The role of the IHS Environmental Health Officer in Healthcare Facility Plan Review CDR Ricardo Murga, CSP, RS, MPH Institutional Environmental Health Officer Phoenix Area IHS

Objectives  Describe the role of the EHO in plan review in the Indian Health Service.  Recognize the codes and types of issues relevant to plan review in the design of new healthcare facilities.  Describe a plan review tool for the design of new healthcare facilities.

IHS Environmental Health Services

Tribal Construction Projects

Assistance to tribes  Consultant/subject matter expert  Plan review validate compliance with the rules and regulations  Comments are “recommendations.”  Findings should validate design by RA/PE. San Carlos Hospital

Healthcare Construction  Facilities built by IHS or tribes  Institutional Environmental Health Officers (IEHO)  Healthcare accreditation  Industrial Hygiene (ventilation)  Radiation Safety  Life Safety Code  Others

Relevance of Plan Review

 Poor design in healthcare may result in:  Negative outcome to patients  Jeopardize safe evacuation  Lost accreditation Parker Indian Health Center

Areas of Plan Review in Healthcare  Life Safety Code Compliance  Industrial Hygiene  Safety Management/OSHA  Infection Control  Security  Environmental Compliance  Public Health Preparedness/Emergency Management  Ergonomics  Environmental Management (Systems)  Accreditation requirements  Radiation Protection  Common sense

NFPA Applicable Codes and Standards  NFPA 10 - Standard for Portable Fire Extinguishers  NFPA 13 - Standard for the Installation of Sprinkler Systems  NFPA 20 - Standard for the Installation of Stationary Pumps for Fire Protection  NFPA 30 - Flammable and Combustible Liquids Code  NFPA 70 - National Electrical Code  NFPA 72 - National Fire Alarm and Signaling Code  NFPA 80 - Standard for Fire Doors and Other Opening Protectives  NFPA 82 - Standard on Incinerators and Waste and Linen Handling Systems and Equipment  NFPA 90A - Standard for the Installation of Air-Conditioning and Ventilating Systems  NFPA 96 - Standard for Ventilation Control and Fire Protection of Commercial Cooking Operations  NFPA 99 - Standard for Health Care Facilities (medical gases)  NFPA Life Safety Code  NFPA Guide for Premises Security

Other Applicable Codes, Standards, and Guidelines  FGI  TJC/AAAHC  CDC  FDA  ASHRAE  OSHA  IHS  USP  NCRP….and others

Applicable Codes  The number of codes and guidelines is extensive  Their interpretation can be challenging.  Can you be an expert in all areas?

Plan Review - Prevention Through Design  Addressing occupational safety and health needs in the design process to prevent or minimize the work-related hazards and risks associated with the construction, manufacture, use, maintenance, and disposal of facilities, materials, and equipment.

Plan Review Process  Consider the practical aspects of the design.  What if they have to replace the boilers? Will they have to cut a whole in the roof or wall ?

The Process – Before and During Construction  Get the plans in a timely and ongoing manner (Schematic, Design Development, 35%, 65%, 100%)  Ideally – make site visits throughout the construction process

The Review Process  Plans are divided into sections  A=Architectural (Code Plan~ Life Safety)  F=Fire Protection (sprinkler system)  M=Mechanical (ventilation)  E=Electrical  C=Civil  P=Plumbing  G=General

The Review Process  What is the occupancy (LSC)  Occupancy will determine requirements for : rated walls, ventilation, sprinkler system, etc  Scale  Symbols Legend

The Review Process  Checklist to facilitate review

Common Path of Travel EXIT ≤ 50 ft ≤ 200 ft EXIT

Exit Access Corridors

Door Leaf Swing

Isolation Room

Kitchen/Cafeteria 60% 40% Volume of storage per meal = 1Cu. Ft.

The Process - After Construction  Punch list  Latent defects  Design errors Hopi Health Care Center Washoe Tribal Health Center

Conclusion  The role of the EHO in plan review in the Indian Health Service is critical – subject matter expert on LSC and other safety and IC related codes.  Identifying code incompliance early in the process can save lives and potentially lots of money to the tribes/IHS.  Developing aid tools such as checklist ensures that the most critical/expensive design elements are not overlooked.

26 Questions?