requirement for all hospitals, we need to go back and take a look at some of these other limitations we included in the previous codes and make some revisions.” ASHE and RJA were unable to find original scientific data supporting the 10 percent rule, but think they are heading in the right direction now with some actual modeling supporting the proposal to move to 20 percent.

“We’ve piled on so many rules and requirements for health care facilities that we may have piled on some rules that essentially don’t improve safety,” Beebe said.

Safety in hospitals has improved dramatically over the last few decades. Of all the structure fires from 2003 to 2006, less than 1 percent occurred in health care facilities, and structure fires in health care facilities have fallen 71 percent, according to a 2009 NFPA report. Much of the improved safety climate can be attributed to code changes, such as those requiring sprinklers, and the advent of non-smoking policies.

On the other hand, some code requirements have contributed little to protecting hospital patients, staff, and firefighters who respond to emergencies. Although some of these requirements may seem small or unimportant, the time and money hospitals spend to make sure they are in compliance with these and hundreds of other code requirements add up and take away resources from a hospital’s chief responsibility – its patients.

“Every dollar a hospital spends on unnecessary codes is a dollar that is drawn away from direct patient care,” said ASHE Deputy Executive Director Douglas Erickson, FASHE, CHFM, HFDP, CHC.

Jon Nisja, with the Fire Marshals Association of Minnesota, wrote in an editorial published in the spring 2011 edition of Fire Marshals Quarterly that adding volume to codes does not necessarily translate into improving fire or life safety. It is his opinion that code development is approaching a crossroads.

“Will it continue to be a tool to save lives, reduce fires, and minimize property damage or will it transition into a process that favors profits, turf, and market share over protecting society as a whole from the ravages of fire?” he wrote. “Will it continue to be a valuable resource for a community wishing to positively influence fire and life safety or will it become a book of confusing and incongruent regulations that cost billions of dollars and provide minimal benefit?”

The ICC Ad Hoc Committee on Healthcare is working to ensure that codes keep hospitals safe but do not burden them with unnecessary regulations. The committee unanimously agreed at its October 2011 meeting to propose changing the I-Codes to allow wall decorations on 20 percent of wall space. The deadline for submitting that proposed change – along with many others the committee is considering – is January 3, 2012. ICC code development hearings, where these proposals will be voted on, are scheduled in Dallas from April 29 to May 6, 2012. The deadline for public comments on the changes approved in April is August 1, 2012, and a final action hearing is scheduled for October 2012 in Portland, Ore.

To get involved with the I-Codes revision process, contact ASHE or the ICC Ad Hoc Committee on Healthcare, attend one of the ad hoc committee meetings, or listen in on the numerous technical calls. Information about the committee’s meetings is available online at http://www.iccsafe.org/cs/AHC/Pages/default.aspx.

For more information, contact Chad Beebe at cbeebe.aha@gmail.com.