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Document Citation: 59A-3.081, F.A.C.
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Header:
FLORIDA ADMINISTRATIVE CODE
TITLE 59 AGENCY FOR HEALTH CARE ADMINISTRATION
59A HEALTH FACILITY AND AGENCY LICENSING
CHAPTER 59A-3 HOSPITAL LICENSURE
Date:
08/31/2009
Document:
59A-3.081 Physical Plant Requirements for General, Rehabilitation and Psychiatric Hospitals.
(1) The following minimum standards of construction and specified minimum essential facilities to be included in hospitals shall apply to all new hospital construction, and all additions, alterations or renovations to an existing hospital on the effective date of these rules. Construction work in process on the effective date of these rules shall conform to the requirements in effect on the date the Stage II preliminary plans were approved.
(2) Site Work.
(a) The site shall be well drained, and all roads and parking areas shall be paved. The design of the road system shall provide access to all entrances, including docks for loading and unloading delivery trucks. Hospitals having an organized emergency services department shall have emergency access that is well marked to facilitate entry from the public roads or streets serving the site. Access to the emergency entrance shall not conflict with other vehicular or pedestrian traffic. Paved sidewalks shall be provided for pedestrian traffic. Parking and ease-of-entry considerations for the handicapped shall be required at all entrances designated for visitors and employees.
(3) The following requirements shall apply to the medical, surgical and postpartum nursing care units. The requirements for other special care areas, recovery rooms, intensive care rooms, critical care units and pediatric units can be found under descriptions of those units.
(a) Patient Rooms.
1. Private and multi-bed rooms shall be provided to meet the needs of patients in the hospital. The maximum room capacity shall be four patients. The minimum room areas, exclusive of toilet rooms, closets, lockers, wardrobes, vestibules and door swing areas shall be 100 square feet per patient in single-bed rooms and 80 square feet per patient in multi-bed rooms. In multi-bed rooms, a minimum clearance of 3 feet 8 inches shall be available at the foot of each bed to permit the passage of equipment and beds. A minimum clearance of 3 feet shall be provided between beds and between the bed and the side wall. For planning purposes, a full-size bed is assumed to be 3 feet 6 inches by 7 feet 0 inches.
2. In multi-bed rooms, visual privacy shall be provided for each patient by the installation of flame retardant cubicle curtains or the equivalent built-in devices. The design for privacy shall not restrict patient access to the entrance, lavatory, toilet, wardrobe or closet, nor shall it block the spray from fire sprinklers. To prevent interference with fire sprinkler spray patterns, cubicle curtains shall be provided with 1/2-inch square mesh at the top or the curtain shall be suspended on bead chains. See NFPA-13 for open area requirements.
3. A lavatory complete with mixing faucet shall be provided in each patient room or patient room toilet, each patient room without an exclusive toilet room, and in patient bedrooms containing three or more beds. Postpartum bedrooms must have a lavatory in each bedroom.
4. Each patient shall have within the room a separate locker or closet suitable for hanging full-length garments and for storing personal effects.
5. Each patient bedroom shall have direct access to a toilet room without going through the general corridor. One toilet facility shall serve no more than four beds.
6. If an isolation room is provided, it shall be equipped with a connecting toilet and bathing facility. A mask and glove station and a hand washing facility shall be provided in the anteroom or directly outside of the isolation room in an alcove if an anteroom is not provided.
(b) Service Areas. Each nursing care unit shall contain the following service areas.
1. There shall be a nurse station for charting by the nurses and doctors, for communication and for storage of administrative supplies. The nurse station area shall include the following facilities.
a. There shall be a hand washing facility near the nurse station. One lavatory may serve several areas if conveniently accessible to each.
b. There shall be a staff toilet room adjacent to the nurse station.
c. There shall be a staff lounge and/or conference room.
2. There shall be a clean workroom or clean holding room for storage and distribution of clean supply materials. If the room is used for preparing patient care items, it shall contain a counter and hand washing and storage facilities. If the room is used only for storage and holding as a part of a system for distribution of clean and sterile supply materials, the work counter and hand washing requirements may be omitted. The minimum size shall be 60 square feet.
3. There shall be an equipment storage room. This storage room may serve more than one nursing unit when it is conveniently located for access by each unit. The equipment storage room may be part of the clean workroom. If this option is used, the room size shall be increased by 5 square feet per bed served or a minimum size of 100 square feet, whichever is larger.
4. There shall be a soiled workroom. This room shall contain a flushing rim clinical service sink with 6-inch wrist blades and bedpan flushing device and a counter with a minimum work surface area of 6 square feet. The counter shall contain a double compartment sink. Where patient toilet rooms have bedpan rinsing devices, flushing rim clinical sinks will not be required. Rooms used only for the temporary holding of soiled materials need contain only a hand washing facility. The minimum size shall be 80 square feet.
5. There shall be a locked medicine room adjacent to the nurse station which shall be equipped with a sink, a refrigerator, locked storage and facilities for the administration of medication. The minimum area shall be 50 square feet. If drug distribution is from a self-contained unit dose cart or by other means as approved by the governing body of the hospital, the cart may be kept in a dedicated alcove in the nurse station provided it is under the visual control of the nursing staff. Medicine preparation may be part of the clean workroom, in which case an additional 20 square feet dedicated for this purpose shall be required. A refrigerator shall also be required if medicine preparation is included in this room.
