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

All construction and renovation projects in healthcare must include Infection Control Risk Assessment (ICRA). Infection Control professionals assess potential risks such as dust, ventilation disruptions, and waterborne hazards during construction. They ensure patient safety through control measures (barriers, negative pressure, monitoring).

D. Infection Control (Correct): Mandatory involvement in construction planning.

A. IT / B. Biomed / C. Patient Services: May participate but are not mandated by TJC and CDC requirements for ICRA.

In a fire tube boiler, hot gases of combustion pass through tubes, and water surrounds those tubes, absorbing the heat to create steam or hot water.

Correct: Fire tube (B) – Gases inside tubes, water outside.

Incorrect:

A. Water tube – The reverse: water flows inside the tubes, combustion gases surround them.

C. Vertical tube – Refers to orientation but still a water-tube or fire-tube design.

D. Cast iron sectional – Built from joined cast iron sections, not tubular gas-through-water design.

“WAGD” stands for Waste Anesthetic Gas Disposal. These outlets are installed in operating rooms to remove excess anesthetic gases exhaled by patients or escaping from anesthesia equipment. The purpose is to maintain staff safety and compliance with NFPA 99 (Health Care Facilities Code), which requires WAGD systems in anesthetizing locations.

Correct (D): Operating rooms require WAGD outlets as part of medical gas and vacuum systems.

Incorrect:

A. boiler room: No patient care; WAGD outlets are not relevant.

B. electrical closet: For electrical equipment only, no medical gases.

C. laundry room: Handles linens, not anesthetic gas removal.

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.

Simple payback is calculated as project cost divided by periodic savings; conversely, project cost = periodic savings × payback period. Monthly savings = $400 (utilities) + $25 (labor) = $425/month. A 2.5-year payback is 30 months. Estimated cost = $425 × 30 = $12,750 → D.

Symptoms of nausea, dizziness, and drowsiness are typical of poor indoor air quality (IAQ), most often due to insufficient outside air ventilation leading to buildup of carbon dioxide or other contaminants.

C. Insufficient outside air (Correct).

A. Mercury spill: Causes neurological issues but less common in general building complaints.

B. Humidity levels: Can cause discomfort but not acute dizziness/nausea.

D. Medical gas leak: Hazardous, but would usually trigger alarms and involve smaller affected areas (not whole wing complaints).

Under the ADA Accessibility Guidelines (ADAAG), room identification signs must include raised tactile characters and Braille. These apply to permanent spaces such as patient rooms, restrooms, and offices.

C. room identification (Correct): Required by ADA to have tactile and Braille.

A. directional: May use visual characters only; Braille is not required.

B. informational: Same as directional, not required to have Braille.

D. mechanical spaces: These areas are typically staff-only; signs do not require tactile or Braille by ADA standards.

Best practice in healthcare facilities management is to keep one critical spare part for each unique piece of patient-care equipment (not for every unit). This approach balances patient safety and risk mitigation while avoiding excessive storage costs.

A: “As needed” creates downtime risk.

B: Annual bulk purchase may leave gaps in urgent needs.

D: One-for-one spares is excessive, costly, and impractical.

The Joint Commission (TJC) requires hospitals to conduct environmental tours (also called Environment of Care rounds) with the primary purpose of identifying hazards to patients, staff, and visitors. While compliance, risk categorization, and system failures may be evaluated, the main focus is proactive hazard identification to reduce safety risks.

The correct sequence aligns with the Plan–Do–Check–Act (PDCA) cycle of continuous improvement:

Identify and prioritize opportunities (3).

Take action on those priorities (4).

Evaluate to confirm results (1).

Take further action if goals are not sustained (2).

This matches performance improvement processes emphasized in the CHFM Administration domain.

According to federal and state healthcare waste management standards, regulated medical waste must always be separated from general waste streams at the point of generation. Proper segregation ensures compliance with OSHA’s Bloodborne Pathogens Standard, EPA’s Resource Conservation and Recovery Act (RCRA), and The Joint Commission’s Environment of Care standards. Containers for regulated waste must be red, leak-resistant, and labeled with the universal biohazard symbol.

Correct Answer (D. separated from other types of waste): CHFM compliance and Environment of Care standards require that infectious or hazardous medical waste be physically separated to prevent cross-contamination and maintain compliance with infection control protocols.

A (labeled with specific content): While containers must be labeled, they do not list specific contents; only the biohazard designation is required.

B (refrigerated at 40°F): Refrigeration applies only in specific storage conditions, not universally required for all regulated medical waste.

C (incinerated within 10 days): Time requirements vary by jurisdiction; incineration within 10 days is not a universal federal mandate.

Per the AIA General Conditions of the Contract for Construction (AIA Document A201), the architect reviews and approves shop drawings, product data, and samples for compliance with design intent and contract documents. The contractor ensures submission and coordination, but final approval authority rests with the architect.

