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Department of Health
Steve Pennington – steve.pennington@doh.wa.gov
Susan Upton – susan.upton@doh.wa.gov
Construction Review Services (CRS)
Construction Review Services
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Agenda
Part 1 – CRS Updates
Part 2 – Current Project Trends
Part 3 – Typical Inspection Deficiencies
Part 4 – Questions???
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Part 1
CRS Updates
CRS accessibility
Constantly monitoring workload
Current region assignments
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Mina Zarelli
Mina.zarelli@doh.wa.gov
Susan Upton
Susan.Upton@doh.wa.gov
Janet Smoot
Janet.Smoot@doh.wa.gov
Matthew Campbell
Matthew.Campbell@doh.wa.gov
Kevin Scarlett
Kevin.Scarlett@doh.wa.gov
Construction Activity
Construction Activity remains strong
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579
424
508
655 696
754
2008 2009 2010 2011 2012 2013 projected
Review Time
Average review time is steadily decreasing
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38.7
32.3
25.7
16.7
2010 2011 2012 2013 YTD
CRS Updates – Code development
Continued participation in code
development
2014 FGI development is complete,
publication early 2014
Projects submitted after July 1, 2013 are
reviewed to the 2012 International Codes
ICC 2015 “One Code Theory” Project is
finishing it’s first complete code cycle
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CRS Updates
Preliminary Conference required on
projects $250,000 and greater
Improved CRS accessibility through
more on-site visits for all facility types
Statewide – let CRS come to you.
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Hospital 48%
Assisted Living Facility 25%
Nursing Home 19%
Residential Treatment
Facility 2%
Temporary Worker Housing
3%
Ambulatory Surgery Facilities
2%
Other 1%
Volume by Facility Type
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Department of Health
Steve Pennington – steve.pennington@doh.wa.gov
Susan Upton – susan.upton@doh.wa.gov
Construction Review Services (CRS)
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Enforceable Codes
State Building
Code
2012 International
Building Code
2012 International Fire
Code
2012 International
Mechanical Code
2012 Uniform
Plumbing Code
2012 National Electric
Code
State
Licensing
Chapter 246-320 WAC
(Hospitals)
2010 Facilities
Guidelines Institute
(FGI)
Federal
2000 NFPA 101
Life Safety Code
1999 NFPA 99 Health Care Facilities
All Other referenced NFPA Documents
2012 NFPA 101
CMS Adoption ???
What do you know?
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CMS Breaking News
CMS Categorical waivers
– August 30, 2013
– Apply to selected 2000 NFPA 101 life safety
issues
– Waiver process similar to humidity S&C
– Website link to information:
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http://www.cms.gov/Medicare/Provider-Enrollment-and-
Certification/SurveyCertificationGenInfo/Downloads/Surv
ey-and-Cert-Letter-13-58.pdf
CMS Breaking News
Medical gas alarms
– Computer monitoring allowed for 1 of 2
required alarms.
Opening into exits
– Certain existing mechanical spaces may open
into stairs.
Doors
– More than one delayed egress device in
series.
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CMS Breaking News
Suites
– Increase of sleeping suites to 10,000 sf.
Sprinkler and Generator testing
– Testing frequency of certain devices are more
lenient.
Clean Waste and Recycling.
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Remember!
CMS Categorical waivers
– Work typically will require CRS review.
– You MUST alert surveyor at entrance conf.
– Must provide documentation at entrance.
– The state building code still applies!
– THIS IS NOT a complete adoption of the
2012 Life Safety Code.
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CMS News
July 26 Federal Register announcement of
new accreditation organization:
CMS approved the Center for
Improvement in Healthcare Quality as
an accreditation organization for hospitals
who want to receive Medicare and
Medicaid payments.
