CHFM Certified Health Care Facility Manager (CHFM) Questions and Answers

The Centers for Disease Control and Prevention (CDC) published the document “Guidelines for Preventing the Transmission of Mycobacterium Tuberculosis in Healthcare Facilities”. These guidelines provide infection control practices for healthcare facilities, including engineering controls, ventilation requirements, and personal protective equipment (PPE) to minimize the risk of TB transmission.

Correct: CDC (B) – Responsible for publishing this guideline.

Incorrect:

A. FDA – Regulates drugs and medical devices.

C. EPA – Oversees environmental protection and pollutants, not healthcare infection prevention.

D. OSHA – Issues workplace safety standards, but this TB guideline is from CDC.

To stay within the $5,000,000 annual budget, the facilities department must reduce monthly spending to $337,500 for the remaining 8 months.

Acceptable indoor CO₂ concentrations in healthcare facilities are generally expected to remain below 1,000 ppm, as recommended by ASHRAE Standard 62.1 (Ventilation for Acceptable Indoor Air Quality). A reading of 1,500 ppm typically signals inadequate ventilation and insufficient outside air being introduced into the space. This is a direct indicator of poor dilution of indoor contaminants.

Correct: Lack of outside air (C) – High CO₂ concentrations are directly linked to reduced outside air supply.

Incorrect:

A. Within design – Not correct, since 1,500 ppm exceeds design thresholds.

B. Vehicular exhaust – Would raise CO and NOx levels, not primarily CO₂.

D. Humidity/dewpoint – Unrelated to CO₂ measurement.

Cost reduction without reducing service scope can be achieved by:

Implementing an in-house first response program (1): Staff address minor issues before calling the vendor, reducing service calls.

Extending the contract length (4): Vendors often offer reduced rates for long-term contracts.

Increasing house calls (2): Increases cost, not savings.

Financing the contract (3): Impacts payment terms, not cost reduction.

EPA and OSHA define regulated medical waste (RMW) as waste that is saturated or dripping with blood or other potentially infectious materials (OPIM).

B. Blood-saturated gauze (Correct): Meets the definition of RMW.

A. Fluorescent bulbs: Considered hazardous universal waste (mercury), not RMW.

C. Urine-soaked pads: Not classified as RMW unless visibly contaminated with blood.

D. Home-use sharps: Not regulated by EPA as medical waste from households.

Comprehensive and Detailed Explanation From Exact Extract:

Per NFPA 101: Life Safety Code, the maximum allowable capacity for soiled linen or trash receptacles located outside of hazardous storage rooms (such as within patient rooms or nurse stations) is 32 gallons (121 liters). If containers are larger than this, they must be stored in a room meeting hazardous area protection requirements.

Correct Answer (C. 32 gal.): Matches NFPA 101, 18/19.7.5.5.7 (Health Care Occupancies), which restricts container size to 32 gallons maximum unless in a protected hazardous storage room.

Incorrect Options:

A. 8 gal. and B. 16 gal. – These are not the standard NFPA thresholds.

D. 64 gal. – Exceeds NFPA’s maximum; would require special hazardous storage protections.

Relevance to CHFM: This falls under the Compliance domain, as CHFM professionals must ensure healthcare facilities follow NFPA 101 and Joint Commission standards regarding fire and life safety.

Predictive maintenance involves techniques that monitor the condition of equipment to anticipate failure before it occurs. Common predictive techniques include:

Vibration monitoring (1) – Detects imbalance, misalignment, or bearing wear.

Oil analysis (2) – Identifies contamination, wear particles, or breakdown in lubricants.

Ultrasound (4) – Detects leaks, arcing, and mechanical friction.

PM frequency analysis (3) is part of preventive maintenance, not predictive maintenance.

Construction projects in healthcare facilities must have secured funding before starting. While approvals, staffing, and security considerations are important, the project cannot begin without the capital budget authorization. This aligns with AIA project delivery requirements and AHA/ASHE guidance for healthcare construction projects.

Leadership requires a business case to justify capital expenditures. The Return on Investment (ROI) demonstrates cost savings, efficiency, and risk reduction benefits of replacing the boiler, making it the most critical piece of information. Size, maintenance cost, or timeline support the request, but ROI is decisive for approval.

Prior to occupancy of newly constructed healthcare space, the local fire department (or fire marshal) must perform a survey/inspection to ensure compliance with life safety requirements, fire alarm functionality, sprinkler coverage, and egress standards. This is part of code compliance and occupancy approval.

