1. The Physical Environment Tracers How Should I Prepare for the Physical Environment Tracers? Healthcare Engineering Consultants  Will limit

2. Likely Physical Environment “Tracer” Areas Healthcare Engineering Consultants 1. Operating Room 2. Endoscopy 3. Obstetrics 4. Behavioral Health 5. Special Care Unit 6. Medical/ Surgical Unit 7. Dialysis 8. MRI Area 9. Wound Care (Hyperbaric Chamber) 10. Emergency Department

3. Operating Room Healthcare Engineering Consultants Likely Questions: 1.What type of portable extinguishers are in use? Why was this type selected? 2.Have you had a fire drill in this area during the past year? 3.Have you had a training program for “heat producing devices”? 4.Do you have isolated power? What do you do if the “LIM” alarms? 5.Where is the oxygen shut-off valve for this room? Who should shut it off in an emergency? 6.What should the air pressure relationship be for the operating rooms? 7.Who is the laser safety officer? 8.How are you measuring temperature and humidity?

4. Endoscopy Healthcare Engineering Consultants Likely Questions: 1.How are you measuring temperature and humidity in this area? 2.What is the pressure relationship between the procedure rooms and the outside corridor? 3.Where do you perform bronchoscopies? What is the pressure relationship to the corridor in that room? 4.How do you minimize cross-contamination during the re- sterilization of the endoscopes? 5.Who maintains the endoscope inventory? 6.Where are the endoscopes stored? How are they kept “clean”? 7.How is ventilation assured in the storage cabinet? 8.Is any glutaraldehyde used for cleaning in this area?

5. Obstetrics Healthcare Engineering Consultants Likely Questions: 1. Do you have infant abduction policies and procedures for this area? Explain. 2. What special precautions have you implemented? 3. Do you conduct infant and/ or child abduction drills in this area? What have you learned from the drills? 4. What is your procedure if you determine that an infant may have been abducted? 5. Has any special equipment been installed to prevent infant abductions? 6. Does activation of the fire alarm system release the locked doors?

6. Behavioral Health Healthcare Engineering Consultants Likely Questions: 1. Has an environmental risk assessment been performed and documented related to the safety of patients and staff in this area? 2. What physical changes or special precautions have you implemented as a result of the risk assessment? 3. Have you had any patient sentinel events or “close calls” in this area? 4. What is your method to contact help in an emergency? 5. Are “means of force” permitted in this unit? Are restraints used? 6. Has the staff had “assaultive behavior” training for disruptive patients?

7. Special Care Unit Healthcare Engineering Consultants Likely Questions: 1. How do you know if the equipment in this area has been tested and when is it due to be tested again? How often should you check the equipment? 2. Do you have written clinical intervention failure procedures for life support equipment? 3. Which devices have battery “back-up” and how long will they last in an emergency? 5. Can you hear all of the critical clinical alarms in this area? 6. If you have a patient that requires respiratory isolation, how do you set up the room and ensure it is operating properly? 7. How do you separate FULL and EMPTY oxygen cylinders? 8. Where is the oxygen shut-off valve located?

8. Medical/ Surgical Unit Healthcare Engineering Consultants Likely Questions: 1.Where are your Safety Data Sheets? When did you last have SDS training? 2.How do you dispose of hazardous pharmaceutical waste? 3.Where are your emergency response procedures? Can you explain the emergency codes? 4.How do you set up the isolation room for a respiratory isolation patient? 5.Where do you store the oxygen cylinders and how do you separate the FULL and EMPTY cylinders? 6.Where is the oxygen shut-off valve for this area and who is responsible to turn it off in an emergency?

9. Dialysis Healthcare Engineering Consultants Likely Questions: 1.Is there an eyewash station located in this unit? Who documents the weekly flush test? 2.Are the dialysis machines plugged into GFCI outlets? What do you do if they “trip”? 3.What is your procedure in the event of a fire in this area? 4.What do you do if the normal power goes out? What if the emergency power does not come on? 5.Where is a patient who requires respiratory isolation dialyzed? 6.If there is a tornado warning for this area, do you move the patients? Where?

10. MRI Area Healthcare Engineering Consultants Likely Questions: 1.Explain each of the four zones for this department 2.Do you have a “quench” policy? Under what conditions would you “quench” the magnet? 3.How do you determine whether patients have ferrous metal before their procedure? 4.Has the local fire department had training to understand the hazards in the magnet room? 5.Do you have “MRI safe” portable fire extinguishers? 6.Who is permitted to clean the magnet room? 7.Have you performed a fire drill in this area during the last year? Do you have a MRI-specific fire plan?

11. Wound Care (Hyperbaric Chamber) Healthcare Engineering Consultants Likely Questions: 1.Do you have a special fire plan for this area? 2.Have you conducted a fire drill in this area during the past year? 3.During an emergency, how quickly can you de- pressurize the chamber with patients inside? 4.Where is the oxygen shut-off valve? Who is authorized to shut it off in an emergency? 5.What is your procedure if the low oxygen pressure alarm sounds? 6.Has the local fire department visited your department for special training?

12. Emergency Department Healthcare Engineering Consultants Likely Questions: 1. Is this area considered a “suite”? 2. Have you performed and documented a risk assessment for behavioral health patients? 3. What actions do you take if a contaminated patient self-presents to the emergency room? 4. Do you have dedicated decontamination facilities? Can you show them to me? 5. How do you separate the FULL and EMPTY oxygen cylinders? Where are they stored? Where do you store the “PARTIALS”? 6. How do you assure patient privacy when it is necessary to have patients in the corridor?

13. Other Possible Tracer Topics Healthcare Engineering Consultants ● Staff role in surveillance rounds ● Last “EC” training received ● Training related to security-sensitive areas ● Response to an “active shooter” ● Safety practices for hazardous energy ● Disaster drill or actual event participation ● Fire drill procedures and participation ● Procedures to maintain clear egress hallways ● Smoke and fire compartmentation for evacuation ● Other topics?

14. The Physical Environment Tracers Questions? Healthcare Engineering Consultants