Header:
TEXAS ADMINISTRATIVE CODE
TITLE 25. HEALTH SERVICES
PART 1. DEPARTMENT OF STATE HEALTH SERVICES
CHAPTER 133. HOSPITAL LICENSING
SUBCHAPTER I. PHYSICAL PLANT AND CONSTRUCTION REQUIREMENTS
Date:
08/31/2009
Document:
§ 133.163. Spatial Requirements for New Construction
(a) Administration and public suite.
(1) Architectural requirements. The following rooms or areas shall be provided.
(A) Primary entrance. An entrance at grade level shall be accessible and protected from inclement weather with a drive under canopy for loading and unloading passengers.
(B) Lobby. A main lobby shall be located at the primary entrance and shall include a reception and information counter or desk, waiting space(s), public toilet facilities, public telephones, drinking fountain(s), and storage room or alcove for wheelchairs.
(C) Admissions area. An admissions area shall include a waiting area, work counters or desk, private interview spaces, and storage room or alcove for wheelchairs. The waiting area and wheelchair storage may be shared with similar areas located in the main lobby. The admission area may be omitted if exclusive bedside registration is used.
(D) General or individual office(s). Office space shall be provided for business transactions, medical and financial records, and administrative and professional staffs.
(E) Multipurpose room(s). Room(s) shall be provided for conferences, meetings, and health education purposes including provisions for showing visual aids.
(F) Storage. Storage for office equipment and supplies shall be provided. The construction protection for the storage room or area shall be in accordance with the National Fire Protection Association 101, Life Safety Code, 2003 edition (NFPA 101), § 18.3.2. All documents published by the NFPA as referenced in this section may be obtained by writing or calling the NFPA at the following address and telephone number: Post Office Box 9101, 1 Batterymarch Park, Quincy, Massachusetts 02269-9101, (800) 344-3555; the NFPA website address is http://catalog.nfpa.org.
(2) Details and finishes. Details and finishes shall be in accordance with § 133.162(d)(2) of this title (relating to New Construction Requirements).
(3) Mechanical requirements. Mechanical requirements shall be in accordance with § 133.162(d)(3) of this title.
(4) Piping systems and plumbing fixtures. Piping systems and plumbing fixtures shall be in accordance with § 133.162(d)(4) of this title.
(5) Electrical requirements. Electrical requirements shall be in accordance with § 133.162(d)(5) of this title.
(b) Cart cleaning and sanitizing unit.
(1) Architectural requirements.
(A) Cart cleaning, sanitizing and storage facilities shall be provided for carts serving central services, dietary services, and linen services.
(B) Cart facilities may be provided for each service or be centrally located.
(C) Hand washing fixtures shall be provided in cart cleaning, sanitizing and storage areas.
(2) Details and finishes. When interior cart cleaning facilities are provided, details and finishes shall be in accordance with § 133.162(d)(2) of this title and this paragraph.
(A) Flooring in the cart cleaning and sanitizing unit shall be of the seamless type, or ceramic or quarry tile as required by § 133.162(d)(2)(B)(iii)(III) or (IV) of this title.
(B) Ceilings in the cart cleaning and sanitizing unit shall be the monolithic type as required by § 133.162(d)(2)(B)(vi)(III) of this title.
(3) Mechanical requirements. Mechanical requirements shall be in accordance with § 133.162(d)(3) of this title.
(4) Piping systems and plumbing fixtures. Piping systems and plumbing fixtures shall be in accordance with § 133.162(d)(4) of this title and this paragraph.
(A) Hand washing fixtures shall be provided with hot and cold water. Hot and cold water fixtures shall be provided in cart cleaning and sanitizing locations regardless of whether or not they are interior or exterior.
(B) Where floor drains or floor sinks are installed, they shall be of a type that can be easily cleaned by removal of the cover. Removable stainless steel mesh shall be provided in addition to a grilled drain cover to prevent entry of large particles of waste which might cause stoppages. Floor drains and floor sinks shall be located to avoid conditions where removal of covers for cleaning is difficult.
(5) Electrical requirements. Electrical requirements shall be in accordance with § 133.162(d)(5) of this title.
(c) Central sterile supply suite.
(1) Architectural requirements.
(A) General. When obstetrical or surgical services are provided, the following rooms or areas shall be provided. (i) Decontamination room. This room shall be physically separated from all other areas of the suite. The room shall include work counters or tables, flush type utility sink, equipment for initial disinfection, and hand washing facilities with hands-free operable controls. Materials shall be transferred from the decontamination room to the clean assembly room by way of pass-through doors, windows or washer equipment. The dirty side of the decontamination room may be combined with a soiled utility room if all functions for each space are provided within the room. (ii) Clean and assembly room. The room shall include counters or tables, equipment for sterilizing and hand washing facilities with hands-free operable controls. Clean and soiled work areas shall be physically separated. (iii) Breakdown storage room. A storage room for breakdown of supplies shall be provided. The storage room shall have adequate areas and counters for breakdown of prepackaged supplies. (iv) Sterile and clean supply room. A sterile and clean supply room shall be provided. Storage of sterile and clean supplies shall not occur within the breakdown room. (v) Equipment storage. An equipment storage room shall be provided. (vi) Cart storage room. The storage room for distribution carts shall be adjacent to clean and sterile storage and close to main distribution points. (vii) Multipurpose room. The equipment storage and cart storage room can be combined into a multipurpose room.
(B) Service areas. The central supply suite shall provide the following. (i) Office space. Office space for director of central services. (ii) Staff toilets. Facilities may be outside the unit but must be convenient for staff use and shall contain hand washing fixtures with hands-free operable controls. (iii) Locker room. When provided, the locker room for staff shall include lockers, toilets, lavatories, showers, and male and female dressing rooms or cubicles. A central changing locker room may be shared and made available within the immediate area of the central sterile supply suite. (iv) Housekeeping room. A housekeeping room shall be provided and contain a floor receptor or service sink and storage space for housekeeping supplies and equipment. The housekeeping room shall be located on the decontamination/soiled side of the central sterile supply suite.
(2) Details and finishes. Details and finishes shall be in accordance with § 133.162(d)(2) of this title and this paragraph.
(A) Details. Mirrors shall not be installed at hand washing fixtures in clean and sterile supply areas.
(B) Finishes. (i) Flooring used in the decontamination room and the clean assembly room shall be of the seamless type as required by § 133.162(d)(2)(B)(iii)(III) of this title. (ii) Ceilings in the decontamination room, clean assembly room, and supply storage room shall be the monolithic type in accordance with § 133.162(d)(2)(B)(vi)(III) of this title.
(3) Mechanical Requirements. Mechanical requirements shall be in accordance with § 133.162(d)(3) of this title and this paragraph.
(A) The sterile supply room and the clean and assembly room shall include provisions for ventilation, humidity, and temperature control.
(B) When provided, installations of ethylene oxide (EO) sterilizers shall comply with the requirements of 30 TAC § 106.417 (relating to Ethylene Oxide Sterilizers), administered by the Texas Commission on Environmental Quality (TCEQ), and the following requirements. (i) All source areas shall be exhausted, including the sterilizer equipment room, service and aeration areas, over sterilizer door, and the aerator. If the EO cylinders are not located in a well-ventilated unoccupied equipment space, an exhaust hood shall be provided over the cylinders. The relief valve shall be terminated in a well-ventilated, unoccupied equipment space, or outside the building. (ii) General airflow shall be away from sterilizer operators and towards the sterilizers. (iii) A dedicated exhaust fan and an exhaust duct system shall be provided for EO sterilizers. The exhaust outlet to the atmosphere shall be located on the highest roof, directed upward, and not less than 25 feet from any air intake. A legible warning sign shall be provided to identify the exhaust stack on the roof. (iv) An audible and visual alarm located in sterilizer work area and a 24-hour staffed location shall be activated upon loss of airflow in the exhaust system.
(C) Filtration requirements for air handling units serving the central sterile supply suite shall be equipped with filters having efficiencies equal to, or greater than specified in Table 4 of § 133.169(d) of this title (relating to Tables).
(D) Duct linings exposed to air movement shall not be used in ducts serving the central sterile supply suite unless terminal filters of at least 90% efficiency are installed downstream of linings. This requirement shall not apply to mixing boxes and acoustical traps that have special coverings over such lining.
(4) Piping systems and plumbing fixtures. Piping systems and plumbing fixtures shall be in accordance with § 133.162(d)(4) of this title. When medical gas systems are provided, the systems shall comply with § 133.162(d)(4) of this title and this paragraph.
(A) Drainage and waste piping shall not be installed within the ceiling or installed in an exposed location in sterile areas unless precautions are taken to protect the space below from leakage and condensation from necessary overhead piping. Any required secondary protection shall be labeled, "code required secondary drain system" every 20 feet in a highly visible print or label.
(B) No plumbing lines may be exposed or on walls where possible leaks would create a potential of contamination of the sterile areas.
(C) The compressed air required for the decontamination room shall not be connected to the medical air piping distribution system such as supporting breathable air for respiratory assistance needs, anesthesia machines, intermittent positive pressure breathing machine (IPPB), etc. A separate compressed air supply source shall be provided for maintenance and equipment needs for facility support use.
(5) Electrical requirements. Electrical requirements shall be in accordance with § 133.162(d)(5) of this title and this paragraph. Electrical circuit(s) to equipment in wet areas shall be provided with ground fault circuit interrupters (GFCIs).
(d) Critical care unit.
(1) Architectural requirements.
(A) General. When a critical care unit(s) (CCU) (also known as intensive care unit) is provided, the unit(s) may be classified as general CCU, coronary CCU (CCCU) or pediatric CCU (PCCU). Requirements for neonatal intensive care units (NCCU) are stated in subsection (u) of this section. (i) The CCU(s) shall be a separate suite(s) operated separately from other units of the hospital. The location shall be arranged to eliminate the need for through traffic. (ii) When elevator transport is required for critically ill patients, the size of the elevator cab, mechanisms and controls shall meet the specialized needs.
(B) CCU services and facilities. The following services and facilities shall apply to all classifications of CCUs unless otherwise noted. (i) The patient area (whether separate rooms, cubicles, or multiple-bed space) shall have a minimum clear floor area of 200 square feet per bed exclusive of anterooms, vestibules, toilet rooms, closets, lockers, wardrobes, and/or alcoves. A minimum of 13 feet width shall be provided for the head wall for each bed. (ii) When an open ward plan is used, at least one private room for every six ward beds shall be provided for medical isolation or psychological needs. (iii) A minimum of one airborne infection isolation room shall be provided for each type of CCU suite. The number of airborne infection isolation rooms shall be determined based on an infection control risk assessment. Each room shall comply with requirements of subsection (t)(1)(C)(iii) and (iv) of this section. In addition, the isolation room shall comply with clause (i) of this subparagraph. (iv) When private rooms or cubicles are provided, view panels in the door or walls of these rooms are required. Curtains or other means shall be provided to cover the viewing panels when visual privacy is required. (v) For open ward environments in adult and pediatric units, the clearance between a bed and a wall/partition shall be a minimum of five feet. The clearance between sides of beds shall be a minimum of eight feet. The minimum distance at the foot of the bed shall not be less than seven feet for single load area/room or ten feet for double load area/room. Four feet of the passage space requirement at the foot of the bed may be shared between two beds. The multiple-bed CCU wards shall contain cabinets, work counters, and hand washing fixtures with hands-free operable controls. The fixed and moveable cabinets and shelves shall not encroach upon the bed/gurney clear floor space/area. The requirements of this clause are illustrated in Table 8, Diagrams A and B of § 133.169(h) of this title. (vi) Each room and ward shall be located on an exterior wall and shall have a window. In a ward, one window may serve more than one patient. The window sill height shall not exceed five feet above the floor. Patient beds shall not be located more than 50 feet from an exterior window. Patients' views to outside windows shall be direct. When partitions are used, the patient's view to the outside window(s) may be through no more than two separate clear vision panels. Windows shall be in accordance with subsection (t)(2)(A)(v) of this section. (vii) Hand washing fixtures with hands-free operable controls shall be located in or adjacent to the nurse station, inside of each room at the entrance of the room, and at a ratio of one fixture to each three beds for an open ward layout. Hand washing fixtures shall be sized to contain splashing and conveniently distributed throughout the ward. When a combination modular swivel/fixed toilet and hand washing fixture is provided, hospital administration shall provide a letter (on hospital letterhead) indicating if the toilet is for staff convenience (bed pan washing) or for patient use.
(I) If the toilet is for patient use, an additional hand washing fixture shall be provided in each room at the entrance of the room. If the modular toilet/hand washing unit is for patient use, provision shall be made for patient privacy and odor control. The toilet room exhaust shall be in accordance with Table 3 of § 133.169(c) of this title.
(II) When the modular toilet/hand washing unit is for staff use, it shall be near the entrance to the room. (viii) The nurse station shall be located to permit direct visual observation of each patient served. Video cameras or mirrors shall not be substituted for direct visual observation. The nurse station shall have space for counters and storage. The counter height shall not exceed 42 inches. The nurse station may be combined with or include centers for reception and communication. (ix) When individual nurse substations are provided and located at each patient room(s), they shall be located to permit direct visual observation of each patient served. The nurse substation shall have space for a counter, storage space and a recessed sitting space. The substation shall, at a minimum, be recessed one foot six inches from the egress corridor. (x) Storage and preparation of medication may be done from a room, alcove area or from a self-contained dispensing unit but must be under visual control of nursing staff. A work counter, hand washing fixture with hands-free operable controls, refrigerator, and double-locked storage for controlled substances shall be provided. Standard cup-sinks are not acceptable for hand washing. (xi) An intravenous solution support shall be provided at each patient crib, bed or bassinet. The intravenous solution shall not be suspended directly over the patient. (xii) Storage space shall be provided for emergency equipment in the unit.
(C) CCCU. When a CCCU is provided, the CCCU shall comply with the requirements contained in subparagraph (B) of this paragraph and the following. (i) Each CCCU bed shall be in a separate room. Equipment for monitoring cardiac patients shall be provided by visual display both at the bed location and at the nurse station. (ii) Each coronary patient shall have direct access to a toilet room and a hand washing fixture. Swivel type commodes may be utilized in lieu of individual toilet rooms, but provision must be made for patient privacy and odor control. The toilet room exhaust rate shall be in accordance with Table 3 of § 133.169(c) of this title. (iii) When medical, surgical, and coronary critical care services are combined in one CCU suite, at least 50% of the beds shall be located in private rooms. (Note: Medical/surgical patients may utilize open areas or private critical care rooms as needed and available but, insofar as possible, coronary patients should not be accommodated in open ward areas.)
(D) PCCU. When a PCCU is provided, the unit shall comply with the requirements contained in subparagraph (B) of this paragraph and the following. (i) The PCCU may be an open ward, private rooms, or combination of both. When an open ward plan is used, one private room is required for each 10 beds or fraction thereof. (ii) In a multiple-bassinet/crib (sleeping unit) room/ward the clearance between the side of the sleeping unit and a wall/partition shall be a minimum of five feet. The clearance between sides of sleeping units shall be a minimum of eight feet. The minimum distance at the foot of the bassinet shall not be less than ten feet for single load area/room or sixteen feet for double load area/room. Four feet of the passage space requirement at the foot of the bassinet may be shared between two bassinets. The fixed and moveable cabinets and shelves shall not encroach upon the bassinet/crib clear floor space/area. The requirements of this clause are illustrated in Table 8, Diagram K of § 133.169(h) of this title. (iii) A sleeping space shall be provided for parents who spend long hours with the patient. This space may be within the patient room or separate from the patient area but shall be in communication with the PCCU staff. (iv) Hand washing fixtures with hands-free operable controls shall be provided in each room near the entrance of the room, and in open wards at a minimum ratio of one fixture to each three cribs, beds or bassinets. Hand washing fixtures shall be sized to contain splashing. (v) A room shall be provided for private discussions and shall be located within, or convenient to, the PCCU. The multipurpose room noted in subparagraph (F)(v) of this paragraph will meet this requirement if conveniently located. (vi) Storage space for infant formula shall be provided. This functional space may be outside the PCCU but shall be available for use at all times. (vii) Storage cabinets or closets for toys and games shall be provided within the unit. (viii) Storage area for cots, bed linens, and other items needed for overnight accommodation of parents shall be provided in the general location of sleeping accommodations. (ix) An examination/treatment room with a minimum of 120 square feet of clear floor area shall be located in or near the PCCU suite. The room shall contain a hand washing fixture with hands-free operable controls, storage facilities, counter, or shelf space for writing. This requirement does not apply when all patient rooms are private rooms.
(E) Additional service spaces. The following additional service spaces shall be immediately available within each type of CCU(s). These may be shared by more than one CCU (unless otherwise noted) provided that direct access is available from each. (i) Securable closets. Securable closets or cabinet compartments for the personal effects of nursing personnel, located in or near the nurse station, shall be provided. At a minimum, these shall be large enough for purses and billfolds. Coats may be stored in closets or cabinets on each floor or in a central staff locker area. (ii) Charting and dictation area(s) for physicians. Space for recording, record storage and reviews shall be provided near cribs, beds or bassinets. Dictation space may be in a separate room or alcove. Suitable space shall be provided when computers are used for the clinical records. (iii) X-ray viewing area. Each type of CCU shall be provided with an X-ray viewing area and film illuminators for handling at least four films simultaneously. When the entire CCU suite is provided with digital imaging system capabilities, a minimum of two X-ray film illuminator viewers shall be provided. The film illuminators shall be mounted within the central area of the suite. (iv) Nourishment station. The nourishment station shall contain a sink with hands-free operable controls, work counter, refrigerator, cabinets, and not be located in the medication room or the clean workroom. Space shall be included for temporary holding of unused or soiled dietary trays. (v) Ice machine. The ice machine shall provide ice for treatment and patient use. Ice-making equipment for treatment may be in the clean workroom or the nourishment station. (vi) Equipment storage. In addition to above, twenty square feet of equipment storage shall be provided for each patient station. These storage areas shall be out of the way of the corridor traffic. (vii) Stretcher storage alcove. The alcove provided for stretcher or bassinet storage shall be located out of direct line of traffic. (viii) Clean workroom. The room shall contain a work counter, a hand washing fixture with hands-free operable controls, and storage facilities for clean and sterile supplies. (ix) Clean linen storage. There shall be a designated area for clean linen storage. This may be within a clean workroom, a separate closet, or an approved distribution system. If a closed cart system is used, storage of the cart may be in an alcove. (x) Soiled workroom. The soiled workroom shall contain a work counter, a clinical sink with hands-free operable controls or equivalent flushing rim type fixture with hot and cold mixing faucet, separate hand washing facilities, and separate waste and soiled linen receptacles. (xi) Soiled holding room. When provided, soiled holding rooms used only for temporary holding of soiled material may omit the clinical sink and work counter. (xii) Housekeeping room. A housekeeping room shall be provided within or immediately adjacent to the CCU. It shall not be shared with other nursing units or departments.
(F) Other required areas/rooms. The following areas/rooms shall be provided and may be located outside the unit if conveniently accessible. (i) Waiting space. A visitors' waiting space shall be provided with toilet facility(ies), public telephone(s), and drinking fountain(s). One waiting space may serve other CCUs. (ii) Offices. Room(s) shall be provided for critical care medical and nursing management and administrative personnel. The offices shall be large enough to permit consulting with members of the critical care team and visitors. The offices shall be linked with the unit by telephone or an intercommunications system. (iii) Staff lounge. A staff lounge shall include toilet facilities with a hand washing fixture with hands-free operable controls. The lounge(s) shall be located so that staff may be recalled quickly to the patient area in emergencies. One lounge may serve multiple CCUs when the lounge is adjacent to the units. Toilet facilities may be shared as long as privacy is maintained for changing areas. (iv) On-call rooms. Physicians and other staff on 24-hour on-call work schedules shall be provided with sleeping rooms with access to a shower(s), toilet(s), and lavatory(ies). If on-call room(s) are not within the CCU served, a dedicated telephone or intercom system shall connect the on-call room(s) to the CCU(s). (v) Multipurpose room(s). A multipurpose room for staff, patients, and patients' families for patient conferences, reports, education, and training sessions shall be provided. This room(s) must be accessible to each nursing unit. (vi) A consultation room shall be provided, if not provided elsewhere in the unit.
(2) Details and finishes. Details and finishes shall be in accordance with § 133.162(d)(2) of this title and this paragraph.
(A) Details. (i) At least one door to a CCU room shall be not less than four feet wide (41.5 inches clear width) and arranged to minimize interference with movement of beds and large equipment. (ii) Sliding doors in CCUs shall not have floor tracks at the latch side of the sliding panel, have hardware that minimizes jamming possibilities, and be in accordance with § 133.162(d)(2)(A)(vi) of this title. (iii) Glazing in viewing panels shall be safety glass, wire glass, or clear plastic. (iv) Noise control and sound attenuation in an open ward environment shall be a design factor and meet the requirements contained in Table 1 of § 133.169(a) of this title. (v) Recreation rooms, exercise rooms, equipment rooms, and similar spaces where impact noises may be generated shall not be located directly over CCU(s), unless special provisions are made to minimize such noise.
(B) Finishes. (i) Flooring used in soiled workrooms shall be of the seamless type as required by § 133.162(d)(2)(B)(iii)(III) of this title. (ii) Ceilings in the soiled workroom shall be monolithic type as required by § 133.162(d)(2)(B)(vi)(III) of this title.
(3) Mechanical Requirements. Mechanical requirements shall be in accordance with § 133.162(d)(3) of this title and this paragraph. Room recirculating units shall not be used.
(4) Piping systems and plumbing fixtures. Piping systems and plumbing fixtures shall be in accordance with § 133.162(d)(4) of this title.
(5) Electrical requirements. Electrical requirements shall be in accordance with § 133.162(d)(5) of this title and this paragraph.
(A) General. (i) Receptacles at each bed location in a CCU(s) shall be served by two branch circuits, one or more from the critical branch panel of the emergency electrical system and one or more from the normal system. One critical branch circuit shall serve only one bed location. All branch circuits from the normal system shall be from a single panelboard. All branch circuits from the emergency electrical system shall be from a single panelboard. (ii) A minimum of seven hospital grade duplex outlets shall be conveniently located at the head of each bed, crib or bassinet. At least three of these duplex outlets shall be on the critical branch of the emergency electrical system. (iii) Hospital grade receptacles in the PCCU shall be tamper-resistant or provided with GFCIs.
(B) Nurses calling systems. The nurse call system shall be in accordance with § 133.162(d)(5)(L) and Table 7 of § 133.169(g) of this title.
(e) Dietary suite.
(1) Architectural requirements.
(A) General. Construction, equipment, and installation shall comply with §§ 229.161 - 229.171 of this title (relating to Texas Food Establishments).
(B) Food service facilities. Food services shall be provided by an on-site food preparation system or an off-site food service system or a combination of the two. The following minimum functional elements shall be provided on site regardless of the type of dietary services. (i) Dining area. Provide dining space(s) for ambulatory patients, staff, and visitors. These spaces shall be separate from the food preparation and distribution areas. (ii) Receiving area. This receiving area shall have direct access to the outside for incoming dietary supplies or off-site food preparation service and shall be separate from the general receiving area. The receiving area shall contain a control station and an area for breakout for loading, unloading, uncrating, and weighing supplies. The entrance area to the receiving area shall be covered from the weather. (iii) Storage spaces. Storage spaces shall be convenient to receiving area and food preparation area and shall be located to exclude traffic through the food preparation area. Regardless of the type of food services provided, the facility shall provide storage of food for emergency use for a minimum of four calendar days.
(I) Storage space(s). Storage space(s) shall be provided for bulk, refrigerated, and frozen foods.
(II) Cleaning supply storage. This room or closet shall be used to store nonfood items that might contaminate edibles. This storage area may be combined with the housekeeping room. (iv) Food preparation area. Counter space shall be provided for food prep work, equipment, and an area to assemble trays for distribution for patient meals. (v) Ice-making equipment. Ice-making equipment shall be provided for both drinks and food products (self-dispensing equipment) and for general use (storage-bin type equipment). (vi) Hand washing. Hand washing fixtures with hands-free operable controls shall be conveniently located at all food preparation areas and serving areas. (vii) Food service carts. When a cart distribution system is provided, space shall be provided for storage, loading, distribution, receiving, and sanitizing of the food service carts. The cart traffic shall be designed to eliminate any danger of cross-circulation between outgoing food carts and incoming soiled carts, and the cleaning and sanitizing process. Cart circulation shall not be through food processing areas. (viii) Ware washing room. A ware washing room equipped with commercial type dishwasher equipment shall be located separate from the food preparation and serving areas. Space shall be provided for receiving, scraping, sorting, and stacking soiled tableware and for transferring clean tableware to the using areas. Hand washing facilities with hands-free operable controls shall be located within the soiled dish wash area. A physical separation to prevent cross-traffic between "dirty side" and "clean side" of the dish wash areas shall be provided. (ix) Pot washing facilities. A three compartmented sink of adequate size for intended use shall be provided convenient to the food preparation area. Supplemental heat for hot water to clean pots and pans shall be by booster heater or by steam jet. (x) Waste storage room. A food waste storage room shall be conveniently located to the food preparation and ware washing areas but not within the food preparation area. It shall have direct access to the hospital's waste collection and disposal facilities. (xi) Sanitizing facilities. Storage areas and sanitizing facilities for garbage or refuse cans, carts, and mobile tray conveyors shall be provided. All containers for trash storage shall have tight-fitting lids. (xii) Housekeeping room. A housekeeping room shall be provided for the exclusive use of the dietary department. Where hot water or steam is used for general cleaning, additional space within the room shall be provided for the storage of hoses and nozzles. (xiii) Office spaces. An office shall be provided for the use of the food service manager or the dietary service manager. In smaller facilities, a designated alcove may be located in an area that is part of the food preparation area. (xiv) Toilets and locker spaces. A toilet room(s) with a hand washing fixture(s) with hands-free operable controls shall be provided for the exclusive use of the dietary staff. Toilet room(s) shall not open directly into the food preparation areas, but must be in close proximity to them. For larger facilities, a locker room or space for lockers shall be provided for staff belongings.
(C) Additional service areas, rooms and facilities. When an on-site food preparation system is used, in addition to the items required in subparagraph (B) of this paragraph, the following service areas, rooms and facilities shall be provided. (i) Food preparation facilities. When food preparation systems are provided, there shall be space and equipment for preparing, cooking, and baking. (ii) Tray assembly line. A patient tray assembly and distribution area shall be located within close proximity to the food preparation and distribution areas. (iii) Food storage. When food is prepared on site, the storage room shall be adequate to accommodate food for a seven calendar day menu cycle. (iv) Additional storage room(s). An additional room(s) shall be provided for the storage of cooking wares, extra trays, flatware, plastic and paper products, and portable equipment. (v) Drying storage area. Provisions shall be made for drying and storage of pots and pans from the pot washing room.
(D) Equipment. Equipment for use in the dietary suite shall meet the following requirements. (i) Mechanical devices shall be heavy duty, suitable for the use intended, and easily cleaned. Where equipment is movable, provide heavy duty locking casters. Equipment with fixed utility connections shall not be equipped with casters. (ii) Floor, wall, and top panels of walk-in coolers, refrigerators, and freezers shall be insulated. Coolers and refrigerators shall be capable of maintaining a temperature down to freezing. Freezers shall be capable of maintaining a temperature of 20 degrees below 0 degrees Fahrenheit. Coolers, refrigerators, and freezers shall be thermostatically controlled to maintain desired temperature settings in increments of two degrees or less. Interior temperatures shall be indicated digitally and visible from the exterior. Controls shall include audible and visible high and low-temperature alarm. The time of alarm shall be automatically recorded. (iii) Walk-in units may be lockable from the outside but must have a release mechanism for exit from inside at all times. The interior shall be lighted. All shelving shall be corrosion-resistant, easily cleaned, and constructed and anchored to support a loading of at least 100 pounds per linear foot. (iv) All cooking equipment shall be equipped with automatic shutoff devices to prevent excessive heat buildup.
(E) Vending services. When vending machines are provided, a dedicated room or an alcove shall be located so that access is available at all times.
(2) Details and finishes. Details and finishes shall be in accordance with § 133.162(d)(2) of this title and this paragraph.
(A) Details. (i) Food storage shelves shall not be less than four inches above the finished floor and the space below the bottom shelf shall be closed in and sealed tight for ease of cleaning. (ii) Operable windows and doors not equipped with automatic closing devices shall be equipped with insect screens. (iii) Food processing areas in the central dietary kitchen shall have ceiling heights not less than nine feet. Ceiling-mounted equipment shall be supported from rigid structures located above the finished ceiling. (iv) Mirrors shall not be installed at hand washing fixtures in the food preparation areas.
(B) Finishes. (i) Floors in areas used for food preparation, food assembly, soiled and clean ware cleaning shall be water-resistant and grease-proof. Floor surfaces, including tile joints, shall be resistant to food acids. (ii) Wall bases in food preparation, food assembly, soiled and clean ware cleaning and other areas which are frequently subject to wet cleaning methods shall be made integral and coved with the floor, tightly sealed to the wall, constructed without voids that can harbor insects, retain dirt particles, and be impervious to water. (iii) In the dietary and food preparation areas, the wall construction, finishes, and trim, including the joints between the walls and the floors, shall be free of voids, cracks, and crevices. (iv) The ceiling in food preparation and food assembly areas shall be washable as required by § 133.162(d)(2)(B)(vi)(II) of this title. (v) The ceiling in the soiled and clean ware cleaning area shall be of the monolithic type as required by § 133.162(d)(2)(B)(vi)(III) of this title.
(3) Mechanical Requirements. Mechanical requirements shall be in accordance with § 133.162(d)(3) of this title and this paragraph.
(A) Exhaust hoods handling grease-laden vapors in food preparation centers shall comply with National Fire Protection Association 96, Standard for Ventilation Control and Fire Protection of Commercial Cooking Operations, 2001 edition. All hoods over cooking ranges shall be equipped with grease filters, fire extinguishing systems, and heat-actuated fan controls. Clean out openings shall be provided every 20 feet and at any changes in direction in the horizontal exhaust duct systems serving these hoods. (Horizontal runs of ducts serving range hoods should be kept to a minimum.)
