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Healthcare, Construction and Regulations

May 3, 2017

Chad E. Beebe

Deputy Executive DirectorAmerican Society for Healthcare

Engineering

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Get to know ASHE

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The American Hospital Association

Founded in 1898

Represents and serves all types of hospitals, health care networks, and their patients and communities

Of the 5,564 hospitals in the U.S nearly 5,000 are AHA members.

8 Personal Membership groups – 43,000 members

The American Society for Healthcare Engineering

Mission: Dedicated to optimizing the health care physical environment

With 12,000+ members, ASHE is the largest personal membership group of the American Hospital Association (AHA).

ashe.org

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ASHE’s diverse membership includes:

• Health care facility professionals

• Architects

• Engineers

• Contractors

• Construction professionals

• Installers

• Infection preventionists

• Plant managers

• Safety and security professionals

• Support service personnel

ASHE Education Programs

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ASHE Education Programs

Education tailored for various ASHE audiences:

• Facility managers

• Engineering professionals

• Architects and planners

• Project mangers

• Contractors

• Compliance managers

• And more

LEARNENGAGELEAD

On Demand Library

• Streaming video library of past webinars and conference recordings

• All content vetted by ASHE to be accurate and up to date

ashe.org/ondemand

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Certified Healthcare Constructor (CHC)

Affirms that you understand all aspects of health care facility management including:

• Infection Control Risk Assessments• Health care industry fundamentals• Planning, design and construction process• Health care facility safety• Financial stewardship

CHC exam resources from ASHE

How can ASHE help you prepare for the CHC exam?

• Certified Healthcare Constructor (CHC) Exam Review Course

• Health Care Construction (HCC) Certificate Workshop

• Reading lists (ashe.org/chcprep)• Related webinars and On Demand

recordings• Discounted self-assessment exam

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Hospital ConstructionA unique environment

Why is hospital construction different?

• 24 hour operation

• Immunosuppressed patients

• Privacy concerns

• Heavily regulated

• Routinely inspected

• Many regulations

• Limited Resources

• Defend in place

• Fire watch

• Restricted access

• Hazardous Mat.

• …

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Infection Control Risk Assessment

What is an ICRA?It’s a Plan to identify and assess…• Impact of disrupting essential services • Hazards and protection levels for each.• Location of immunosuppressed patients• Impact of potential outages• Protection plans for patients, movement of debris, traffic flow,

cleanup, and testing and certification.• External as well as internal construction activities.• Location of known hazards.

Why ICRA is important

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Healthcare Regulationsa history of healthcare and the physical

environment

Events that changed health care | 1903

Dr. Couney discovers the use of incubators for

use with premature babies

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Events that changed health care | 1928

Fleming discovers medical usefor penicillin

People are admitted to hospitals to live

Events that changed health care | 1950’s

Incubators move from side show at Coney island to

hospital

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Events that changed health care | 1960

Events that changed health care | 1940s

• Pre WWII – “nursing type care” long hospital stays

• Industrial Might• Lots of jobs• Wage Control• Benefits added

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Events that changed health care | 1945

• Hill-Burton Act

• The need to develop Americas Infrastructure

Events that changed health care | 1960s

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Events that changed health care | 1970’s

• Flammable anesthetics are replaced with safer non flammable options

Events that changed health care | 1980s

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Events that changed health care | 2010’s

Events that changed health care | 2010’s

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Construction Can’t Keep Up

• Design standards lag by minimum of 5 years

• Constructed Facilities don’t get upgraded for 30+ years

• Capacity to accept influx of new patients is limited

• Limited resources prevent timely responses

• While changes in healthcare delivery impact hospitals, so do changes in the construction requirements…..

Events that changed Construction | 1980

• MGM Grand Fire

• Sprinklers

• Alarms

• Shaft Pressurization

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Events that changed Construction | 1990s

Smoking is prohibited within hospitals

• Fires in hospitals drop dramatically

Events that changed Construction | 1994

Northridge Earthquake

• Seismic Standards

• Importance Factors

• Zone Reclassification

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Events that changed Construction | 2001

Houston Floods

• Emergency Power

• Access to and from site

Events that changed Construction | 2003

Northeast Blackout

• Extended Fuel Supply

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Events that changed Construction | 2005

Hurricane Katrina

• Extended Outage

• Family Care

• Aide Agreements

• Temperature Control

Events that changed Construction | 2011

Mercy Hospital hit by F5 Tornado

• Stairwell Construction

• Glazing

• Generator Placement

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Events that changed Construction | 2012

Hurricane Sandy

• Evacuation Plans

• Emergency Electrical System

• Media

Use of Current Codes

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Who regulates hospitals?

Codes and Standards

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NFPA 101

IBC

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IFC

How the codes work in health care

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Major Regulators

State Licensing Agency

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Building Department

CMS

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Accreditation

Conditions of Participation

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Provider Types

PART 403—SPECIAL PROGRAMS AND PROJECTS

PART 416—AMBULATORY SURGICAL SERVICES

PART 418—HOSPICE CARE

PART 460—PROGRAMS OF ALL INCLUSIVE CARE FOR THE ELDERLY (PACE)

PART 482—CONDITIONS OF PARTICIPATION FOR HOSPITALS

PART 483—REQUIREMENTS FOR STATES AND LONG TERM CARE FACILITIES

PART 485—CONDITIONS OF PARTICIPATION: SPECIALIZED PROVIDERS