6. There shall be a designated area for storage of clean linen. This area may be located within the clean workroom. Storage of clean linens, even a closed cart system, shall not be in an alcove off the corridor.
7. There shall be a nourishment room which shall contain a sink, a refrigerator, storage cabinets and equipment for serving nourishments between scheduled meals.
8. There shall be a dispensing type ice machine to provide ice for treatments and nourishment. Ice making equipment may be in the clean workroom or at the nourishment rooms under the control of the staff.
9. There shall be an alcove for the storage of stretchers and wheelchairs.
10. When individual bathing facilities are not provided for each patient bedroom, there shall be a minimum of 1 shower or tub for every 12 beds or fraction thereof. Each tub or shower shall be in an individual room or enclosure which provides privacy for bathing, drying and dressing. One sitz bath and one roll-in shower, including space for an attendant, shall be provided for patients at a ratio of 1 per every 100 beds or fraction thereof. This may be located on a separate floor.
11. There shall be an emergency equipment storage alcove. Space shall be provided for storing emergency equipment such as a cardiopulmonary resuscitation (CPR) cart. This area shall be under the direct control of the nursing staff and shall be located in close proximity to the nurse station but out of normal traffic.
12. There shall be a janitor closet for each nurse station. Each janitor closet shall contain a service sink or floor receptor and provisions for the storing of janitorial supplies.
(4) When intensive care units are provided, the following requirements shall be met.
(a) The location shall be convenient for access from emergency, respiratory therapy, laboratory, radiology and surgery.
(b) The location shall be arranged to eliminate the need for through traffic.
(c) The nurse station shall have space for charting and monitoring and shall be located so that nurses shall have visual control of each patient from common spaces.
(d) A nurse call system shall be provided at each bed for summoning assistance. The call system for the unit shall include provisions for an emergency code resuscitative alarm to summon assistance from outside the intensive care unit.
(e) Each bed shall be provided with one outside operable window. The minimum size of the window shall be 10 square feet of glass area.
(f) Each patient bed area shall include provisions for visual privacy to prevent casual observation by other patients and visitors.
(g) Separate rooms for single patient use shall contain a minimum net usable area of 120 square feet; multiple bed spaces using cubical curtain separators shall contain a minimum net usable area of 100 square feet per bed. The minimum room dimension perpendicular to the head wall shall be 12 feet.
(h) When private rooms or cubicles are provided, borrowed light shall have drapes or curtains which may be closed. Doors to these spaces shall be a minimum of 3 feet 8 inches wide and shall be arranged so as to minimize interference with movement of beds and large equipment.
(i) Sliding doors may be used for access to cubicles within a suite provided the outside door has a side-hinged breakaway feature that swings in the direction of egress and the hardware used eliminates the possibility of jamming and that any floor tracks do not impede wheel traffic or present a tripping hazard. When intensive care unit rooms are located on an exit access corridor, the sliding doors must be smoke resistant and may have the breakaway feature swing into the room.
(j) At least one private room or cubicle shall be provided in each intensive care unit for patients requiring isolation or separation.
(k) A space shall be provided for emergency cardiopulmonary resuscitation carts. This space shall be out of and not interfere with normal traffic in the unit.
(l) Each intensive care unit shall have a medication administration station or unit dose cart under staff control with locked storage for controlled drugs. The station or unit dose cart shall provide for emergency drugs as well as routine medication.
(m) If the intensive care unit is in excess of 5,000 square feet, it shall be designed with a corridor system and the medication dispensing station must be in a room.
(n) Each intensive care unit shall have staff hand washing facilities convenient to the nurse station and the area served. There shall be at least one lavatory for every three patient beds in open plan areas and one in each patient room or cubicle.
(o) The following additional service spaces shall be immediately available within each intensive care unit. These services may be shared by more than one intensive care unit if direct access is available from each intensive care unit suite.
1. There shall be a soiled workroom with a flushing rim clinical service sink with bedpan flushing device or the equivalent, and hand washing facilities. If each patient bed space has direct access to a patient toilet with a bedpan rinsing device, the requirement for the flushing rim clinical service sink with bedpan flushing device in the soiled workroom may be disregarded.
2. There shall be a separate space for the storage and distribution of clean medical and surgical supplies.
3. There shall be a clean linen closet or linen cart alcove.
4. There shall be a nourishment station, including a refrigerator, storage cabinets, ice dispenser and equipment for heating food and drinks.
5. There shall be a room or an alcove designated for the storage of equipment used in patient care areas. This room or alcove shall not interfere with the flow of traffic.
6. Portable commodes may be utilized in lieu of individual room toilets, but provisions shall be made for user privacy, storage, servicing and odor control.
7. There shall be purse lockers at each nurse station for the secure storage of staff's personal effects.
8. There shall be a janitor closet with floor receptor or service sink and storage space for janitorial cleaning equipment and supplies.
9. There shall be a staff toilet which may be in conjunction with the staff lounge. One staff lounge may serve several intensive care units.
10. There shall be a visitor waiting room for the unit, or units, with convenient access to telephones, drinking fountains and toilets. Such waiting rooms may serve several intensive care units.
(5) The following are additional special requirements for coronary intensive care.
(a) Each cardiac patient shall have a private room or enclosure for acoustical and visual privacy.
(b) Each cardiac patient shall have access to a toilet directly from the room or cubicle.
(6) Neonatal care facilities shall meet all of the following requirements.
(a) General Requirements.