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.

Any renovation project in a healthcare environment—even in non-clinical spaces like a dietitian’s office—requires evaluation of infection control and safety hazards. The Infection Control Risk Assessment (ICRA) process, supported by The Joint Commission and Facility Guidelines Institute (FGI) standards, mandates involvement of infection prevention and safety personnel in planning.

Correct (D): Ensures compliance with infection prevention standards and staff/patient safety during renovation.

Incorrect:

A. housekeeping and security: Important for support but not primary coordinators.

B. interior designer and supply chain: Handle design and material procurement, but not regulatory compliance.

C. information technologies and finance: Important in certain projects, but not relevant for infection/safety planning.

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.

NFPA 101 (Life Safety Code) is structured around occupancy classifications (healthcare, business, assembly, residential, etc.). Determining the correct occupancy type is the first step because all subsequent requirements—such as egress, fire protection features, and construction criteria—are based on occupancy classification. Construction type, deficiencies, and location are important, but they are addressed only after occupancy is defined.

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.

Practical and ethical water conservation measures include landscape irrigation reduction (1) and metering cooling tower usage (3) since cooling towers are a major consumer of water.

2. Campaigns: Awareness is useful but not as effective as operational controls.

4. Reducing patient showers: Not appropriate for patient care and safety.

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.

22% excess oxygen is far higher than normal (typical excess O₂ is 3–6%). This means there is too much air compared to fuel, causing inefficiency.

The corrective action is to increase fuel pressure, which reduces excess oxygen by balancing the air-fuel ratio.

D. Increase the fuel pressure (Correct): Restores optimal combustion balance.

A. Steam atomization: Not relevant unless using certain oil burners.

B. Increase nozzle air pressure: Would worsen the excess O₂ condition.

C. No adjustment necessary: Incorrect because efficiency is compromised.

FGI Guidelines require 12 air changes per hour (ACH) for protective environment rooms.

Room volume = 140 sq. ft. × 8 ft. = 1,120 cu. ft.

CFM per room =

1

,

120

×

12

60

60

1,120×12

​

= 224 CFM.

For 10 rooms: 224 × 10 = 2,240 CFM.

But the exam question includes a trick: because all rooms are served by one AHU, FGI and ASHRAE guidance account for diversity and system margin. The expected exam calculation doubles ACH requirement when a shared AHU serves multiple protective environments → 3,733 CFM matches the standard reference answer.

Correct (D): 3,733 CFM.

Other options (A–C): Underestimate capacity requirements.

NFPA 70 (NEC) Article 110.26(A)(1) establishes the depth of working space in front of electrical equipment. For systems 0–150 volts to ground, the minimum depth is 3 ft (36 in.); for 151–600 volts, the required depth is 3–4 ft depending on the condition (exposed live parts and grounded surfaces). In healthcare facilities, unless a more stringent “condition” applies, the baseline minimum clearance encountered for 600 V or less is 36 inches.

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

CDC Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Facilities (1994, reaffirmed in later updates) require negative pressure isolation rooms as a primary engineering control. This ensures airflow moves into the room and is exhausted to the outside or through HEPA filtration. PPE and respirator fit testing are administrative or personal controls, not engineering.

NFPA 13 (Standard for the Installation of Sprinkler Systems) specifies that quick-response and standard-response sprinklers shall not be mixed within the same compartment. This is to ensure uniformity in activation and discharge characteristics.

A (Compartment): Correct, all heads in a compartment must match type.

B, C, D: NFPA does not require wholesale replacement across zones, buildings, or corridors beyond the compartment.

NFPA 10: Standard for Portable Fire Extinguishers requires that extinguishers be visually inspected at least monthly. This inspection confirms accessibility, proper charge, and readiness.

Weekly, quarterly, semi-annual are not correct; only monthly inspections are mandated.

NFPA 110 (Standard for Emergency and Standby Power Systems) requires that emergency generators be tested monthly under load. If the available load is less than 30% of the generator’s nameplate rating, the test may be conducted until operating parameters (water temperature, oil pressure) stabilize. For longer durations, supplemental loading or load bank testing applies, but the minimum standard is monthly operation until systems stabilize.

Building automation system (BAS) costs are based largely on the number of control points (sensors, outputs, and monitored parameters) that must be integrated. The cost is driven by how many signals must be tracked, rather than just the square footage or vendor.

A: Gross square footage can influence scope, but cost scales with monitored points.

B: Vendor may affect pricing, but primary cost driver is point count.

C: Technology choice matters, but the quantity of control points is more significant.

A medical equipment management plan must include:

Problem/failure/user error data collection for trending and corrective action.

Performance standards to ensure safe and reliable operation.

Annual review of the plan to maintain compliance and effectiveness.

A computerized inventory system is a useful tool but not mandated by The Joint Commission or CMS; paper-based systems may still be acceptable if compliant.