(B) When air change standards in Table 3 of § 133.169(c) of this title do not provide sufficient air for proper operation of exhaust hoods (when in use), supplementary filtered make-up air shall be provided in these rooms to maintain the required airflow direction and exhaust velocity. Make-up systems for hoods shall be arranged to minimize "short circuiting" of air and to avoid reduction in air velocity at the point of contaminant capture.
(C) Air handling units serving the dietary suite shall be equipped with filters having efficiencies equal to, or greater than specified in Table 4 of § 133.169(d) of this title.
(4) Piping systems and plumbing fixtures. Piping systems and plumbing fixtures shall be in accordance with § 133.162(d)(4) of this title and this paragraph.
(A) The kitchen grease traps shall be located and arranged to permit easy access without the need to enter food preparation or storage areas. Grease traps shall be of capacity required and shall be accessible from outside of the building without need to interrupt any services.
(B) Grease traps or grease interceptors shall be located outside the food preparation area and shall comply with the requirements in the National Association of Plumbing-Heating-Cooling Contractors (PHCC), National Standard Plumbing Code, 2000 edition. This publication may be obtained from the National Association of Plumbing-Heating-Cooling Contractors, 180 South Washington Street, Falls Church, VA 22046; telephone (703) 237-8100.
(C) The material used for plumbing fixtures shall be nonabsorptive and acid-resistant.
(D) Water spouts used at lavatories and sinks shall have clearances adequate to avoid contaminating utensils and containers.
(E) Hand washing fixtures used by food handlers shall be trimmed with valves that can be operated without hands. Single lever or wrist blade devices may be used. Blade handles used for this purpose shall not be less than four inches in length.
(F) Drainage and waste piping shall not be installed within the ceiling or installed in an exposed location in food preparation centers, food serving facilities and food storage areas unless precautions are taken to protect the space below from leakage and condensation from necessary overhead piping. Any required secondary protection shall be labeled, "code required secondary drain system" every 20 feet in a highly visible print or label.
(G) No plumbing lines may be exposed overhead or on walls where possible leaks would create a potential for food contamination.
(5) Electrical requirements. Electrical requirements shall be in accordance with § 133.162(d)(5) of this title and this paragraph.
(A) Exhaust hoods shall have an indicator light indicating that the exhaust fan is in operation.
(B) The electrical circuit(s) to equipment in wet areas shall be provided with five milliampere GFCI.
(f) Emergency suite. This subsection applies to all hospitals (general or special) included under the hospital license, including those licensed as a multiple-location hospital.
(1) Architectural requirements.
(A) Emergency treatment area. (i) Emergency treatment room. As a minimum requirement, all hospitals shall provide at least one emergency treatment room and facilities to handle emergencies. The room(s) and facilities shall meet the following requirements.
(I) The emergency treatment room for a single patient shall have a minimum clear area of 120 square feet clear floor area exclusive of fixed and movable cabinets and shelves. The minimum clear room dimension exclusive of fixed cabinets and built-in shelves shall be 10 feet. The emergency treatment room shall contain cabinets, medication storage, work counter, examination light, and a hand washing fixture with hands-free operable controls.
(II) When a multiple-bed emergency treatment room is provided, the clearance between the side of a bed/gurney and a wall/partition shall be a minimum of four feet. The clearance between the sides of beds/gurneys shall be a minimum of six feet. The minimum distance at the foot of the bed/gurney shall not be less than seven feet for single load area/room or ten feet for double load area/room. Four feet of the passage space at the foot of the bed may be shared between two beds/gurneys. The multiple-bed emergency treatment room shall contain cabinets, medication storage, work counter, examination light, and a hand washing fixture with hands-free operable controls. The fixed and movable cabinets and shelves shall not encroach upon the bed/gurney clear floor space/area. The requirements of this subclause are illustrated in Table 8, Diagram C of § 133.169(h) of this title.
(III) One hand washing fixture with hands-free operable controls shall be provided for each bed/gurney location. One hand washing fixture may serve two beds/gurneys if distributed appropriately between the two.
(IV) Storage space shall be provided within the room or suite and be under staff control for general medical-surgical emergency supplies and medications. Adequate space shall be provided for emergency equipment such as emergency treatment trays, ventilator, defibrillator, splints, cardiac monitor, etc.
(V) Locked storage space shall be provided for drugs and an area for preparation of medication with a work counter, refrigerator, and hand washing fixture with hands-free operable controls.
(VI) An alcove shall be provided for stretcher and wheelchair storage. The storage shall be located out of the line of traffic.
(VII) Patient toilet room(s) shall be provided and shall be convenient to treatment rooms, examination rooms, and holding rooms, and a hand washing fixture with hands-free operable controls.
(VIII) In a special hospital, comprehensive medical rehabilitation hospital, or pediatric and adolescent hospital, the emergency treatment room and facilities may be located anywhere in the hospital. (ii) Additional requirements for a general hospital. Except for comprehensive medical rehabilitation hospitals and pediatric and adolescent hospitals that generally provide care that is not administered for or in expectation of compensation, a general hospital shall also meet the following requirements.
(I) Emergency entry signage. An emergency sign shall be provided at the entry from the public road(s) or street(s) serving the site. The emergency sign at the entry to the site shall be illuminated and connected to the emergency essential electrical system. Additional sign(s) on-site may be required to direct patients to the emergency treatment area entrance when the emergency treatment area is not visible from the site entry. The letters on the entry sign shall be red with a contrasting background, all capitalized, at least eight inches in height, and an arrow indicating direction.
(II) Entrances. Separate ambulance and pedestrian entrances at grade level shall be well-illuminated, identified by signs, and protected from inclement weather. The ambulance entry shall have a drive under canopy for protection from inclement weather. The emergency access to permit discharge of patients from automobile and ambulances shall be paved. Parking shall be provided near and convenient to the pedestrian entrance.
(III) Control station. A registration, reception, discharge or control station shall be located to permit staff observation and control of access to treatment room(s), pedestrian and ambulance entrances, and public waiting area(s). When a dedicated triage space is provided, it shall include a counter with a hand washing fixture with hands-free operable controls.
(IV) Public waiting room. A public waiting room shall be provided.
(V) Public facilities. Toilet facilities, public telephone(s), and drinking fountain(s) shall be provided for the exclusive use of the waiting room.
(VI) Diagnostic radiographic (X-ray) room. Imaging facilities for diagnostic services shall be readily available to the emergency suite. If a separate radiographic (X-ray) room is installed within the emergency suite, it shall comply with the requirements in subsection (l)(1)(A) of this section. When the diagnostic X-ray room is exclusively used for the emergency treatment area, the dressing rooms may be omitted.
(VII) Laboratory unit. Laboratory services shall be made available to the emergency suite. If a separate laboratory workroom is installed within the emergency suite, it shall comply with the requirements in subsection (n)(1)(C)(i) of this section. All laboratory services provided on site or by contractual arrangement shall comply with § 133.41(h) of this title (relating to Hospital Functions and Services).
(VIII) Medical staff work area and charting area(s). A medical staff work area and charting area(s) shall be provided. The area may be combined with the reception and control area.
(IX) Clean storage room. A clean storage room shall be provided for clean supplies, linens and medications as needed. A hand washing fixture shall be provided with hands-free operable controls.
(X) Soiled workroom. The workroom shall contain a work counter, a clinical sink or equivalent flushing type fixture, hand washing fixture with hands-free operable controls, waste receptacles, and soiled linen receptacles.
(XI) Housekeeping room. The housekeeping room shall contain a floor receptor or service sink, storage space for housekeeping supplies and equipment, and be located within the suite. When automatic film processors are used, a receptacle of adequate size with hot and cold water for cleaning the processor racks shall be provided.
(XII) Staff toilets. Toilets may be outside the suite but shall be convenient for staff use and include hand washing fixtures with hands-free operable controls. When a department has four or more treatment or examination rooms, toilet facilities shall be in the suite. (iii) Other rooms. If a hospital provides the following rooms, the rooms shall meet these requirements.
(I) Examination room. When provided, the examination room for a single patient shall have a minimum clear area of 100 square feet clear floor area exclusive of fixed and movable cabinets and shelves. The minimum clear room dimension exclusive of fixed cabinets and built-in shelves shall be 9 feet. The examination room shall contain cabinets, medication storage, work counter, examination light, and a hand washing fixture with hands-free operable controls.
(II) Multi-bed examination room. In a multiple-bed examination room the clearance between the side of the bed/gurney and a wall/partition shall be a minimum of three feet. The clearance between sides of the beds/gurneys shall be a minimum of six feet. The minimum distance at the foot of the bed/gurney shall not be less than seven feet for single load area/room or ten feet for double load area/room. Four feet of the passage space at the foot of the bed may be shared between two beds/gurneys. The multiple-bed examination room shall contain cabinets, work counters, and a hand washing fixture with hands-free operable controls. One hand washing fixture shall be provided for every four beds/gurneys or fraction thereof. Fixtures shall be uniformly distributed. The fixed and moveable cabinets and shelves shall not encroach upon the bed/gurney clear floor space/area.
(III) Isolation room. The need for an airborne infection isolation room in the emergency suite shall be determined by the hospital and the infection risk assessment. When the hospital provides treatment rooms to perform procedures on persons who are known or suspected of having an airborne infectious disease, these procedures shall be performed in a designated treatment room meeting airborne infection isolation ventilation requirements. The isolation room shall have functional space in accordance with clause (i)(I) of this subparagraph, and meet the ventilation requirements contained in Table 3 of § 133.169(c) of this title.
(IV) Secured holding room. When provided, this room shall be constructed to allow for security, patient and staff safety, patient observation, and sound mitigation. The secure holding room shall have a minimum clear area of 100 square feet clear floor area exclusive of fixed cabinets. The minimum clear room dimension exclusive of fixed cabinets shall be 10 feet.
(V) Orthopedic and cast room. The room(s) may be in separate room(s) or in the trauma room. The room(s) shall contain a work counter, storage for splints and orthopedic supplies, traction hooks, medication storage, examination light, and a hand washing fixture with hands-free operable controls. When a cast room is provided it shall be equipped with hand washing facilities, plaster sink, storage, and other provisions required for cast procedures.
(VI) Film processing room. When a radiographic (X-ray) room is provided, a darkroom for processing film shall be provided unless the processing equipment does not require a darkroom for loading and transfer. When daylight processing is used, the darkroom may be minimal for emergency and special uses. Film processing shall be located convenient to the darkroom.
(VII) Decontamination room. A decontamination room shall have an exterior entry point and as far as practical from any other entry point to the emergency treatment area. The internal door from the decontamination room shall open directly to the corridor into the emergency treatment area. The door shall swing into the room and be lockable against ingress from the corridor. The room shall be a minimum of 80 square feet of clear floor area with a hand washing fixture with hands-free operable controls.
(B) Holding or observation room/area. (i) When a holding or observation room/area is provided within or adjacent to the emergency suite, it shall comply with the following.
(I) A single holding/observation room shall have a minimum clear area of 100 square feet exclusive of fixed and movable cabinets and shelves. The holding/observation room shall contain a work counter and hand washing fixture with hands-free operable controls.
(II) The single holding/observation room shall be near the nurses station and near a patient toilet room which contains a hand washing fixture with hands-free operable controls.
(III) In a multiple-bed holding/observation room/area, the clearance between the side of the bed/gurney and a wall/partition shall be a minimum of three feet. The clearance between sides of the beds/gurneys shall be a minimum of six feet. The minimum distance at the foot of the bed/gurney shall not be less than seven feet for single load area/room or ten feet for double load area/room. Four feet of the passage space at the foot of the bed may be shared between two beds/gurneys. The multiple-bed holding/observation room/area shall contain cabinets, work counters, and a hand washing fixture with hands-free operable controls. One hand washing fixture shall be provided for every four holding/observation beds or fraction thereof. Fixtures shall be uniformly distributed. The fixed and moveable cabinets and shelves shall not encroach upon the bed/gurney clear floor space/area. The requirements of this subclause are illustrated in Table 8, Diagram D of § 133.169(h) of this title.
(IV) In a multiple-bed holding/observation room/area, a patient toilet room with a hand washing fixture with hands-free operable controls shall be provided within the room or area. (ii) When a multiple-bed gurney holding or observation room is not within or adjacent to the emergency suite, the following additional spaces shall be provided:
(I) stretcher and wheelchair storage alcove. The alcove provided for stretcher and wheelchair storage shall be located out of the line of traffic;
(II) clean storage room. A clean storage room shall be provided within or adjacent to the holding or observation room. The clean storage room shall be provided for clean supplies, linen and medication as needed. A hand washing fixture shall be provided with hands-free operable controls;
(III) soiled workroom. A soiled workroom shall be provided within or adjacent to the holding or observation room. The workroom shall contain a work counter, a clinical sink or equivalent flushing type fixture, hand washing fixture with hands-free operable controls, waste receptacles, and soiled linen receptacles; and
(IV) housekeeping room. A housekeeping room shall be provided within or near the holding or observation room. The housekeeping room shall contain a floor receptor or service sink and storage space for housekeeping supplies and equipment.
(C) Trauma center. When provided, a trauma center shall comply with subparagraph (B) of this paragraph and in addition contain the following. (i) Trauma room. A minimum of one trauma room shall be provided with 250 square feet of clear floor area exclusive of aisles and fixed and moveable cabinets and shelves. The minimum clear dimension between fixed cabinets and built-in shelves shall be 12 feet. The trauma room shall contain a work counter, cabinets, medication storage, and examination light. (ii) Multiple-station trauma room. When multiple-patient stations are provided, the clearance between the head of the bed/gurney to the wall/partition shall be a minimum of three feet. The clearance between the side of a bed/gurney and a wall/partition shall be a minimum of six feet. The clearance between the sides of beds/gurneys shall be a minimum of twelve feet. The minimum distance at the foot of the bed/gurney shall not be less than seven feet for single load area/room or ten feet for double load area/room. Four feet of the passage space at the foot of the bed may be shared between two beds/gurneys. The multiple-bed trauma room shall contain cabinets, medication storage, work counter, examination light, and scrub sink with hands-free operable controls. The fixed and moveable cabinets and shelves shall not encroach upon the bed/gurney clear floor space/area. The requirements of this clause are illustrated in Table 8, Diagrams E of § 133.169(h) of this title. Provisions shall be made for visual privacy between multiple stations. (iii) Scrub facilities. A scrub station shall be located at the entrance to each trauma room either inside or outside of the room. One scrub station may serve two trauma beds/gurneys. Scrub facilities shall be arranged to minimize any incidental splatter on nearby personnel or supply carts. The scrub sinks shall be recessed out of the main line of traffic. (iv) Doorways. All doorways openings from the ambulance entrance to the trauma room shall be a minimum of five feet wide.
(D) Emergency clinic. When an emergency clinic (which may also be referred to as "urgent care", "fast track", "express care", "minor care", etc.) is provided, the clinic shall be separate and distinct from the emergency treatment area and trauma center and shall meet all the requirements of subparagraph (A) of this paragraph. All facilities required by subparagraph (A) of this paragraph may be shared with the emergency treatment area and trauma center except for the emergency treatment room. The emergency treatment room(s) in the emergency clinic shall not be less than 100 square feet. The emergency exam room(s) in the emergency clinic shall not be less than 80 square feet.
(2) Details and finishes. Details and finishes shall be in accordance with § 133.162(d)(2) of this title and this paragraph.
(A) Details. (i) Trauma rooms shall have ceiling heights not less than nine feet. (ii) The decontamination room shall be equipped with two hand-held showerheads with temperature controls and a dedicated holding tank with a floor drain.
(B) Finishes. (i) Flooring used in a trauma room, treatment room, examination room, holding area, and soiled workroom shall be of the seamless type as required by § 133.162(d)(2)(B)(iii)(III) of this title. Seamless type flooring is not required in the examination room in the emergency clinic. (ii) Ceilings in soiled workrooms, isolation rooms, and trauma rooms shall be of the monolithic type as required by § 133.162(d)(2)(B)(vi)(III) of this title. (iii) The decontamination room floor shall be self-coved to a height of six inches. The room shall have all smooth, nonporous, scrubable, nonabsorbent and nonperforated surfaces.
(3) Mechanical requirements. Mechanical requirements shall be in accordance with § 133.162(d)(3) of this title and this paragraph.
(A) Duct linings exposed to air movement shall not be used in ducts serving any trauma rooms, treatment rooms, examination rooms, holding areas, and clean room. This requirement shall not apply to mixing boxes and acoustical traps that have special coverings over such lining.
(B) When a trauma room is provided under paragraph (1)(C)(i) of this subsection, the air supply for the trauma/surgical room shall be from ceiling outlets that are as near the work centers as possible, and a minimum of two low return inlets shall be located diagonally opposite from one another.
(C) Return air inlets shall be not lower than four inches nor higher than 12 inches from floor level.
(4) Piping systems and plumbing fixtures. Piping systems and plumbing fixtures shall be in accordance with § 133.162(d)(4) of this title and this paragraph.
(A) Medical gas systems. Medical gas systems shall be provided in accordance with § 133.162(d)(4)(A)(iii) of this title.
(B) Ice machine. An ice machine shall be provided for therapeutic purposes and shall be located in the clean utility room. A self-dispensing ice machine shall be provided for ice for human consumption.
(5) Electrical requirements. Electrical requirements shall be in accordance with § 133.162(d)(5) of this title and this paragraph.
(A) General. (i) Each treatment and examination room in the emergency treatment area and trauma center shall have a minimum of six duplex electrical receptacles located convenient to the head of each bed. (ii) Each treatment and examination room in the emergency clinic suite shall have a minimum of four duplex electrical receptacles located convenient to the head of each bed/table. (iii) Each work counter and table shall have access to at least one duplex receptacle connected to the critical branch of the emergency electrical system. (iv) The hospital shall provide X-ray film illuminators for handling at least four films simultaneously in all treatment, examination, and trauma rooms in the emergency treatment area. When the entire emergency treatment area is provided with digital imaging, a minimum of two X-ray film illuminators shall be provided within a central location within the emergency treatment area.
(B) Nurses calling systems. The nurse call system shall be in accordance with § 133.162(d)(5)(L) and Table 7 of § 133.169(g) of this title.
(g) Employees suite.
(1) Architectural requirements.
(A) Architectural requirements shall be in accordance with § 133.162(d)(1) of this title and this paragraph.
(B) Lockers, lounges, toilets and showers shall be provided within the hospital for employees and volunteers. These facilities are in addition to, and separate from, those required for the medical staff and the public.
(2) Details and finishes. Details and finishes shall be in accordance with § 133.162(d)(2) of this title.
(3) Mechanical requirements. Mechanical requirements shall be in accordance with § 133.162(d)(3) of this title.
(4) Piping systems and plumbing fixtures. Piping systems and plumbing fixtures shall be in accordance with § 133.162(d)(4) of this title.
(5) Electrical requirements. Electrical requirements shall be in accordance with § 133.162(d)(5) of this title.
(h) Engineering suite and equipment areas.
(1) Architectural requirements. Architectural requirements shall be in accordance with § 133.162(d)(1) of this title and this paragraph.
(A) General. The following facilities shall be provided: (i) an engineer's office with file space and provisions for protected storage of facility drawings, records, manuals, etc.; (ii) a general maintenance shop(s) for repair and maintenance; (iii) a separate room(s) for building maintenance supplies and equipment. Storage of bulk solvents and flammable liquids shall be in a separate building and not within the hospital building; (iv) a medical equipment room which includes provisions for the storage, repair, and testing of electronic and other medical equipment; (v) a separate room or building for yard maintenance equipment and supplies. When a separate room is within the physical plant the room shall be located so that equipment may be moved directly to the exterior. Yard equipment or vehicles using flammable liquid fuels shall not be stored or housed within the general hospital building; and (vi) sufficient space in all mechanical and electrical equipment rooms for proper maintenance of equipment. Provisions shall also be made for removal and replacement of equipment.
(B) Additional areas or room(s). Additional areas or room(s) for mechanical, and electrical equipment shall be provided within the physical plant or installed in separate buildings or weatherproof enclosures with the following exceptions. (i) An area shall be provided for cooling towers and heat rejection equipment when such equipment is used. (ii) An area for the medical gas park and equipment shall be provided. For smaller medical gas systems, the equipment may be housed in a room within the physical plant in accordance with National Fire Protection Association 99, Standard for Health Care Facilities, 2002 edition (NFPA 99), Chapters 4 and 8. (iii) When provided, compactors, dumpsters, and incinerators shall be located in an area remote from public entrances.
(2) Details and finishes. Details and finishes shall be in accordance with § 133.162(d)(2) of this title.
(3) Mechanical requirements. Mechanical requirements shall be in accordance with § 133.162(d)(3) of this title.
(4) Piping systems and plumbing fixtures. Piping systems and plumbing fixtures shall be in accordance with § 133.162(d)(4) of this title.
(5) Electrical requirements. Electrical requirements shall be in accordance with § 133.162(d)(5) of this title.
(i) General stores.
(1) Architectural requirements. Architectural requirements shall be in accordance with § 133.162(d)(1) of this title and this paragraph.
(A) General. In addition to storage facilities in individual departments, a central storage room shall be provided. General stores may be located in a separate building on-site with provisions for protection against inclement weather during transfer of supplies.
(B) Receiving. Facilities for central storage areas shall be provided with an off-street unloading and receiving area protected from inclement weather.
(C) General storage room. General storage room with a total area of not less than 20 square feet per inpatient bed shall be provided. The storage room may be within the facility, or separate building on-site. Fifty percent of the storage may be provided off-premises. When additional inpatient beds are constructed, additional general storage shall be provided.
(2) Details and finishes. Details and finishes shall be in accordance with § 133.162(d)(2) of this title.
(3) Mechanical requirements. Mechanical requirements shall be in accordance with § 133.162(d)(3) of this title.
(4) Piping systems and plumbing fixtures. Piping systems and plumbing fixtures shall be in accordance with § 133.162(d)(4) of this title.
(5) Electrical requirements. Electrical requirements shall be in accordance with § 133.162(d)(5) of this title.
(j) Hospital-based skilled nursing units.
(1) Architectural requirements. When a hospital-based skilled nursing unit is provided, each unit shall comply with the requirements contained in subsection (t)(1) of this section and the requirements listed below. The skilled nursing unit may be separated from the rest of the hospital with two-hour fire protection rated construction in order to define areas for certification inspections.
(A) At least 50% of patient rooms and bathrooms and all public and common use areas in a newly constructed, or reconstructed hospital-based skilled nursing unit, are required to be handicapped accessible in accordance with § 133.162(d)(1)(D) of this title.
(B) At least 10% of patient rooms and bathrooms and all public and common use areas shall be made handicapped accessible in accordance with § 133.162(d)(1)(D) of this title when remodeling a hospital-based skilled nursing unit or remodeling an existing nursing unit to a hospital-based skilled nursing unit.
(C) Activity and dining space shall be part of the unit. It may be located in a separate room or open to the corridor and shall be convenient to the unit. The floor area of this space shall provide at least 30 square feet per patient bed with a minimum of 160 square feet. Additional space shall be required if this space is also used for other programs.
(D) When physical and occupational therapy services are provided for rehabilitating patients, spaces and equipment that conform to program intent shall be provided. These spaces may be located in the unit or elsewhere in the hospital.
(E) Each unit shall have at least one assisted bathing wheelchair shower or tub room per floor or nursing unit. The bathtub shall be accessible to patients in wheelchairs or the shower shall accommodate a gurney. The room shall be centrally located, convenient to the units and shall be directly accessible from the corridor. The room shall have space for drying and dressing and provided with hand washing fixture with hands-free operable controls and toilet training facilities with three feet of clear space on sides and front of the water closet.
(F) A housekeeping room shall be provided for the exclusive use of the unit. The housekeeping room shall contain a floor receptor or service sink and storage space for housekeeping supplies and equipment.
(2) Details and finishes. Each unit shall comply with the requirements contained in subsection (t)(2) of this section and this paragraph.
(A) All portions of corridor walls in the unit with an uninterrupted length of two feet or more shall have graspable handrails. The handrails shall comply with NFPA 101, § 7.2.2.4, and the provisions found in 16 TAC Chapter 68, Texas Accessibility Standards, April 1, 1994 edition, issued by the Texas Department of Licensing and Regulation, under the Texas Architectural Barriers Act, Texas Government Code, Chapter 469. No handrail shall protrude more than three and one-half inches into the egress corridor. All handrail ends shall be returned to the wall.
(B) Floor finishes shall comply with the requirements of § 133.162(d)(2)(B)(iii) of this title.
(3) Mechanical requirements. Mechanical requirements in each unit shall be in accordance with subsection (t)(3) of this section.
(4) Plumbing fixtures and piping systems. The plumbing fixtures and piping systems shall be in accordance with subsection (t)(4) of this section.
(5) Electrical Requirements. Electrical requirements shall be in accordance with subsection (t)(5) of this section. The nurse call shall be in accordance with § 133.162(d)(5)(L) and Table 7 of § 133.169(g) of this title.
(k) Hyperbaric suite.
(1) Architectural requirements. When a hyperbaric suite is provided, it shall meet the requirements of Chapter 20, NFPA 99, and Chapter 18, NFPA 101.
(A) Hyperbaric chamber clearances. Multiple occupancy chambers (Class A) shall be in accordance with NFPA 99, Chapter 20. The minimum clearances for individual (Class B) hyperbaric chambers and the side of a chamber and a wall/partition shall be a minimum of three feet. The clearance between sides of chambers shall be a minimum of six feet. The minimum distance at the chamber entry shall not be less than seven feet for single load area/room or ten feet for double load area/room. Four feet of the passage space at the chamber entry may be shared between two chambers. The chamber room shall contain cabinets, medication storage, work counter and a hand washing fixture with hands-free operable controls. The fixed and movable cabinets and shelves shall not encroach upon the chamber clear floor space/area. The requirements of this subparagraph are illustrated in Table 8, Diagram F of § 133.169(h) of this title.
(B) Service areas. The following minimum service areas and facilities shall be provided convenient to the hyperbaric chamber suite. (i) Patient waiting area. The area shall be out of traffic, under staff control, and shall have seating capacity in accordance with the functional program. Outpatients and inpatients shall be provided with separate waiting areas with screening for visual privacy between the waiting areas. Patient waiting areas may be omitted for two or less individual hyperbaric chamber units. (ii) Control desk and reception area. A control desk and reception area shall be provided. (iii) Holding area. A holding area under staff control shall accommodate inpatients on stretchers or beds. Stretcher patients shall be out of the direct line of normal traffic. The patient holding area may be omitted for two or less individual hyperbaric chamber units. (iv) Patient toilet rooms. Toilet rooms shall be provided with hand washing fixtures with hands-free operable controls and with direct access from the hyperbaric suite. (v) Patient dressing room(s). A dressing room(s) for outpatients shall be provided and shall include a seat or bench, mirror, and provisions for hanging patients' clothing and for securing valuables. At least one dressing room shall be provided to accommodate wheelchair patients. (vi) Staff facilities. Toilets with hand washing fixtures with hands-free operable controls may be outside the suite but shall be convenient for staff use. These facilities may be shared with an adjacent suite. (vii) Consultation room. An appropriate consultation room for individual consultation with referring clinicians shall be provided for outpatients. This room may be shared with an adjacent suite. (viii) Storage space. A clean storage space shall be provided for clean supplies and linens. The space shall contain a hand washing fixture with hands-free operable controls. The storage room may be shared with another department if convenient to both. (ix) Soiled holding room. A soiled holding room shall be provided with waste receptacles and soiled linen receptacles. This room may be shared with an adjacent suite. (x) Hand washing. A lavatory equipped for hand washing with hands-free operable controls shall be located in the room where the hyperbaric chambers are located. (xi) Housekeeping room. The housekeeping room shall contain a floor receptor or service sink, storage space for housekeeping supplies and equipment, and be located nearby.
(2) Details and finishes. Details and finishes shall be in accordance with § 133.162(d)(2) of this title.
(3) Mechanical requirements. Mechanical requirements shall be in accordance with § 133.162(d)(3) of this title.
(4) Piping systems and plumbing fixtures. Piping systems and plumbing fixtures shall be in accordance with § 133.162(d)(4) of this title.
(5) Electrical requirements. Electrical requirements shall be in accordance with § 133.162(d)(5) of this title and this paragraph.
(A) Grounding of hyperbaric chambers shall be connected only to the equipment ground in accordance with NFPA 99, § 3-3.2.1.2, and National Fire Protection Association 70, National Electrical Code, 1999 edition, (NFPA 70), Article 250 (A) - (C), and Article 517.
(B) Additional grounds such as earth or driven grounds shall not be permitted.
(C) The nurse call shall be in accordance with § 133.162(d)(5)(L) and Table 7 of § 133.169(g) of this title.
(l) Imaging suite.
(1) Architectural requirements.
(A) General. Each hospital shall have a diagnostic radiographic (X-ray) room convenient to emergency, surgery, cystoscopy, and outpatient suites. (i) All diagnostic imaging room sizes shall be in compliance with the manufacturer's recommendations for the specific equipment. Clearance and unobstructed space shall not be less than three feet around the diagnostic equipment. (ii) When radiation protection is required for any diagnostic imaging room, a medical physicist licensed under the Texas Medical Physics Practice Act, Occupations Code, Chapter 602, shall specify the type, location, and amount of radiation protection to be installed for the layout and equipment selections. (iii) Each room where radiation protection is required shall include a shielded control alcove. The control alcove shall be provided with a view window designed to permit full view of the examination table and the patient at all times. (iv) Warning signs capable of indicating that the equipment is in use shall be provided. (v) Diagnostic and procedure room intended for patients with airborne infectious diseases shall meet the ventilation requirements as contained in Table 3 of § 133.169(c) of this title.
(B) Diagnostic X-ray and radiographic and fluoroscopy (R&F) rooms. X-ray and R&F rooms shall be in compliance with the manufacturer's recommendations for the specific equipment. Clearance and unobstructed space shall not be less than three feet around the diagnostic equipment. (i) A control alcove shall be provided with a view window designed to provide full view of the patient at all times. (ii) A toilet room shall be provided including a hand washing fixture with hands-free operable controls and have direct access to each R&F room and a corridor.