1. General categories of neonatal services are Level I, newborn nursery; Level II, intermediate care; and Level III, intensive care. Facilities which offer obstetrical services shall provide a Level I newborn nursery or a holding nursery. See subparagraph 59A-3.081(10)(a)6., F.A.C. Existing hospitals which have Levels I, II or III services may continue to function without modifying existing facilities. Hospitals that remodel or build new Levels I, II or III nurseries shall comply with the requirements set forth hereinafter.
2. Those facilities providing obstetrical services but not Level I neonatal care shall provide a holding nursery for maternal respite. The postpartum rooms shall be designed for rooming-in capabilities. The holding nursery shall be immediately adjacent to the postpartum nurse station and shall be a minimum of 24 square feet per bassinet. The area shall contain a hand washing facility, a nurse call duty station and a vision panel to accommodate vision from the nurse station.
3. General room illumination shall provide a maximum of 100 footcandles. The lighting fixture layout shall be designed to avoid a fixture directly over the neonate.
4. All nurseries shall be provided with ceiling air supply and returns at or near the floor. Ventilation shall be designed to avoid a draft over the neonate.
5. A janitor closet shall be provided which has a floor receptor to serve new Levels I, II and III nurseries.
(b) Level I, newborn nurseries, shall meet the following requirements.
1. There shall be a minimum of 24 square feet of floor area for each bassinet.
2. There shall be a minimum of 3 feet between bassinets and between a bassinet and any fixed equipment or side wall.
3. There shall be no more than 24 bassinets per room.
4. There shall be a hand washing facility at each entrance to the nursery unit. A large diameter clock with a sweep second hand shall be provided in each nursery.
5. There shall be a minimum of one hand washing facility for every six bassinets or portion thereof. These hand washing facilities shall be evenly distributed within the nursery.
6. There shall be a workroom or work corridor for each nursery. The workroom shall contain a work counter, space for storing daily supplies, space for charting and view windows for observing the nursery. One workroom may serve more than one nursery. The following shall be provided immediately adjacent to the workroom or work corridor:
a. A staff toilet;
b. A soiled holding room with a minimum of 10 square feet of counter area and a double compartment sink. This room shall be accessible from both the public corridor and the workroom or work corridor; and
c. An equipment storage area with a minimum of 6 square feet of floor space for each patient station.
7. There shall be no doorways between adjacent nurseries. Doorways in nurseries are permitted only between the nursery and the workroom and between the nursery and the corridor.
8. There shall be at least one duplex electrical receptacle for every two parallel adjacent patient stations. The minimum spacing shall be 3 feet on center.
9. There shall be at least one oxygen, one medical air and one vacuum station for every six neonatal stations. These are to be evenly distributed within the nursery.
(c) Level II, intermediate care nurseries, shall meet the following requirements.
1. There shall be a minimum of 50 net square feet for each neonatal station.
2. There shall be a scrub and gown area at each entrance to the unit. This area shall be equipped with a minimum of two scrub sinks and gowning supply and disposal facilities.
3. There shall be a minimum of 4 feet between neonatal care isolettes and between a platform and fixed equipment or a side wall. There shall be 8 feet, foot to foot, between rows of isolettes in their normal positions.
4. There shall be a hand washing facility for every four neonatal stations or portion thereof and shall be conveniently located and evenly distributed.
5. There shall be a work counter at each neonatal care station at approximately the height of the platform mattress. The shelf shall be the width of the station. To accommodate the monitoring equipment, there shall be a shelf or other device at eye level. Sixty inches above the floor is suggested. The apron of the lower shelf shall accommodate oxygen, vacuum and compressed air.
6. There shall be a clean utility room for each nursery. The room shall contain a work counter and sink and space for storage of daily supplies. At the hospital's discretion, this area may be replaced by storage areas and clean work surfaces in the nursery.
7. There shall be a control center in a location that offers a view of all of the neonatal stations.
8. There shall be charting and dictation space for physicians.
9. There shall be a medication preparation room with a minimum area of 50 square feet. The room shall contain a work counter, a sink and a refrigerator.
10. There shall be a multipurpose room for breast feeding demonstration and counseling with a minimum area of 80 square feet. The room shall be equipped with a hand washing facility.
11. There shall be a soiled holding room with a counter with a double compartment sink and a minimum of 10 square feet of counter area. This room shall be accessible from both the public corridor and the work eonatal work areas.
12. There shall be a blood gas station.
13. Access to the Level II nursery suite is permitted only through exit access corridor doorways.
14. There shall be a lounge, a locker room and a toilet within or adjacent to the suite for staff use.
15. There shall be an equipment storage room with a minimum area of 18 square feet per neonatal station.
16. There shall be a minimum of four duplex electrical receptacles for each patient station. Two shall be connected to the critical branch of the essential electrical system with at least one of the required number connected to a dedicated circuit. Two receptacles shall be connected to a normal power circuit. There shall not be more than four receptacles per circuit. All branch circuits from the emergency system shall be from the same panel board. All branch circuits from the normal system shall be from the same panel board. Emergency system and normal system receptacles shall be identified and shall also indicate the panel board and circuit numbers. Both normal and emergency branch circuit over-current devices shall be readily accessible to nursing and other authorized personnel. Install one of the receptacles at the monitoring level, one above the main counter and two in the apron of the cabinet.
17. There shall be two oxygen, two medical air and two vacuum outlets per patient station.
(d) Level III, intensive care nurseries, shall meet all of the Level II, intermediate care nursery, requirements and the following modifications and additions.