Comprehensive and Detailed Explanation From Exact Extract:

Symptoms such as nausea, dizziness, headaches, and drowsiness are commonly associated with poor indoor air quality (IAQ). The most likely cause in this case is insufficient outside air ventilation, which allows buildup of carbon dioxide and other indoor contaminants.

Correct Answer (C. insufficient outside air): According to ASHRAE Standard 62.1 (Ventilation for Acceptable Indoor Air Quality) and referenced in NFPA 99 Health Care Facilities Code, inadequate outside air results in occupant discomfort and health complaints known as “sick building syndrome.”

Incorrect Options:

A. mercury spill: Causes more acute, localized toxic exposure symptoms; less likely across an entire wing unless a large spill occurred (and it would be unusual in general occupancy areas).

B. humidity levels: Low or high humidity can cause discomfort, but not typically dizziness or drowsiness.

D. medical gas leak: Could cause similar symptoms depending on the gas, but would typically trigger alarms and affect specific zones tied to gas lines, not general wing-wide complaints.

Relevance to CHFM:

This question relates to the Compliance and Maintenance & Operations domains. CHFM professionals must ensure compliance with ventilation codes (ASHRAE 62.1, NFPA 99, Joint Commission EC standards) and manage HVAC systems to maintain proper indoor air quality, protecting patient and staff health.

A Hazard Vulnerability Analysis (HVA) evaluates probability/likelihood of events, impact/consequences on operations and safety, and surge/demand effects on services to prioritize preparedness and mitigation. While cost considerations inform later planning, the core HVA scoring focuses on likelihood, consequences, and demand effects.

NFPA 101 (Life Safety Code) requires that on-call sleep rooms provided in healthcare facilities must be protected by single-station smoke alarms or an automatic smoke detection system. This requirement ensures early warning for occupants who may be sleeping and unable to respond as quickly in an emergency.

B: Rated doors may be required in certain hazardous areas but are not the mandated feature for on-call sleep rooms.

C: Emergency call buttons are part of patient care areas, not sleep rooms.

D: Bathrooms are not required by Life Safety Code in on-call rooms.

The RCRA (1976) governs the proper management of hazardous waste from generation to disposal (“cradle to grave”). While healthcare organizations often think of sharps or medical waste, RCRA is broader, addressing hazardous chemicals, solvents, and pharmaceuticals. Medical waste is regulated under other federal and state rules.

The simple payback period is calculated by dividing the initial investment cost by the annual operating savings (reduction in operating cost). It does not consider time value of money, inflation, or full life-cycle costs.

A (Correct): Annual operating cost directly determines the annual savings, which is essential for payback calculation.

B: Inflation is considered in more advanced financial models (e.g., NPV, IRR), not simple payback.

C: Replacement cost is relevant for life-cycle cost analysis, not simple payback.

D: Life of the equipment may determine feasibility but is not part of the basic payback formula.

Fuel requirements for emergency systems are determined by calculating total consumption per hour multiplied by the required operating duration.

Generator: 25 gallons/hour

Boiler: 35 gallons/hour

Total consumption per hour = 25 + 35 = 60 gallons/hour

For 72 hours: 60 × 72 = 4,320 gallons

Therefore, the fuel tank must have at least 4,320 gallons capacity to meet the 72-hour requirement.

Correct Answer (D. 4,320 gallons).

Other options are underestimations of total combined consumption and would not meet compliance with CMS and NFPA 110 standards, which require hospitals to maintain a 72-hour supply of fuel for emergency power and critical operations.

When Alternate B is chosen, total price = Base Bid + price for Alternate B (or zero if “Included”).

A: Not available → cannot be selected.

B: $20,000 + Included ($0) = $20,000.

C: $19,000 + $500 = $19,500.

D: $19,000 + $1,000 = $20,000.

Lowest total = $19,500 (Company C).

Federal and accreditor requirements establish two emergency exercises per year for hospitals: one full-scale community-based (or facility-based if community-based is not available) and a second exercise (which may be a second full-scale or an exercise such as a tabletop). Real events may be used to meet one of the required exercises when criteria are met.

The operations and maintenance (OandM) operating budget includes recurring expenses needed to run the facility: labor, staff training, utilities, and equipment/vehicle repairs. Capital improvements such as major building upgrades are typically not part of the operating budget; they belong in the capital budget.

Correct: Training (1), Utilities (3), and Vehicle repairs (4) are OandM operating costs.