(C) Noninvasive angiography imaging room. When noninvasive angiography imaging is provided, the room shall have minimum clear floor area of 250 square feet exclusive of built-in shelves or cabinets. Clearance and unobstructed space shall not be less than three feet around the diagnostic equipment. (i) A control alcove shall be provided with a view window designed to provide full view of the patient at all times. (ii) A viewing room or area shall be provided and shall be a minimum of 10 feet in length. The viewing room or area may be provided in combination with the control room. (iii) A scrub sink shall be near the entrance to each angiographic room and shall be recessed out of the main traffic areas or corridor. Scrub facilities shall be arranged to minimize any incidental splatter on nearby personnel or supply carts. (iv) Storage space for portable equipment and supplies shall be provided.
(D) Computerized tomography (CT) scanning. When CT services are provided, the CT room(s) size shall be in compliance with the manufacturer's recommendations and shall contain the following. (i) A control room shall be provided with a view window permitting view of the patient. The control room shall be located to allow convenient film processing. (ii) A patient toilet shall be provided conveniently to the procedure room. When directly accessible to the scan room, the toilet shall be arranged so that a patient may leave the toilet room without having to reenter the scan room. The toilet room shall have a hand washing fixture with hands-free operable controls.
(E) Mammography. When mammography services are provided, the room(s) shall have a minimum clear floor area of 100 square feet exclusive of built-in shelves or cabinets. (i) A control alcove shall be provided with a view window designed to provide full view of the patient at all times. (ii) When mammography machines with built-in shielding for the operator are provided, the alcove may be omitted when approved by a medical physicist licensed under the Texas Medical Physics Practice Act, Occupations Code, Chapter 602.
(F) Magnetic resonance imaging (MRI). When MRI services are provided, the room shall be of sufficient size to house equipment but no less than 325 square feet of clear floor area exclusive of built-in shelves or cabinets. (i) A control alcove shall be provided with a view window designed to provide full view of the patient at all times. (ii) A separate computer room shall be provided to accommodate the equipment. (iii) When cryogen is provided, a storage room or closet shall have a minimum clear floor area of 50 square feet for two large dewars of cryogen. A storage room or closet shall be required in areas where service to replenish supplies is not readily available. (iv) When a darkroom is provided, the room shall be located near the required control room and shall be outside the 10-gauss field. (v) When spectroscopy is provided, caution should be exercised in locating it in relation to the magnetic fringe fields. (vi) Magnetic shielding may be required to restrict the magnetic field plot. Radio frequency shielding is required to attenuate stray radio frequencies. (vii) A patient holding area shall be provided and shall be located near the MRI unit and be large enough to accommodate stretchers. (viii) A hand washing fixture with hands-free controls shall be provided near the entrance to the MRI room and shall be recessed out of the main traffic areas or corridor. (ix) A 3T or larger magnetic strength MRI shall be secured behind locked doors. The patient and staff entrance to the MRI shall have a traffic pattern from the waiting, dressing, holding and work areas through a lockable control station before entering the MRI. At no time shall patients or nonpatients be allowed to enter this restricted area without MRI staff present when the magnet is active.
(G) Ultrasound room. When ultrasound services are provided, the room(s) size shall be in compliance with the manufacturer's recommendations. A patient toilet room shall be provided convenient to the procedure room and a corridor. The toilet room shall have a hand washing fixture with hands-free operable controls.
(H) Cardiac catheterization laboratory. The cardiac catheterization laboratory is normally a separate suite, but may be within the imaging suite. If provided, a cardiac catheterization laboratory shall comply with the requirements of subsection (dd)(1)(C) of this section.
(I) Service areas. The following common service areas shall be provided. (i) Patient waiting area. The area shall be out of traffic and under direct staff visual control. When the waiting area serves both outpatient and inpatients, separate areas shall be provided and include visual privacy between the waiting areas. (ii) Control desk and reception area. A control desk and reception area shall be provided. (iii) Holding area. The holding area shall be out of direct traffic patterns and under visual control by staff. A minimum of one stretcher station shall be provided for each three diagnostic and procedure rooms or fraction thereof. The minimum clear floor space in the holding area shall be 80 square feet exclusive of aisles and fixed and moveable cabinets and shelves. The area shall contain cabinets, a work counter, and a hand washing fixture with hands-free operable controls. The holding area may be reduced to 50 square feet exclusive of aisles and fixed and moveable cabinets and shelves for mammography, bone density and other similar procedures. (iv) Post-procedure observation room. When invasive diagnostic X-ray services for outpatients are provided with anesthesia, a room for extended post-procedure observation of patients shall be provided. The minimum clear floor space for the observation space shall be 100 square feet exclusive of aisles and fixed and moveable cabinets and shelves. The room shall contain cabinets, a work counter, and a hand washing fixture with hands-free operable controls. (v) Patient toilet rooms. Toilet room(s) with hand washing facilities shall be located convenient to the waiting area. (vi) Patient dressing rooms or cubicles. Dressing rooms or cubicles shall be convenient to the waiting areas and X-ray rooms. Each room shall include a seat or bench, mirror, and provisions for hanging patients' clothing and for securing valuables. At least one dressing room shall be provided to accommodate wheelchair patients. (vii) Hand washing facilities. A hand washing fixture with hands-free controls shall be provided in or near the entrance to each diagnostic and procedure room unless noted otherwise. When a hand washing fixture is provided in the room, the fixture shall be located near the entrance to the room or near the staff entrance. When a hand washing fixture is located outside the room, the fixture shall be recessed in the egress corridor and located within five feet of the entrance to the room. Hand washing facilities shall be arranged to minimize any incidental splatter on nearby personnel or equipment. (viii) Staff facilities. Toilets may be outside the suite and may be shared with other departments but shall be convenient for staff use. When four or more diagnostic or procedure imaging rooms are provided, a staff toilet is required with a hand washing fixture with hands-free controls. (ix) X-ray film illuminator viewers. When all the diagnostic and imaging procedures are provided with digital imaging, two mounted X-ray film illuminator viewers shall be provided in the central viewing area/room. (x) Contrast media preparation. This room shall include a work counter, a sink with hands-free operable controls, and storage. One preparation room may serve any number of rooms. When prepared media is used, this area may be omitted, but storage shall be provided for the media. (xi) Film processing room. A darkroom shall be provided for processing film unless the processing equipment normally used does not require a darkroom for loading and transfer. When daylight processing is used, the darkroom may be minimal for emergency and special uses. Film processing shall be located convenient to the procedure rooms and to the quality control area. (xii) Quality control area or room. An area or room for film viewing shall be located near the film processor. All view boxes shall be illuminated to provide light of the same color value and intensity. (xiii) Film storage (active). When X-ray film is used, it shall be stored in a room with a cabinet or shelves for filing patient film for immediate retrieval. (xiv) Film storage (inactive). When X-ray film is used, a room for inactive film storage shall be provided. It may be outside the imaging suite, but must be under the administrative control of imaging suite personnel and be properly secured to protect films against loss or damage. (xv) Storage for unexposed film. When X-ray film is used, storage facilities for unexposed film shall include protection of film against exposure or damage. (xvi) Storage of cellulose nitre film. When used, cellulose nitrate film shall be stored in accordance with the requirements of National Fire Protection Association 40, Standard for the Storage and Handling of Cellulose Nitrate Motion Picture Film, 1994 edition. (xvii) Additional spaces. When four or more diagnostic or procedure rooms are provided in the hospital, the following shall be required:
(I) office(s) for radiologist(s) and assistant(s);
(II) clerical office spaces, as necessary for the functional program;
(III) consultation area/room;
(IV) medication station. Storage and preparation of medication shall be done from a room, alcove area, or from a self-contained dispensing unit but must be under visual control of nursing staff. A work counter, hand washing fixture with hands-free operable controls, refrigerator, and double-locked storage for controlled substances shall be provided. Standard cup-sinks are not acceptable for hand washing;
(V) clean storage room. Clean storage room shall be provided for clean supplies and linens. A hand washing fixture shall be provided with hands-free operable controls. When conveniently located, the clean storage room may be shared with another department; and
(VI) soiled workroom. The soiled workroom shall not have direct connection to the diagnostic and procedure rooms. The room shall contain a clinical sink or equivalent flushing type fixture, work counter, hand washing fixture with hands-free operable controls, waste receptacle, and soiled linen receptacle. When contaminated soiled material or fluid waste is not handled, only a soiled holding room shall be required. (xviii) Housekeeping room. The room may serve multiple departments when conveniently located.
(2) Details and finishes. Details and finishes shall be in accordance with § 133.162(d)(2) of this title and this paragraph.
(A) Details. (i) Radiation protection shall be designed, tested and approved by a medical physicist licensed under the Texas Medical Physics Practice Act, Occupations Code, Chapter 602.
(I) Room shielding calculations for linear accelerators, teletherapy units and remote control brachytherapy units must be submitted to the Department of State Health Services' Radiation Control (RC) for approval prior to use. Shielding in diagnostic radiographic rooms will be reviewed by RC inspectors, in the field, subsequent to use. Any changes in design or shielding which affects radiation exposure levels adjacent to those rooms, requires prior approval by RC. The RC mailing address is: Radiation Control, Department of State Health Services, 1100 West 49th Street, Austin, Texas 78756.
(II) Facility design and environmental controls associated with licensable quantities of radioactive material in laboratories and/or imaging rooms shall be approved by RC prior to licensed authorizations. (ii) Where protected alcoves with view windows are required, provide a minimum of one foot six inches from the edge where the glazing and the frame connect and the outside partition edge. (iii) Imaging procedure rooms shall have ceiling heights not less than nine feet. Ceilings containing ceiling-mounted equipment shall be of sufficient height to accommodate the equipment of fixtures and their normal movement.
(B) Finishes. (i) Flooring used in contrast media preparation and soiled workroom shall be of the seamless type as required by § 133.162(d)(2)(B)(iii)(III) of this title. (ii) A lay-in type ceiling is acceptable for the diagnostic and procedure rooms.
(3) Mechanical Requirements. Mechanical requirements shall be in accordance with § 133.162(d)(3) of this title and this paragraph.
(A) The cryogen gas venting from the MRI unit shall be exhausted to the exterior. When a cryogen storage room is provided to replenish supplies, the storage room shall be vented and exhausted to the exterior.
(B) Self-contained air conditioning to supplement the cooling capacity in computer rooms is permitted.
(C) Air handling units serving the imaging suite shall be equipped with filters having efficiencies equal to, or greater than specified in Table 4 of § 133.169(d) of this title.
(4) Piping systems and plumbing fixtures. Piping systems and plumbing fixtures shall be in accordance with § 133.162(d)(4) of this title and this paragraph. When automatic film processors are used, a receptacle of adequate size with hot and cold water for cleaning the processor racks shall be provided.
(5) Electrical requirements. Electrical requirements shall be in accordance with § 133.162(d)(5) of this title and this paragraph.
(A) General. (i) Each imaging procedure room shall have at least four duplex electrical receptacles. (ii) A special grounding system in areas such as imaging procedures rooms where a patient may be treated with an internal probe or catheter shall comply with Chapter 9 of NFPA 99, and Article 517 of NFPA 70. (iii) General lighting with at least one light fixture powered from a normal circuit shall be provided in imaging procedures rooms in addition to special lighting units at the procedure or diagnostic tables.
(B) Nurses calling system. The nurse call shall be in accordance with § 133.162(d)(5)(L) and Table 7 of § 133.169(g) of this title.
(m) Intermediate care suite (Step down suite).
(1) Architectural requirements.
(A) General. The requirements in this subsection apply to intermediate care units for acute care patients who require frequent monitoring that exceed the level of care for nursing units and less than that provided in critical care units. The suite may share services with an adjacent suite.
(B) Intermediate care services and facilities. The following services and facilities shall apply to all classifications of intermediate care unless otherwise noted. (i) In a single-bed patient room, the minimum clear floor area shall be 150 square feet exclusive of anterooms, vestibules, toilet rooms, closets, lockers, wardrobes, and/or alcoves. A minimum of 12 feet width shall be provided for the head wall for each bed. A hand washing fixture with hands-free operable controls shall be located in the patient room and in the patient bathroom. (ii) In a multi-bed intermediate care patient room the maximum capacity shall be no more than four patients per room. In a multiple-bed open ward patient room, the clearance between the side of a bed and a wall/partition shall be a minimum of four feet. The clearance between sides of beds shall be a minimum of eight feet. The minimum distance at the foot of the bed shall not be less than seven feet for single load area/room or ten feet for double load area/room. Four feet of the passage space at the foot of the bed may be shared between two beds. The ward shall contain cabinets, work counter, and washing fixture with hands-free operable controls located centrally to the beds. The fixed and moveable cabinets and shelves shall not encroach upon the bed/gurney clear floor space/area. The requirements of this clause are illustrated in Table 8, Diagram P of § 133.169(h) of this title. (iii) Each single-bed or multi-bed open ward patient room shall have access to a bathroom without having to enter the general corridor area. Each bathroom shall contain a toilet, a hand washing fixture with hands-free operable controls, bathing facilities, and a storage shelf or cabinet. (iv) Each single and open ward patient room shall be located on an exterior wall and shall have a window. In a ward, one window may serve more than one patient. The window sill height shall not exceed three feet above the floor. Patient beds shall not be located more than 50 feet from an exterior window. Patients' views to outside windows shall be direct and not through other clear vision panels. Windows shall be in accordance with subsection (t)(2)(A)(iv) and (v) of this section. (v) The nurse station shall be located to permit direct visual observation of each patient served. Video cameras or mirrors shall not be substituted for direct visual observation. The nurse station shall have space for counters and storage. The counter height shall not exceed 42 inches. The nurse station may be combined with or include centers for reception and communication. In multi-bed intermediate care patient room the nurse station shall be located within the room and have space for counters and storage. (vi) When individual nurse substations are provided and located at each patient room(s), they shall be located to permit direct visual observation of each patient served. The nurse substation shall have space for counter, storage space and a recessed sitting space. The substation shall be at a minimum recessed from the egress corridor one foot six inches. (vii) Visual privacy shall be provided each patient in multi-bed rooms. Design for privacy shall not restrict independent patient access to the corridor, lavatory, or bathroom. (viii) Each patient shall have a separate wardrobe, locker, or closet that is suitable for hanging full-length garments and for storing personal effects. A minimum of 12 lineal inches of hanging space shall be provided per patient.
(C) Service areas. Service areas shall be located in, adjacent to, or readily available to, each nursing unit. Each service area may be arranged and located to serve more than one nursing unit. The following service areas shall be provided. (i) A visitors' waiting space shall be provided with a toilet facility(ies), public telephone(s), and drinking fountain(s). One waiting space may serve other units on the floor. (ii) A nurses station with a hand washing fixture with hands-free operable controls and an adjacent but separate dictation space shall be provided when the single-bed intermediate care patient rooms concept is used. An adjacent nurse station may be used and shared when feasible. (iii) Storage space shall be provided for emergency equipment in the suite. (iv) Storage and distribution of medication may be done from a medicine preparation room, medicine alcove area or from a self-contained medicine dispensing unit but must be under visual control of nursing staff. A work counter, hand washing fixture with hands-free operable controls, refrigerator, and double-locked storage for controlled substances shall be provided. Standard cup-sinks provided in many self-contained units are not acceptable for hand washing. The medication station may be located with the clean work room. (v) A soiled workroom shall be provided. The room shall contain a clinical sink or equivalent flushing rim type fixture with hot and cold mixing faucet, separate hand washing facilities with hands-free operable controls, and separate waste and soiled linen receptacles. When facilities for cleaning bedpans are provided elsewhere, the flushing rim clinical sink may be omitted. (vi) A clean workroom or clean supply room shall be provided. A clean workroom when used for preparing patient care items shall contain a work counter, hand washing facilities with hands-free operable controls, and storage facilities for clean and sterile supplies. When used only for storage and holding as part of a distribution system of clean and sterile supplies, the work counter and hand washing facilities may be omitted. (vii) A nourishment station containing a work counter with sink, microwave, refrigerator and storage cabinets and not located in the clean workroom shall be provided. (viii) A conveniently located examination room shall be provided and have a minimum clear floor area of 100 square feet and contain a counter for writing and hand washing facilities with hands-free operable controls. This room may be omitted if all patient rooms on the floor are single-bed patient rooms. (ix) A housekeeping room shall be provided and contain a service sink, and storage for housekeeping supplies and equipment. A shared nursing unit housekeeping room that is adjacent to the intermediate care suite is acceptable.
(2) Details and finishes. Details and finishes shall be in accordance with § 133.162(d)(2) of this title and this paragraph.
(A) Details. (i) At least one door to an intermediate care multi-bed open ward patient room shall be not less than four feet wide and arranged to minimize interference with movement of beds and large equipment. (ii) Sliding doors in intermediate care rooms shall not have floor tracks and shall have hardware that minimizes jamming possibilities and break-away feature from any position and be in accordance with § 133.162(d)(2)(A)(vi) of this title.
(B) Finishes. (i) Flooring used in soiled workrooms shall be of the seamless type as required by § 133.162(d)(2)(B)(iii)(III) of this title. (ii) Ceilings in the soiled workroom shall be monolithic type as required by § 133.162(d)(2)(B)(vi)(III) of this title.
(3) Mechanical Requirements. Mechanical requirements shall be in accordance with § 133.162(d)(3) of this title and this paragraph. Room recirculating units shall not be used.
(4) Piping systems and plumbing fixtures. Piping systems and plumbing fixtures shall be in accordance with § 133.162(d)(4) of this title.
(5) Electrical requirements. Electrical requirements shall be in accordance with § 133.162(d)(5) of this title and this paragraph.
(A) General. (i) Receptacles at each bed location shall be served by two branch circuits, one or more from the critical branch panel of the emergency electrical system and one or more from the normal system. One critical branch circuit shall serve only one bed location. All branch circuits from the normal system shall be from a single panelboard. All branch circuits from the emergency electrical system shall be from a single panelboard. (ii) A minimum of three hospital grade duplex outlets shall be conveniently located at the head of each bed. At least two of these duplex outlets shall be on the critical branch of the emergency electrical system. (iii) One duplex receptacle connected to a normal branch circuit and one duplex outlet connected to the critical branch circuit shall be located on opposite sides of the head of each bed. In addition at least one duplex outlet shall be located on each wall. A dedicated outlet shall be provided at the television location.
(B) Illumination requirements. (i) Each single patient room and multi-patient wards shall be provided with general lighting and night lighting. General lighting and night lighting shall be controlled at the room entrance. All controls for lighting in patient areas shall be of the quiet operating type. Control of night lighting circuits may be achieved by automatic means and in such instances control of night lighting at the room entrance shall not be required. At least one general light fixture and night lighting shall be powered from the critical branch of the essential electrical system. (ii) A reading light shall be provided over each patient bed. Reading light control shall be readily accessible from each patient bed. Flexible light arms, if used, shall be mechanically controlled to prevent the bulb from coming in contact with bed linen. High heat-producing light sources such as incandescent and halogen shall be avoided to prevent burns to patients and/or bed linen. Light sources shall be covered with a diffuser or a lens. (iii) A wall or ceiling-mounted lighting fixture shall be provided above each lavatory. (iv) A ceiling-mounted fixture shall be provided in patient bathrooms where the lighting fixture above the lavatory does not provide adequate illumination of the entire bathroom. Some form of fixed illumination shall be powered from the critical branch.
(C) Nurses calling systems. The nurse call shall be in accordance with § 133.162(d)(5)(L) and Table 7 of § 133.169(g) of this title.
(n) Laboratory suite.
(1) Architectural requirements.
(A) General. (i) Laboratory facilities and services shall be provided by the hospital such as hematology, clinical chemistry, urinalysis, cytology, anatomic pathology, immunohematology, microbiology, bacteriology and others. (ii) Each laboratory unit shall meet the requirements of Chapter 11 of NFPA 99 (relating to Laboratories), and Chapter 18 of NFPA 101 (relating to New Health Care Occupancies).
(B) Minimum laboratory facilities. When laboratory services are provided off site by contract, the following minimum facilities shall be provided within the hospital. (i) Laboratory work room. The laboratory workroom shall include a counter and a sink with hands-free operable controls. (ii) General storage. Cabinets or closets shall be provided for supplies and equipment used in obtaining samples for testing. A refrigerator or other similar equipment shall be provided for specimen storage waiting for transfer to off-site testing. (iii) Blood storage facilities. Refrigerated blood storage facilities for transfusions shall be provided. The blood storage refrigerator shall be equipped with temperature monitoring and alarm signals. (iv) Specimen collection facilities. A blood collection area shall be provided with a counter, space for seating, and hand washing fixture with hands-free operable controls. A toilet and lavatory with hands-free operable controls shall be provided for specimen collection. This facility may be outside the laboratory suite if conveniently located.
(C) On-site laboratory facilities. When the hospital provides on-site laboratory services, the following facilities shall be provided in addition to the requirements in subparagraphs (A) and (B) of this paragraph. (i) Laboratory workroom(s). The laboratory work room shall include counter(s), space appropriately designed for laboratory equipment and sink(s) with hands-free operable controls. (ii) General storage. Storage, including refrigeration for reagents, standards, supplies, and stained specimen microscope slides, etc. shall be provided. Separate facilities shall be provided for such incompatible materials as acids and bases, and vented storage shall be provided for volatile solvents. (iii) Chemical safety facilities. When chemical safety is a requirement, provisions shall be made for an emergency shower and eye flushing devices. (iv) Flammable liquids. When flammable or combustible liquids are used, the liquids shall be stored in approved containers, in accordance with National Fire Protection Association 30, Flammable and Combustible Liquids Code, 2003 edition. (v) Radioactive materials. When radioactive materials are employed, storage facilities shall be provided.
(D) Bone marrow laboratory. A cryopreservation laboratory and a human leukocyte antigen laboratory shall be provided in hospitals providing bone marrow transplantation services.
(E) Service areas and facilities. The following service areas and facilities shall be provided. (i) Hand washing facilities. Each laboratory room or work area shall be provided with a hand washing fixture(s) with hands-free operable controls. (ii) Office spaces. The scope of laboratory services shall determine the size and quantity for administrative areas including offices as well as space for clerical work, filing, and record maintenance. At a minimum, an office space shall be provided for the use of the laboratory service director. (iii) Staff facilities. Lounge, locker, and toilet facilities shall be conveniently located for male and female laboratory staff. These may be outside the laboratory area and shared with other departments. (iv) Housekeeping room. A housekeeping room shall be located within the suite or conveniently located nearby.
(2) Details and finishes. Details and finishes shall be in accordance with § 133.162(d)(2) of this title. Floors in laboratories shall comply with the requirements of § 133.162(d)(2)(B)(iii) of this title except that carpet flooring shall not be used.
(3) Mechanical requirements. Mechanical requirements shall be in accordance with § 133.162(d)(3) of this title and this paragraph.
(A) No air from the laboratory areas shall be recirculated to other parts of the facility. Recirculation of air within the laboratory suite is allowed.
(B) When laboratory hoods are provided, they shall meet the following general requirements. (i) The average face velocity of each exhaust hood shall be at least 75 feet per minute. (ii) The exhaust shall be connected to an exhaust system to the exterior which is separate from the building exhaust system. Biological safety cabinets with HEPA filters and alarms to alert staff do not have to be exhausted to the exterior. If the air changes for biological safety cabinets as provided in Table 3 of § 133.169(c) of this title do not provide sufficient air for proper operation of the safety cabinets (when in use), supplementary make-up air (filtered and preheated) shall be provided around these units to maintain the required airflow direction and exhaust velocity. Make-up air system for safety cabinets shall be arranged to minimize "short circuiting" of air and to avoid reduction in air velocity at the point of contaminant capture. (iii) The exhaust fan shall be located at the discharge end of the system. (iv) The exhaust duct system shall be of noncombustible and corrosion-resistant material. (v) Where fume hoods are used, the design should consider the placement and types of air distribution devices to avoid the disturbance of a uniform velocity across the face of the hood.
(C) When special laboratory hoods are provided, they shall meet the following special standards for these types of hoods. (i) Fume hoods, and their associated equipment in the air stream, intended for use with perchloric acid and other strong oxidants, shall be constructed of stainless steel or other material consistent with special exposures, and be provided with a water wash and drain system to permit periodic flushing of duct and hood. Electrical equipment intended for installation within such ducts shall be designed and constructed to resist penetration by water. Duct systems serving these hoods shall be constructed of acid-resistant stainless steel for at least 10 feet from the hood. Lubricants and seals shall not contain organic materials. When perchloric acid or other strong oxidants are only transferred from one container to another, standard laboratory fume hoods and the associated equipment may be used in lieu of stainless steel construction. (ii) Each laboratory hood used to process infectious or radioactive materials shall have a minimum face velocity of 90-110 feet per minute, be connected to an independent exhaust system, with suitable pressure-independent air modulating devices and alarms to alert staff of fan shutdown or loss of airflow. Each hood shall also have filters with a 99.97% efficiency (based on the dioctyl-phthalate (DOP) test method) in the exhaust stream, and be designed and equipped to permit the safe removal, disposal, and replacement of contaminated filters. Filters shall be as close to the hood as practical to minimize duct contamination. (iii) Fume hoods intended for use with radioactive isotopes shall be constructed of stainless steel or other material suitable for the particular exposure and shall comply with National Fire Protection Association 801, Standard for Facilities Handling Radioactive Materials, 2003 edition and NFPA 99, § 11.3.5. (iv) Each laboratory hood shall have a suitable pressure-independent air modulating device and alarm to alert staff of fan shutdown or loss of airflow. The alarm shall be audible within the laboratory and at a 24-hour manned location.
(D) Filtration requirements for air handling units serving the laboratory suite shall be equipped with filters having efficiencies equal to, or greater than specified in Table 4 of § 133.169(d) of this title.
(E) Duct linings exposed to air movement shall not be used in ducts serving any laboratory room and clean room unless terminal filters of at least 80% efficiency are installed downstream of linings. This requirement shall not apply to mixing boxes and acoustical traps that have special coverings over such lining.
(4) Piping systems and plumbing fixtures. Piping systems and plumbing fixtures shall be in accordance with § 133.162(d)(4) of this title and this paragraph.
(A) General. (i) Faucet spouts at lavatories and sinks shall have clearances adequate to avoid contaminating utensils and the contents of beakers, test tubes, etc. (ii) Drain lines from sinks used for acid waste disposal shall be made of acid-resistant material. (iii) Drain lines serving some types of automatic blood-cell counters must be of carefully selected material that will eliminate potential for undesirable chemical reactions (and/or explosions) between sodium azide wastes and copper, lead, brass, and solder, etc.
(B) Medical gas systems. When provided, medical gas systems shall comply with § 133.162(d)(4)(A)(iii) and (iv) of this title. The number of outlets in the laboratory for vacuum, gases, and air shall be determined by the functional program requirements.
(5) Electrical requirements. Electrical requirements shall be in accordance with § 133.162(d)(5) of this title.
(A) The blood storage refrigerator shall have an alarm device to indicate a temperature increase or malfunction and indicate an audible warning at a 24-hour manned location.
(B) The blood storage refrigerator shall be connected to the critical branch of the emergency essential electrical system.
(C) All exhausts hoods shall be connected to the emergency essential electrical system.
(o) Laundry suite. Laundry facilities shall be provided on site or off site. On-site laundry services may be within the hospital or in a separate building on-site. The laundry facilities shall be separated from patient rooms, areas of food preparation and storage, and areas in which clean supplies and equipment are stored.
(1) Architectural requirements.
(A) When laundry service is provided on site, it shall comply with the following. (i) Soiled and clean linen processing rooms shall be provided. When the soiled and clean linen processing are combined in a single room, each process shall be physically separated within the room. (ii) Adequate hand washing facilities shall be provided in both the soiled and clean processing areas. (iii) A receiving, holding, and sorting room for control and distribution of soiled linen shall be provided. This area may be combined with the soiled linens processing room. Discharge from soiled linen chutes may be received in the soiled room/area or in a separate dedicated room. (iv) A laundry processing room shall be provided with a commercial washer(s) and dryer(s) capable of processing at least a seven-day laundry supply within the regular scheduled work week. (v) A clean linen processing room/area shall be provided with folding counters or tables. This area shall have provisions for inspections, folding, packing and mending of linen. (vi) A holding room or area for storage and issuing of clean linen shall be provided but may be combined with clean linen processing room. (vii) Storage space and cabinets for soaps, stain removers, and other laundry processing agents shall be located in the soiled and clean processing room/areas. (viii) Laundry equipment shall be arranged so that the processing of laundry is an orderly work flow from soiled to clean operations. Cross-traffic shall be held to a minimum to prevent contamination.
(B) When laundry service is provided off site, the following minimum requirements shall be provided on site: (i) a service entrance which shall have a drive under canopy for protection from inclement weather, for loading and unloading of linen; (ii) a control station for pickup and receiving. This may be a room at the common loading dock, in the soiled linen holding room, or the central clean linen storage room; (iii) a soiled linen holding room; and (iv) a central clean linen storage/issuing room in addition to linen storage required at the individual patient units.
(C) The following areas/rooms shall be provided regardless of delivery type of laundry service: (i) office space for the director of laundry services; (ii) cart storage rooms for clean and soiled linen. The cart storage areas may be provided within the clean and soiled rooms. Carts may not be parked or stored in the egress corridor; (iii) cart sanitizing facilities which comply with subsection (b) of this section; (iv) staff toilet in the laundry suite or convenient for staff use and with a hand washing fixture with hands-free operable controls; (v) lockers for staff use may be in laundry suite or part of a central locker room when convenient to the laundry; and (vi) housekeeping room within the laundry suite or available near by.
(2) Details and finishes. Details and finishes shall be in accordance with § 133.162(d)(2) of this title.
(3) Mechanical Requirements. Mechanical requirements shall be in accordance with § 133.162(d)(3) of this title and this paragraph.
(A) The ventilation system shall include adequate intake, filtration, exchange rate, and exhaust in accordance with Table 3 and Table 4 of § 133.169(c) and (d) of this title, respectively.
(B) Filtration requirements for air handling units serving the laundry suite shall be equipped with filters having efficiencies equal to, or greater than specified in Table 4 of § 133.169(d) of this title.
