Premier Safety Share
Premier Safety Web site
April 28, 2004
Bulletin: A major win for alcohol hand rub dispenser placement
This bulletin is a service of Premier Safety Share. Please forward this time-sensitive information to interested colleagues. As always, visit Premier's Safety Web site for safety tools and resources.
Sincerely,
Gina Pugliese, RN, MS, editor
Vice president, Premier Safety Institute
A major win for alcohol hand rub dispenser placement
On April 28 2004, the National Fire Protection Association (NFPA) announced an amendment of the 2000 and 2003 Life Safety Code (LSC) that will now permit the use of alcohol-based hand rubs not only in rooms and suites, but also in corridors where installment was previously prohibited. This is good news for those agencies that are required to enforce the LSC, including the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the Center for Medicare and Medicaid Services (CMS), and local and state fire safety agencies.
This amendment provides detailed criteria on the use and storage of alcohol-based hand rubs designed to minimize any potential fire risk while permitting hand rub dispensers to be located in convenient locations to maximize access and use by healthcare workers. Adoption of this tentative interim amendment (TIA) provides clear code language for authorities having jurisdiction (AHJ) to permit the use of these hand rubs in corridors. JCAHO, CMS, and many state and local authorities enforce the Life Safety Code.
The adoption of the TIA is the culmination of the American Society of Healthcare Engineering's (ASHE) yearlong advocacy effort in collaboration with the American Hospital Association (AHA), the Centers for Disease Control and Prevention (CDC), the Association for Professionals in Infection Control and Epidemiology (APIC), the Society for Healthcare Epidemiology of America (SHEA) and other members of the infection control and fire safety community to address the fire safety concerns of the enforcement community.
Implementing handwashing with alcohol-based hand rubs to reduce healthcare-associated infections (HAI) as recommended by the CDC has been a challenge for practitioners. Existing national and local fire codes did not explicitly address placement of flammable liquids -- such as the hand rubs -- in hallways, a convenient location expected to promote handwashing compliance. But as reported in the September 16, 2003 Safety Share Bulletin, many healthcare facilities found it difficult to install dispensers since many states interpreted current fire codes narrowly and limited the location of flammable liquids, such as the alcohol-based hand rubs, to patient rooms only.
At a July, 2003 stakeholders' meeting among ASHE, AHA, CDC, APIC, SHEA, JCAHO and other members of the healthcare and fire safety communities, fire safety officials expressed concerns about HAIs, but stated that their mandate was to comply with existing fire codes that restricted the use and storage of flammable liquids. At that meeting, ASHE introduced the results of a fire safety engineering study commissioned to determine how alcohol-based hand rub dispensers could be safely installed and managed in corridors. The review and acceptance of the study's findings led to the development of the exact code language of the TIA.
The TIA allows the installation of dispensers in corridors provided 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 hand rub solution in dispensers and maximum of five gallons in storage.
This is a significant step toward allowing healthcare facilities convenient access to life saving hand rubs, 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 hand rubs. The task group is comprised of fire marshals, hospital engineers, and industry experts, and work is moving forward with a strong sense of collaboration to best meet the patients' clinical and fire safety needs. If amended, this will pave the way for state agencies to also permit dispensers in corridors, and effective align national, state, and local fire agencies on the issue of alcohol hand rubs.
Updates will be provided on progress related to code interpretation and policy changes. In the meantime, practitioners are urged to contact their local and state fire safety professionals before acting on these changes.
Download fire modeling study documents:
- Fire modeling analysis executive summary (.doc) (23 KB)
- Fire modeling analysis - full report (.pdf) (1.7 MB)
- Fire Modeling analysis - charts Appendix B (.pdf) (2.0 MB)
More background information is available from the Safety Institute.