1. There shall be a minimum of 80 net square feet for each high-risk neonatal station.
2. There shall be a minimum of 6 feet between neonatal care platforms and between a platform and fixed equipment or a side wall. There shall be 8 feet, foot to foot, between rows of isolettes in their normal positions.
3. There shall be an area out of normal traffic paths for storage of a portable x-ray machine.
4. There shall be a blood gas station.
5. There shall be a physicians' sleeping room equipped with a private toilet and shower room.
6. There shall be a respiratory therapy workroom with a minimum area of 120 square feet. This may be located in the respiratory department provided a dedicated area is provided for neonatology.
7. There shall be a minimum of six duplex electrical receptacles for each patient station. Four shall be connected to the critical branch of the essential electrical system with at least two of the required number connected to dedicated circuits. Two receptacles shall be connected to a normal power circuit. There shall not be more than two receptacles per circuit. All branch circuits from the emergency system shall be from the same panel board. All branch circuits from the normal system shall be from the same panel board. Emergency system and normal system receptacles shall be identified and shall also indicate the panel board and circuit numbers. Branch circuit over-current devices shall be readily accessible to nursing and other authorized personnel. Install two of the receptacles above the top shelf, two above the main counter and four in the apron of the cabinet.
8. There shall be two oxygen, two medical air and two vacuum outlets per patient station.
(7) Pediatric Nursing Unit.
(a) The spatial requirements which apply to patient bedrooms shall also apply to pediatric and adolescent nursing units. Additional provisions for parental hygiene, toilet, sleeping and personal belongings shall be included in facilities where parents will be allowed to remain with young children.
(b) There shall be an examination and treatment room which shall be a minimum of 120 square feet in area. It shall contain a work counter, storage facilities and a hand washing facility.
(c) The service areas in pediatric and adolescent nursing units shall conform to the same requirements as for acute care areas.
(d) There shall be a minimum of one isolation room in each pediatric unit.
(e) There shall be an equipment storage room for each unit which shall contain a minimum of 10 square feet of storage space for each pediatric bed.
(f) There shall be a playroom with a minimum size of 250 square feet.
(8) Surgical Facilities.
(a) The number of operating rooms and recovery beds and the sizes of the service areas shall be based on the anticipated surgical workload. The surgical suite shall be located and arranged to prevent non-related traffic through the suite. Additions to and adaptations of the following elements and requirements shall be made for the special procedure operating rooms found in larger facilities. Care shall be exercised in the location of the rooms to be used for surgical cystoscopic and other endoscopic procedures so that cross traffic is minimized.
(b) Each general surgery room shall have a minimum clear area of 360 square feet exclusive of fixed cabinets and built-in shelves. Each room shall contain a telephone and an x-ray film illuminator capable of illuminating a minimum of two standard size films simultaneously.
(c) Operating rooms specifically intended for orthopedic surgery shall have an adjacent room for the storage of splints and traction equipment. If plaster of paris is used for cast work, there shall be a sink with a plaster trap. If a case cart system is utilized and the carts are to be stored elsewhere within the unit, this requirement will be waived.
(d) Operating rooms for the specific use of surgical cystoscopic and other endoscopic procedures shall have a minimum clear area of 250 square feet exclusive of fixed cabinets and built-in shelves. These rooms shall be located within the surgical department in such a manner as to minimize the distance between them and the recovery room, the main entrance and the staff lounge.
(e) Each recovery room shall contain a medication administration station, hand washing facilities, a nurse station with charting facilities, a flushing rim clinical service sink, and storage space for stretchers, supplies and equipment. The design shall provide space for additional equipment and shall provide a minimum of 3 feet between the patient recovery beds and adjacent wall surfaces. There shall be space and equipment for recovery beds at a ratio of 1-1/2 beds for each operating room. In facilities anticipating 1,000 or more surgical procedures per year, separate and additional recovery space will be necessary to accommodate surgical outpatients. There shall be an isolation room in the recovery room.
(f) Service Areas.
1. There shall be a control station which is located to permit visual observation of all traffic into and within the suite.
2. There shall be a surgical director's office which is located to allow visitors to the suite to confer with the director without passage through the suite or the sterile quarters.
3. There shall be a minimum of one high-speed sterilizer conveniently located to serve all operating rooms.
4. There shall be two scrub positions which are located near the entrance to each operating room. Two scrub positions may serve two operating rooms if both are located adjacent to the entrance of both operating rooms. Scrub facilities shall be arranged to minimize any incidental splatter on nearby personnel or on medical equipment or supplies, and sufficient space shall be provided around the scrub facilities to eliminate any incidental contact with other surfaces by the medical personnel.
5. There shall be a soiled workroom for the exclusive use of the surgical suite staff, or there shall be a soiled holding room that is part of the system for the collection and disposal of soiled material. The soiled workroom shall contain a flushing rim clinical service sink, a work counter with a minimum area of 10 square feet and a double compartment sink, a waste receptacle and linen receptacle. When a soiled holding room is used, the flushing rim clinical service sink and work counter may be omitted. If this technique is chosen, a separate fluid waste disposal room will be required. The soiled work or storage facilities, or the fluid waste disposal facility, shall not have direct connection with operating rooms but shall open only to the sterile corridor.
6. There shall be a clean workroom. This workroom is required when clean materials are assembled within the surgical suite prior to use. A clean workroom shall contain a work counter with a minimum area of 14 square feet, a sink equipped for hand washing and a space for clean and sterile supplies. If a clean holding room is the technique desired by the hospital, the counter may be eliminated and a lavatory substituted for the sink.