(C) Direction of air flow of the HVAC systems shall be from clean to soiled areas.
(D) The ventilation system for soiled processing area shall have negative air pressure while the clean processing area shall have positive pressure.
(E) Lint interceptors shall be located outside the laundry area. Drainage piping that serves laundry equipment shall employ suds-control features.
(4) Piping systems and plumbing fixtures. Piping systems and plumbing fixtures shall be in accordance with § 133.162(d)(4) of this title.
(5) Electrical requirements. Electrical requirements shall be in accordance with § 133.162(d)(5) of this title.
(p) Medical records suite.
(1) Architectural requirements. The following rooms, areas, or offices shall be provided in the medical records suite:
(A) medical records administrator or technician office;
(B) review and dictating rooms or spaces;
(C) work area which includes provisions for sorting, recording, scanning, or microfilming records; and
(D) file room. When nondigital files are stored on site, the room shall be considered as hazardous. The construction protection for the storage room or area shall comply with Chapter 18 of NFPA 101, § 18.3.2.
(2) Details and finishes. Details and finishes shall be in accordance with § 133.162(d)(2) of this title.
(3) Mechanical requirements. Mechanical requirements shall be in accordance with § 133.162(d)(3) of this title.
(4) Piping systems and plumbing fixtures. Piping systems and plumbing fixtures shall be in accordance with § 133.162(d)(4) of this title.
(5) Electrical requirements. Electrical requirements shall be in accordance with § 133.162(d)(5) of this title.
(q) Mental health and chemical dependency nursing suite.
(1) Architectural requirements. When mental health and chemical dependency patient care services are provided, the suite shall comply with the requirements contained in subsection (t)(1) of this section and the requirements of this paragraph.
(A) A minimum of two separate social spaces, one appropriate for noisy activities and the other for quiet activities, shall be provided. The combined total area shall be not less than 40 square feet per bed with not less than 120 square feet for each of the two spaces, whichever is greater.
(B) A room for group therapy shall be provided. The room shall not be less than 250 square feet. The group therapy room may be combined with the quiet space required in subparagraph (A) of this paragraph when the unit accommodates not more than 12 patients.
(C) Space shall be provided for occupational therapy at the rate of 15 square feet per bed with a minimum total area of 200 square feet, whichever is greater. Space shall include hand washing, work counters, storage, and displays. When the mental health and chemical dependency nursing unit contains less than 12 beds, the occupational therapy functions may be performed within the noisy activities area, if at least 10 additional square feet per patient served is included.
(D) A consultation room for each 12 beds or any portion thereof shall be provided. Each consultation room shall have a minimum floor space of 100 square feet. Each room shall be designed for acoustical and visual privacy.
(E) There shall be a suite in each nursing unit for mental health and chemical dependency patients intended for short-term occupancy by a single person requiring security and protection from self or others. The seclusion suite shall consist of seclusion room(s), an anteroom or a vestibule, and a toilet. (i) Each seclusion room shall be located and designed in a manner affording direct visual supervision by nursing staff and shall be constructed to prevent patient hiding, escape, injury, or suicide. There shall be a minimum of one seclusion room for each 24 beds or any portion thereof.
(I) The floor area of each seclusion room shall be not less than 60 square feet. The minimum room dimension shall be 6 feet.
(II) The seclusion room shall have a minimum ceiling height of 9 feet.
(III) The door to each seclusion room shall have no hardware on the room side and shall open out. A vision panel shall be provided in each door to permit staff observation of the entire room while maintaining privacy from the public and other patients.
(IV) Each seclusion room shall have natural light (skylight or window) in order to maintain a therapeutic environment. Skylight wells or windows shall be not less than 400 square inches in area. (ii) Access to the seclusion room from any public space such as a corridor shall be through an anteroom. When the seclusion suite is directly accessible from the nurse station, a vestibule may be provided in place of an anteroom. A cased opening to the vestibule in lieu of a door may be provided as long as the arrangement assures privacy from the public and other patients.
(I) At least one dimension of the anteroom or vestibule shall be 8 feet.
(II) The door to the anteroom shall swing out. (iii) There shall be at least one toilet room directly accessible from the anteroom or vestibule.
(I) The toilet room shall be a minimum of 50 square feet.
(II) The toilet room door shall swing out into the anteroom or vestibule.
(III) A water closet and hand washing facilities shall be provided in the toilet room. An unbreakable wall hung mirror may be provided.
(F) When a smoking room is provided, all air shall have a dedicated exhaust system to the exterior.
(G) Service areas shall be provided in accordance with the requirements of subsection (t)(1)(F) of this section and the following additional requirements. (i) Nurses and doctor's charting areas shall be provided with separation needed for acoustical privacy as well as space required for the function. A view window to permit observation of patient area by the charting nurse or physician may be used provided that it is located so that patient files cannot be read from outside the charting space. (ii) A small kitchen for patient use shall be provided. It shall contain a sink, refrigerator, kitchen cabinets, ice dispenser, and a microwave. This kitchen may serve as a nourishment center for patients between meals. It may be located in the noisy activity area. (iii) Patient laundry facilities with automatic washer and an electric dryer shall be provided. This requirement may be omitted in nursing units intended only for adolescent and gero-psychiatric patients.
(2) Details and finishes. Details and finishes in each mental health and chemical dependancy nursing unit shall comply with the requirements contained in subsection (t)(2) of this section and this paragraph.
(A) Details. (i) The type and degree of security and patient safety required in the suite shall be determined by hospital administration and described in the hospital's functional program narrative, unless stated otherwise within these rules. (ii) All areas of the mental health suite, including entrances to patient rooms, shall be visible from the nurse station(s). Observation by video cameras of seclusion rooms, entrances, hallways, and activity areas shall be acceptable. (iii) All exposed and accessible fasteners shall be tamper-resistant. (iv) Suitable hardware shall be provided on doors to toilet rooms so that access to these rooms can be controlled by staff. Hardware shall be utilized which is appropriate to prevent patient injury. (v) Only breakaway or collapsible clothes bars in wardrobes, lockers, and closets and shower curtain rods shall be permitted in nursing units for mental health and chemical dependency patients. (vi) Wire coat hangers shall not be permitted in the suite. (vii) Special fixtures, hardware, and tamper-proof screws are required throughout the suite. (viii) Horizontal grab bars shall be constructed to prevent looping or tying of cords, ropes, etc. (ix) Where glass fragments may create a hazard, safety glazing or other appropriate security features shall be incorporated.
(B) Finishes. Patient sleeping rooms, patient toilet rooms and seclusion rooms shall have monolithic ceilings and bonded walls for patient safety and security measures. The ceiling in the soiled workroom shall be monolithic type as required by § 133.162(d)(2)(B)(vi)(III) of this title. Gero-psychiatric patient rooms and toilet rooms may omit the monolithic ceiling requirement when hospital administration provides a written statement (on hospital letterhead) that the type and degree of security is appropriate for the patient areas.
(3) Mechanical requirements. Mechanical requirements shall be in accordance with subsection (t)(3) of this section and this paragraph.
(A) Special consideration shall be given to the type of heating and cooling units, ventilation outlets, and appurtenance installed in patient-occupied areas of mental health nursing units. The following shall apply:
(B) All air grilles and diffusers shall be of a type that prevents the insertion of foreign objects.
(C) All convector or HVAC enclosures exposed in the room shall be constructed with rounded corners and shall have enclosures fastened with tamper-resistant fasteners.
(D) HVAC equipment shall be of a type that minimizes the need for maintenance within the room.
(4) Piping systems and plumbing fixtures. Piping systems and plumbing fixtures shall be in accordance with subsection (t)(4) of this section and this paragraph.
(A) Piping systems. (i) Piped medical gas systems are not required. (ii) Only tamper-proof sprinkler and tamper-proof showerheads from which it is not possible to suspend any objects shall be installed.
(B) Plumbing fixtures. (i) Faucet controls shall not be equipped with handles that may be easily broken off. (ii) Bedpan washers are not required in patient bathrooms.
(5) Electrical requirements. Electrical requirements shall be in accordance with subsection (t)(5) of this section and this paragraph.
(A) A nurses calling system is not required in patient rooms. However, when a nurses calling system is provided, the system shall meet the requirements of § 133.162(d)(5)(L) and Table 7 of § 133.169(g) of this title. Pull cords shall not exceed 18 inches in length, and provisions shall be made to permit removal of call buttons and use of blank plates as required for security.
(B) Each patient room shall have duplex grounded receptacles. There shall be one receptacle at each side of the head of each bed and one on every other wall. Receptacles in areas intended for mental health and chemical dependency patients of all ages shall be protected by GFCI breakers installed in distribution panel enclosures serving the unit.
(C) Fifteen-ampere and 20-ampere, 125-volt receptacles intended to supply patient care areas shall be tamper-resistant as permitted by NFPA 70, § 517-18, or shall be protected by GFCI breakers. A tamper-resistant receptacle is one that is constructed to limit improper access to its energized contacts.
(r) Morgue.
(1) Architectural requirements.
(A) General. When a morgue or body-holding room is provided, it shall be located to avoid the need for transporting bodies of deceased patients through public areas. A body-holding room shall be provided as a minimum for a general hospital.
(B) Autopsy performed within hospital. When autopsies are performed within the hospital, the following rooms, areas, and equipment shall be provided. (i) Refrigerated facilities shall be provided for body-holding. (ii) The autopsy room shall contain work counters, hand washing facilities with hands-free operable controls, autopsy table and storage space for supplies, equipment and specimens. (iii) A deep sink shall be provided for washing specimens. (iv) A clothing change area shall be provided with shower, toilet, hand washing facilities and lockers.
(C) Service areas. The following service areas shall be provided: (i) a pathologist office; (ii) staff toilets. Toilets may be outside the suite but be convenient for staff use with hand washing fixture(s) with hands-free operable controls; and (iii) a housekeeping room. A housekeeping room which meets the requirements of § 133.162(d)(2)(A)(xxviii) of this title shall be provided for the exclusive use of the morgue when autopsies are performed.
(D) Minimum requirements. If autopsies are performed outside the hospital, a well-ventilated, temperature-controlled, nonrefrigerated body-holding room shall be provided.
(2) Details and finishes. Details and finishes shall be in accordance with § 133.162(d)(2) of this title and this paragraph.
(A) Flooring used in the autopsy room shall be the seamless type as required by § 133.162(d)(2)(B)(iii)(III) of this title.
(B) Ceilings in the autopsy rooms shall be monolithic as required by § 133.162(d)(2)(B)(vi)(III) of this title.
(3) Mechanical requirements. Mechanical requirements shall be in accordance with § 133.162(d)(3) of this title and this paragraph.
(A) The autopsy room shall be equipped with low exhaust grilles.
(B) The body-holding room shall be ventilated in accordance with Table 3 of § 133.169(c) of this title.
(4) Piping systems and plumbing fixtures. Piping systems and plumbing fixtures shall be in accordance with § 133.162(d)(4) of this title.
(5) Electrical requirements. Electrical requirements shall be in accordance with § 133.162(d)(5) of this title and this paragraph. Refrigerators for body-holding in the autopsy room shall be connected to the equipment branch of the essential electrical distribution system.
(s) Nuclear medicine suite.
(1) Architectural requirements.
(A) General. When nuclear medicine services are provided, the facilities may be in a separate suite or combined with an imaging suite. (i) When nuclear medicine requires radiation protection, a medical physicist licensed under the Texas Medical Physics Practice Act, Occupations Code, Chapter 602, shall specify the type, location, and amount of radiation protection to be installed for the layout, equipment selections and storage, handling and disposal of radioactive material. (ii) The nuclear medicine room shall be sufficiently sized to house all fixed and moveable equipment and allow a minimum of three feet of clear and unobstructed working space on all sides of equipment accessible to staff and patient.
(B) Radioisotope room (Hot lab). When radiopharmaceutical preparation is performed on site, the room shall include sufficient space for equipment, storage of radionuclides, chemicals for preparation, dose calibrators, and record keeping. When preprepared materials are used, storage and calculation area may be smaller than for on-site preparation. (i) The room and isotope handling areas within the room shall have appropriate radiation shielding. (ii) There shall be a shielded area or enclosed shielded cabinet for long-term storage of decaying radioisotopes. (iii) When venting of radioactive gases is required, a hood shall exhaust to the exterior.
(C) Positron emission tomography (PET). When PET services are provided, scanner and cyclotron rooms shall be in compliance with the manufacturer's recommendations and provide a minimum of three feet of clear and unobstructed working space on all sides of equipment accessible to staff and patient. (i) A control alcove shall be provided with a view window permitting view of the patient. (ii) An equipment area large enough to contain necessary electronic and electrical gear shall be provided. (iii) A dose administration room(s) with radiation shielding shall be located near the treatment room. Patients in route to procedure rooms shall not pass through public corridors and waiting rooms after injection with radioisotope. (iv) A patient toilet with radiation shielding shall be provided with or adjacent to dose administration room(s). The patient toilet room shall contain a hand washing fixture with hands-free operable controls.
(D) Service areas. (i) Patient waiting area. The area shall be out of traffic and under direct staff visual control. When the waiting area serves both outpatients and inpatients, separate areas shall be provided and include visual privacy between the waiting areas. (ii) Control desk and reception area. A control desk and reception area shall be provided. (iii) Dictation and report preparation area. The dictation and report preparation area may be incorporated with the control station. (iv) Holding area. The holding area shall be under direct staff control, out of the direct line of traffic, and have space for stretchers. The holding area shall accommodate two stretchers for the first procedure room with one additional station for each additional procedure room. (v) Patient toilet facilities. A toilet room with a hand washing fixture with hands-free operable controls shall be provided convenient to the waiting room and procedure room. (vi) Staff toilet facilities. Toilets and hand washing fixtures with hands-free operable controls may be outside the suite but shall be convenient for staff use. (vii) Patient dressing rooms or cubicles. Dressing rooms or cubicles shall be provided convenient to the waiting areas and procedure rooms. Each room or cubicle shall include a seat or bench, mirror, and provisions for hanging patients' clothing and for securing valuables. At least one dressing room shall be provided to accommodate wheelchair patients. (viii) Exam room(s). When examination rooms are provided, each room shall have a minimum of 100 square feet of clear floor area exclusive of built-in shelves or cabinets. Each exam room shall be equipped with a work counter and a hand washing fixture with hands-free operable controls. (ix) Dose administration area. When a dose administration area is provided, the area shall be located near the preparation area and include visual privacy for the patients. (x) Computer control area/room. Computer control area shall be located within or adjacent to the treatment room(s). When a centralized computer area is provided, it shall be a separate room with access terminals available within the treatment rooms. (xi) Film processing room. A darkroom shall be provided for film processing unless the processing equipment normally used does not require a darkroom for loading and transfer. When daylight processing is used, the darkroom may be minimal for emergency and special uses. Film processing shall be located convenient to the treatment room(s) and to the quality control area. (xii) Quality control area or room. A quality control area shall include view boxes illuminated with light of the same color value and intensity. (xiii) Film storage room (active). A room with cabinet or shelves for filing patient film for immediate retrieval shall be provided. (xiv) Film storage room (inactive). A room for inactive film storage may be located outside the nuclear medicine suite, but must be under the administrative control of nuclear medicine personnel and properly secured to protect films against loss or damage. (xv) If digital imaging is utilized throughout the suite, the darkroom film processing area and film viewers may be omitted. (xvi) Storage for unexposed film. Storage facilities for unexposed film shall include protection of film against exposure or damage. (xvii) Offices for physicians, oncologist, physicists, and assistants. Offices shall include provisions for individual consultation, viewing, and charting of film. (xviii) Clerical office(s) spaces. Clerical office(s) spaces shall be provided. (xix) Consultation room. A consultation room shall be provided. (xx) Clean storage room. A clean storage room shall be provided for clean supplies and linens. A hand washing fixture shall be provided with hands-free operable controls. When conveniently located, the clean storage room may be shared with another department. (xxi) Soiled workroom. The soiled workroom shall not have direct connection to the nuclear medicine procedure or diagnostic rooms or sterile activity rooms. The room shall contain a clinical sink or equivalent flushing type fixture, work counter, hand washing fixture with hands-free operable controls, waste receptacle, and soiled linen receptacle. When contaminated soiled material or fluid waste is not handled, only a soiled holding room is required. (xxii) Housekeeping room. The housekeeping room shall be located within the suite.
(2) Details and finishes. Details and finishes shall be in accordance with § 133.162(d)(2) of this title and this paragraph.
(A) Details. (i) Radiation protection shall be designed, tested and approved by a medical physicist licensed under the Texas Medical Physics Practice Act, Occupations Code, Chapter 602.
(I) Room shielding calculations for the stipulated rooms within the nuclear medicine suite must be submitted to the Department of State Health Services, Radiation Control (RC) for approval prior to use. Shielding in diagnostic radiographic rooms will be reviewed by RC inspectors, in the field, subsequent to use. Any changes in design or shielding which affects radiation exposure levels adjacent to those rooms, requires prior approval by RC.
(II) Facility design and environmental controls associated with licensable quantities of radioactive material in laboratories or procedure rooms must be approved by RC prior to licensed authorizations. (ii) The nuclear medicine treatment rooms shall have ceiling heights not less than nine feet. Ceilings containing ceiling-mounted equipment shall be of sufficient height to accommodate the equipment of fixtures and their normal movement.
(B) Finishes. (i) Flooring used in the nuclear medicine procedure room, any work or treatment areas where radioactive material is handled, and soiled workroom shall be of the seamless monolithic type as required by § 133.162(d)(2)(B)(iii)(III) of this title. (ii) Ceilings in radiopharmacy, hot laboratory, and soiled workrooms shall be monolithic as required by § 133.162(d)(2)(B)(vi)(III) of this title.
(3) Mechanical requirements. Mechanical requirements shall be in accordance with § 133.162(d)(3) of this title and this paragraph.
(A) When radiopharmaceutical preparations are performed, vents and traps for radioactive gases shall be provided.
(B) Direction of air flow of the HVAC system shall be from nonradioactive spaces into the radioactive spaces. A minimum of two return air inlets located diagonally opposite from one another and near floor level shall be provided.
(C) In the PET suite, special ventilation systems together with monitors, sensors, and alarm systems shall be required to vent gases and chemicals. The ventilation shall be directly to the exterior.
(D) Filtration requirements for air handling units serving the nuclear medicine suite shall be equipped with filters having efficiencies equal to, or greater than specified in Table 4 of § 133.169(d) of this title.
(E) Where fume hoods are used, the design should consider the placement and types of air distribution devices to avoid the disturbance of a uniform velocity across the face of the hood. Fume hoods shall be exhausted directly to the exterior.
(4) Piping systems and plumbing fixtures. Piping systems and plumbing fixtures shall be in accordance with § 133.162(d)(4) of this title.
(5) Electrical requirements. Electrical requirements shall be in accordance with § 133.162(d)(5) of this title and this paragraph.
(A) General. (i) Each nuclear medicine procedure room shall have at least four duplex electrical hospital grade receptacles. (ii) Nuclear medicine procedures rooms shall have general lighting in addition to that provided by special lighting units at the procedure tables.
(B) Nurses calling systems. The nurse call shall be in accordance with § 133.162(d)(5)(L) and Table 7 of § 133.169(g) of this title.
(t) Nursing unit. The requirements in this subsection apply to nursing units in hospitals for all types of inpatient care. Facilities providing care to less than 15 pediatric inpatients may be included with an adult nursing unit. Additional requirements for a nursing unit providing care to 15 or more pediatric patients are contained in subsection (w) of this section.
(1) Architectural requirements. Architectural requirements shall be in accordance with § 133.162(d)(1) of this title and this paragraph.
(A) Handicapped accessibility requirements. At least 10% of each patient room type, isolation room, bathing units and toilets in medical/surgical, intermediate care, universal care, antepartum, postpartum, mental health, chemical dependency, and pediatric nursing units and all public and common use areas shall be designed and constructed to be handicapped accessible. These requirements shall apply in all new construction and when an existing nursing unit or a portion thereof is converted from one service to another, i.e. mental health care to medical or surgical nursing care.
(B) Patient room suites. A patient room suite shall consist of the patient room and a bathroom. Patient room suites shall comply with the following requirements. (i) Maximum patient room capacity. The maximum patient room capacity shall be two patients. In existing facilities where renovation work is undertaken and the present capacity is more than two patients, the maximum room capacity shall be no more than the present capacity with a maximum of four patients. (ii) Single-bed patient room. In a single-bed patient room, the minimum clear floor area shall be 120 square feet. (iii) Multi-bed (two) patient room. The clearance between the side of a bed and a wall/partition shall be a minimum of three feet. The clearance between sides of beds shall be a minimum of five feet. The minimum distance at the foot of the bed shall not be less than four feet for a single load area/room or seven feet for a double load area/room. Four feet of the passage space at the foot of the bed may be shared between two beds. The requirements of this clause are illustrated in Table 8, Diagram G of § 133.169(h) of this title. (iv) Multi-bed (two) accessible patient room. The clearance between the side of a bed and a wall/partition shall be a minimum of five feet. The clearance between sides of beds shall be a minimum of four feet. The minimum distance at the foot of the bed shall not be less than four feet for a single load area/room or seven feet for a double load area/room. Four feet of the passage space at the foot of the bed may be shared between two beds. The requirements of this clause are illustrated in Table 8, Diagram H of § 133.169(h) of this title. (v) Arrangement of patient rooms. Minor encroachments including columns and wall hung lavatories that do not interfere with functions may be ignored when determining space requirements for patient rooms.
(I) Required clear floor space in patient rooms shall be exclusive of toilet rooms, closets, lockers, built-in cabinets, wardrobes, alcoves, or vestibules.
(II) Visual privacy shall be provided each patient in multi-bed rooms. Design for privacy shall not restrict independent patient access to the corridor, lavatory, or bathroom. (vi) Patient bathroom. Each patient shall have access to a bathroom without having to enter the general corridor area. Each bathroom shall contain a toilet with bed pan washers, hand washing fixture with hands-free operable controls, bathing facilities, and storage shelf or cabinet and serve not more than two patient rooms. Hand washing facilities shall be located in the patient room and in the patient bathroom. The hand washing fixture in the room shall be located outside of the patient's cubicle curtain in multi-bed patient room. (vii) Patient storage. Each patient shall have a separate wardrobe, locker, or closet that is suitable for hanging full-length garments and for storing personal effects. A minimum of 12 lineal inches of hanging space shall be provided per patient.
(C) Airborne infection isolation suites. A minimum of one isolation suite shall be provided for each 30 acute care beds or fraction thereof. The suite may be located within a nursing unit or in a separate isolation unit. When a pediatric patient suite is located in an adult nursing unit and is not part of a pediatric or adolescent nursing unit, a minimum of one isolation room shall be designated for pediatric patient care. Each airborne infection isolation suite shall consist of a work area, a patient room, and a patient bathroom. (i) The work area may be a separately enclosed anteroom or a vestibule that is open to and is located immediately inside the door to the patient room. It shall have facilities for hand washing, gowning, and storage of clean and soiled materials. One enclosed anteroom may serve multiple isolation rooms. (ii) Each patient room shall have a clear floor area of 120 square feet exclusive of the work area and shall contain only one bed. A patient bathroom shall be provided in accordance with subparagraph (B)(vi) of this paragraph. (iii) At least one airborne infection isolation suite with an enclosed anteroom shall be provided. (iv) A door(s) from an anteroom to an airborne infection isolation room(s) and a door(s) from an egress corridor into an anteroom shall be provided with a self-closing device(s). When an isolation room does not have an anteroom, the door from the egress corridor into the isolation room shall be provided with a self-closing device. When sliding doors are used in isolation rooms in CCU suites and in surgical suite post-anesthesia care units, the self-closing device may not be required as long as assurances of negative air pressure are met when sliding doors are opened. (v) Pressure differential monitors or air flow devices shall be installed outside the isolation room and anteroom. Devices shall be installed in corridors, passageways, etc.
(D) Protective environment suite. When specialized services for patients with extreme susceptibility to infection are provided, spatial requirements for the suite shall be identical to those for airborne infection isolation suites contained in subparagraph (C) of this paragraph with the exception that an enclosed anteroom shall be provided.
(E) Room for disturbed medical patients. Each general hospital shall provide at least one private patient room for patients needing close supervision for medical and/or psychiatric care. The room may be part of the mental health and chemical dependency nursing suite described in subsection (q) of this section. If the room is part of a nursing suite, the provisions of subparagraph (B)(ii) of this paragraph shall apply. Each room shall be designed in accordance with subsection (q)(2)(A) and (B) of this section.
(F) Service areas. Service areas shall be located in, or readily available to, each nursing unit. Each service area may be arranged and located to serve more than one nursing unit, but at least one service area shall be provided on each nursing floor. The following service areas shall be provided: (i) an administrative center or nurses station with an adjacent but separate dictation space; (ii) a nurses office; (iii) an area for charting. The area may be combined with the nurses station when adequate space is provided for both; (iv) a medication room, medicine alcove area, or a self-contained medicine dispensing unit under visual control of nursing staff. The medication alcove area may be located in the clean workroom. The self-contained medicine dispensing unit may be located in an alcove at the nurse station. The room, area or unit shall contain a work counter, hand washing fixture with hands-free operable controls, refrigerator, and double-locked storage for controlled substances. Standard cup-sinks provided in many self-contained units are not adequate for hand washing; (v) a nourishment station containing a work counter with sink, microwave, refrigerator and storage cabinets and not located in the clean workroom; (vi) a multipurpose room for staff and patient conferences, education, demonstrations, and consultation. The room shall be conveniently accessible to each nursing unit and may serve several nursing units or departments. The room may be located on another floor if convenient for regular use; (vii) a conveniently located examination/treatment room which may serve several nursing units located on the same floor. The room shall have a minimum clear floor area of 100 square feet and contain a counter for writing and hand washing facilities with hands-free operable controls. This room may be omitted if all patient rooms on the floor are single-bed patient rooms; (viii) special assisted bathing facilities, including space for attendant, for patients on stretchers, carts, and wheelchairs at the ratio of one per 100 beds or a fraction thereof. This may be on another floor if convenient for use. The central bathing room shall contain a bathtub which is accessible to a patient in a wheelchair or a shower that can accommodate a gurney. The room shall have space for drying and dressing and be provided with a hand washing fixture with hands-free operable controls and a toilet with three feet of clear space on sides and front of the water closet; (ix) staff lounge with unisex dressing cubicles, lockers, toilets and hand washing facilities. These facilities may be on another floor; (x) securable closets or cabinet compartments for personal articles of nursing unit staff. The closets or lockers shall be located at or near the nurse station. At a minimum, these shall be large enough for purses and billfolds. Coats may be stored in closets or cabinets on each floor or in a central staff locker area; (xi) clean workroom or clean supply room. When used for preparing patient care items, it shall contain a work counter, hand washing facilities with hands-free operable controls, and storage facilities for clean and sterile supplies. When used only for storage and holding as part of a distribution system of clean and sterile supplies, the work counter and hand washing facilities may be omitted; (xii) clean linen storage for each nursing unit. This may be within a clean workroom, a separate closet, or an approved distribution system on each floor. If a closed cart system is used, storage may be in an alcove, but must be out of the path of normal traffic and under staff control; (xiii) a soiled workroom or soiled holding room. The room shall contain a clinical sink or equivalent flushing rim fixture, hand washing facilities with hands-free operable controls, both with hot and cold water. The room shall have a work counter and space for separate covered containers for soiled linen and waste. When facilities for cleaning bedpans are provided elsewhere, the flushing rim clinical sink may be omitted; (xiv) an equipment storage room or alcove. The room(s) or alcove(s) shall be located on the patient floor to keep the corridor width free of all equipment and supplies. Ten square feet of equipment storage or supplies shall be provided for each patient bed. Combustible supplies shall not be stored in an alcove in the egress corridors; (xv) an emergency equipment storage room or alcove under direct visual control of the nursing staff; (xvi) a housekeeping room which may also serve adjacent nursing units; (xvii) stretcher and wheelchair storage space which is located without restricting normal traffic; (xviii) public toilets with hand washing facilities. The toilets shall be located on each floor containing a nursing unit; (xix) staff toilet conveniently located to each nursing unit. At least one staff toilet shall be located on each patient sleeping floor. Toilet may be unisex; and (xx) an ice dispensing machine for each nursing unit which is located at the nourishment station or the clean work room.
(2) Details and finishes. Details and finishes shall be in accordance with § 133.162(d)(2) of this title and this paragraph.
(A) Details. (i) Egress. Means of egress from each patient suite shall comply with the requirements of NFPA 101, § 18.2. (ii) Patient bathroom and toilet room doors. Door leaves to all patient bathrooms and toilet rooms shall be at least 36 inches wide and shall swing outward or be double acting so that nursing staff may gain access to a patient who has collapsed against the door. Doors lockable from the inside shall have hardware that allows staff to open the door from the outside. (iii) Vision panels. Vision panels shall be provided in the door between an anteroom and an airborne infection isolation room or a protective environment room. (iv) Patient room windows. Each patient sleeping room shall have an outside door or an outside window. When operable windows are provided and the operation of windows requires the use of tools or keys, the tools or keys shall be located at each nurses station, on the same floor, and easily accessible to staff. The allowable window sill height shall not exceed 36 inches above the floor. (v) Location of patient room windows. Windows in patient sleeping rooms shall be located on an outside wall. These windows may face an atrium, an inner court, or an outer court provided the following requirements are met.
(I) Patient room atria windows. When patient room windows face an atrium, the atrium shall comply with the requirements of NFPA 101, § 8.6.7. When windows are operable, an engineered smoke control system shall be provided in accordance with National Fire Protection Association 92B, Guide for Smoke Management Systems in Malls, Atria, and Large Areas, 2000 edition.
(II) Outer courts. Outer court (not enclosed by building on one side) onto which the required windows open shall have a minimum width, at all levels, of not less than three inches for each foot, or fraction thereof, of the height (average height of enclosing walls) of such court, but in no case shall the width be less than five feet. An outer court shall have a horizontal cross-sectional area not greater than four times the square of its width.
