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Certified Health Constructor
Q/A
EOP ✔Ans -Emergency Operations Procedure is based on HVA or Hospital Vulnerability Analysis. Natural events, utility interruptions, communication failure. Aii is what pressure ✔Ans -Airborne Infection Isolation / Negative pressure and 12 ACH. Tuberculosis and Corona Virus patients are examples of where AII rooms are used. LCC ✔Ans -Life Cycle Costing is found by adding C capital cost of a building, plus M maintenance, plus E yearly energy cost, plus R replacement and repair cost of equipment, less S any salvage of a system. CMER-S= LCC FCI ✔Ans -Facility Condition Index, is found by the sum of all repairs and maintenance needed on a building, divided by the cost of a replacement building. .05 is good, .05-.15 is fair, more than .15 is poor. ROI ✔Ans -Return On Investment, is found by dividing the profit from sale, by initial cost. ROI will be a percentage. Bought for 1,000, sold for 1,200, 200 profit divided by 1,000=.20 or 20%. HVA ✔Ans -Hospital Vulnerability Assessment is used to create EOP or Emergency Operations Plan. Natural events, utility interruptions, communication failure. ACH ✔Ans -Air Changes per Hour, is found by Cubic feet of a room, divided by Cubic Feet of air per HOUR, not minute. Multiply CFM by 60 minutes for an hour. Important to note, ACH is figured with supply air on positive pressure rooms, and exhaust and return air on negative pressure rooms.
6 Stages of PDC ✔Ans -Planning Design Construction. (1) Schematic Design, (2) Design Development, (3) Construction Drawings, (4) Construction, (5) Occupancy, (6) Post Occupancy Evaluation (POE) LEED ✔Ans -Leadership in Energy and Environmental Design IAQ ✔Ans -Indoor Air Quality CMS ✔Ans -Centers for Medicare and Medicaid Services FGI ✔Ans -Facility Guidelines Institute ETO ✔Ans -Ethylene Oxide, or chemical sterilization of devices that cannot withstand high temperatures. HEPA ✔Ans -High-Efficiency Particulate Air Define ILSM ✔Ans -Interim Life Safety Measures. Defend in place, evacuation is the last option. Compartments. Detection, Alarm, Extinguish. Planning, training, drilling. Required when altering any exit or the integrity of fire or smoke walls, when life threatening condition exists. EDUCATE and DOCUMENT. If any exit is blocked fire drills must be doubled. ICRA ✔Ans -Infection Control Risk Assessment ICRMR and examples? ✔Ans -Infection Control Risk Mitigation Recommendation. Barriers, pressures, construction routes, monitoring, documentation. L&D ✔Ans -Labor and Delivery LDRP ✔Ans -Labor, Delivery, Recovery, Postpartum
NFPA 99 - "Building System Category" med gas most stringent class. ✔Ans -Category 1 failure is likely to cause serious injury or death. Cat. 2 failure likely to cause minor injury. Cat 3 failure not likely to cause injury. Cat. 4 no impact. Name 6 med gas valve types. ✔Ans -Source, Main, Service, Riser, Zone, Future Responsibility of Contractor concerning med gas (3) ✔Ans -Facility personnel shuts valves, installer needs certification, 3rd party certification for use. Med gas pipe is made how? ✔Ans -Hard drawn seamless per ASTM B819. Plugged and capped. Copper or stainless. Med gas pipes are joined how and purged with what? ✔Ans -Brazing, welding, memory metal fittings, axially swaged, elastic preload fittings. Threaded connection. Purged w/ nitrogen to eliminate oxidation. Med gas pressure test before use? ✔Ans -Initial test of 150%, then standing 120% for 24 hours. 4 Med gas certification tests? ✔Ans -Cross connection, Particulates, Purity, Alarm tests. Illumination, fire alarm, med gas alarm, exit signs, communication systems, elevator cab light, doors for egress, essential loads to make the generator operational, are on what branch of electrical system? ✔Ans -Life Safety Branch Task illumination and selected outlets for patient care in critical care areas & psych & med prep & Rx, Nurse stations, Nurse call, blood & bone & tissue bank, telephone equipment are on what branch of electrical system? ✔Ans -Critical Branch
Safety sump pumps for major equipment, compressed air pumps, smoke control and stair pressurization, kitchen hoods, pressurization for PE, Aii, fume hoods, Nuc Med, hot lab, ETO, select elevators, HVAC for critical areas, Autoclave, are on what branch of electrical system? ✔Ans -Equipment Branch What 2 branches are kept separate from all other systems? ✔Ans -Life Safety and Critical Branches. What order are electrical branches prioritized for emergency shutdown? ✔Ans -Equipment branch is shut down first, then Critical, then Life Safety is shut down last. Operating rooms Class B & C are what pressure to adjacent and what total ACH is required? ✔Ans -Positive pressure with 20 ACH. B&C are most stringent. Critical & Intensive Care are what pressure to adjacent and what ACH is required? ✔Ans -Positive pressure with 6 ACH. Aii rooms are what pressure to adjacent and what ACH is required? ✔Ans -Negative pressure with 12 ACH. PE rooms are what pressure to adjacent and what ACH is required? ✔Ans -Positive pressure with 12 ACH. Patient or med surg rooms are what pressure to adjacent and what AHC is required? ✔Ans -No regulation on pressure. 4 ACH. With type D or low diffusers ACH is 6. Which guideline agency has codes written for HVAC? ✔Ans -ASHRAE Room pressure rule of thumb? ✔Ans -Protecting the patient= positive pressure. Protecting the public= negative pressure.