7. There shall be an anesthesia workroom for cleaning, testing and storing anesthesia equipment. This workroom shall contain a work counter with a minimum area of 10 square feet and a sink equipped for hand washing.
8. There shall be an equipment storage room. This room is for the equipment and supplies to be used in the surgical suite and shall have a minimum area of 100 square feet.
9. There shall be clothing change areas for male and female personnel. The areas shall contain lockers, shower, toilets, urinals, lavatories equipped for hand washing and space for donning scrub surgical attire. These areas shall be arranged to require a one-way traffic pattern so that personnel entering from the outside of the surgical suite can change and move directly into the sterile corridor of the surgical suite.
10. There shall be a staff lounge and toilet facilities. Separate or combined lounges for male and female staff shall be provided. The lounge shall be designed to minimize the need to leave the suite and shall have convenient access to the recovery room.
11. There shall be areas for dictation and report preparation which shall be accessible from the lounge area.
12. There shall be a janitor closet in both the sterile and non-sterile areas. Each shall contain a floor receptor or service sink and storage for janitorial supplies and equipment.
(9) Outpatient Surgery.
(a) There shall be a separate area where outpatients may change from street clothing into hospital gowns and be prepared for surgery. This would include male and female locker rooms, toilets, clothing change or gowning areas. A common waiting room shall be provided. This function may be accommodated in the patient bedroom area.
(b) There shall be an outpatient recovery room. The recovery room may be part of the inpatient recovery area.
1. If a separate recovery room is provided, it shall accommodate a minimum of two recovery beds for each operating room. The size of the room shall be based on a minimum of 80 square feet per recovery bed.
2. There shall be a work counter and a hand washing facility.
(c) There shall be toilet rooms for patients with direct access from the outpatient recovery area. Smaller facilities may use the same spaces as for preoperative preparation.
(d) Outpatient surgical operating rooms shall have a minimum clear area of 170 square feet.
(e) If outpatient surgery is provided but not contiguous with the surgical department, all of the following requirements shall be met.
1. There shall be a control station located to permit visual observation of all traffic into and within the suite.
2. There shall be a surgical director's office which shall be located to allow visitors to the suite to confer with the director without passing through the suite or through the sterile quarters.
3. There shall be at least one high-speed sterilizer conveniently located to serve all operating rooms.
4. There shall be two scrub positions near the entrance to each operating room. Two scrub positions may serve two operating rooms if both are located adjacent to the entrance of each operating room. Scrub facilities shall be arranged so as to minimize any incidental splatter on nearby personnel, medical equipment or supplies, and sufficient space shall be provided around the scrub facilities to eliminate any incidental contact with other surfaces by the medical personnel.
5. There shall be a soiled workroom or decontamination room for the exclusive use of the surgical suite staff, or a soiled holding room that is part of the system, for the collection and disposal of soiled material.
a. The soiled workroom shall contain a flushing rim clinical service sink with a rinsing device, a work counter with a minimum area of 10 square feet, a double compartment sink with equipment for hand washing, a waste receptacle and a linen receptacle.
b. When a soiled holding room is used, the flushing rim clinical service sink and work counter may be omitted and a lavatory for hand washing substituted.
c. The soiled work or holding facilities shall not have direct connection with the operating rooms but shall open only into the sterile corridor.
6. There shall be a clean workroom. This workroom is required when clean materials are assembled within the surgical suite prior to use.
a. A clean workroom shall contain a work counter with a minimum of 14 square feet, a sink equipped for hand washing and space for clean and sterile supplies.
b. If a clean holding room is utilized by the hospital, the counter may be eliminated and a lavatory substituted for the sink.
7. There shall be an equipment storage room for storing supplies and equipment to be used in the surgical suite. The minimum area for this room shall be 100 square feet.
8. There shall be a lounge for staff use. Separate or combined lounges for male and female staff shall be provided. The lounge shall be designed to minimize the need to leave the suite and to ensure convenient access to the recovery room.
9. There shall be areas for dictation and report preparation which shall be accessible from the lounge area.
10. There shall be a janitor closet in both the sterile and non-sterile areas. Each shall contain a floor receptor or service sink and storage for janitorial supplies and equipment.
11. There shall be staff toilets.
12. There shall be a medication storage and distribution room which shall include a hand washing facility and a refrigerator.
13. If the outpatient surgery unit is located in a separate building or on a different campus, there shall be toilets for the handicapped.
(10) Obstetrical Facilities.
(a) At the option of the hospital, obstetrical suites may consist of any combination of the following major elements except that a Cesarean section/delivery room shall be provided in each facility. The requirement for a Cesarean section/delivery room will be waived for hospitals with 1, 500 or fewer births per year. If the number of births exceeds 1, 500 per year for 2 consecutive years, this requirement will no longer be subject to waiver and a Cesarean section/delivery room, recovery room and service areas as described shall be provided.
1. Cesarean Section/Delivery Room.
a. Each room shall have a minimum net usable clear area of 300 square feet with a minimum dimension of 15 feet.
b. Room temperature shall be individually controlled.
c. An area of the room shall be designated for infant resuscitation. There shall be a minimum of one oxygen, vacuum, medical air outlet and one critical power duplex receptacle in the resuscitation area.
d. There shall be two scrub sinks at the entrance to the Cesarean section/delivery room which shall be located to allow the physician to observe the patient while scrubbing.