(III) Inner courts. Inner court (enclosed by building on all sides) onto which the required windows open shall have minimum width, at all levels, of not less than one foot for each foot, or fraction thereof, of the height (average height of enclosing walls) of such courts, but in no case shall the width be less than 10 feet. When operable windows are provided, a horizontal, unobstructed, and permanently open air intake or passage having a cross-sectional area of not less than 21 square feet shall be provided at or near the bottom of the court. Metal decorative grilles not effectively reducing the open area by more than 5.0% shall be permitted at the ends. Walls, partitions, floor, and floor-ceiling assemblies forming intakes or passages shall be noncombustible and shall be constructed in accordance with NFPA 101, § 18.3.1.1. An inner court shall have a horizontal cross-sectional area of not less than one and one-half times the square of its width. (vi) Hand washing facilities. Hand washing facilities shall be conveniently located near the nurses station and in the medication area. One lavatory in an open medication area can meet this requirement. (vii) Elevator lobbies. Elevator lobbies shall be provided in accordance with § 133.164 of this title (relating to Elevators, Escalators, and Conveyors). (viii) Patient's privacy. Cubicle curtains to assure privacy for each patient shall be provided in all multi-bed patient rooms. (ix) Telephone access. Each patient shall have access to a telephone directly from each bed.
(B) Finishes. (i) Seamless floors with coved wall bases described in § 133.162(d)(2)(B)(iii)(III) of this title shall be provided in soiled workrooms. (ii) Wall bases in the soiled workroom shall be made integral and coved with the floor, tightly sealed to the wall, constructed without voids that can harbor insects, retain dirt particles, and impervious to water. (iii) Monolithic ceilings described in § 133.162(d)(2)(B)(vi)(III) of this title shall be provided in airborne infection isolation rooms, protective environment rooms, and soiled workrooms.
(3) Mechanical requirements. Mechanical requirements shall be in accordance with § 133.162(d)(3) of this title and this paragraph.
(A) Outside air shall be supplied to each patient room by a central air handling unit to provide make-up air for air exhausted from the bathroom in accordance with Note 3 of Table 3 of § 133.169(c) of this title.
(B) Each patient room bathroom shall be exhausted continuously to the exterior in accordance with Table 3 of § 133.169(c) of this title.
(C) The isolation room exhaust shall be a dedicated system which exhausts all air continuously to the exterior in accordance with Table 3 of § 133.169(c) of this title. Multiple isolation rooms may be interconnected to the same exhaust system.
(4) Piping systems and plumbing fixtures. Piping systems and plumbing fixtures shall be in accordance with § 133.162(d)(4) of this title and this paragraph. Each patient bathroom shall contain a water closet with a bedpan washer, bathtub or shower and a lavatory.
(5) Electrical requirements. Electrical requirements shall be in accordance with § 133.162(d)(5) of this title and this paragraph.
(A) Electric receptacles in nursing units. (i) Each receptacle shall be grounded to the reference grounding point by means of an insulated copper grounding conductor. (ii) Each patient bed location shall be supplied by at least two branch circuits, one from the critical branch of the emergency system as required by NFPA 99, § 3-4 and one from the normal system. All branch circuits from the normal system shall originate in the same panelboard. (iii) One duplex receptacle connected to a normal branch circuit and one duplex outlet connected to the critical branch circuit shall be located on opposite sides of the head of each bed. In addition at least one duplex outlet shall be located on each wall. A dedicated outlet shall be provided at the television location. (iv) Each examination table shall have access to two duplex receptacles. (v) Each work table or counter shall have access to one duplex receptacle for every six feet of table or counter space or fraction thereof. (vi) One duplex receptacle protected with a GFCI shall be installed in the bathroom to permit the use of electrical appliances in front of the mirror. (vii) Duplex receptacles shall be installed not more than 50 feet apart in corridors and within 25 feet of corridor ends. (viii) The isolation exhaust system shall be connected to the emergency essential electrical system.
(B) Nurses calling systems. The nurse call shall be in accordance with § 133.162(d)(5)(L) and Table 7 of § 133.169(g) of this title.
(C) Illumination requirements. (i) General illumination requirements. Nursing unit corridors shall have general illumination with provisions for reducing light levels at night. Illumination of corridors for egress purposes shall comply with NFPA 101, § 18.2.8 and § 18.2.9. (ii) Illumination of the nurses station. Illumination of the nurses station and all nursing support areas shall include fixtures powered from the critical branch of the emergency electrical system NFPA 99, § 4.4.2.2.2.3(3)(d). (iii) Patient suite lighting.
(I) Each patient room shall be provided with general lighting and night lighting. General lighting and night lighting shall be controlled at the room entrance. All controls for lighting in patient areas shall be of the quiet operating type. Control of night lighting circuits may be achieved by automatic means and in such instances control of night lighting at the room entrance shall not be required. At least one general light fixture and night lighting shall be powered from the critical branch of the essential electrical system.
(II) A reading light shall be provided for each patient. Reading light control shall be readily accessible from each patient bed. Flexible light arms, if used, shall be mechanically controlled to prevent the bulb from coming in contact with bed linen. High heat-producing light sources such as incandescent and halogen shall be avoided to prevent burns to patients and/or bed linen. Light sources shall be covered by a diffuser or a lens.
(III) A wall or ceiling-mounted lighting fixture shall be provided above each lavatory.
(IV) A ceiling-mounted fixture shall be provided in patient bathrooms where the lighting fixture above the lavatory does not provide adequate illumination of the entire bathroom. Some form of fixed illumination shall be powered from the critical branch.
(u) Obstetrical suite.
(1) Architectural requirements.
(A) General. When obstetrical services are provided, the obstetrical suite shall be located and arranged to preclude unrelated traffic through the suite. Regardless of the clinical model used for labor, delivery, recovery and postpartum, a hospital offering such services shall be able to demonstrate the availability of one room designed, equipped and held in reserve for emergency, caesarean section deliveries. This room shall be located either in the labor and delivery suite or surgical suite.
(B) Caesarean section (c-section) operating room(s). A minimum of one dedicated c-section operating room shall be located in either the obstetrical or surgical suite. This room shall have a minimum clear floor area of 360 square feet with a minimum dimension of 18 feet exclusive of built-in shelves or cabinets. There shall be no direct access between operating rooms.
(C) Delivery room(s). A minimum of one delivery room shall be provided in every obstetrical suite. The delivery room shall have a minimum clear floor area of 300 square feet with a minimum dimension of 16 feet exclusive of fixed and moveable cabinets and built-in shelves. In facilities having only one c-section operating room, the delivery room shall be designed to function as an emergency c-section operating room. When two c-section operating rooms are provided, the delivery room requirement may be omitted.
(D) Infant resuscitation area. An infant resuscitation space shall be provided within the c-section operating room; delivery room; labor, delivery, and recovery room (LDR); and labor, delivery, recovery and postpartum room (LDRP) with a minimum clear floor area of 40 square feet in addition to the required area of each room or may be provided in a separate but immediately accessible room with a clear floor area of 150 square feet.
(E) Labor room(s). A minimum of two labor beds shall be provided for each delivery room. Each labor room shall be designed for one or two beds with a minimum clear floor area of 120 square feet per bed. (i) An LDR or LDRP may be substituted for a labor room. (ii) In facilities having only one delivery room, one of the two required labor beds shall be in a separate room with a minimum clear floor area of 160 square feet to serve as an emergency vaginal delivery room. Medical gas outlets shall be the same as for delivery room. (iii) Each labor room shall contain a lavatory equipped with hands-free operable controls. Each labor room shall have direct access to a toilet room. One toilet room may serve two labor rooms. (iv) Labor rooms shall be arranged so that doors are visible from a nurses work station. (v) A minimum of one shower shall be provided for each four labor beds. Each shower room shall contain a toilet and hand washing fixture with hands-free operable controls.
(F) Recovery room(s). Recovery room(s) shall contain not less than two beds. There shall be enough space for baby and crib and a chair for the support person. Visual privacy of the new family shall be provided. LDRs or LDRPs may be substituted for recovery rooms. (i) In multiple recovery patient stations, the clearance between the side of a bed/gurney and a wall/partition shall be a minimum of five feet. The clearance between sides of beds/gurneys shall be a minimum of six feet. The minimum distance at the foot of the bed/gurney shall not be less than eight feet for single load area/room or twelve feet for double load area/room. Four feet of the passage space at the foot of the bed may be shared between two beds/gurneys. The fixed and movable cabinets and shelves shall not encroach upon the bed/gurney clear floor space/area. The requirements of this clause are illustrated in Table 8, Diagram N of § 133.169(h) of this title. (ii) A nurse station and charting area shall be provided and arranged to permit staff visual observation of recovery beds. (iii) A work counter, facilities for dispensing medicine, storage for supplies and equipment, and a clinical sink with bedpan-flushing device shall be provided. (iv) One hand washing fixture with hands-free operable controls shall be provided for every three recovery beds or fraction thereof. Fixtures shall be uniformly distributed. (v) There shall be cubicle curtains at each station for patient privacy.
(G) Postpartum and antepartum suite. Postpartum and antepartum patient suites shall be provided in accordance with subsection (t)(1)(B) of this section.
(H) LDR. (i) When provided, each LDR room shall have controlled access and shall be located so that a patient may be transported to the c-section operating room without the need to pass through other functional areas. (ii) Each LDR room shall be designed for single occupancy and have a minimum clear floor area of 200 square feet exclusive of the infant resuscitation area, built-in shelves or cabinets, alcove, vestibule or other adjoining rooms. The minimum clear room dimension shall not be less than 11 feet. (iii) A hand washing fixture with hands-free operable controls shall be provided in each LDR room. (iv) Each LDR shall have direct access to and exclusive use of a bathroom with a shower, or tub with shower, hand washing fixture with hands-free operable controls and a toilet.
(I) LDRP. When provided, each LDRP room shall have controlled access and shall be located on an exterior wall and have a window in accordance with subsection (t)(2)(A)(iv) and (v) of this section. (i) Each room shall be designated for single occupancy and have a minimum clear floor area of 260 square feet exclusive of the infant resuscitation area, built-in shelves or cabinets, alcove, vestibules, or other adjoining rooms. The minimum clear room dimension shall not be less than 11 feet. (ii) A hand washing fixture with hands-free operable controls shall be provided in each LDRP room. (iii) Each LDRP shall have direct access to and exclusive use of a bathroom with a shower, or tub with shower, hand washing fixture with hands-free operable controls and a toilet.
(J) Isolation rooms. When patients who have airborne infectious diseases are treated, an isolation room shall be provided in the obstetrical suite which complies with the functional space requirements as specified in subparagraphs (G) - (I) of this paragraph, and with the ventilation requirements for infection isolation rooms in Table 3 of § 133.169(c) of this title.
(K) Nursery suite. One infant station for each LDRP and each postpartum bed shall be provided in the nursery. Nurseries shall be located and arranged convenient to the postpartum nursing unit and near or part of the obstetrical suite. The nurseries shall be located and arranged to preclude the need for nonrelated pedestrian traffic. Each nursery unit shall meet the following requirements.
(L) Full-term nursery. A full-term nursery shall have a maximum of 16 infant stations. The clearance between the side of a bassinet and a wall/partition shall be a minimum of two feet six inches. The clearance between sides of bassinets shall be a minimum of four feet. The minimum distance at the foot of the bassinet shall not be less than five feet for single load area/room or seven feet for double load area/room. Three feet of the passage space at the foot of the bassinet may be shared between two bassinets. The requirements of this subparagraph are illustrated in Table 8, Diagram I of § 133.169(h) of this title. Additional area shall be provided to accommodate workroom functions if these are located within the nursery area as specified in subparagraph (N)(iv) of this paragraph. (i) When a rooming-in program is used, the total number of bassinets in full-term nursery units shall be not less than one bassinet for every two LDRP and postpartum beds. (ii) When a rooming-in program is used but all infants are returned to the nursery at night, a reduction in bassinets shall not be allowed. (iii) There shall be one lavatory with hands-free operable controls for each six infant stations or fraction thereof. Fixtures shall be uniformly distributed but not in the clear floor area of the infant stations. (iv) An observation window to permit the viewing of infants from public areas shall be provided. The public viewing areas shall not encroach into the egress corridor.
(M) Continuing care nursery suite. Hospitals with 25 or more maternity beds shall provide a continuing care nursery for infants requiring close observation. The suite shall have a maximum of 16 infant stations. The clearance between the side of the bassinet and a wall/partition shall be a minimum of three feet. The clearance between sides of bassinets shall be a minimum of six feet. The minimum distance at the foot of the bassinet shall not be less than six feet for single load area/room or nine feet for double load area/room. Three feet of the passage space at the foot of the bassinet may be shared between two bassinets. The requirements of this subparagraph are illustrated in Table 8, Diagram J of § 133.169(h) of this title. Additional area shall be provided to accommodate workroom functions if these are located within the nursery area as specified in subparagraph (N)(iv) of this paragraph. (i) The continuing care nursery shall be located on an exterior wall and shall have a window(s). In the nursery, one window may serve more than one bassinet. The window sill height shall not exceed five feet above the floor. Bassinets shall not be located more than 50 feet from an exterior window. A newborn's view to outside windows shall be direct. When partitions are used, the newborn's view to the outside windows may be through no more than two separate clear vision panels. (ii) The continuing care nursery shall not be located within a full-term nursery. (iii) There shall be a minimum of one lavatory with hands-free operable controls for each four infant stations or fraction thereof. Fixtures shall be uniformly distributed but not in the clear floor area of the infant stations.
(N) General requirements for nurseries. Each nursery regardless of type shall meet the following requirements: (i) Observation windows to permit the viewing of infants from public areas for full-term nurseries and from workroom(s) into adjacent nurseries shall be provided. Windows between nurseries may be provided for the convenience of staff observation. (ii) Ten square feet per bassinet shall be provided for convenient, accessible storage for linens, infant supplies, and equipment. (iii) A room for consultation, demonstration, breast feeding or breast pumping shall be provided convenient to the unit. A counter with sink with hands-free operable controls, refrigeration and freezer, storage for pump and attachments, and educational materials shall be provided in or convenient to the room. (iv) Each nursery room shall be served by a connecting workroom(s). The workroom shall contain scrubbing and gowning facilities at the entrance for staff and housekeeping personnel, work counter, refrigerator, storage for supplies, and hand washing fixture with hands-free operable controls. One workroom may serve no more than two nursery rooms provided that required services are convenient to each. No nursery shall open directly into another nursery. (v) The workroom serving the full-term and continuing care nurseries may be omitted if equivalent work and storage areas and facilities, including those for scrubbing and gowning, are provided within that nursery at the entrance. Space required for work areas located within the nursery is in addition to the area required for infant care. Adequate provisions shall be made for storage of emergency carts and equipment, and for sanitary storage and disposal of soiled waste for the nursery. (vi) Charting and dictation facilities shall be provided for physicians and nurses. This may be in a separate room or part of the workroom. (vii) An examination/treatment room or space shall be provided and shall contain a work counter, storage, and lavatory equipped for hand washing with hands-free operable controls. The examination/treatment room or space shall have a minimum clear area of 80 square feet in addition to the required area of each workroom exclusive of fixed and movable cabinets and shelves. The examination treatment space shall be located within the nursery. (viii) An airborne infection isolation room is required in at least one level of nursery care and the neonatal critical care unit. The isolation room shall be enclosed and separated from the nursery unit with provisions for observation of the infant from adjacent nurseries or control area(s). The minimum size of the room shall be 120 square feet of clear floor area. The isolation room shall contain cabinets, a work counter, and a hand washing fixture with hands-free operable controls. Fixed and moveable cabinets and shelves shall not encroach upon bed/gurney clear floor space/area. The isolation room shall comply with the ventilation requirements in Table 3 of § 133.169(c) of this title. (ix) A housekeeping room shall be provided for the exclusive use of the nursery.
(O) Neonatal critical care unit (NCCU). When an NCCU is provided, the unit shall comply with the following. (i) The NCCU shall be conveniently located near the obstetrical suite and be arranged to preclude unrelated traffic. (ii) Each room and ward shall be located on an exterior wall and shall have a window. In a ward, one window may serve more than one patient. The window sill height shall not exceed five feet above the floor. Patient beds shall not be located more than 50 feet from an exterior window. Patients' views to outside windows shall be direct. When partitions are used, the patient's direct view to the exterior may be through no more than two separate clear vision panels. Window shall be in accordance with subsection (t)(2)(A)(v) of this section. (iii) The NCCU shall have a clearly identified public entrance and reception area arranged to permit visual observation and contact with all traffic entering the unit. Gowning facilities, lockers, and scrub area shall be provided at each public entrance to the patient care area(s) of the NCCU. All scrub sinks shall be provided with hands-free operable controls and large enough to contain splashing. (iv) A control station shall be provided in a central area and shall have space for counters and storage, and shall have convenient access to a hand washing fixture with hands-free operable controls. The control station may be combined with or include centers for reception, communication and patient monitoring. (v) NCCU patients may be housed in private rooms or a room with multiple bassinets or cribs. Each unit shall not exceed 24 bassinets or cribs. There shall be at least one enclosed private room for every six bassinets or cribs. (vi) A single-bassinet/crib patient NCC room shall have a minimum clear floor area of 120 square feet per bassinet/crib exclusive of work counter, vestibule, sink and aisle. A minimum of 12 feet width shall be provided for the head wall for each bed. (vii) In a multiple-bassinet/crib room/ward the clearance between the side of a sleeping unit and a wall/partition shall be a minimum of five feet. The clearance between sides of sleeping units shall be a minimum of eight feet. The minimum distance at the foot of the bassinet shall not be less than ten feet for single load area/room or sixteen feet for double load area/room. Four feet of the passage space at the foot of the bassinet may be shared between two bassinets. The fixed and moveable cabinets and shelves shall not encroach upon the bassinet/crib clear floor space/area. The requirements of this clause are illustrated in Table 8, Diagram K of § 133.169(h) of this title. (viii) A minimum of one isolation room shall be provided with a minimum clear floor area of 120 square feet per bassinet/crib exclusive of work counter, vestibule, sink and aisle. A minimum of 12 feet width shall be provided for the head wall for each bed. A toilet room is not required. (ix) A lavatory equipped for hand washing with hands-free operable controls shall be provided in each single-bed room. In rooms with multiple beds, one lavatory with hands-free operable controls for each four patient stations or fraction thereof shall be provided. These lavatories shall be located convenient to infant stations. (x) Each NCCU shall be served by a connecting workroom containing gowning facilities at the entrance for staff and housekeeping personnel, a work space with counter, storage facilities, a lavatory or sink equipped for hand washing with hands-free operable controls, and individual closet or lockers for personal effects of nursing personnel. One workroom may serve not more than two NCCUs. (xi) A storage space for infant formula shall be provided. This functional space may be outside the NCCU but shall be available for use at all times. (xii) A breast feeding or pump room shall be provided convenient to the unit. Provision shall be made, either within the room or conveniently located nearby, for a sink with hands-free operable controls, counter, refrigeration and freezer, storage for pump and attachments, and educational materials. (xiii) A room(s) shall be provided within the NCCU for parents and infants for extended private time together and the room is not considered a patient room. The room(s) shall have direct access to toilet facilities and a hand washing fixture with hands-free operable controls. The room(s) shall have a sleeping area for at least one parent, and sufficient space for the infant's bassinet/crib and equipment. The room(s) shall have electrical and medical gas outlets as specified for NCCU bassinet/cribs. This room(s) shall have direct communication with the NCCU staff. (xiv) Twenty square feet of equipment storage shall be provided for each patient station. The storage areas shall be out of the way of the corridor traffic. (xv) Charting and dictation space shall be provided for physicians and nurses. (xvi) A respiratory therapy work area and storage room shall be provided. (xvii) Blood gas lab facilities shall be immediately accessible to the NCCU. (xviii) A staff lounge shall include toilet facilities with a hand washing fixture with hands-free operable controls. The lounge(s) shall be located so that staff may be recalled quickly to the patient area in emergencies. Toilet facilities may be shared as long as privacy is maintained for changing areas. (xix) Physicians and other staff on 24-hour on-call work schedules shall be provided with sleeping rooms with access to a shower(s), toilet(s), and lavatory(ies). If on-call room(s) are not within the NCCU served, a dedicated telephone or intercom system shall connect the on-call room(s) to the NCCU. (xx) A waiting room/area shall be provided and contain toilet room(s) with hand washing facilities. Waiting room/area maybe shared with other waiting room/areas if conveniently located. (xxi) A consultation room shall be provided, if not provided elsewhere in the suite. (xxii) A housekeeping room shall be provided exclusively within or immediately adjacent to the NCCU. It shall not be shared with other nursing units or departments.
(P) Infant formula facilities. Infant formula facilities shall meet the following requirements. (i) When infant formula is prepared on site, the infant formula preparation room shall contain a lavatory equipped for hand washing with hands-free operable controls, warming facilities, refrigerator, work counter, formula sterilizer, and storage facilities. The formula room may be located near the nurseries or at another appropriate place within the hospital. Direct access from the formula preparation room to any nursery room is prohibited. (ii) An infant formula clean-up room shall be provided and include a hand washing fixture with hands-free operable controls, facilities for bottle washing, a work counter, and sterilization equipment. (iii) When commercial infant formula is used, the separate clean-up and formula preparation rooms may be omitted. The storage and handling may be done in the nursery workroom or in another appropriate room in the hospital that is conveniently accessible at all hours. (iv) A refrigerated storage and warming facilities for infant formula shall be provided and be accessible for use by nursery personnel at all times.
(Q) Service areas. The following service areas shall be provided to support an obstetrical suite unless otherwise noted. (i) Control station. The control station shall be located to permit direct visual surveillance of all traffic which enters the obstetrical suite. (ii) Office. A supervisor's office shall be provided. (iii) Waiting room/area. A waiting room/area shall be provided and contain toilet room(s) with hand washing facilities, public telephone(s), and drinking fountain(s). (iv) Scrub facilities. Two scrub stations shall be within 5 feet of the entrance to each c-section operating room and delivery room. Two scrub stations may serve two c-section operating rooms or delivery rooms if the scrub stations are located adjacent to the entrance of each c-section operating room or delivery room. Scrub facilities shall be arranged to minimize any incidental splatter on nearby personnel or supply carts. Viewing panels shall be provided for observation of c-section operating rooms and delivery rooms from the scrub area. (v) Sterilizing facilities. Sterilizing facilities with high speed sterilizers shall be conveniently located to serve all c-section operating rooms and delivery rooms. A work space and a hand washing fixture with hands-free operable controls shall be included. High speed autoclaves should only be used in an emergency situation (e.g. replacements unavailable for dropped instruments). Sterilization facilities would not be necessary when spare instruments are available. (vi) Anesthesia workroom. An anesthesia workroom shall be provided with work counter, sink with hands-free operable controls, and storage space for small style D or E medical gas cylinders and other anesthesia equipment. (vii) Medication station. Storage and distribution of medication may be done from a medicine preparation room, medicine alcove area or from a self-contained medicine dispensing unit but must be under visual control of nursing staff. A work counter, hand washing fixture with hands-free operable controls, refrigerator, and double-locked storage for controlled substances shall be provided. Standard cup-sinks provided in many self-contained units are not adequate for hand washing. The medication station may be shared with the clean work room. (viii) Nourishment station. The nourishment station shall contain sink with hands-free operable controls, work counter, self-dispensing ice machine, refrigerator, cabinets, and not located in the clean work room. Space shall be included for temporary holding of unused or soiled dietary trays. A nourishment station is not required in the nursery suite. (ix) General storage room(s). A minimum of 50 square feet per operating room is required for general storage space(s). The storage space is exclusive of soiled holding, sterile supplies, clean storage, drug storage, locker rooms. In addition to general storage, equipment storage shall be provided for labor, LDR and LDRP rooms. (x) Emergency storage. Equipment used for emergencies shall be stored in a room or alcove under direct visual control of the nursing staff. (xi) Storage alcove. The alcove provided for stretcher storage, portable X-ray equipment, warming devices, auxiliary lamps, etc. shall be located out of direct line of traffic. (xii) Obstetrical suite staff clothing change rooms. Appropriately sized areas shall be provided for male and female personnel working within the obstetrical suite. These areas shall contain lockers, showers, toilets, hand washing fixtures with hands-free operable controls, and space to change into scrub suits and boots. Separate locker/changing rooms shall be provided for male and female staff. The shower and toilet room(s) may be unisex. These areas shall be arranged to provide a traffic pattern so that personnel entering from outside the obstetrical suite can shower, change, and move directly into the restricted areas of the obstetrical suite. (xiii) Lounge. A lounge shall be provided in hospitals with four or more obstetrical surgical and delivery rooms. The lounge shall permit staff use without leaving the obstetrical surgical suite or delivery suite and may be accessed from the obstetrical suite staff clothing change rooms or staff changing room for delivery suite. The lounge shall not have direct access from outside the surgical suite. When the lounge is remote from the clothing change rooms, toilet facilities and a hand washing fixture with hands-free operable controls accessible from the lounge shall be provided. (xiv) Staff toilet facilities. Toilet facilities located in the obstetrical suite for exclusive staff use shall be provided and contain hand washing facilities with hands-free operable controls. The toilet room may be accessible from a staff lounge, when provided. (xv) Nurses' toilet. A nurses' toilet room shall be provided at the labor and recovery area(s) and shall include hand washing fixture with hands-free operable controls. (xvi) Dictation and report preparation area. This may be accessible from the lounge area. (xvii) On-call rooms. Physicians and staff on 24-hour on-call work schedules shall be provided with sleeping rooms with access to a toilet, lavatory and shower. If not contained within the unit itself, the area shall have a telephone or intercom connection to the obstetrical suite(s). (xviii) Clean workroom or clean supply room. A clean workroom is required. It shall contain a work counter, a hand washing fixture with hands-free operable controls, storage facilities for clean supplies, and a space to package reusable items. The storage for sterile supplies must be in a separated room. When the room is used only for storage and holding as part of a system for distribution of clean and sterile supply materials, the work counter and hand washing fixture may be omitted. (xix) Soiled workroom. The soiled workroom shall be for the exclusive use of the obstetrical suite and shall be in addition to the soiled workroom required for the obstetrical surgical suite. The soiled workroom for the obstetrical c-section operating room or delivery room suite shall not have direct connection with operating rooms or other sterile activity rooms. The soiled workroom shall contain a clinical sink with hands-free operable controls or equivalent flushing type fixture, work counter, sink equipped for hand washing, waste receptacle, and linen receptacle. There shall be a designated soiled workroom for the exclusive use of the NCCU. (xx) Housekeeping rooms. A separate housekeeping room containing a floor receptor or service sink and storage space for housekeeping supplies and equipment shall be provided for the exclusive use of the obstetrical suite, the c-section operating room, and nurseries (one for each). (xxi) Triage room. When triage services are provided, there shall be a minimum of one triage room in the obstetrical suite.
(I) An obstetrical triage room shall be a minimum clear floor area of 100 square feet with a minimum dimension of nine feet. The obstetrical triage room shall contain cabinets, work counter, examination light, and a hand washing fixture with hands-free operable controls. The fixed and movable cabinets and shelves shall not encroach upon the bed/gurney clear floor space/area.
(II) When a multiple-bed/gurney triage patient station is provided, the clearance between the side of a bed/gurney and a wall/partition shall be a minimum of three feet. The clearance between sides of beds/gurneys shall be a minimum of six feet. The minimum distance at the foot of the bed/gurney shall not be less than seven feet for single load area/room or ten feet for double load area/room. Four feet of the passage space at the foot of the bed may be shared between two beds/gurneys. The multiple-bed/gurney triage room shall contain cabinets, medication storage, work counter, examination light, and a hand washing fixture with hands-free operable controls. The fixed and movable cabinets and shelves shall not encroach upon the bed/gurney clear floor space/area. Privacy shall be provided for each patient with cubicle curtains or movable screens. The requirements of this subclause are illustrated in Table 8, Diagram D of § 133.169(h) of this title.
(III) A patient in a triage bed shall have access to a patient toilet room without entering the corridor.
(2) Details and finishes. Details and finishes shall be in accordance with § 133.162(d)(2) of this title and this paragraph.
(A) Details. (i) C-section operating rooms and delivery rooms shall have ceiling heights not less than nine feet. (ii) Recreation rooms, exercise rooms, equipment rooms, and similar spaces where impact noises may be generated shall not be located directly over operating rooms or delivery rooms, unless special provisions are made to minimize such noise as contained in Table 1 of § 133.169(a) of this title. (iii) When vision panels are provided in labor rooms, LDRs, and LDRPs, the windows shall be located, draped, or otherwise arranged to preserve patient privacy from casual observation from outside the labor room. (iv) Shower controls shall be outside the wet area for use by nursing staff for labor room showers. In the LDRP rooms shower control outside of the wet area may be omitted. (v) When viewing windows are provided in a NCCU, provision shall be made to control casual viewing of infants. (vi) Noise control and sound attenuation in a NCCU shall be a design factor and meet the requirements contained in Table 1 of § 133.169(a) of this title.
(B) Finishes. (i) Finishes for LDR and LDRP rooms shall be selected for ease of cleaning and resistance to strong detergents. (ii) Flooring in c-section operating rooms, delivery rooms, labor rooms, isolation room, and soiled workroom shall be of the seamless type in accordance with the requirements of § 133.162(d)(2)(B)(iii)(III) of this title. LDR and LDRP rooms shall have seamless type flooring below the bed and four feet at each side of the bed and foot of the bed. (iii) Ceilings and walls in c-section operating rooms, delivery rooms, soiled workroom, isolation and anteroom, and sterile processing room shall be of the monolithic type in accordance with § 133.162(d)(2)(B)(vi)(III) of this title. Acoustic lay-in ceiling is permissible in the LDR and LDRP rooms.
(3) Mechanical requirements. Mechanical requirements shall be in accordance with § 133.162(d)(3) of this title and this paragraph.
(A) The air supply for the c-section operating room and delivery room shall be from ceiling outlets near the center of the work area. Return air shall be from near the floor level. Each c-section operating room and delivery room shall have at least two return air inlets located as remotely from each other as practical. (Design should consider turbulence and other factors of air movement to minimize fall of particulate into a wound site).
(B) Air supply for LDRs, LDRPs, and nurseries shall be from ceiling outlets or high wall outlets. Return air shall be from near the floor level. Each LDR, LDRP, and nursery shall have at least two return air inlets located diagonally opposite from each other.