Separation of floors requirements? ✔Ans -Must resist the passage of fire and smoke. 1 hour wall consist of what construction? ✔Ans - layers of 5/8 type X or equal drywall sealed to the deck. 45 minute rated frame and door. Rule of thumb: 1 layer of 5/8= 1/ hour with door rated 75% of the wall. Examples of 1 hour rated wall requirements. ✔Ans -Storage areas 50 sq ft or more must have a 1 hour rating, and must have a closer. Labs with small amount of flammables. There is an exception for sprinkled rooms. Stairway wall rating requirement for 3 stories or less not a fire exit? ✔Ans -1 hour for stairways that are not designated fire exits. Stairway wall rating requirement for 4 or more stories? ✔Ans -2 hour rated walls are required. Requirements for doors opening to exit corridors. ✔Ans -Must have the same rating as the exit corridor or stair, and must be self closing and latching. Alarmed exit doors requirements. ✔Ans -If delayed, it must sound between 15-30 seconds, and cannot be automatic resetting. NFPA How long can a fire alarm or sprinkler be out of service before a fire watch is implemented? What other steps should be taken? What type of sprinkler heads are to be used in sleeping rooms? ✔Ans -When fire alarm is out for 4 hours or more, or sprinkler off for 10 hours or more, must have fire watch or empty the building, notify fire dept., document. Quick response heads are required in sleeping rooms. If an exit is blocked, fire alarm testing doubles. Hospital workplace safety needs/issues identified ✔Ans -Infectious red bag trash, sharps, Nuc med therapy, chemo
therapy, soiled utility, x-ray exposure, MRI zones, radiation exposure. Hospital workplace security needs/issues identified. ✔Ans -Pharmacy, Psych, ED, Peds, Dementia areas. Cannot work in a pharmacy without a Pharmacist present under any circumstances. Construction related safety concerns. ✔Ans - Personal identification, traffic, information signage, communication with emergency response for changed paths and exits. ADC / LOS ✔Ans -Average Daily Census, is total admissions in a month, divided by days in a period. Length Of Stay is discharge date less admission date. Average Length of Stay, is sum of all days admitted (less admission date), divided by total discharge of all patients in a period. Hospital reimbursements. ✔Ans -Hospital are now reimbursed per patient episode, as in lump sum for a heart attach patient, regardless of treatment provided. Returning patients within 30 days for the same ailment are not reimbursed. Simple Payback Period ✔Ans -Simple Payback Period is found by savings per year, divided by cost of investment. NPV ✔Ans -Net Present Value is found by, no idea... Lottery winnings: $150m=$6m per year for 25 years. Or cash payment of $9m Emergency generators must have fuel for a run time of how long? ✔Ans -24 hours minimum. How many type E oxygen cylinders can be stored in any smoke compartment? ✔Ans -300 cu ft maximum. Type E cylinders are the smaller 23.5 cu ft. or 300 divided by 23.5, or 12
PACU (post anesthesia care unit / some call it recovery), POST- OP (might combine recovery and discharge in ambulatory surgery) Explain the Departmental Relationships: OR Classification, Cath Lab ✔Ans -O.R. = Class A, B, & C. Cath Lab = Cardiac Catheterization Lab -Often treated as surgery Definition: MOB ✔Ans -Medical Office Building Definition: PACU ✔Ans -Post Anesthesia Care Unit Definition: CATH LAB ✔Ans -Cardiac Catheterization Lab Definition: OB ✔Ans -Obstetrics Definition: LDR ✔Ans -Labor Delivery Recovery Definition: LDRP ✔Ans -Labor Delivery Recovery Post Partum Definition: C-SECTION ✔Ans -Caesarian Section Definition: ICU ✔Ans -Intensive Care Unit Definition: NICU ✔Ans -Neonatal Intensive Care Unit Definition: PICU ✔Ans -Pediatric Intensive Care Unit Definition: SICU ✔Ans -Surgical Intensive Care Unit Definition: CICU ✔Ans -Cardiac Intensive Care Unit Definition: CCU ✔Ans -Coronary Care Unit
