NFPA 99, the Health Care Facilities Code, sets the requirements for medical gas and vacuum systems, electrical systems, and hyperbaric facilities in hospitals and other health care settings across the United States. Every three years the code is revised, and the 2024 edition of NFPA 99 brings meaningful changes that facility managers, medical gas technicians and verifiers, designers, and compliance teams should understand before their state or accrediting body adopts it.
The 2024 edition adds several important updates intended to improve safety, reliability, and resilience in health care facilities. The list below is not comprehensive, but it calls out some of the more significant changes from the 2021 edition that may affect day-to-day hospital operations.
1. Surgical Smoke (Medical Plume) Provisions
One major change is the addition of new provisions for surgical smoke, also called medical plume. Surgical smoke can create health risks for operating room staff and others nearby. The 2024 edition adds guidance for removing this smoke and allows limited use of medical-surgical vacuum systems for that purpose. The goal is to support safer operating rooms by improving air quality and reducing staff exposure to harmful airborne contaminants.
2. Auxiliary Source Connections
The 2024 edition also adds a new(ish) requirement for medical gas and vacuum systems to have an auxiliary connection on the patient side of the source valve. In plain terms, this gives facilities a way to connect a temporary or supplemental source of supply if the normal system needs support. These valves can be used during emergencies, maintenance, equipment failure, or high-demand situations. Depending on how the intake/exhaust is piped, they may also be used to facilitate a total system replacement without a shutdown, which is a Pretty Big Deal.
3. Pipe Sizing Calculations & the New ASSE 6060 Medical Gas Designer
The 2024 edition also requires pipe sizing and system design calculations to show that pressure loss across the system does not exceed 10 percent. These calculations must also be kept as part of the facility’s permanent records. This makes the design process more transparent and helps confirm that the system can deliver gas or vacuum service properly under expected demand. Coinciding with this new requirement is the introduction of a (yet another) new ASSE 6000 series credential: the 6060 Medical Gas Designer!
4. Cryogenic Liquid Withdrawal and Piping
Another new section addresses cryogenic liquid withdrawal and cryogenic liquid piping. This includes requirements related to cryogenic liquid containers, ventilation for rooms where those containers are located, approved materials, pressure relief valves, and manifold arrangements. These updates provide clearer safety expectations for facilities that store or use cryogenic liquids.
5. Hyperbaric Chamber Fire Suppression
Hyperbaric chamber requirements were also updated. The 2024 edition adds requirements for both primary and secondary fire suppression systems. Earlier language was more prescriptive and generally required a deluge-type water spray system and a handline for Class A chambers. The revised language allows more flexibility by permitting alternatives to both the deluge and handline systems, provided the alternatives meet the applicable safety intent.
6. Electrical System Updates
The electrical system provisions were also revised. The 2024 edition adds language intended to consolidate electrical system performance, testing, and maintenance requirements within NFPA 99. It also restructures the section on ground-fault protection, making the electrical requirements more organized and easier to apply.