(C) The ventilation system for anesthesia storage rooms shall conform to the requirements of NFPA 99, § 4-3.1.1.2.
(D) Each c-section operating room, delivery room and nursery shall have temperature and humidity indicating devices mounted at eye level.
(E) Air handling units serving the obstetrical and surgical suite shall be equipped with filter having efficiencies equal to, or greater than specified in Table 4 of § 133.169(d) of this title.
(4) Piping systems and plumbing fixtures. Piping systems and plumbing fixtures shall be in accordance with § 133.162(d)(4) of this title and this paragraph.
(A) General. (i) Drainage and waste piping shall not be installed within the ceiling or installed in an exposed location in c-section operating rooms and delivery rooms unless special precautions are taken to protect the spaces below from leakage and condensation from necessary overhead piping systems. Any required secondary protection shall be labeled every 20 feet "code required secondary drain system." The labeling shall be in highly visible print. (ii) Floor drains shall not be installed in c-section rooms and delivery rooms. (iii) Bedpan-flushing devices shall be installed in all patient toilet rooms serving LDRs and LDRPs.
(B) Medical gas systems. Medical gas systems shall be provided in accordance with § 133.162(d)(4)(A)(iii)-(vi) of this title. (i) Nonflammable medical gas and clinical vacuum outlets shall be provided in accordance with Table 6 of § 133.169(f) of this title. (ii) Nonflammable medical gas and clinical vacuum outlets for the infant resuscitation area or room shall be provided in addition to the required medical gas and vacuum for the mother in accordance with Table 6 of § 133.169(f) of this title. (iii) When a labor room is intended to function as an emergency delivery room the nonflammable medical gas and clinical vacuum outlets shall be provided in accordance with Table 6 of § 133.169(f) of this title.
(5) Electrical requirements. Electrical requirements shall be in accordance with § 133.162(d)(5) of this title and this paragraph.
(A) General. (i) X-ray film illuminators for handling at least four films simultaneously shall be provided in each c-section operating room, labor, and delivery room. When the entire obstetrical suite is provided with digital imaging system capabilities, a minimum of two X-ray film illuminator viewers shall be provided. The film illuminators shall be mounted within the central area of the suite. (ii) Each c-section operating room shall have at least eight duplex hospital grade receptacles. (iii) Each delivery room, LDR and LDRP shall have at least six duplex hospital grade receptacles. (iv) Operating rooms and delivery rooms shall have at least three of the required duplex hospital grade receptacles located convenient to the head of the procedure table. (v) Newborn and continuing care nurseries shall have one normal and one critical duplex outlet for every two bassinets. (vi) In the infant resuscitation area or room, three duplex hospital grade receptacles shall be provided for the infant in addition to those required for the mother. (vii) The electrical circuit(s) to equipment in wet areas shall be provided with five milliampere GFCI. GFCI circuits shall not be used in c-section operating rooms and delivery rooms. When GFCIs are used in critical areas, provisions shall be made to ensure that other essential equipment is not affected by activation of one interrupter. (viii) C-section operating rooms and delivery rooms shall have general lighting in addition to that provided by special lighting units at the surgical and obstetrical tables. Each fixed special lighting unit at the operating or delivery table shall be connected to an independent circuit powered by the critical branch of the essential electrical system. Portable units may share circuits. (ix) Indirect lighting and high-intensity lighting shall be provided in the NCCU(s). The lighting shall be able to be adjusted over individual patient care spaces. No direct ambient lighting shall be permitted in the infant care spaces, and any direct ambient lighting used outside the infant care area shall be located or framed so as to avoid any infant's direct line of sight to the fixture. This does not exclude the use of direct procedure lighting. (x) Receptacles at each bed location in a NCCU shall be served by two branch circuits, one or more from the critical branch panel of the emergency electrical system and one or more from the normal system. One critical branch circuit shall serve only one bed location. All branch circuits from the normal system shall be from a single panelboard. All branch circuits from the emergency electrical system shall be from a single panelboard. (xi) A minimum of seven hospital grade duplex outlets shall be conveniently located at the head of each NCCU bed, crib or bassinet. At least three of these duplex outlets shall be on the critical branch of the emergency electrical system.
(B) Nurses calling system. The nurse call shall be in accordance with § 133.162(d)(5)(L) and Table 7 of § 133.169(g) of this title.
(v) Outpatient suite.
(1) Architectural requirements.
(A) General. Outpatient services that the hospital provides to patients under the hospital license shall be within the hospital. Outpatient services and facilities (diagnostics, imaging, surgical, etc.) may be provided throughout the hospital within other suites, departments or units within the hospital. When an organized outpatient suite is provided for the hospital, it shall be in one identifiable contiguous location within the hospital and meet all the elements described in this subsection. To be included in the hospital license, an outpatient suite located in an office building or other building shall be physically connected to the hospital and become contiguous to the hospital. In no case may one leave the hospital, traverse the other occupancies, and then reenter the hospital to access the remaining portion of the hospital. A hospital may not occupy two or more noncontiguous areas of nonhospital occupancies, which contain intervening space of the nonhospital occupancies even if on the same floor or other floors. Outpatient facilities physically connected to the hospital with a common wall or an enclosed connection shall comply with the requirements of NFPA 101, Chapter 18.
(B) Site, administration and public areas. The following shall be provided. (i) Parking. When an outpatient suite is provided, four parking spaces shall be required for each surgical procedure room, treatment room, and diagnostic room, plus additional spaces for each staff member. (ii) Entrance. When an established outpatient suite in one identifiable location provides surgical services, an illuminated covered drive through entrance shall be provided. (iii) Public waiting area. Toilet facilities, public telephone, and drinking fountain shall be provided. When pediatric services are provided, pediatric and adult patients waiting areas shall be separate. (iv) Control station. A control station shall be located to permit staff observation of waiting area and control of access to treatment rooms, procedure rooms, diagnostic rooms, and the surgical suite. (v) Wheelchair storage alcove. The alcove provided for wheelchair storage shall be located out of line of traffic. (vi) Interview space. Interview spaces shall be provided for social services, credit, and admissions. Provisions shall be made for privacy and dignity of the patient during interview, examination, and treatment. (vii) Offices. General or individual offices shall be provided for business transaction, records, and administrative and professional staff. (viii) Multipurpose rooms. Multipurpose rooms for conferences, meetings, and health education purposes shall be provided.
(C) Examination, treatment, and observation rooms. When examination, treatment, or observation facilities are provided, the following shall be included. (i) Examination room. The room shall have a minimum clear floor area of 100 square feet exclusive of fixed cabinets and shelves. Each examination room shall contain a work counter, cabinets, examination light and hand washing fixture with hands-free operable controls. A clearance of three feet shall be provided at each side and the foot of the examination table. (ii) Special purpose examination rooms. The special purpose examination room shall comply with the requirements of an examination room as described in clause (i) of this subparagraph, but room size and configuration may be modified for specialized equipment. (iii) Treatment room. The room shall have a minimum clear floor area of 120 square feet exclusive of fixed and movable cabinets and shelves. The minimum clear dimension between fixed cabinets and built-in shelves shall be 10 feet. The treatment room shall contain a work counter, cabinets, medication storage, examination light and a hand washing fixture with hands-free operable controls. (iv) Observation room. The room shall be located to permit close observation from either a nurse station or the control station. The room shall have a minimum clear area of 80 square feet exclusive of fixed and movable cabinets and shelves. Patients shall have access to a toilet room without entering the general corridor area. (v) Multiple-bed holding/observation room/area. In a multiple-bed holding/observation room/area, the clearance between the side of a bed/gurney and a wall/partition shall be a minimum of three feet. The clearance between sides of beds/gurneys shall be a minimum of six feet. The minimum distance at the foot of the bed/gurney shall not be less than seven feet for single load area/room or ten feet for double load area/room. Four feet of the passage space at the foot of the bed may be shared between two beds/gurneys. The multiple-bed holding/observation room/area shall contain cabinets, work counters, and a hand washing fixture with hands-free operable controls. The fixed and moveable cabinets and shelves shall not encroach upon the bed/gurney clear floor space/area. The requirements of this clause are illustrated in Table 8, Diagram D of § 133.169(h) of this title.
(D) Diagnostic facilities. Services shall be available to the outpatient suite. When separate radiology units are located within the outpatient suite, the requirements in subsection (l) of this section shall be met.
(E) Laboratory. Services shall be made available to the outpatient suite. When a separate laboratory unit is installed within the outpatient suite, the requirements in subsection (n) of this section shall be met. All laboratory services provided within the outpatient suite or by a written contractual arrangement shall comply with the requirements of § 133.41(h) of this title.
(F) Surgical facilities. Outpatient surgical facilities may be provided separately or may be shared with the inpatient facilities. (i) When a separate outpatient surgery suite is provided, it shall meet the requirements in subsection (ee) of this section. (ii) The following additional rooms and areas shall be provided in each surgical suite wherever outpatient surgical procedures are performed. A preoperative area for outpatient use shall be provided. The area shall include a waiting room, public toilet facilities, sitting space for ambulatory patients, and at least one or more of the following: a single patient preoperative room, multiple-bed/gurney preoperative patient stations, single patient preoperative/recovery room, or multiple-bed/gurney preoperative/recovery patient stations. Traffic patterns shall be arranged for patients to enter the preoperative area from outside the surgical suite, prepare for surgical procedure and then move directly into the restricted corridor of the operating suite.
(I) When a single patient preoperative room is provided the minimum clear area is 100 square feet exclusive of aisles and fixed and moveable cabinets and shelves. The room shall contain cabinets, work counter, and a hand washing fixture with hands-free operable controls.
(II) When a multiple-bed/gurney preoperative patient station is provided, the clearance between the side of the bed/gurney and a wall/partition shall be a minimum of three feet. The clearance between sides of beds/gurneys shall be a minimum of six feet. The minimum distance at the foot of the bed/gurney shall not be less than seven feet for single load area/room or ten feet for double load area/room. Four feet of the passage space at the foot of the bed may be shared between two beds/gurneys. The multiple-bed/gurney preoperative patient room shall contain cabinets, medication storage, and work counter. The fixed and movable cabinets and shelves shall not encroach upon the bed/gurney clear floor space/area. One hand washing fixture with hands-free operable controls shall be provided for every four stations or fraction thereof. Privacy shall be provided for each patient with cubicle curtains or movable screens. The requirements of this subclause are illustrated in Table 8, Diagram D of § 133.169(h) of this title.
(III) When a single patient preoperative/recovery room is provided the minimum clear area is 120 square feet exclusive of aisles and fixed and moveable cabinets and shelves. The room shall contain cabinets, work counter, and hand washing fixture with hands-free operable controls.
(IV) When a multiple-bed/gurney preoperative/recovery patient station is provided, the clearance between the side of a bed/gurney and a wall/partition shall be a minimum of four feet. The clearance between sides of beds/gurneys shall be a minimum of six feet. The minimum distance at the foot of the bed/gurney shall not be less than eight feet for single load area/room or twelve feet for double load area/room. Four feet of the passage space at the foot of the bed may be shared between two beds/gurneys. The multiple-bed/gurney preoperative/recovery patient station shall contain cabinets, medication storage, and work counter. The fixed and movable cabinets and shelves shall not encroach upon the bed/gurney clear floor space/area. One hand washing fixture with hands-free operable controls shall be provided for every four stations or fraction thereof. Privacy shall be provided for each patient with cubicle curtains or movable screens. The requirements of this subclause are illustrated in Table 8, Diagram M of § 133.169(h) of this title. (iii) A secondary recovery lounge (for outpatients requiring additional observation) with a nurse's station and a hand washing fixture with hands-free operable controls shall be provided. One hand washing fixture with hands-free operable controls shall be provided for every four secondary recovery stations or fraction thereof. In each secondary recovery station, the clearance between a side of lounger/gurney and a wall/partition shall be a minimum of three feet. The clearance between sides of lounger/gurney shall be a minimum of six feet. The minimum distance at the foot of the lounger/gurney shall not be less than six feet for single load area/room or nine feet for double load area/room. Three feet of passage space requirement at the foot of the lounger/gurney may be shared between two loungers/gurneys. The fixed and movable cabinets and shelves shall not encroach upon the lounger/gurney clear floor space/area. Privacy shall be provided for each patient with cubicle curtains or movable screens. The requirements of this clause are illustrated in Table 8, Diagram D of § 133.169(h) of this title. (iv) A toilet room for use by outpatients shall be provided directly accessible from the outpatient preoperative, recovery and secondary recovery lounge areas. The toilet room shall contain a water closet and a hand washing fixture with hands-free operable controls. There shall be one outpatient toilet room for every ten patient stations or fraction thereof. Toilet rooms may be shared if convenient to the outpatient preoperative, recovery and secondary recovery lounge areas.
(G) Special procedure room(s). When outpatient special procedures services are provided within the outpatient suite, the special procedure room(s) shall comply with the requirements in subsection (dd) of this section.
(H) Service areas. The following service areas and facilities shall be provided within the outpatient suite unless noted otherwise. (i) Nurse station(s). The nurse station shall contain a work counter, communication system, space for supplies, and provisions for charting. (ii) Hand washing fixtures. Hand washing fixtures with hands-free operable controls shall be available at all patient care areas. (iii) Patient toilet room(s). Toilet room(s) shall be conveniently located to treatment room(s), examination room(s), and diagnostic room(s) and shall include hand washing fixture(s) with hands-free operable controls. (iv) Staff toilet facilities. Toilet rooms equipped with hand washing fixtures with hands-free operable controls shall be provided for the exclusive staff use. Toilet facilities may be provided in conjunction with the staff lounge. (v) Staff lounge. A staff lounge with separate male and female staff clothing change rooms and toilets with hand washing fixtures with hands-free operable controls shall be provided in hospitals having a total of six or more diagnostic and treatment rooms. (vi) Medication station. Storage and distribution of medication may be done from a medicine preparation room, medicine alcove area or from a self-contained medicine dispensing unit but must be under visual control of nursing staff. A work counter, a hand washing fixture with hands-free operable controls, refrigerator, and double-locked storage for controlled substances shall be provided. Standard cup-sinks provided in many self-contained units are not acceptable for hand washing. The medication station may be shared with the clean workroom. (vii) Dictation and report preparation area. This area may be accessible from the lounge. (viii) Cast room. When a cast room is provided, it shall be equipped with hand washing facilities, plaster sink, storage, and other provisions required for cast procedures. (ix) Wheelchair and stretcher storage. Wheelchair and stretcher storage space or alcove shall be provided and located out of direct line of traffic. (x) Storage. Storage facilities shall be provided for office supplies, sterile supplies, pharmaceutical supplies, splints and other orthopedic supplies, and housekeeping supplies and equipment. (xi) Ice machine. A self-dispensing ice machine shall be provided. (xii) Clean workroom. A clean workroom or clean supply room shall be provided. (xiii) Storage room. A storage room for the outpatient services shall be provided at least equal to 5.0% of the total area of the outpatient suite. This required storage room area may be combined with general stores. (xiv) Soiled workroom. A soiled workroom shall be provided. It shall not have direct access to any patient treatment, examination, diagnostic rooms, or sterile rooms. The room shall contain a clinical sink or equivalent flushing rim fixture, work counter, hand washing fixture with hands-free operable controls, waste receptacle, and linen receptacle. (xv) Housekeeping room. The housekeeping room shall be located within the suite. The room may be shared with an adjacent emergency suite when directly accessible from both sides.
(2) Details and finishes. Details and finishes shall be in accordance with § 133.162(d)(2) of this title and this paragraph. Treatment rooms shall be provided with seamless flooring in accordance with requirements contained in § 133.162(d)(2)(B)(iii)(III) of this title.
(3) Mechanical requirements. Mechanical requirements shall be in accordance with § 133.162(d)(3) of this title and this paragraph. Filtration requirements for air handling units serving the outpatient and surgical suite shall be equipped with filters having efficiencies equal to, or greater than specified for patient care areas in Table 4 of § 133.169(d) of this title.
(4) Piping systems and plumbing fixtures. Piping systems and plumbing fixtures shall be in accordance with § 133.162(d)(4) of this title and this paragraph. Sinks used for the disposal of plaster of paris shall have a plaster trap.
(5) Electrical requirements. Electrical requirements shall be in accordance with § 133.162(d)(5) of this title and this paragraph. The nurse call shall be in accordance with § 133.162(d)(5)(L) and Table 7 of § 133.169(g) of this title.
(w) Pediatric and adolescent nursing unit.
(1) Architectural requirements. When a facility offers pediatric care services and the nursing unit contains a total of 15 or more patient beds, cribs or bassinets, the unit shall meet the requirements contained in this subsection. Units containing less than 15 beds, cribs or bassinets, may be a part of the medical/surgical nursing unit. Each pediatric and adolescent nursing unit shall comply with the requirements contained in subsection (t)(1) of this section and the following requirements.
(A) Patient rooms. Patient rooms in a pediatric and adolescent nursing unit containing hospital beds or cribs shall comply with subsection (t)(1)(B) of this section with the following exceptions: (i) The minimum clear floor space in a private patient room within a dedicated pediatric unit intended for a crib shall be 100 square feet exclusive of toilet room, closet, built-in cabinets, wardrobe, alcove, or vestibules. Minor encroachments including columns and wall hung lavatories that do not interfere with functions may be ignored. (ii) Patient rooms used for multiple cribs shall have no more than six cribs in a room. The clearance between the side of a crib and a wall/partition shall be a minimum of three feet six inches. The clearance between sides of crib shall be a minimum of six feet. The minimum distance at the foot of the crib shall not be less than seven feet for single load area/room or ten feet for double load area/room. Four feet of the passage space at the foot of the crib may be shared between two cribs. The fixed and moveable cabinets and shelves shall not encroach upon the crib clear floor space/area. One hand washing fixture with hands-free operable controls shall be provided for every three patients cribs. The requirements of this clause are illustrated in Table 8, Diagram L of § 133.169(h) of this title.
(B) Airborne infection isolation suites and protective environment suites. (i) Airborne infection isolation suites shall comply with the requirements contained in subsection (t)(1)(C) of this section and shall be located within the pediatric and adolescent nursing unit. (ii) Protective environment suites shall comply with the requirements contained in subsection (t)(1)(D) of this section and shall be located within the pediatric and adolescent nursing unit.
(C) Pediatric nursery suite. When provided, the pediatric nursery suite shall be located in the pediatric nursing unit and shall consist of a nursery, examination/treatment room, workroom, and formula preparation room and contain the following elements. (i) Nursery. Each pediatric nursery shall contain not more than eight bassinets. The clearance between the side of bassinet and a wall/partition shall be a minimum of three feet. The clearance between sides of bassinets shall be a minimum of six feet. The minimum distance at the foot of the bassinet shall not be less than six feet for single load area/room or nine feet for double load area/room. Four feet of the passage space at the foot of the bassinet may be shared between two bassinets. The fixed and moveable cabinets and shelves shall not encroach upon the bassinet clear floor space/area. The requirements of this clause are illustrated in Table 8, Diagram J of § 133.169(h) of this title. Additional area shall be provided to accommodate workroom functions if these are located within the nursery area as specified in clauses (ii) and (iii) of this subparagraph.
(I) One hand washing fixture with hands-free operable controls shall be provided for every four patients bassinets in each pediatric nursery.
(II) Each pediatric nursery shall be provided with viewing windows for observing infants from public areas and workroom(s). (ii) Nursery workroom. A connecting workroom shall be provided which shall contain gowning facilities at the entrance for staff, visitors, and housekeeping personnel, work space with counter, refrigerator, lavatory or sink equipped for hand washing, and storage. One workroom shall serve no more than two nurseries provided that required services are convenient to each. The workroom may be omitted if only one nursery is provided and the equivalent work area and facilities are provided within the nursery in which case the gowning facilities shall be located near the entrance to the nursery and shall be separated from the work area. (iii) Examination/treatment room or area. An examination/treatment room or area shall be provided. The examination/treatment area may be located in a separate room or a designated part of the nursery. It shall contain a work counter, storage facilities, and a lavatory for hand washing. (iv) On-site formula preparation. Where infant formula is prepared on the hospital site, the hospital shall provide cleanup facilities for washing and sterilizing supplies. These shall consist of a lavatory or sink equipped for hand washing, a bottle washer, work counter space, and an equipment sterilizer. A separate room for preparing infant formula shall be provided. The room shall contain a lavatory or sink equipped for hand washing, hot plate, refrigerator, work counter, formula sterilizer, and storage facilities. It may be located in the pediatric nursery or in another appropriate place within the hospital. There shall be no direct access from the formula room to a nursery. (v) Commercially prepared formula. If a commercial infant formula is used, the storage and handling may be done in the nursery workroom or in another appropriate room elsewhere in the hospital which has a work counter, sink equipped for hand washing, and storage facilities. (vi) Housekeeping room. A housekeeping room shall be located in the pediatric nursery suite.
(D) Service areas. The service areas in the pediatric and adolescent nursing unit shall comply with the requirements listed in subsection (t)(1)(F) of this section and the following requirements. (i) Multipurpose or individual room(s) shall be provided for dining, educational, and play purposes. Special provision shall be made to minimize the impact noise transmission through the floor of the multipurpose room(s) to occupied spaces below. Requirements in Table 1 of § 133.169(a) of this title shall be met. (ii) Patient toilet room(s) shall be provided convenient to multipurpose room(s) and central bathing facilities. (iii) Storage closets or cabinets for toys and educational and recreational equipment shall be provided. (iv) Storage space shall be provided for replacement of cribs and adult beds to provide flexibility for interchange of patient accommodations.
(2) Details and finishes. Each pediatric and adolescent nursing unit shall comply with the requirements contained in subsection (t)(2) of this section.
(3) Mechanical requirements. Mechanical requirements in each pediatric and adolescent nursing unit shall comply with the requirements contained in subsection (t)(3) of this section and this paragraph.
(A) Special consideration for safety shall be given to the type of heating and cooling units, ventilation outlets, and appurtenances installed in patient areas of pediatric and adolescent nursing units.
(B) All air grilles and diffusers shall be of a type that prevents the insertion of foreign objects.
(C) All convector or HVAC enclosures exposed in the room shall be constructed with rounded corners and shall have enclosures fastened with tamper-resistant fasteners.
(4) Plumbing fixtures and piping systems. Plumbing fixtures and piping systems shall be in accordance with subsection (t)(4) of this section.
(5) Electrical requirements. Electrical requirements shall be in accordance with § 133.162(d)(5) of this title and this paragraph. The nurse call shall be in accordance with § 133.162(d)(5)(L) and Table 7 of § 133.169(g) of this title.
(x) Pharmacy suite.
(1) Architectural requirements.
(A) General. The pharmacy room or suite shall be located for convenient access, staff control, and security for drugs and personnel.
(B) Dispensing area. The pharmacy room or suite shall include the following functional spaces and facilities: (i) area(s) for pickup, receiving, reviewing and recording; (ii) extemporaneous compounding area with sufficient counter space for drug preparation and sink with hands-free operable controls; (iii) work counter space for automated and manual dispensing activities; (iv) storage or areas for temporary storage, exchange, and restocking of carts; and (v) security provisions for drugs and personnel in the dispensing counter area.
(C) Manufacturing. The pharmacy room or suite shall provide the following functional spaces and facilities for the manufacturing area(s): (i) bulk compounding area with work space and counters; and (ii) area(s) for packaging, labeling and quality control.
(D) Storage. The following spaces shall be provided in cabinets, shelves, and/or separate rooms or closets: (i) space for bulk storage, active storage, and refrigerated storage; (ii) storage in a fire safety cabinet or storage room that is constructed under the requirements for protection from hazardous areas in accordance with NFPA 101, Chapter 12, for alcohol or other volatile fluids, when used; (iii) storage in a secure vault, safe, or double locking wall cabinet for narcotics and controlled drugs; and (iv) storage space for general supplies and equipment not in use.
(E) Intravenous (IV) solutions area. When IV solutions are prepared in a pharmacy, a sterile work area shall be provided and be in compliance with 22 TAC § 291.26 (relating to Pharmacies Compounding Sterile Pharmaceuticals) and the United States Pharmacopoeia, Chapter 797, Pharmaceutical Compounding-Sterile Preparations. (i) The IV work area shall consist of a preparation room, hood room and, if provided, a separate chemo-hood room. Access to the preparation room shall be through the pharmacy only, access to the hood room or chemo-hood room shall be through the preparation room only. (ii) The preparation room shall contain a work counter, gowning area and shelving. (iii) A hand washing fixture with hands-free operable controls shall be in the preparation room and within five feet of each entrance to the hood room or chemo-hood room. Hand washing fixtures and floor drains are not allowed inside the hood room or chemo-hood room. (iv) Laminar-flow hoods/work stations shall be located inside the hood room.
(F) Compounding aseptic isolator (CAI). When a CAI is used for compounding, in lieu of the IV solutions area, it may be done within the pharmacy provided it complies with the following. (i) The CAI shall provide isolation from the room and maintain the International Organization for Standardization (ISO) Class 5 (100 particles greater than or equal to 0.5 microns per cubic foot) levels during dynamic operating conditions including transferring ingredients, components, and devices into and out of the isolator and during preparation of compounded sterile preparations. (ii) The particle counts sampled shall be 6 to 12 inches upstream of the critical exposure site within the CAI and maintain ISO Class 5 levels during compounding operations. (iii) The facility shall obtain documentation from the manufacturer that the CAI will meet this standard when located in worse than ISO Class 7 (10,000 particles greater than or equal to 0.5 microns per cubic foot environments).
(G) Administrative area(s). The following functional spaces and facilities shall be included for the administrative area(s): (i) office area for the chief pharmacist and any other offices areas required for records, reports, accounting activities, and patients profiles; (ii) poison control center with storage facilities for reaction data and drug information centers; and (iii) a room or area for counseling and instruction when individual medication pick-up is available for inpatients or outpatients.
(H) Satellite pharmacy facilities. When provided, the room(s) shall include a work counter, a sink with hands-free operable controls, storage facilities, and refrigerator for medications. As applicable, items required in subparagraphs (B) and (C) of this paragraph may be incorporated into the satellite pharmacy.
(I) Service areas and facilities. The following service areas and facilities shall be provided. (i) Hand washing facilities. A hand washing fixture with hands-free operable controls shall be located in each room where open medication is handled except for IV prepared chemo-hood rooms. (ii) Staff facilities. Toilet rooms with hand washing fixture with hands-free operable controls may be outside the suite but shall be convenient for staff use.
(2) Details and finishes. Details and finishes shall be in accordance with § 133.162(d)(2) of this title and this paragraph.
(A) Flooring in the IV solutions area for the preparation room, hood room and chemo-hood room shall be seamless and coved to the wall.
(B) IV solutions area ceiling and wall finishes for the preparation room, hood room and chemo-hood room shall be interlocking monolithic panels and sealed together or monolithic epoxy-painted gypsum board. The ceiling shall be coved to the wall.
(C) All penetrations in the walls and ceilings shall be sealed.
(D) The door from hood room shall swing into the preparation room. The door from preparation room shall swing into the chemo room. The door from preparation room shall swing into pharmacy.
(3) Mechanical Requirements. Mechanical requirements shall be in accordance with § 133.162(d)(3) of this title and this paragraph.
(A) When IV solutions are prepared, the required laminar-flow system shall include a nonhygroscopic filter rated at 99.97% (HEPA). A pressure gauge shall be installed for detection of filter leaks or defects.
(B) When fume hoods are used for chemotherapy, the air/fumes shall be exhausted directly to the exterior. The hood exhaust shall not use the building exhaust system. When more than one fume hood is in the same hood room and the work stations face each other, at least six feet must separate work area openings.
(C) When fume hoods are used, the design should consider the placement and types of air distribution devices to avoid the disturbance of a uniform velocity across the face of the hood.
(D) All air entering the IV solutions area for the preparation room, hood room and chemo-hood room shall be HEPA filtered.
(E) In the IV solutions area the air pressure in the preparation room shall be positive to the pharmacy, the hood room shall be positive to the preparation room and the chemo-hood room shall be negative to the preparation room.
(4) Piping systems and plumbing fixtures. Piping systems and plumbing fixtures shall be in accordance with § 133.162(d)(4) of this title and this paragraph.
(A) Material used for plumbing fixtures shall be nonabsorptive and acid-resistant.
(B) Water spouts used at lavatories and sinks shall have clearances adequate to avoid contaminating utensils and the contents of carafes, etc.
(5) Electrical requirements. Electrical requirements shall be in accordance with § 133.162(d)(5) of this title and this paragraph.
(A) Under-counter receptacles and conduits shall be arranged (raised) to not interfere with cleaning of the floor below or of the equipment.
(B) Exhaust hoods shall have an indicator light indicating that the exhaust fan is in operation.
(C) Electrical circuit(s) to equipment in wet areas shall be provided with five milliampere GFCI.
(y) Radiotherapy suite. When radiotherapy services are provided, the suite may contain equipment for electron beam therapy, radiation therapy, or both. The following facilities shall be provided.
(1) Architectural requirements.
(A) Cobalt, linear accelerators, and simulation rooms require radiation protection. A medical physicist licensed under the Texas Medical Physics Practice Act, Occupations Code, Chapter 602, shall specify the type, location, and amount of radiation protection to be installed for the layout and equipment selections. Room layouts and construction shall prevent the escape of radioactive particles. Openings into the room, including doors, ductwork, vents, and electrical raceways and conduits, shall be baffled to prevent direct exposure to other areas of the facility.
(B) Cobalt, linear accelerator, and simulator rooms shall be sized in accordance with the installed equipment requirements, patient access on a stretcher, medical staff access to the equipment and patient, and access for servicing the equipment.
(C) When a mold room is provided, it shall contain a ventilation hood exhausted to the exterior and a hand washing fixture with hands-free operable controls.
(D) A block room with storage for the linear accelerator may be combined with the mold room.
(E) A hot laboratory in support of cobalt therapy shall be provided.