Definition: BMT ✔Ans -Bone Marrow Transplant Definition: SDs ✔Ans -Schematic Design Definition: DDs ✔Ans -Design Development Definition: CDs ✔Ans -Construction Drawings Definition: POE ✔Ans -Post Occupancy Evaluation Definition: IBC ✔Ans -International Building Code Definition: UBC ✔Ans -Unified Building Code Definition: NFPA ✔Ans -National Fire Protection Association Definition: AHJ ✔Ans -Authority Having Jurisdiction Definition: TJC ✔Ans -The Joint Commission Definition: HFAP ✔Ans -Healthcare Facilities Accreditation Program Definition: DNV ✔Ans -Det Norske Veritas Definition: OSHA ✔Ans -Occupational Safety and Health Administration Definition: EPA ✔Ans -Environmental Protection Agency Definition: HIPAA ✔Ans -Health Insurance Portability and Accountability Act Definition: ADA ✔Ans -Americans with Disabilities Act
Definition: EOP ✔Ans -Emergency Operations Plan Definition: HVA ✔Ans -Hospital Vulnerability Analysis What type of space needs lead lining ✔Ans -Spaces that use ionizing radiation (X-Ray, CT) How to calculate ACH ✔Ans -Air Changes per Hour = room volume in cuft/60 result is cuft/hr Definition: AII ✔Ans -Airborne Infection Isolation Difference Between PE and AII ✔Ans -PE (Protective Environment) is + pressure (immunocompromised) AII (Airborne Infection Isolation) is - pressure (isolation). Both have 12 ACH. Definition: MERV ✔Ans -Minimum Efficiency Reporting Value, and is used to measure the overall efficiency of media air filters Explain OR Classes ✔Ans -Class A - local anesthesia / procedures, 15 ACH. 2 outdoor ACH. Class B - general anesthesia, CYSTO (urethra and bladder), 20 ACH. 4 outdoor ACH. Class C - Highest, Neuro/heart/other open body surgery, 20 ACH. 4 outdoor ACH. When is 2 stage filtering required? ✔Ans -In all clinical areas. Admin Office areas don't require this. What does it Govern: ASHRAE 188 ✔Ans - Legionella in Hot Water Standard What determines Capital Expense Vs. Operational Expense ✔Ans -Cost and life expectancy Explain MRI Zones ✔Ans -1- when you first enter to check in. 2- patient screening area and prep. 3- already
screened patients and personnel. 4- screened MRI patients under direct super vision of trained MRI personnel only (inside room with magnet) What is Emergency Planning and Mitigation based on? ✔Ans -HVA (Hazard Vulnerability Analysis) List 5 places for heightened safety and security needs / issues in the hospital ✔Ans -Pharmacy, Behavioral / psychiatric care areas, Emergency department, Infant / pediatric security, Patient dementia related security needs When to implement ILSM? ✔Ans -When construction alters any required life safety code elements 4 things required when Fire Alarm is out of service more than 4 hrs in 24 hr period ✔Ans -Fire watch, notify the fire department, Document, Possible other measures including emptying the building. Explain: Vertical exits - Exit stairways ✔Ans -Walls constructed as a fire barrier. FRR (fire resistance rating) 1hr where exit connects 3 stories or less, 2hr for 4 and up (new healthcare), cannot be supported by structure >2hr rating Explain: Horizontal Exit Passageways ✔Ans - Similar to vertical exits - must equal rating of stairwell it serves. Doors must be rated same as exit enclosure, be self closing and latching Explain: Horizontal Exit ✔Ans -2hr Fire rated barrier min. All spaces must have at least one exit that isn't a horizontal exit What does it Govern: *NFPA 241 ✔Ans -Fire Protection During Construction 4 things exit enclosures cannot be used for ✔Ans - Utility chase, storage, an office, construction staging area
Where does it come from: PCRA requirement ✔Ans -Pre-Construction Risk Assessment. TJC (The Joint Commission) PACS ✔Ans -PACS (picture archiving and communication system) is a medical imaging technology used primarily in healthcare organizations to securely store and digitally transmit electronic images and clinically-relevant reports Definition: *Code Red ✔Ans -Fire Response Definition: *Code Green ✔Ans -Evacuation Response Definition: *Code Orange ✔Ans -Disaster Plan Activation Definition: *Code Brown ✔Ans -Hazardous Substance Release Definition: *Code Black ✔Ans -Bomb Threat / Search Definition: *Code Grey ✔Ans -External Air Exclusion Definition: *Code White ✔Ans -Aggressive / Assaultive Behavior Definition: *Code Blue ✔Ans -Cardiac Arrest / Medical Emergency Definition: *Code Yellow ✔Ans -Missing Patient Definition: *Code Pink ✔Ans -Pediatric / Neonatal Emergency Definition: HCF ✔Ans -Health Care Facility