Incorrect: Building improvements (2) are capital budget items.

Step 1: Calculate utility cost per square foot.

$1,200,000 ÷ 500,000 sq. ft. = $2.40 per sq. ft.

Step 2: Calculate new total square footage.

500,000 + 100,000 = 600,000 sq. ft.

Step 3: Projected utility cost.

600,000 × $2.40 = $1,440,000

Thus, the anticipated utility budget after expansion is $1,440,000.

The outsourcing scenario matches the current in-house budget exactly; therefore, no savings are achieved. This type of financial analysis is common in the CHFM Financial Management domain.

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The CHFM exam Financial Management domain requires knowledge of cost savings and revenue generation calculations from operational changes such as recycling initiatives. In this example, gross revenue is calculated by summing the total recycling income streams (cardboard and aluminum).

Correct Answer (C. $7,200): Derived from combining $6,000 (cardboard) and $1,200 (aluminum) revenue.

Other options are incorrect because:

A ($6,000): Considers cardboard only.

B ($6,600): Misapplies aluminum tonnage conversion.

D ($18,000): Exaggerates revenue beyond calculated amounts.

Comprehensive and Detailed Explanation From Exact Extract:

MRI (Magnetic Resonance Imaging) scanners do not use ionizing radiation; instead, they use powerful magnetic fields and radiofrequency energy. The primary safety hazard is the projectile effect (missile effect), where ferromagnetic objects are pulled violently into the scanner bore. This is one of the most well-documented risks in MRI safety and is a leading cause of MRI accidents.

Correct Answer (D. missile projection): Strong magnetic fields can accelerate ferromagnetic objects, causing serious patient/staff injury or equipment damage.

Incorrect Options:

A. visual impairment: Not a recognized risk from MRI scanning itself.

B. radiation overexposure: MRI does not use ionizing radiation, unlike CT or X-ray.

C. permanent hearing loss: While MRI noise can be damaging without ear protection, the most likely injury of those listed is projectile accidents.

Relevance to CHFM: This falls under Compliance and Safety domains. Facility managers must ensure MRI safety zones, access control, ferromagnetic detection systems, and staff training to prevent accidents.

The Joint Commission (TJC) aligns with NFPA 101: Life Safety Code. For business occupancies (such as outpatient clinics), the requirement is that fire drills be conducted annually (every 12 months).

Quarterly (every 3 months) drills are required for healthcare occupancies (hospitals, nursing care).

Outpatient business occupancies are less stringent.

NFPA 80 (Standard for Fire Doors and Other Opening Protectives) and NFPA 101 (Life Safety Code) both require that fire doors in a means of egress must be self-closing and equipped with a positive-latching device. This ensures that the door will automatically return to the closed position and latch securely to prevent fire and smoke from spreading through the egress path.

A: Doors can be held open magnetically only when connected to the fire alarm system, but the essential code requirement is positive latching.

B: Materials and vision panels are not universal requirements.

D: Smoke-tight doors are required in smoke barriers, not all egress fire doors.

Per NFPA 13: Standard for the Installation of Sprinkler Systems, 18 inches of clearance must be maintained below sprinkler deflectors to ensure proper spray pattern and fire suppression coverage.

C. 18 (Correct).

Less than 18 inches (12 or 15) is insufficient clearance.

More than 18 (24 inches) exceeds the standard, not required.

In the schematic design phase, the design team establishes overall building configuration, circulation, and code-driven life safety concepts, including means of egress. Life Safety Code requirements (occupant loads, exit access, number and arrangement of exits, travel distances) are fundamental constraints that shape the plan early; they must be set before moving into design development where specific fixtures and detailed equipment specifications are finalized. Contract “general conditions” are part of procurement/contract documents later, not schematic design.

The Utilities Management standard under The Joint Commission’s Environment of Care requires healthcare organizations to manage utility systems—including water supply systems—to reduce the risk of healthcare-associated infections caused by waterborne pathogens such as Legionella. This includes monitoring, maintenance, and water management programs.

B: Safety Management deals with physical and occupational safety.

C: Medical Equipment Management relates to device safety and maintenance.

D: Hazardous Materials and Waste Management applies to chemical and biological waste handling, not waterborne pathogens.

According to NFPA 72: National Fire Alarm and Signaling Code, the following frequencies apply:

Waterflow devices (D): Must be tested quarterly.

Supervisory signal devices: Semiannual testing.

Duct detectors and door holders: Tested annually.

Thus, only water flow devices require quarterly testing.