2. Recovery Room.
a. Each recovery room shall contain a minimum of two beds and have a nurse position with charting facilities located to permit visual control of all beds. Each room shall include facilities for medicine administration and hand washing, a flushing rim clinical service sink with a bedpan flushing device, and cabinets for storage of equipment and supplies.
3. Service Area.
a. There shall be a control or nurse station located to permit observation of all traffic entering the obstetrical department.
b. There shall be an office for the obstetrical department director's office which shall be located to allow visitors to the suite to confer with the director without passing through the suite or the sterile quarters.
c. There shall be a minimum of one high-speed sterilizer conveniently located to serve all delivery rooms.
d. At Cesarean section/delivery rooms, there shall be separate clothing change areas for male and female staff. These areas shall contain lockers, showers, toilets, urinals, lavatories equipped for hand washing, and space for changing into scrub attire. They shall be arranged to require a one-way traffic pattern so that personnel entering from outside the obstetrical suite can shower, change and move directly into the sterile corridor of the obstetrical suite.
e. There shall be a medication room with a work counter and sink.
f. There shall be an anesthesia storage and workroom which shall contain a work counter with a double compartment sink and storage cabinets.
g. There shall be a clean workroom with an area in the room for exchange carts. The room shall contain a work counter with sink and storage shelves.
h. There shall be an equipment cleanup and soiled workroom. This room shall include an area for carts and a work counter with a double compartment sink. There shall be a clinical service sink with a rinsing device.
i. There shall be an equipment storage room in a convenient location. The minimum size shall be 1 percent of the gross area of the department or 100 square feet, whichever is larger.
j. There shall be a family room near the entrance to the unit. Toilet facilities for the handicapped shall be adjacent to this room.
k. There shall be a janitor closet containing a floor receptor or service sink and storage for janitorial supplies and equipment for the exclusive use of the obstetrical suite.
l. There shall be a lounge and toilet facilities for obstetrical staff which is conveniently located to the labor, delivery and recovery areas.
m. There shall be private on-call bedrooms with toilets for physicians.
n. There shall be an area for storing stretchers which is out of the path of normal traffic.
o. There shall be a nourishment room with counter, sink and refrigerator.
p. If Labor-Delivery-Recovery (LDR) or Labor-Delivery-Recovery-Postpartum (LDRP) rooms are not provided, labor rooms complying with the following shall be provided.
(I) Each room shall be designed for either one or two beds with a minimum area of 100 square feet per bed. Two labor beds shall be provided for each delivery room.
(II) In facilities having only one delivery room, two separate labor rooms shall be provided, one of which shall be a minimum of 160 square feet and shall be equipped with a minimum of two oxygen outlets and two suction outlets in order to perform as an emergency delivery room.
(III) Each labor room shall contain a lavatory equipped for hand washing and shall have access to a toilet room. One toilet room may serve two labor rooms.
(IV) Labor rooms shall have controlled access with doors arranged for observation from a nurse work station.
(V) There shall be at least one shower for the use of patients in labor. A water closet shall be conveniently accessible to each shower facility.
4. Labor-Delivery-Recovery Room (LDR).
a. LDR rooms shall contain a minimum area of 250 square feet with a minimum dimension of 12 feet. This includes the toilet and shower room and concealable equipment storage area. Without a change in room area, the equipment may be kept in an additional storage room near the nurse station in lieu of a concealable storage area.
b. An infant resuscitation area shall be provided. This area shall be provided with a minimum of one oxygen, vacuum and medical air outlet. One duplex receptacle shall be connected to the critical branch and one duplex receptacle shall be connected to the normal branch.
c. The following shall be provided in the delivery area:
(I) One oxygen and one vacuum outlet;
(II) Four duplex receptacles connected to the critical branch and two duplex receptacles connected to the normal branch;
(III) Examination light controls;
(IV) A telephone or a communication system;
(V) A hand washing facility; and
(VI) Room light intensity controls.
d. Each LDR room shall have direct and exclusive access to a toilet and shower without going through the general corridor. All finishes in the room shall be selected for ease in cleaning as well as for contributing to a homelike atmosphere. The LDR room shall be located within the obstetrical department.
e. The service area requirements for normal patient rooms shall be provided for the LDR suite.
5. Labor-Delivery-Recovery-Postpartum Rooms (LDRP) shall meet all of the requirements of the labor-delivery-recovery suite. Additionally, each patient room shall have a window to the exterior. The window shall comply with all of the size, location and operational requirements of other patient room windows. Windows shall be appropriately curtained.
6. Holding Nursery.
a. In facilities that provide only LDR rooms with postpartum bedrooms or LDRP rooms, a full-term or Level I nursery is not required. In that case, a holding nursery shall be provided.
b. The holding nursery shall be sized at a ratio of one bassinet for every two and one-half postpartum beds.
c. Each bassinet position shall have 24 square feet of floor area.
d. There shall be a hand washing facility at a ratio of one for every six bassinets in each nursery.
e. Locate the nursery next to the nurse station and provide view windows to allow staff viewing.
(11) Emergency Service Department. When 24-hour emergency service is to be provided, the following elements shall be required.
(a) There shall be a grade level entrance sheltered from the weather. The entrance and driveway shall have direct access from the public roads for ambulance and vehicle traffic and shall be clearly marked. If a raised platform is used for ambulance discharge, a separate entrance for pedestrians and the handicapped shall be provided. There shall be an emergency access area to permit discharge of patients from automobiles and ambulances at the sheltered entrance. There shall be an area for temporary parking of such vehicles away from the entrance.