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Part 2
Current Project Trends
Efficiency
– Energy
– Workflow
Model of Care
Infrastructure Upgrades
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Energy Efficiency
Project goals
o Lighting systems
o Boilers systems
o HVAC systems
o Conversion from steam
to hot water heating
o Solar systems
o Ground source heat
pumps
o Chilled beam systems
o In-room re-circulated
air (where allowed)
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Challenges identified
o Phasing issues
o Infection control
o New technologies
meeting older codes
o Existing infrastructure
limitations
Potential solutions
o Involve CRS early
o Define project goals
o Identify code
deficiencies
o Describe any alternate
methods to meet intent
of code
Workflow Efficiency
Project goals
o Lean Design o Reduced Storage
o Reduced Steps
o Reduced Patient Waiting
o Universal Design o Reduced errors
o Flexibility
o Patient Centered Care o Healing environments
o Family integrated
o Private Patient rooms
o On-Stage/Off-Stage
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Challenges identified
o Non-traditional floor plans
o Life Safety Issues o Smoke Compartments
o Suites
o Corridors
o New technologies meeting
older codes
o Existing infrastructure
limitations
Potential solutions
o Involve CRS early
o Define project goals
o Identify code deficiencies
o Describe any alternate
methods to meet intent of
code
Model of Care Trends
Project goals
o More outpatient
surgeries
o More outpatient
hospital based services
o More affiliations and
mergers
o Hospital inside another
hospital
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Challenges identified
o Life Safety Compliance
o Clearly defined procedural
level of services
o Levels of anesthesia
o Infection control
o Existing infrastructure
limitations
o Certificate of Need
Potential solutions
o Involve CRS early
o Define project goals
o Identify code deficiencies
o Describe any alternate
methods to meet intent of
code
o Contact CON early
Infrastructure Upgrades
Project goals
o New patient care
equipment and
technology
o IT upgrades
o Generator upgrades
o Electronic Medical
Record
o Nurse Call Systems o Wireless
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Challenges identified
o Life Safety Compliance
o Infection control
o Existing infrastructure
limitations
o Existing MEP limitations
o Structural impacts
Potential solutions
o Involve CRS early
o Define project goals
o Identify code deficiencies
o Describe any alternate
methods to meet intent of
code
Part 3
Typical Inspection Deficiencies
DOH Process for Hospital Survey Inspections
Top 5 – 10 things hospitals can do better
Tips for better compliance with CMS & JC
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Survey Inspection Deficiencies
Environment of Care - Plumbing cross
connection controls (B1965)
Lack of appropriate air gap or BFP
– Hand-held shower wands
– Chemical dispensers at utility sinks
– Lab equipment
– Ice Machines
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Survey Inspection Deficiencies
Environment of Care - Ventilation and Air
Pressure (B-1975)
Failure to provide appropriate air pressure
relationships
Failure to provide adequate ventilation ACH
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Survey Inspection Deficiencies
Environment of Care - Electrical Wiring & Equipment
Misuse of extension cords
Daisy chains or piggy-backed power cords
Obstructed electrical panels
Mislabeled/ unlabeled electrical circuit boxes
Outlets that are not GFCI (where required)
Portable space heaters
Open junction boxes
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Survey Inspection Deficiencies
Environment of Care - Corridor Doors
Doors that do not close and/or latch
Doors propped open (door wedges/stops) that are
required to be closed to maintain air pressure
Penetrations in doors that compromise smoke
resistance
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Survey Inspection Deficiencies
Life Safety – Fire Sprinkler System
Overdue tests/ inspections
Missing escutcheon plates/rings
Painted sprinkler heads
Obstructed sprinkler heads
Areas with no sprinkler protection
Damaged or otherwise compromised sprinkler heads
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Survey Inspection Deficiencies
Life Safety – Fire Extinguishers
Failure to maintain fire extinguishers (re-fill)
No documentation that portable fire extinguishers have
been inspected monthly for the past 12 months.
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Survey Inspection Deficiencies
Life Safety – Hazardous Areas
Lack of one-hour fire-rated construction where required
Improper fire rating on doors
Missing door closures at rated doors
Plates on doors that are:
– Nonrated or field applied
– Exceed 48 inches AFF
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Survey Inspection Deficiencies
Life Safety – Hazardous Areas
Soiled linen or trash collection receptacles larger
than 32 gallon where located outside a one-hour
rated enclosure.
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Common CRS Site
Observations
Avoid These Conditions
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Avoid this condition
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Missing
monolithic floor
cove to panels
and casework;
not just the
walls
Avoid this condition
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Missing
monolithic floor
cove to panels
and casework;
not just the
walls
Do this condition
Monolithic floor
cove to panels
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Avoid this condition
Gaps
Between top
of casework
and ceiling at
sterile areas
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Avoid this condition
Locating ABS
within 6” of
ignition source.
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Avoid this condition
Cluttered Corridors
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Avoid this condition
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Visual Distractions
Part 4
Questions???
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Thanks for having us.
Steve Pennington – steve.pennington@doh.wa.gov
Susan Upton – susan.upton@doh.wa.gov
Construction Review Services (CRS)
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