Definition: EMR ✔Ans -Electronic medical record Definition: EHR ✔Ans -Electronic health record Definition: PACS ✔Ans -Picture archive and control system To recharge Plumbing Systems (4 options) ✔Ans - Flush lines, retest water quality, potential hyper-chlorination, potential super heating to 180°. Definition: RO ✔Ans -Reverse osmosis Definition: DI ✔Ans -De-Ionization List 3 types of water treatment system used in a Dialysis system ✔Ans -Carbon Filters (used to remove gases and chlorine), RO (reverse osmosis), DI (De-ionization) What does it Govern: FGI 2010/ASHRAE 170 ✔Ans -HVAC Systems Ventilation, Filtration, and pressure relationships Pressure relationship in w/c: AII ✔Ans --.01w.c. for airborne infection isolation rooms Pressure Relationship in w/c: construction sites at Risk Class 3 or 4 ✔Ans --.03w.c.; should flow clean to less clean What are risk factors for Legionella ✔Ans -Amoeba in water (aid growth), dead legs in system piping, aerosolization of water, stagnant water, trives in 77-108° Door requirements of egress corridors ✔Ans -Solid core, self latching, self closing, doors must be double egress in egress path
Filtration Required: Admin, bulk storage, soiled holding, laundry, food prep, other outpatient spaces ✔Ans -Filter Bank 1 MERV7; Filter Bank 2 N/A Filtration Required: Laboratories and Class A surgery ✔Ans -Filter Bank 1 MERV13; Filter Bank 2 N/A What electrical branch should serve: auto doors used for building egress, elevator cab lighting / control / communication / signaling, generator lighting, battery charger for emergency power battery lighting? ✔Ans -Life safety branch - required by NFPA 101 What electrical branch should serve: task illumination / fixes equipment / for patient care of critical care areas, psych bed areas, medication prep areas, pharmacy dispensing areas ✔Ans -Critical Branch per NFPA 99- What electrical branch should serve: egress lighting, exit signs, fire alarms, med gas and med vac alarms, hospital communications systems ✔Ans -Life safety branch
- required by NFPA 101 What electrical branch should serve: isolated power systems in special environments, nurses' stations, nurse call systems, blood / bone / and tissue banks, telephone equipment rooms and closets ✔Ans -Critical Branch per NFPA 99- What electrical branch should serve: Non-delayed automatic connection - generator accessories essential for generator operation (must auto transfer) ✔Ans -Equipment Branch What electrical branch should serve: Delayed - auto connection - vacuum, compressed air, medical and controls air, smoke control stair pressurization, heating, select elevators ✔Ans -Equipment Branch
What electrical branch should serve: HVAC surgery, (OB, ICU, CCU, Nursery, Emergency Procedure areas) and critical areas (AII, PE,...), controls for emergency system equipment ✔Ans -Equipment Branch Explain Med Gas System Levels ✔Ans -Level 1 - imminent danger of morbidity or mortality. Level 2 -manageable risk of morbidity or mortality. Level 3 -Not place patients at risk of morbidity or mortality. Where must the emergency oxygen supply connection be located? ✔Ans -on the exterior of the building being served in a location accessible by emergency supply vehicles at all times in all weather conditions What are the 6 types of valves in a Med Gas System? ✔Ans -Source, main, service, riser, zone, and future What material is to be used on med gas Levels 1&2 and how to join? ✔Ans -Hard-drawn seamless copper to ASTM B819; brazed What material is to be used on med gas Level 3 and how to join? ✔Ans -Hard-drawn seamless copper to ASTM B819; soldering may be used, brazing acceptable How do you purge a med gas system? ✔Ans - continuous, oil-free, dry nitrogen purge is required during all work on med gas systems What tests are required for med gas systems? ✔Ans -Initial blow down (oil free, medical grade Nitrogen). Initial pressure test (150% working pressure). Cross connection test. Piping purge test. Standing pressure test (24hr @ 120% working pressure) What tests are required for med gas system certification? ✔Ans -Cross connection (individual pressurization, pressure