(F) The following service areas shall be provided unless these are accessible from other departments such as imaging or outpatient areas: (i) a stretcher hold area adjacent to the treatment rooms, screened for privacy, and combined with a seating area for outpatients; (ii) exam rooms for each treatment room. The rooms shall be a minimum of 100 square feet and shall be provided with hand washing facilities; (iii) a patient gowning area with provisions for safe storage of valuables and clothing. At least one space shall be sized to allow for staff-assisted dressing; (iv) convenient access to a housekeeping room; (v) film file area; (vi) film storage area for unprocessed film; and (vii) a radioisotope decay room. This room may be combined with the hot lab.
(2) Details and finishes. Details and finishes shall be in accordance with § 133.162(d)(2) of this title and this paragraph.
(A) Details. (i) Radiation protection shall be designed, tested and approved by a medical physicist licensed under the Texas Civil Statutes, Occupations Code, Chapter 602. (ii) Room shielding calculations for linear accelerators, cobalt and simulation rooms shall be submitted to the Department of State Health Services' Radiation Control (RC) for approval prior to use. Shielding in diagnostic radiographic rooms will be reviewed by inspectors, in the field, subsequent to use. Any changes in design or shielding, which affects radiation exposure levels adjacent to those rooms, requires prior approval by RC. (iii) The cobalt, simulation and linear accelerator rooms shall have ceiling heights not less than nine feet. Ceilings containing ceiling-mounted equipment shall be of sufficient height to accommodate the equipment of fixtures and their normal movement. (iv) Properly designed rigid support structures for ceiling-mounted equipment shall be located above the finished ceiling.
(B) Finishes. (i) Flooring in the soiled workroom and any work or treatment areas in the radiotherapy suite where radioactive materials are handled shall be of the seamless type as required by § 133.162(d)(2)(B)(iii)(III) of this title. (ii) Walls shall be constructed of materials that are easily decontaminated from accidental radioactive spills and finished in accordance with § 133.162(d)(2)(B)(iv) of this title. (iii) Ceilings in the hot laboratory and soiled workroom shall be monolithic as required by § 133.162(d)(2)(B)(vi)(III) of this title.
(3) Mechanical requirements. Mechanical requirements shall be in accordance with § 133.162(d)(3) of this title and this paragraph.
(A) Where fume hoods are used, the design should consider the placement and types of air distribution devices to avoid the disturbance of a uniform velocity across the face of the hood.
(B) Each hood used to process radioactive materials shall have a minimum face velocity of 90-110 feet per minute, be connected to an independent exhaust system, with suitable pressure-independent air modulating devices and alarms to alert staff of fan shutdown or loss of airflow. Each hood shall also have filters with a 99.97% efficiency (based on the dioctyl-phthalate (DOP) test method) in the exhaust stream, and be designed and equipped to permit the safe removal, disposal, and replacement of contaminated filters. Filters shall be as close to the hood as practical to minimize duct contamination.
(4) Plumbing fixtures and piping systems. Piping systems and plumbing fixtures shall comply with the requirements of § 133.162(d)(4) of this title.
(5) Electrical requirements. Each radiotherapy suite shall comply with the requirements of § 133.162(d)(5) of this title and this paragraph.
(A) Each radiotherapy procedure room shall have at least four electrical receptacles.
(B) Ground fault circuit interrupters shall not be used in radiotherapy procedure rooms.
(C) Nurses calling system. The nurse call shall be in accordance with § 133.162(d)(5)(L) and Table 7 of § 133.169(g) of this title.
(z) Rehabilitation nursing unit.
(1) Architectural requirements. When provided, each rehabilitation nursing unit shall comply with the requirements contained in subsection (t)(1) of this section and the following requirements.
(A) Accessibility requirements. All patient rooms, bathing units and toilets in each rehabilitation nursing unit and all public and common use areas shall be designed and constructed to be handicapped accessible in accordance with § 133.162(d)(1)(D) of this title. These requirements shall apply in all new construction and when an existing nursing unit or a portion thereof is converted to rehabilitation nursing care from other nursing care, e.g. mental health care to rehabilitation care.
(B) Patient room suites. Patient room suites shall comply with the requirements of subsection (t)(1)(B) and the following requirements. (i) Multi-bed patient room. The clearance between the side of a bed and a wall/partition shall be a minimum of five feet. The clearance between sides of beds shall be a minimum of four feet. The minimum distance at the foot of the bed shall not be less than four feet for single load area/room or seven feet for double load area/room. Four feet of the passage space at the foot of the bed may be shared between two beds. The fixed and moveable cabinets and shelves shall not encroach upon the bed clear floor space/area. The requirements of this clause are illustrated in Table 8, Diagram H of § 133.169(h) of this title. (ii) Training toilet room. When a training toilet room is provided, there shall be three feet of clearance on both sides and front of the water closet fixture. The room shall be designed to comply with accessibility requirements of § 133.162(d)(1)(D) of this title.
(2) Details and finishes. Details and finishes shall be in accordance with § 133.162(d)(2) of this title.
(3) Mechanical requirements. Mechanical requirements shall be in accordance with § 133.162(d)(3) of this title.
(4) Piping systems and plumbing fixtures. Piping systems and plumbing fixtures shall be in accordance with subsection (t)(4) of this section. All plumbing fixtures shall comply with the requirements for the handicapped in accordance with § 133.162(d)(1)(D) of this title.
(5) Electrical requirements. Electrical requirements shall be in accordance with § 133.162(d)(5) of this title and this paragraph. The nurse call shall be in accordance with § 133.162(d)(5)(L) and Table 7 of § 133.169(g) of this title.
(aa) Rehabilitation therapy suite. Rehabilitation therapy may include one or more categories of services. Where two or more rehabilitation services are provided, the services may share common areas when appropriate.
(1) Architectural requirements.
(A) Occupational therapy. When occupational therapy services are provided, the following rooms or areas shall be included: (i) an activity area with work areas, counters and a hand washing fixture with hands-free operable controls. Work areas and counters shall be suitable for wheel chairs; (ii) an area for teaching daily living activities with space for a bed, kitchen counter with appliances and sink, bathroom, and a table and chair. The daily living activities area may be combined with the activity area; (iii) an office for the occupational therapist; and (iv) a storage room for supplies and equipment.
(B) Physical therapy. When physical therapy services are provided, the following rooms or areas shall be included. (i) Provisions shall be made for thermotherapy, diathermy, ultrasonics, and hydrotherapy when required by the functional program. (ii) Treatment area(s) shall be provided with a minimum of 70 square feet of clear floor area for each patient station, exclusive of four foot aisle space. Privacy screens or curtains shall be provided at each treatment station. (iii) A hand washing fixture with hands-free operable controls shall be provided in each treatment room/space. One hand washing fixture may serve up to four patient stations when cubicles or open room concepts are used and when the fixture is conveniently located. (iv) An area shall be provided for exercise and may be combined with treatment areas in open plan concepts. (v) An office shall be provided for the physical therapist. (vi) Separate storage shall be provided for soiled linen, towels, and supplies. (vii) A storage area or room for equipment, clean linen, and supplies shall be provided. (viii) When outpatient physical therapy services are provided, the suite shall have as a minimum patient dressing areas, showers and lockers. These shall be accessible and usable by the disabled.
(C) Prosthetics and orthotics. When prosthetics and orthotics services are provided, the following rooms or areas shall be included: (i) work space with counters and shelves for technicians; (ii) a treatment space for evaluating and fitting with privacy screens or curtains; and (iii) a storage area or room for equipment and supplies.
(D) Speech and hearing. When speech and hearing services are provided, the following rooms or areas shall be included: (i) a space for evaluating and treatment with privacy screens or curtains; and (ii) a storage area or room for equipment and supplies.
(E) Service areas. The following areas or items shall be provided in a rehabilitation therapy suite, but may be shared when multiple rehabilitation services are offered: (i) patient waiting area(s) out of traffic with space for wheelchairs; (ii) patient toilet facilities containing hand washing fixtures, with hands-free operable controls; (iii) reception and control station(s). The reception and control station shall be located to provide supervision of activities areas. The control station may be combined with office and clerical spaces; (iv) office and clerical space; (v) wheelchair and stretcher storage room or alcove which shall be in addition to other storage requirements; (vi) lockable closets, lockers or cabinets for securing staff personal effects; (vii) staff toilets. The toilets may be outside the suite but shall be convenient for staff use and contain hand washing fixtures with hands-free operable controls; (viii) soiled holding room; and (ix) housekeeping room with service sink, conveniently accessible.
(2) Details and finishes.
(A) Details. Details shall be in accordance with § 133.162(d)(2)(A) of this title.
(B) Finishes. Finishes shall be in accordance with § 133.162(d)(2)(B) of this title and this paragraph. (i) Flooring in a treatment room and soiled workroom shall be of the seamless type as required by § 133.162(d)(2)(B)(iii)(III) of this title. (ii) Wall finishes shall be in accordance with the requirements of § 133.162(d)(2)(B)(iv) of this title.
(3) Mechanical requirements. Mechanical requirements shall be in accordance with § 133.162(d)(3) of this title and this paragraph. Air handling units serving the rehabilitation therapy suite shall be equipped with filters having efficiencies equal to, or greater than specified for patient care areas in Table 4 of § 133.169(d) of this title.
(4) Piping systems and plumbing fixtures. Piping systems and plumbing fixtures shall be in accordance with § 133.162(d)(4) of this title.
(5) Electrical requirements. Electrical requirements shall be in accordance with § 133.162(d)(5) of this title and this paragraph. The nurse call shall be in accordance with § 133.162(d)(5)(L) and Table 7 of § 133.169(g) of this title.
(bb) Renal dialysis suite. Outpatient renal dialysis shall not be performed in the hospital's inpatient renal dialysis suite unless authorized under § 133.41(t) of this title. When outpatient renal dialysis is provided within a hospital building, the service and facilities shall be separated from the hospital with a two-hour fire rated partition. The owner of the outpatient renal dialysis facility must obtain a separate license under Texas Health and Safety Code, Chapter 251, End Stage Renal Disease Facilities. Mechanical, electrical and plumbing services may be contracted from the hospital and the hospital shall maintain all rights and controls of all systems. When inpatient renal dialysis services are provided, the following rooms or areas shall be included.
(1) Architectural requirements.
(A) Dialysis services (acute). Dialysis services (acute) may be performed in critical care units and designated areas in the hospital, with appropriate equipment and space.
(B) Treatment area(s). The treatment area(s) shall be separate from the administrative area(s). (i) Individual patient treatment room(s) shall have a minimum of 120 square feet of clear floor area exclusive of fixed and movable cabinets and shelves. The patient treatment room shall contain cabinets, work counter, and a hand washing fixture with hands-free operable controls. (ii) In multiple-treatment stations, the clearance between the side of a station and a wall/partition shall be a minimum of three feet. The clearance between sides of stations shall be a minimum of six feet. The minimum distance at the foot of the bed/gurney shall not be less than seven feet for single load area/room or ten feet for double load area/room. Four feet of the passage space at the foot of the bed may be shared between two beds/gurneys. The multiple-treatment stations shall contain cabinets, work counters, and hand washing fixtures with hands-free operable controls. The fixed and moveable cabinets and shelves shall not encroach upon the patient treatment station clear floor space/area. The requirements of this clause are illustrated in Table 8, Diagram D of § 133.169(h) of this title. (iii) A nurse station shall be located within the dialysis treatment area(s) and designed to provide visual observation of all patient stations. The nurse station shall have counters for storage and access to a hand washing fixture(s) with hands-free operable controls. (iv) Privacy shall be provided for each patient in the open treatment area with cubicle curtains or moveable screens. (v) Storage and preparation of medication may be done from a medicine preparation room, medicine alcove or from a self-contained medicine dispensing unit and shall be under visual control of nursing staff. A work counter, a hand washing fixture that is operable without the use of hands, a refrigerator, and double-locked storage for controlled substances shall be provided. (Standard cup-sinks provided in many self-contained units are not adequate for hand washing.)
(C) Home training room. When home training is provided in the unit, a private treatment area of at least 120 square feet exclusive of fixed and movable cabinets and shelves shall be provided. This room shall contain a work counter, a hand washing fixture with hands-free operable controls, and a separate drain for fluid disposal.
(D) Isolation rooms. (i) When renal dialysis treatment is provided for persons who are known or suspected of having airborne infectious disease, these procedures shall be performed in a designated treatment room of not less than 120 square feet of floor area meeting airborne infection isolation ventilation requirements as contained in Table 3 of § 133.169(c) of this title. Bathing facilities are not required. (ii) When medical isolation for hepatitis B surface antigen (HbsAg) is provided, it shall be in a separate dedicated treatment room for a single patient with a minimum of 100 square feet clear area exclusive of fixed and movable cabinets and shelves. The treatment room shall include a work counter and a hand washing fixture with hands-free operable controls, and space for patient care supplies and equipment. The dialyzed equipment shall be designated and reserved for individual renal dialysis patients. The equipment shall be disinfected after each use. Disinfection of equipment shall occur in the treatment room.
(E) Service areas and facilities. (i) Patient toilet(s). Patient toilet rooms shall be convenient to the treatment area(s) and include hand washing fixture(s) with hands-free operable controls. (ii) Storage space. A storage space shall be available for wheelchairs, supply carts and stretchers. This storage shall be located out of the direct line of traffic and in addition to other storage requirements. (iii) Water treatment room. The water treatment and equipment for the dialysis shall be located in a dedicated enclosed room. (iv) Mixing room. Dialysis solutions may be processed from a central batch delivery system or prepared in an on-site mixing room. When provided, a mixing room shall include a work counter, sink with hands-free operable controls, storage space, and holding tanks. (v) Dialyzers reprocessing room. When provided, the room shall be arranged for the separation and one-way movement of soiled and clean materials. This room shall include a work counter, service sink, separate hand washing fixture with hands-free operable controls, refrigerator and storage space. (vi) Breakdown room. When provided, the room shall include a work counter, service sink, separate hand washing fixture with hands-free operable controls, and storage space. This function may be included as part of the soiled processing area of the dialyzers reprocessing room. (vii) Nourishment station. When provided, the nourishment station shall include a work counter, a sink with hands-free operable controls, refrigerator, microwave, and storage cabinets. (viii) Hand washing facilities. Hand washing facilities shall be provided in each examination room and treatment room. In an open multiple-treatment area one hand washing fixture shall be provided for every four treatment stations or fraction thereof. (ix) Dictation and report preparation area. This area may be incorporated with the nurse station if adequate work space is provided. (x) Staff facilities. Toilets may be outside the suite but shall be convenient for staff use. (xi) Offices work area. Office space and clinical work area shall include space for records storage and report preparation. (xii) Clean workroom. When the functional program dictates preparing patient care items, a clean workroom shall be provided and contain a work counter, a hand washing fixture with hands-free operable controls, and storage facilities for clean and sterile supplies. This function may be within the mixing room. (xiii) Clean linen storage. There shall be a designated area for clean linen storage. This may be within a clean workroom, a mixing room, a separate closet, or an approved distribution system. If a closed cart system is used, storage of the cart shall be in an alcove. (xiv) Soiled workroom. The soiled workroom shall contain a work counter, a clinical sink with hands-free operable controls or equivalent flushing type fixture, separate hand washing facilities, and separate waste and linen receptacles. (xv) Housekeeping room. A housekeeping room for the exclusive use of the unit shall contain a service sink and storage for housekeeping supplies and equipment.
(2) Details and finishes.
(A) Details. Details shall be in accordance with § 133.162(d)(2)(A) of this title.
(B) Finishes. Finishes shall be in accordance with § 133.162(d)(2)(B) of this title and this paragraph. (i) Flooring in a treatment room and soiled workroom shall be of the seamless type as required by § 133.162(d)(2)(B)(iii)(III) of this title. (ii) Wall finishes shall be in accordance with the requirements of § 133.162(d)(2)(B)(iv) of this title. (iii) Ceilings in the isolation and hepatitis B rooms shall be of the monolithic type as required by § 133.162(d)(2)(B)(vi)(III) of this title.
(3) Mechanical requirements. Mechanical requirements shall be in accordance with § 133.162(d)(3) of this title and this paragraph. Air handling units serving the renal dialysis suite shall be equipped with filters having efficiencies equal to, or greater than specified for patient care areas in Table 4 of § 133.169(d) of this title.
(4) Piping systems and plumbing fixtures. Piping systems and plumbing fixtures shall be in accordance with § 133.162(d)(4) of this title and this paragraph. The dialysis water treatment shall meet the standards as described in the American National Standard, Hemodialysis Systems, July 2003 edition, published by the American Association for the Advancement of Medical Instrumentation (AAMI), 1110 North Glebe Road, Suite 220, Arlington, Virginia 22201, telephone (703) 525-4890.
(5) Electrical requirements. Electrical requirements shall be in accordance with § 133.162(d)(5) of this title and this paragraph.
(A) General. Each treatment area and treatment room shall have at least two duplex electrical receptacles located on each side of a patient bed or lounge chair.
(B) Grounding. All equipment and appliances shall be properly grounded in accordance with the National Fire Protection Association 99, Standard for Health Care Facilities, §§ 3-3.2.1.2(a)(2) and 7-5.1, 2002 Edition (NFPA 99), published by the National Fire Protection Association. All documents published by the NFPA as referenced in this section may be obtained by writing or calling the NFPA at the following address or telephone number: National Fire Protection Association, 1 Batterymarch Park, Post Office Box 9101, Quincy, Massachusetts 02269-9101, 1-800-344-3555.
(C) Nurses calling system. The nurse call shall be in accordance with § 133.162(d)(5)(L) and Table 7 of § 133.169(g) of this title.
(cc) Respiratory therapy suite. The type and extent of respiratory therapy services vary greatly in each hospital. Therapy can be delivered from a large centralized area or basic services can be provided at the patient bedside.
(1) Architectural requirements.
(A) Respiratory therapy suite. When respiratory services are provided from a centralized area, the following rooms or areas shall be included: (i) an office for the respiratory therapist; (ii) office and clerical space with provision for filing and retrieval of patient records; (iii) receiving/decontamination workroom with work counter or table, a deep sink, and a hand washing fixture with hands-free operable controls; and (iv) a storage room for clean and sterile supplies which is separate from the receiving/decontamination workroom. (v) When a blood gas analyzer is provided, it shall be located in a room and contain a counter and hand washing sink. When a portable blood gas analyzer is used, it may be used in rooms which have a work counter and hand washing facilities with hands-free operable controls. Storage of the unit may occur in an alcove or equipment storage room.
(B) Outpatient respiratory therapy services. When respiratory therapy services are provided for outpatients, the following additional areas and facilities shall be included in the centralized respiratory therapy suite: (i) patient waiting area with space for wheelchairs; (ii) reception and control station(s) with visual control of waiting and activities areas; (iii) patient toilet facilities which include hand washing fixtures with hands-free operable controls; (iv) office and clerical space; and (v) consultation/education room.
(C) Cough-inducing and aerosol-generating procedures. All cough-inducing procedures performed on patients who may have infectious Mycobacterium tuberculosis shall be performed in rooms, booths or special enclosures using local exhaust ventilation devices with HEPA filters located at the discharge end and exhaust directly to the outside.
(D) Service areas. The following areas and facilities shall be provided for the respiratory therapy suite but may be shared with other departments when conveniently located: (i) wheelchair and stretcher storage room or alcove which is in addition to other storage requirements; (ii) lockable closets, lockers or cabinets for securing staff personal effects; (iii) staff toilets which include a hand washing fixture with hands-free operable controls. Staff toilets may be located outside suite if location is near and convenient; and (iv) housekeeping room. The housekeeping room shall be located within the suite or nearby, and shall contain a service sink and storage space for housekeeping supplies and equipment.
(2) Details and finishes.
(A) Details. Details shall be in accordance with § 133.162(d)(2)(A) of this title.
(B) Finishes. Finishes shall be in accordance with § 133.162(d)(2)(B) of this title and this paragraph. (i) Flooring in a decontamination room shall be of the seamless type as required by § 133.162(d)(2)(B)(iii)(III) of this title. (ii) Wall finishes shall be in accordance with the requirements of § 133.162(d)(2)(B)(iv) of this title. (iii) Ceilings shall be in accordance with § 133.162(d)(2)(B)(vi)(III) of this title.
(3) Mechanical requirements. Mechanical requirements shall be in accordance with § 133.162(d)(3) of this title.
(4) Piping systems and plumbing fixtures. Piping systems and plumbing fixtures shall be in accordance with § 133.162(d)(4) of this title.
(5) Electrical requirements. Electrical requirements shall be in accordance with § 133.162(d)(5) of this title.
(dd) Special procedure suite.
(1) Architectural requirements.
(A) General. When special procedures such as endoscopy, bronchoscopy, and cardiac catheterization and other similar special procedures are provided, procedure rooms may be in a separate suite or may be part of the surgical suite. (i) Special procedure rooms may be incorporated in an outpatient suite. (ii) When special procedure rooms are part of the surgical suite and noninvasive procedures are performed, these rooms are not required to be part of the sterile environment. (iii) Nonsurgical or noninvasive procedure rooms shall have a minimum clear floor area of 250 square feet, and a minimum clear dimension between fixed cabinets and built-in shelves shall be 14 feet. (iv) A hand washing fixture or a scrub sink with hands-free controls shall be located within five feet of the entrance to each nonsurgical procedure room either in the room or outside. Hand washing facilities shall be arranged to minimize any incidental splatter on nearby personnel or supply carts and recessed out of the main traffic areas. (v) When general anesthesia or inhalation anesthetizing agents are used during special procedures, these rooms shall comply with the detail, finish, mechanical and electrical requirements for an operating room contained in subsection (ee) of this section.
(B) Special procedure rooms for surgical cystoscopic and other endourologic procedures. (i) The procedure room shall have a minimum clear floor area of 350 square feet exclusive of fixed cabinets and shelves. The minimum clear dimension between fixed cabinets and built-in shelves shall be 15 feet. (ii) Procedure rooms shall be designed for visual and acoustical privacy for the patient. (iii) One scrub station shall be located within five feet of the outside entrance of each special procedure surgical room. Scrub facilities shall be arranged to minimize any incidental splatter on nearby personnel, medical equipment or supply carts. The scrub sinks shall be recessed out of the main traffic areas. The scrub sink shall be located off the restricted areas of the special procedure surgical procedure rooms. Scrub sinks or sinks shall not be located inside the sterile area. (iv) Appropriately sized areas shall be provided for male and female changing rooms within the special procedure surgical suite. These areas shall contain lockers, showers, toilets, hand washing fixtures with hands-free operable controls, and space to change into scrub suits and boots. Separate locker/changing rooms shall be provided for male and female staff. The shower and toilet room(s) may be unisex. These areas shall be arranged to provide a traffic pattern so that personnel entering from outside the special procedure surgical suite can shower, change, and move into the restricted portions of special procedure surgical suite.
(C) Catheterization laboratory. A catheterization procedure room may be in a separate suite, part of a special procedure suite, surgical suite, or in the imaging suite. The following items and facilities shall be provided. (i) The room(s) shall be located in an area restricted to authorized personnel. (ii) The procedure room shall be a minimum of 400 square feet of clear floor area exclusive of fixed and movable cabinets and shelves. The minimum clear dimension between fixed cabinets and built-in shelves shall be 18 feet. (iii) A control room shall have a view window which permits complete observation of the patient from the control console. The control room shall be large enough to contain the efficient functioning of the X-ray and image recording equipment. (iv) An area for viewing images and film file room shall be provided. When digital imaging is provided throughout the suite, a minimum of two X-ray film illuminators shall be provided within a central location within the catheterization laboratory and the film file room may be omitted. (v) An equipment room large enough to contain X-ray transformers, power modules, and necessary electronics and electrical gear shall be provided. (vi) Appropriately sized areas shall be provided for male and female changing rooms within the catheterization laboratory suite. These areas shall contain lockers, showers, toilets, hand washing fixtures with hands-free operable controls, and space to change into scrub suits and boots. Separate locker/changing rooms shall be provided for male and female staff. The shower and toilet room(s) may be unisex. These areas shall be arranged to provide a traffic pattern so that personnel entering from outside the catheterization laboratory can shower, change, and move into the restricted portions of catheterization laboratory. (vii) One scrub station shall be located within five feet of the outside entrance of each cardiac catheterization laboratory procedure room. Scrub facilities shall be arranged to minimize any incidental splatter on nearby personnel, medical equipment or supply carts. The scrub sinks shall be recessed out of the main traffic areas. The scrub sink shall be located off the restricted areas of the cardiac catheterization laboratory. Scrub sinks or sinks shall not be located inside the sterile area. (viii) Sterilizing facilities for immediate or emergency use shall be provided unless instruments are all disposable. A work space and hand washing fixture with hands-free operable controls shall be included.
(D) Patient holding and preparation area. In suites with two or more special procedure rooms, a patient holding and preparation area shall be provided to accommodate ambulatory and stretcher patients and meet the following requirements: (i) two-stretcher stations shall be provided for first procedure room with one additional station for each additional procedure room; (ii) the minimum clear floor space in a private holding and preparation room shall be 100 square feet exclusive of toilet room, built-in cabinets, work counter, alcove, or vestibules. A hand washing fixture with hands-free operable controls shall be provided. A minimum of 10 feet width shall be provided for the head wall; (iii) in a multiple-bed holding and preparation area, the clearance between the side of a bed/gurney and a wall/partition shall be a minimum of three feet. The clearance between sides of beds/gurneys shall be a minimum of six feet. The minimum distance at the foot of the bed/gurney shall not be less than seven feet for single load area/room or ten feet for double load area/room. Four feet of the passage space at the foot of the bed may be shared between two beds/gurneys. The fixed and moveable cabinets and shelves shall not encroach upon the bed/gurney clear floor space/area. The requirements of this clause are illustrated in Table 8, Diagram D of § 133.169(h) of this title; (iv) a control station and charting area arranged to permit staff visual observation of holding and preparation area; (v) a work counter and a hand washing fixture with hands-free operable controls for every four beds/gurneys located in the preparation area; and (vi) cubicle curtains at each station for patient privacy.
(E) Recovery room or area. In suites with two or more special procedure rooms, a recovery room or area shall be provided to accommodate ambulatory and stretcher patients and meet the following requirements: (i) a minimum of one patient recovery station shall be provided for each special procedure room; (ii) in a single patient recovery room, there shall be a minimum clear area of 130 square feet exclusive of aisles and fixed and moveable cabinets and selves. A minimum of 10 feet width shall be provided for the head wall. The room shall contain cabinets, work counter, and a hand washing fixture with hands-free operable controls. The fixed and movable cabinets and shelves shall not encroach upon the bed/gurney clear floor space/area; (iii) when multiple-bed/gurney recovery patient stations are provided, the clearance between side of bed/gurney and a wall/partition shall be a minimum of four feet. The clearance between sides of beds/gurneys shall be a minimum of six feet. The minimum distance at the foot of the bed/gurney shall not be less than eight feet for single load area/room or twelve feet for double load area/room. Four feet of passage space requirement at the foot of the bed may be shared between two beds/gurneys. The multiple-bed/gurney recovery patient station shall contain cabinets, medication storage, and work counter. The fixed and movable cabinets and shelves shall not encroach upon the bed/gurney clear floor space/area. One hand washing fixture with hands-free operable controls shall be provided for every four stations or fraction thereof. The requirements of this clause are illustrated in Table 8, Diagram M of § 133.169(h) of this title; (iv) a nurse station with a hand washing fixture with hands-free operable controls and charting area shall be provided and arranged to provide visual observation of recovery room area; (v) a staff toilet room with a hand washing fixture with hands-free operable controls shall be provided and located within the working area to maintain staff availability to patients; (vi) cubicle curtains shall be provided at each station for patient privacy; and (vii) the recovery room or area may be within the patient holding area.
(F) Instrument processing room. When instruments and equipment are processed, cleaned and disinfected within the suite, dedicated rooms shall be provided. The room may serve multiple procedure rooms. The following rooms shall be included. (i) A decontamination room shall be provided and equipped with work counters, two sinks remote from each other and a hand washing fixture with hands-free operable controls. One of the sinks shall be utility type. (ii) A clean room shall be provided and the process of cleaning the instruments or equipment shall flow from the contaminated area to the clean area, and finally, to storage. The room shall include a work counter and a hand washing sink fixture with hands-free operable controls. Instruments and equipment shall be protected from contamination. (iii) When endoscopy scope wash rooms are provided, cleaning, washing and drying may occur in the same room. The room shall contain two sinks.
(G) Service areas. The following services shall be provided for all types of special procedure rooms unless noted otherwise. (i) Control station. In facilities with two or more special procedure rooms in a suite, a nurse station shall be provided and located to permit visual surveillance of all traffic which enters the special procedure rooms suite. (ii) Dictation and report preparation area. This area may be incorporated with the control station. (iii) Medication station. Provision shall be made for the storage and distribution of medication to be administered to patients. This may be done from a medicine preparation room, medicine alcove area or from a self-contained medicine dispensing unit. The medicine preparation room, medicine alcove area or self-contained medicine dispensing unit shall be under visual control of nursing staff. A work counter, hand washing fixture with hands-free operable controls, refrigerator, and double-locked storage for controlled substances shall be provided. Standard cup-sinks provided in many self-contained units are not acceptable for hand washing. The medication station may be shared with the clean work room. (iv) Outpatient services. When outpatient services are provided in the special procedure suite, a separate waiting/change area shall include waiting room, dressing/gowning area, and toilet facilities and a hand washing fixture with hands-free operable controls. (v) Patient toilet room(s). Toilet room(s) shall be conveniently located to special procedure rooms and patient changing areas and shall include hand washing fixture(s) with hands-free operable controls. (vi) Staff toilet facilities. Facilities shall be provided for exclusive staff use and include a hand washing fixture with hands-free operable controls. The toilet may be accessible from a staff lounge, when a staff lounge is provided. (vii) Storage. A storage room(s) shall be provided for equipment and supplies used in the special procedure suite. Each special procedure suite shall provide a minimum of 150 square feet of storage area or 50 square feet per procedure room, whichever is greater. (viii) Wheelchair and stretcher storage. Wheelchair and stretcher storage space/alcove shall be provided and located out of direct line of traffic. (ix) Staff storage. Storage space for employees' personal effects shall be provided. (x) Ice machine. An ice machine shall be provided. (xi) Clean storage room. A clean storage room shall be provided for clean supplies and linens. A hand washing fixture shall be provided with hands-free operable controls. (xii) Soiled workroom. The soiled workroom shall not have direct connection to the special procedure or diagnostic rooms or other sterile or clean activity rooms. The room shall contain a clinical sink or equivalent flushing type fixture, work counter, hand washing fixture with hands-free operable controls, waste receptacle, and linen receptacle. (xiii) Housekeeping room. A housekeeping room shall be provided for the exclusive use of the special procedure suite. It shall be directly accessible from the suite and shall contain a floor receptor or service sink and storage for supplies and housekeeping equipment.