(b) There shall be a reception and control station located so as to permit staff to observe and control the access to treatment areas, pedestrian and ambulance entrances and the public waiting area.
(c) There shall be convenient wheelchair and stretcher storage. Such storage shall be out of the flow of traffic but with convenient access to emergency entrances.
(d) There shall be a public waiting area with adjacent toilet facilities, drinking fountains and telephones.
(e) There shall be a treatment and examination room which shall have a minimum of 100 square feet of clear floor space and shall contain a work counter with storage cabinets, hand washing facilities and an examination light. The number of treatment or examination rooms is dependent on the anticipated workload. These treatment areas may be in a large room with cubicle curtains providing privacy. In each such case, a minimum of one fully enclosed treatment or examination room shall be provided.
(f) There shall be an x-ray film illuminator which shall be conveniently located in the department.
(g) Provisions for orthopedic and cast work may be in a separate room. Located conveniently to the orthopedic work area, facilities shall be provided for storing splints and other orthopedic supplies, a plaster sink, an x-ray film illuminator and an examination light.
(h) A poison control center may be part of the nurse station.
(i) There shall be a shower near the entrance for the emergency wash-down of patients. The arrangement shall permit staff assistance.
(j) There shall be a soiled workroom. This room shall contain a flushing rim clinical service sink, a work counter with a double compartment sink. Receptacles for the disposal of soiled items shall also be included. If the room is to function as a soiled holding room, the work counter and double compartment sink may be eliminated, but a hand washing facility must be provided.
(k) There shall be a clean workroom equipped with a work counter and storage for medical supplies and a lavatory or sink for hand washing. If a clean holding room is provided, the requirements for fixed storage and hand washing are eliminated.
(l) There shall be a storage area for crash carts. Portable x-ray units and other equipment shall be located out of traffic and clearly accessible to each operating and treatment room.
(m) The hospital corridor system shall not pass directly through this unit.
(n) There shall be a station for staff work and charting with counters, cabinets and medication storage. This area may be combined with or include centers for reception control, poison control, after hours admitting and communication. There shall be convenient access to the hand washing facilities.
(o) There shall be locked cabinets or other secure storage for staff's personal effects within the nurses' work area or lounge.
(p) There shall be staff toilets.
(q) There shall be a janitor closet for the exclusive use of the emergency department. This must be located within or adjacent to the emergency service area.
(r) For electrical design purposes only, trauma rooms shall be synonymous with treatment rooms.
(12) Radiology Suite.
(a) Each hospital shall provide facilities for diagnostic radiographic examination of patients. The number of radiographic and fluoroscopic rooms is dependent on the anticipated workload and shall contain the following features.
(b) Radiographic and fluoroscopic functions may be performed in one room or in separate rooms. The room shall be appropriately sized to accommodate equipment, patient stretchers and staff work area. Shielded control areas shall be included in or adjacent to each radiographic room with provisions for viewing the entire table and patient and for audio communication during film exposure. See the licensing and registration requirements in Chapter 10D-56, F.A.C.
1. Each fluoroscopic room shall have an adjacent patient toilet room. This patient toilet room shall contain a water closet and a hand washing facility. One door must open out from the toilet room.
2. A barium preparation area shall be provided with sink, work counter and storage area to allow mixing of contrast media. One barium preparation unit may serve several radiographic rooms. Premixed commercial preparations, if used, may be stored in a conveniently located clean workroom.
3. A cleanup facility shall be provided within the suite and shall include a service sink and storage space for equipment and supplies.
4. An alcove shall be provided near the processor for viewing film immediately after it is processed.
5. There shall be offices for the radiologists and other staff as required. There shall be facilities for the storage of active x-ray film conveniently located for immediate film retrieval.
6. There shall be a film storage room for inactive records. The room may be outside the radiology suite but must be under the administrative control of the radiology department with provisions to secure films against loss or damage.
7. There shall be the necessary clerical offices.
8. There shall be a patient stretcher holding alcove adjacent to each radiographic area.
9. There shall be a hand washing facility in each procedure room. Hand washing facilities may be omitted from rooms used only for routine screening such as chest x-rays.
10. There shall be a toilet room with hand washing facilities conveniently located to waiting areas. The toilet room shall be usable and accessible for wheelchair patients. Separate toilets shall be provided with direct access to each radiographic room routinely used for fluoroscopic procedures and arranged so that a patient may leave the toilet room without reentering the fluoroscopic area.
11. There shall be staff toilets.
12. There shall be patient dressing rooms conveniently located to the waiting area and to the radiographic rooms. Dressing rooms shall include a seat or bench, a mirror and provisions for hanging the patient's clothing. At least one dressing room in the radiographic suite shall be sized for access and use by wheelchair patients.
(13) Laboratory Suite.
(a) Each hospital shall provide laboratory facilities for hematology, clinical chemistry, urinalysis, microbiology, serology, anatomic pathology and a transfusion service to meet the workload anticipated by the hospital. At a minimum, the laboratory shall provide for the following procedures to be performed on site:
1. Blood count;
2. Urinalysis;
3. Blood glucose, electrolytes, blood urea and nitrogen (BUN), amylase; and
4. Transfusion type and cross match capacity.
(b) At a minimum, the laboratory suite shall contain the following.
