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Life Safety Code Amendment Allows Alcohol Based Hand Rubs

On April 28, 2004 the National Fire Protection Association (NFPA) announced the amendment of the 2000 and 2003 editions of the Life Safety Code (LSC) to specifically recognize and permit the use of alcohol-based handrub solutions in patient rooms, corridors and suites of healthcare facilities. The LSC is enforced by a number of regulatory and compliance organization including the Joint Commission (JCAHO), the Center for Medicare and Medicaid Services (CMS), and many state and local authorities.

Adoption of this tentative interim amendment (TIA) provides Authorities having Jurisdiction (AHJ) with clear code language required to allow the use of these handrubs. By providing detailed criteria on the use and storage of alcohol-based handrubs, the TIA provides guidance to minimize any potential fire risk while allowing handrub dispensers to be located in convenient locations to maximize access and use by healthcare workers.

The adoption of the TIA is the result of a year-long advocacy effort led by ASHE in collaboration with the American Hospital Association (AHA), the Centers for Disease Control (CDC), the Association for Professionals in Infection Control Inc., (APIC) the Society for Healthcare Epidemiology of America, Inc., (SHEA) and other members of the infection control and fire safety community.

According to the CDC, Healthcare-Acquired Infections (HAI)strike nearly two million people each year, leading to roughly 88,000 deaths per year[1]. To combat this problem, in October 2002 the CDC issued recommendations stating that "alcohol based handrubs may be a better option than traditional hand washing with plain soap and water”. Additionally JCAHO established National Patient Safety Goals to focus attention on the reduction of HAIs by calling for hospitals to follow the CDC recommendations.  However, according to AHA News health care facilities ran into problems installing dispensers since national and local fire codes restrict the location and use of flammable liquids, such as the alcohol based rubs.

In July 2003 ASHE, AHA, CDC, APIC, SHEA, and other members of the healthcare and fire safety communities, including fire safety officials, met to address the HAI issue.  While it was agreed upon that in theory, the use of alcohol-based handrubs had an impact on infection rates, it was noted that current fire codes restricted the use and storage of flammable liquids.  During the course of the meeting ASHE provided the results of a fire safety engineering study[2] they had commissioned to determine how alcohol-based handrub dispensers could be safely installed and managed in corridors.  The review and acceptance of the findings of the study led to the development of the exact code language of the TIA.

The TIA allows the installation of dispensers in corridors provided that the following conditions are met:

  • The corridor width is 6 feet or greater and dispensers are separated at least 4 feet apart.
  • The maximum individual dispenser fluid capacity is 1.2 liters for dispensers in rooms, corridors, and areas open to corridors, and 2.0 liters for dispensers in suites of rooms
  • The dispensers are not installed over or directly adjacent to electrical outlets and switches.
  • In locations with carpeted floor coverings, dispensers installed directly over carpeted surfaces are permitted only in sprinklered smoke compartments.

In addition:

  • Each smoke compartment may contain a maximum aggregate of 10 gallons of alcohol-based handrub solution in dispensers and a maximum of 5 gallons in storage.

This is a significant step toward allowing hospitals convenient access to life-saving alcohol handrubs, but it is not the final step. The International Code Council (ICC) publishes the International Fire Code (and companion International Building Code), which are referenced by many state and local fire agencies. ASHE has collaborated with the ICC task force charged with investigating and providing recommendations regarding the safe usage of alcohol-based handrubs. The task group is comprised of fire marshals, hospital engineers, and industry experts and is moving forward with a strong sense of what best meets the patients clinical and fire safety needs. If amended, this action paves the way for state agencies to also allow dispensers in corridors effectively getting national, state, and local fire agencies all on the same page on the issue of alcohol-based handrubs.


[1] www.cdc.gov/handhygiene/pressrelease.htm
[2] The study is available at www.ashe.org/ashe/codes/handrub/index.html