(2) Details and finishes. Details and finishes shall be in accordance with § 133.162(d)(2) of this title and this paragraph.
(A) Details. Special procedure rooms shall have ceiling heights not less than nine feet.
(B) Finishes. (i) Flooring used in special procedure rooms, decontamination room, and in the soiled workroom shall be of the seamless type as required by § 133.162(d)(2)(B)(iii)(III) of this title. (ii) Ceiling finishes in special surgical procedure rooms and isolation rooms, soiled workroom and sterile processing rooms shall be monolithic as required by § 133.162(d)(2)(B)(vi)(III) of this title. (iii) A lay-in type ceiling is acceptable in nonsurgical special procedure rooms. (iv) A nonsurgical or noninvasive catheterization lab shall have a washable ceiling.
(3) Mechanical Requirements. Mechanical requirements shall be in accordance with § 133.162(d)(3) of this title and this paragraph.
(A) Air supply for the special procedure rooms shall be from ceiling outlets that are as near the work centers as possible. A minimum of two low return inlets shall be located diagonally opposite from one another.
(B) Return air inlets shall be not lower than four inches nor higher than 12 inches from floor level.
(C) Smoke removal systems shall be provided in accordance with § 133.162(d)(3)(D)(iv)(II) of this title, for special procedure rooms that have piped-in nitrous oxide medical gas or where anesthesia is administered to patients.
(D) The decontamination room shall meet the ventilation requirements that are contained in Table 3 of § 133.169(c) of this title.
(E) Each special procedure room and recovery room shall have wall-mounted temperature and humidity indicating devices.
(F) When patients with airborne infectious disease are treated, the room shall meet requirements for airborne infection ventilation for patient care areas in accordance with Table 3 of § 133.169(c) of this title.
(4) Piping systems and plumbing fixtures. Piping systems and plumbing fixtures shall be in accordance with § 133.162(d)(4) of this title and this paragraph.
(A) Drainage and waste piping shall not be installed within the ceiling or installed in an exposed location in special procedure rooms and sterile processing rooms unless precautions are taken to protect the space below from leakage and condensation from necessary overhead piping. Any required secondary protection shall be labeled, "code required secondary drain system" every 20 feet in a highly visible print or label.
(B) A medical gas system shall be provided in accordance with § 133.162(d)(4)(A)(iii) and (iv) and Table 6 of § 133.169(f) of this title.
(5) Electrical requirements. Electrical requirements shall be in accordance with § 133.162(d)(5) of this title and this paragraph.
(A) General. (i) X-ray film illuminators for handling at least four films simultaneously shall be provided in a central location. When the entire special procedure suite is provided with digital imaging system capabilities, a minimum of two X-ray film illuminators viewers shall be provided. (ii) Each special procedure room shall have at least six duplex electrical hospital grade receptacles. (iii) In locations where mobile X-ray, laser, or other equipment requiring special electrical configuration is used, the additional receptacles shall be distinctively marked for the special use. (iv) The electrical circuit(s) to equipment in wet areas shall be provided with GFCIs. GFCI circuits shall not be used in special procedure rooms. When ground fault circuit interrupters are used in critical areas, provisions shall be made to ensure that other essential equipment is not affected by activation of one interrupter. (v) Special grounding system in areas such as special procedure rooms where a patient may be treated with an internal probe or catheter the ground system shall comply with Chapter 10, NFPA 99 and Article 517, NFPA 70. (vi) Special procedures rooms shall have general lighting in addition to that provided by special lighting units at the procedure tables.
(B) Nurses calling system. The nurse call shall be in accordance with § 133.162(d)(5)(L) and Table 7 of § 133.169(g) of this title.
(ee) Surgical suite.
(1) Architectural requirements.
(A) General. (i) A public waiting room shall be provided. (ii) Toilet facilities, public telephone(s), and drinking fountain(s) shall be provided within or nearby. (iii) The surgical suite shall be located and arranged to preclude unrelated traffic through the suite. (iv) When outpatient surgery is provided within the surgical suite additional requirements in subsection (v)(1)(F) of this section shall be provided.
(B) General operating room(s). A minimum of one operating room shall be provided and shall have a minimum clear floor area of 400 square feet exclusive of fixed and movable cabinets and shelves. The minimum clear dimension between fixed cabinets and built-in shelves shall be 20 feet. There shall be no direct access between operating rooms.
(C) Operating rooms for cardiovascular, orthopedic, neurological, and other special surgical procedures that require additional personnel and large equipment. (i) When provided, these rooms shall have a minimum clear floor area of 600 square feet, with a minimum of 20 feet clear dimension exclusive of fixed or wall-mounted cabinets and built-in shelves. (ii) An additional room shall be provided in the restricted area of the surgical suite, preferably adjoining this operating room, where extra corporeal pump(s), supplies and accessories can be stored and serviced. (iii) When complex orthopedic surgery and neurosurgery are performed, additional rooms shall be provided in the restricted area of the surgical suite, preferably adjoining the specialty operating rooms, for storage of equipment used during these procedures.
(D) Preoperative patient holding area(s) or room(s). In facilities with two or more operating rooms, a patient holding area or rooms shall be provided. The preoperative patient holding area may be used for secondary recovery. The area shall meet the following requirements. (i) The minimum clear floor space in a private preoperative holding room shall be 100 square feet exclusive of aisles and fixed and moveable cabinets and selves. A minimum of nine feet width shall be provided for the head wall. (ii) In a multiple-bed preoperative holding area, the clearance between the side of a bed/gurney and a wall/partition shall be a minimum of three feet. The clearance between sides of beds/gurneys shall be a minimum of six feet. The minimum distance at the foot of the bed/gurney shall not be less than seven feet for single load area/room or ten feet for double load area/room. Four feet of the passage space at the foot of the bed may be shared between two beds/gurneys. The fixed and moveable cabinets and shelves shall not encroach upon the bed/gurney clear floor space/area. The requirements of this clause are illustrated in Table 8, Diagram D of § 133.169(h) of this title. (iii) A control station and charting area shall be provided and arranged to permit staff visual observation of holding and preparation area. (iv) A work counter with hand washing fixture with hands-free operable controls shall be provided and located in the preparation area. (v) Cubicle curtains shall be provided at each station for patient privacy. (vi) One hand washing fixture with hands-free operable controls shall be provided for every four preoperative holding beds or fraction thereof. Fixtures shall be uniformly distributed. One hand washing fixture with hands-free operable controls shall be provided within each single-bed preoperative holding room.
(E) Post-anesthesia care units. (i) Post-anesthesia care units (PACU) for surgical patients shall contain a medication distribution station, nurse station with charting facilities, clinical sink provisions for bedpan cleaning, and storage space for stretchers, supplies and equipment. The nurse station shall be arranged to permit the staff to have full visual control of the PACU area. (ii) A minimum of one and a half patient stations per operating room shall be provided for post-anesthesia care or fraction thereof. A minimum of two stations shall be provided when there is only one operating room. (iii) The minimum clear floor space in a private recovery room shall be 130 square feet exclusive of aisles and fixed and moveable cabinets and selves. A minimum of 10 feet width shall be provided for the head wall. The room shall contain cabinets, work counter, and hand washing fixture with hands-free operable controls. The fixed and movable cabinets and shelves shall not encroach upon the bed/gurney clear floor space/area. (iv) In multiple-bed/gurney recovery patient stations, the clearance between the side of bed/gurney and a wall/partition shall be a minimum of five feet. The clearance between sides of beds/gurneys shall be a minimum of six feet. The minimum distance at the foot of the bed/gurney shall not be less than eight feet for single load area/room or twelve feet for double load area/room. Four feet of the passage space at the foot of the bed may be shared between two beds/gurneys. The multi-bed/gurney recovery patient station shall contain cabinets, medication storage, and work counter. The fixed and movable cabinets and shelves shall not encroach upon the bed/gurney clear floor space/area. The requirements of this clause are illustrated in Table 8, Diagram N of § 133.169(h) of this title. (v) Special provisions shall be made to keep medical isolation infectious patients separate during surgical recovery. An isolation room meeting the requirements in subsection (t)(1)(C) of this section may meet this requirement if conveniently located near the surgical suite and otherwise complies with requirements for a PACU except that a patient toilet room is not required. The recovery isolation room shall have a minimum clear floor area of 120 square feet. In addition, the recovery isolation room medical gas system outlet requirements shall be in accordance with Table 6 of § 133.169(f) of this title for recovery room(s). (vi) Cubicle curtains shall be provided for patient privacy. (vii) At least one door to the PACU room shall be within the surgical suite. (viii) Staff toilet facilities and a hand washing fixture with hands-free operable controls shall be located within or immediately adjacent to the PACU. (ix) One hand washing fixture shall be provided for every four recovery beds or fraction thereof in open wards. Fixtures shall be uniformly distributed. One hand washing fixture shall be provided within each single-bed recovery room.
(F) Separation of recovery patients. Provisions shall be made for separating all patients subject to general anesthesia from those who did not receive general anesthesia. This requirement may be satisfied by providing separate recovery rooms, cubicles, secondary recovery rooms or scheduling of procedures.
(G) Service areas. Services, except for the enclosed soiled workroom and the housekeeping room, may be shared with the obstetrical facilities if the functional program reflects this concept. Service areas, when shared with delivery rooms, shall be designed to avoid the passing of patients or staff between the operating room and the delivery room areas. (i) Control station. A control station located to permit visual surveillance of all traffic entering the surgical suite shall be provided. (ii) Office. A supervisor's office or station shall be provided. (iii) Scrub facilities. Two scrub stations shall be located in the restricted corridor within five feet of the entrance of each operating room. Two scrub stations may serve two operating rooms if the scrub stations are located adjacent to the entrance of both operating rooms. Scrub facilities shall be arranged to minimize any incidental splatter on nearby personnel, medical equipment, or supply carts. Viewing panels shall be provided for observation of the surgical room interior. The scrub sinks shall be recessed out of the main traffic areas. The alcove shall be located within the restricted areas of the surgical suite. Scrub sinks shall not be located inside the sterile area. (iv) Substerile facilities. Sterilizing facilities located conveniently to the operating rooms for immediate or emergency use with work counter shall be provided. (v) Anesthesia workroom. The anesthesia workroom shall contain a work counter, sink with hands-free operable controls and storage space for medical gas cylinders and other anesthesia equipment. (vi) Medication station. Storage and distribution of medication may be done from a medicine preparation room, medicine alcove area or from a self-contained medicine dispensing unit but must be under visual control of nursing staff. A work counter, hand washing fixture with hands-free operable controls, refrigerator, and double-locked storage for controlled substances shall be provided. Standard cup-sinks provided in many self-contained units are not acceptable for hand washing. The medication station may be shared with the clean work room. (vii) General storage room(s). A minimum of 50 square feet per operating room is required for general storage space(s). The minimum requirement for three operating rooms or less is 150 square feet. This storage room is exclusive of soiled holding, sterile supplies, clean storage, drug storage, locker rooms and storage alcoves. (viii) Orthopedic surgery storage. Splints and traction equipment shall be stored in an enclosed storage room. Storage shall be outside the operating room but must be conveniently located. (ix) Storage alcove. An alcove(s) located out of the direct line of traffic shall be provided for the storage of stretchers, portable X-ray equipment, fracture tables, warming devices, auxiliary lamps, etc. (x) Surgical suite staff clothing change rooms. Appropriately sized areas shall be provided for male and female personnel working within the surgical suite. These areas shall contain lockers, showers, toilets, hand washing fixtures with hands-free operable controls, and space to change into scrub suits and boots. Separate locker/changing rooms shall be provided for male and female staff. The shower and toilet room(s) may be unisex. These areas shall be arranged to provide a traffic pattern so that personnel entering from outside the surgical suite can shower, change, and move directly into the restricted areas of the surgical suite. (xi) Lounge. A lounge shall be provided in hospitals with three or more operating rooms. The lounge shall permit staff use without leaving the surgical suite and may be accessed from the clothing changing rooms. The lounge shall not have direct access from outside the surgical suite. When the lounge is remote from the clothing change rooms, toilet facilities and a hand washing fixture with hands-free operable controls accessible from the lounge shall be provided. (xii) Staff toilet facilities. Toilet facilities located in the surgical suite for exclusive staff use shall be provided and contain a hand washing fixture with hands-free operable controls. The toilet room may be accessible from a staff lounge, when provided. (xiii) Dictation and report preparation area. This may be accessible from the lounge area. (xiv) Cast room. When a cast room is provided it shall be equipped with hand washing facilities, plaster sink, storage, and other provisions required for cast procedures. This room may be located in the emergency room. (xv) Ice machines. An ice machine shall be provided for therapeutic purposes. A self-dispensing ice machine shall be provided for human consumption. (xvi) Clean workroom or clean supply room. A clean workroom is required when clean materials are assembled within the surgical suite prior to use or following the decontamination cycle. It shall contain a work counter, a hand washing fixture with hands-free operable controls, storage facilities for clean supplies, and a space to package reusable items. The storage for sterile supplies must be in a separate room. When the room is used only for storage and holding as part of a system for distribution of clean and sterile supply materials, the work counter and hand washing fixture may be omitted. (xvii) Sterile core. When a surgical suite contains a sterile core, it shall be free of any cross-traffic of staff and supplies from the soiled/decontaminated areas to the sterile/clean areas. The use of facilities outside the operating room for soiled/decontaminated processing, clean assembly and sterile processing shall be designed to move the flow of goods and personnel from dirty to clean without compromising universal precautions or aseptic techniques in both departments. (xviii) Soiled workroom. The soiled workroom shall contain a clinical sink or equivalent flushing type fixture, work counter, hand washing fixture with hands-free operable controls, waste receptacle, and linen receptacle. The clinical sink and work counter may be eliminated if the room is used only for temporary holding of soiled material and cleaning of equipment/instruments and sterilization is provided outside the surgical suite. Provisions shall be made for the disposal of liquid waste. The soiled workroom shall be provided for the exclusive use of the surgical suite, shall be located in the restricted area of the surgical suite, and shall not have direct connection with operating rooms, delivery rooms or other sterile activity rooms. (xix) Housekeeping room. A housekeeping room containing a floor receptor or service sink and storage space for housekeeping supplies and equipment shall be provided for the exclusive use of the surgical suite and shall be directly accessible from the surgical suite.
(2) Details and finishes. Details and finishes shall be in accordance with § 133.162(d)(2) of this title and this paragraph.
(A) Details. (i) Operating rooms shall have ceiling heights not less than nine feet. (ii) Recreation rooms, exercise rooms, equipment rooms, and similar spaces where impact noises may be generated shall not be located directly over operating suites, unless special provisions are made to minimize such noise.
(B) Finishes. (i) Flooring within operating rooms, soiled workrooms and sterile processing rooms shall be of the seamless type as required by § 133.162(d)(2)(B)(iii)(III) of this title. (ii) Walls in operating rooms, special procedures rooms, and soiled workrooms shall comply with the requirements of § 133.162(d)(2)(B)(iv)(II)of this title. (iii) Ceilings in operating rooms, isolation rooms, soiled workroom and sterile processing rooms shall be monolithic as required by § 133.162(d)(2)(B)(vi)(III) of this title.
(3) Mechanical requirements. Mechanical requirements shall be in accordance with § 133.162(d)(3) of this title and this paragraph.
(A) Air supply for the operating rooms shall be from ceiling outlets near the center of the work area to efficiently control air movement. A minimum of two return air inlets located diagonally opposite from one another and near floor level shall be provided. Design should consider turbulence and other factors of air movement to minimize airborne particulate matter. Where extraordinary procedures require special designs, the installation shall be reviewed on a case by case basis.
(B) Smoke removal systems shall be provided in accordance with § 133.162(d)(3)(D)(iv)(II) of this title.
(C) The ventilation system for anesthesia storage rooms and medical gases storage shall conform to the requirements of Chapter 5, NFPA 99, § 5.1.3.3.3.
(D) Each operating room, PACU, and recovery room shall be provided with conveniently mounted temperature and humidity indicating devices.
(4) Piping systems and plumbing fixtures. Piping systems and plumbing fixtures shall be in accordance with § 133.162(d)(4) of this title and this paragraph.
(A) General. (i) Drainage and waste piping shall not be installed above or below ceilings in operating rooms, and sterile processing rooms unless precautions are taken to protect the space below from leakage and condensation from necessary overhead piping. Any required secondary protection shall be labeled, "code required secondary drain system" every 20 feet in a highly visible print or label. (ii) Floor drains shall not be installed in operating rooms. Flushing rim type floor drains may be installed in cystoscopic operating rooms. If a floor drain is installed in cystoscopy, it shall contain a nonsplash, horizontal-flow flushing bowl beneath the drain plate. (iii) Sinks used for the disposal of plaster of paris shall have plaster trap.
(B) Medical gas systems. Medical gas systems and outlets shall be provided in accordance with § 133.162(d)(4)(A)(iii) and Table 6 of § 133.169(f) of this title.
(5) Electrical requirements. Electrical requirements shall be in accordance with § 133.162(d)(5) of this title and this paragraph.
(A) General. (i) X-ray film illuminators for handling at least four films simultaneously shall be provided in each operating room. When the entire surgical suite is provided with digital imaging system capabilities, a minimum of two X-ray film illuminator viewers shall be provided. The film illuminators shall be mounted within the central area of the suite. (ii) Each operating room shall have at least eight duplex electrical hospital grade receptacles of which three shall be located convenient to the head of the procedure table. Each PACU recovery station shall have a minimum of seven receptacles at the head of each bed. (iii) Special grounding system for critical care areas such as operating rooms, and special procedure rooms where patients are subjected to invasive procedures and connected to line-operated, electromedical devices shall comply with NFPA 99, Chapter 9, and NFPA 70, Article 517. (iv) Operating rooms and special procedure rooms shall have general lighting in addition to that provided by special lighting units at the surgical tables. Each fixed special lighting unit at the operating or delivery table shall be connected to an independent circuit powered by the critical branch of the essential electrical system. Portable units may share circuits. At least one general lighting fixture shall be served from a normal branch panel. (v) Operating rooms shall be provided with one or more battery-powered emergency lighting units as required by NFPA 99, § 13.4.1.2.6(E). (vi) Operating rooms shall be provided with at least one receptacle powered from a normal power panel. Receptacle shall be labeled, "Normal power receptacle, use only in the event of loss of critical system."
(B) Nurses calling system. The nurse call shall be in accordance with § 133.162(d)(5)(L) and Table 7 of § 133.169(g) of this title.
(ff) Universal care suite.
(1) Architectural requirements. Architectural requirements shall be in accordance with § 133.162(d)(1) of this title and this paragraph.
(A) General. When a universal care suite is provided, the universal care suite shall be a separate suite(s) operated separately from other suites in the hospital. (i) All universal care suite patient rooms shall be single patient rooms and have a minimum clear floor area of 200 square feet per bed exclusive of anterooms, vestibules, toilet rooms, closets, lockers, wardrobes, and/or alcoves. A minimum of 13 feet width shall be provided for the head wall. (ii) Minor encroachments including columns and wall hung lavatories that do not interfere with functions may be ignored when determining space requirements for patient rooms. Required clear floor space for patient rooms shall be exclusive of toilet rooms, closets, lockers, built-in cabinets, wardrobes, alcoves, or vestibules. (iii) Each universal care suite patient room shall be located on an exterior wall and shall have a window. Windows shall be in accordance with subsection (t)(2)(A)(iv) and (v) of this section. (iv) Each universal care suite patient room shall have access to a bathroom without having to enter the general corridor area. Each bathroom shall contain a toilet, a hand washing fixture with hands-free operable controls and bathing facilities, and storage shelf or cabinet. (v) A hand washing fixture with hands-free operable controls shall be located in each patient room near the entrance of the room and in the patient bathroom. (vi) A minimum of one airborne infection isolation room and patient bathroom shall be provided in accordance with subsection (t)(1)(C)(iii), (iv) and (v) of this section. The universal care suite infection isolation room shall have a minimum clear floor area of 200 square feet per bed exclusive of anterooms, vestibules, toilet rooms, closets, lockers, wardrobes, and/or alcoves. A minimum of 13 feet width shall be provided for the head wall. The universal care suite isolation patient room shall have a bathroom without having to enter the general corridor area. Each bathroom shall contain a toilet, a hand washing fixture with hands-free operable controls and bathing facilities, and storage shelf or cabinet. (vii) Viewing panels in the door or walls of these rooms are required. Curtains or other means shall be provided to cover the viewing panels when visual privacy is required. (viii) Each patient shall have a wardrobe, locker, or closet that is suitable for hanging full-length garments and for storing personal effects. A minimum of 12 lineal inches of hanging space shall be provided per patient. (ix) Each universal care room shall be provided with X-ray film illuminators for handling at least two films simultaneously. When the entire universal care suite is provided with digital imaging system capabilities, a minimum of two X-ray film illuminator viewers shall be provided. The film illuminators shall be mounted within the central area of the suite.
(B) Pediatrics. When a universal care suite is provided for pediatrics, the suite shall comply with the requirements contained in this paragraph and the following. (i) A sleeping space shall be provided for parents who spend long hours with the patient. This space may be within the patient room or separate from the patient area but shall be in communication with the universal care suite staff. (ii) A room shall be provided for private consultation and shall be located within, or convenient to, the universal care suite. The multipurpose room noted in subparagraph (D)(iv) of this paragraph will meet this requirement if conveniently located. (iii) Storage space for infant formula shall be provided. This functional space may be outside the universal care suite but shall be available for use at all times. (iv) Storage cabinets or closets for toys and games shall be provided within the room. (v) Storage closet for cots, bed linens, and other items needed for overnight accommodation of parents shall be provided in the general location of sleeping accommodations.
(C) Universal care suite services and facilities. The following services and facilities shall be provided. (i) A visitors' waiting space shall be provided with toilet facility(ies), public telephone(s), and drinking fountain(s). One waiting space may serve other units. (ii) The nurse station shall be located to permit direct visual observation of each patient served. Video cameras or mirrors shall not be substituted for direct visual observation. The nurse station shall have space for counters and storage. The counter height shall not exceed 42 inches. The nurse station may be combined with or include centers for reception and communication. (iii) When individual nurse substations are provided and located at each patient room(s), they shall be located to permit direct visual observation of each patient served. The nurse substation shall have space for counter, storage space and a recessed sitting space. The substation shall be at a minimum recessed from the egress corridor one foot six inches. (iv) Charting and dictation area(s) for physicians for recording, record storage and reviews shall be provided. Dictation space may be in a separate room or alcove. Suitable space shall be provided when computers are used for the clinical records. (v) Storage space shall be provided for emergency equipment in the unit. (vi) Storage and distribution of medication may be done from a medicine preparation room, medicine alcove area or from a self-contained medicine dispensing unit but must be under visual control of nursing staff. A work counter, hand washing fixture with hands-free operable controls, refrigerator, and double-locked storage for controlled substances shall be provided. Standard cup-sinks provided in many self-contained units are not acceptable for hand washing. The medication station may be located with the clean work room. (vii) A soiled workroom shall be provided and contain a clinical sink or equivalent flushing rim type fixture with hot and cold mixing faucet, separate hand washing facilities with hands-free operable controls, and separate waste and soiled linen receptacles. (viii) A soiled holding room may be provided when all the universal care suite patient toilet rooms have bedpan washers. The soiled holding room shall contain a hand washing fixture with hands-free operable controls and separate waste and soiled linen receptacles. (ix) A clean workroom or clean supply room shall be provided. A clean workroom when used for preparing patient care items shall contain a work counter, hand washing facilities, and storage facilities for clean and sterile supplies. When a clean supply room is used only for storage and holding as part of a distribution system of clean and sterile supplies, the work counter and hand washing facilities may be omitted. (x) A nourishment station shall contain a work counter, a sink with hands-free operable controls, refrigerator, cabinets, and not be located in the medication room or the clean workroom. Space shall be included for temporary holding of unused or soiled dietary trays. (xi) An ice machine shall be provided for ice for treatment and patient use. Ice-making equipment for treatment may be in the clean workroom or the nourishment station. (xii) An intravenous solution support shall be provided at each patient bed. The intravenous solution shall not be suspended directly over the patient. (xiii) The stretcher storage alcove provided for stretcher or bassinet storage shall be located out of direct line of traffic. (xiv) Securable closets or cabinet compartments for the personal effects of nursing personnel, located in or near the nurse station, shall be provided. At a minimum, these shall be large enough for purses and billfolds. Coats may be stored in closets or cabinets on each floor or in a central staff locker area. (xv) Twenty square feet of equipment storage shall be provided for each patient station. These storage areas shall be out of the way of the corridor traffic. (xvi) A housekeeping room shall be provided and contain a service sink, storage for housekeeping supplies, and equipment. A shared nursing unit housekeeping room that is adjacent to the universal care suite is acceptable.
(D) Other required areas/rooms. The following areas/rooms shall be provided and may be located outside the unit if conveniently accessible. (i) Offices. Room(s) shall be provided for the universal care suite medical staff, nursing management and administrative personnel. The offices shall be large enough to permit consulting with members of the universal care suite staff and visitors. The offices shall be linked with the unit by telephone or an intercommunications system. (ii) Staff lounge. A staff lounge shall include toilet facilities with a hand washing fixture with hands-free operable controls. The lounge(s) shall be located so that staff may be recalled quickly to the patient area in emergencies. One lounge may serve multiple units when the lounge is adjacent to the units. (iii) On-call rooms. Physicians and other staff on 24-hour on-call work schedules shall be provided with sleeping rooms with access to a shower(s), toilet(s), and lavatory(ies). If an on-call room(s) is not within the universal care suite served, a dedicated telephone or intercom system shall connect the on-call room(s) to the universal care suite. (iv) Multipurpose room(s). A multipurpose room shall be provided for patient conferences, reports, education, training sessions, and consultation. This room(s) must be accessible to the universal care suite.
(2) Details and finishes. Details and finishes shall be in accordance with § 133.162(d)(2) of this title and this paragraph.
(A) Details. (i) At least one door to a universal care suite room shall be not less than four feet wide and arranged to minimize interference with movement of beds and large equipment. (ii) Sliding doors in the universal care suite shall not have floor tracks and shall have hardware that minimizes jamming possibilities, in accordance with § 133.162(d)(2)(A)(vi) of this title. (iii) Glazing in viewing panels shall be safety glass, wire glass, or clear plastic. (iv) Recreation rooms, exercise rooms, equipment rooms, and similar spaces where impact noises may be generated shall not be located directly over the universal care suite, unless special provisions are made to minimize such noise. (v) Each patient shall have access to a telephone directly from each bed. The telephone may be omitted at a pediatric universal care suite bed.
(B) Finishes. (i) Flooring used in universal care suite patient rooms, patient toilet rooms, and soiled workrooms shall be of the seamless type as required by § 133.162(d)(2)(B)(iii)(III) of this title. (ii) Ceilings in the soiled workroom shall be monolithic type as required by § 133.162(d)(2)(B)(vi)(III) of this title.
(3) Mechanical Requirements. Mechanical requirements shall be in accordance with § 133.162(d)(3) of this title and this paragraph. Room recirculating units shall not be used.
(A) Outside air shall be supplied to each patient room by a central air handling unit to provide make-up air for air exhausted from the bathroom in accordance with Note 3, Table 3 of § 133.169(c) of this title.
(B) Each patient room bathroom shall be exhausted continuously to the exterior in accordance with Table 3 of § 133.169(c) of this title.
(4) Piping systems and plumbing fixtures. Piping systems and plumbing fixtures shall be in accordance with § 133.162(d)(4) of this title.
(5) Electrical requirements. Electrical requirements shall be in accordance with § 133.162(d)(5) of this title and this paragraph.
(A) General. (i) Receptacles at each bed location in a universal care suite shall be served by two branch circuits, one or more from the critical branch panel of the emergency electrical system and one or more from the normal system. One critical branch circuit shall serve only one bed location. All branch circuits from the normal system shall be from a single panelboard. All branch circuits from the emergency electrical system shall be from a single panelboard. (ii) A minimum of seven hospital grade duplex outlets shall be conveniently located at the head of each bed. At least three of these duplex outlets shall be on the critical branch of the emergency electrical system. (iii) One duplex receptacle connected to a normal branch circuit and one duplex outlet connected to the critical branch circuit shall be located on opposite sides of the head of each bed. In addition at least one duplex outlet shall be located on each wall. A dedicated outlet shall be provided at the television location. (iv) Hospital grade receptacles in the pediatric universal care suite shall be tamper-resistant or provided with GFCIs.
(B) Illumination requirements. (i) Each single patient room and multi-patient wards shall be provided with general lighting and night lighting. General lighting and night lighting shall be controlled at the room entrance. All controls for lighting in patient areas shall be of the quiet operating type. Control of night lighting circuits may be achieved by automatic means and in such instances control of night lighting at the room entrance shall not be required. At least one general light fixture and night lighting shall be powered from the critical branch of the essential electrical system. (ii) A reading light shall be provided over each patient bed. Reading light control shall be readily accessible from each patient bed. Flexible light arms, if used, shall be mechanically controlled to prevent the bulb from coming in contact with bed linen. High heat-producing light sources such as incandescent and halogen shall be avoided to prevent burns to patients and/or bed linen. Light sources shall be covered with a diffuser or a lens. (iii) A wall or ceiling-mounted lighting fixture shall be provided above each lavatory. (iv) A ceiling-mounted fixture shall be provided in patient bathrooms where the lighting fixture above the lavatory does not provide adequate illumination of the entire bathroom. Some form of fixed illumination shall be powered from the critical branch.
(C) Nurses calling systems. The nurse call shall be in accordance with § 133.162(d)(5)(L) and Table 7 of § 133.169(g) of this title.
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