1. There shall be a laboratory work counter with space for microscopes, appropriate chemical analyzers, incubators and centrifuge. Work areas shall include access to vacuum, gas and electrical services, as needed, and sinks with water.
2. There shall be refrigerated facilities for the storage of blood for transfusions. The blood storage refrigerator shall be equipped with temperature monitoring and alarm signaling devices.
3. There shall be lavatories or counter sinks equipped for hand washing. These counter sinks may be used for the disposal of nontoxic fluids.
4. There shall be storage facilities for reagents, standards, supplies and stained specimens, microscope slides, etc., including refrigeration as needed. There shall be separate, well ventilated storage facilities for volatile liquids.
5. There shall be separate rooms for bacteriology and histology. The minimum size for each room shall be 80 square feet.
6. If outpatient services are provided, a specimen blood, urine and feces collection facility shall be required. The blood collection area shall have work counter space and hand washing facilities. The urine and fecal collection room shall be equipped with a water closet with a rinsing device and a lavatory.
7. There shall be emergency shower and eye flushing devices and fire blankets.
8. If radioactive materials are employed, there shall be facilities for long-term storage and disposal of these materials. No special provisions will be required for body waste products for patients receiving low level isotope diagnostic material.
9. There shall be administrative areas including offices and space for clerical work, filing and records maintenance.
10. There shall be lounge, locker and toilet facilities which shall be conveniently located for male and female laboratory staff. These may be outside the laboratory area and shared with other departments.
(c) Licensure for this laboratory facility shall be required in accordance with Chapter 483, F.S., and as prescribed in Chapter 59A-7, F.A.C.
(14) Rehabilitation Therapy Department.
(a) If formal rehabilitative therapy services are included as part of the services rendered by the hospital such as physical therapy, occupational therapy or respiratory therapy, all of the requirements of this section shall be met. Where two or more rehabilitative services are included, some of the requirements may be shared as appropriate.
(b) Each rehabilitative therapy department shall include the following common elements which may be shared or provided as separate units for each service.
1. There shall be an office and clerical space for filing and retrieving patient records.
2. There shall be a reception and control station with visual control of the waiting and activities areas. This may be combined with the office and clerical space.
3. There shall be outpatient waiting areas which are out of the general traffic.
4. There shall be patient toilets with hand washing facilities accessible to the handicapped.
5. There shall be storage space or spaces for parking wheelchairs and stretchers out of traffic while patients are using the services. These spaces may be separate from the service area but must be located for convenient use.
(c) Physical Therapy. If physical therapy is part of the service, at a minimum, the following shall be included.
1. There shall be individual treatment areas which shall have a minimum of 60 square feet of clear floor area.
2. There shall be hand washing facilities either within or at each treatment area for staff use. One hand washing facility may serve a maximum of three treatment areas.
3. There shall be an exercise area and facilities.
4. There shall be storage for clean linen and towels. This may be in cabinets, closets or in carts located for convenient use and out of traffic.
5. There shall be storage for equipment and supplies.
6. There shall be separate storage for soiled linen, towels and supplies.
7. There shall be a patient toilet room with a hand washing facility.
(d) Occupational Therapy. If occupational therapy services are provided, the following shall be included.
1. There shall be work areas and counters suitable for wheelchair access.
2. There shall be hand washing facilities.
3. There shall be storage for supplies and equipment.
(e) Respiratory Therapy Services.
1. If respiratory therapy services are provided, the following requirements shall be met.
a. There shall be storage for supplies and equipment.
b. There shall be space and utilities for cleaning and sanitizing equipment.
c. There shall be service facilities for calibrating, adjusting, servicing and minor repairing of equipment.
2. Respiratory therapy services shall be conveniently accessible on a 24-hour basis to the intensive care units.
3. If respiratory therapy services such as testing and demonstration for outpatients are part of the hospital's services, additional facilities and equipment shall be provided as necessary.
(15) Morgue and Autopsy.
(a) Morgue and autopsy facilities shall be accessible to the exterior entrance and shall be located so as to avoid the need for transporting bodies through public areas.
(b) At a minimum, the following facilities shall be provided when autopsies are performed within the hospital.
1. There shall be refrigerated body holding facilities.
2. There shall be an autopsy room. This room shall contain an autopsy table and a work counter with a sink equipped for hand washing.
3. There shall be storage space for supplies, equipment and specimens.
4. There shall be a clothing change area equipped with shower, toilet and lockers.
5. There shall be a janitor closet with floor receptor or sink and facilities for storing janitorial equipment and supplies.
(c) If autopsies are performed outside the facility, only a well ventilated body holding room shall be required.
(16) Pharmacy.
(a) A pharmacy shall be provided in the hospital. The facilities and equipment necessary shall be adequate to handle the pharmacy and medicine requirements of the hospital.
(b) The pharmacy shall include the following.
1. There shall be a pick-up and receiving counter, an area for reviewing and recording orders, an extemporaneous compounding area, work counters and cabinets for pharmaceutical activities and an area for temporary storage, exchange and restocking of carts.
2. There shall be a compounding area.
3. There shall be space for packaging, labeling and quality control.
4. There shall be space for bulk, active and refrigerated storage. Special care shall be taken in storing bulk quantities and alcohol. There shall be secure storage for controlled substances. There shall be separate storage for general supplies and equipment when not in use.
5. There shall be separate administrative space for office functions including filing, communication and reference. This is not required in psychiatric hospitals.
6. There shall be hand washing facilities within each room where open medication is handled.
7. If a unit dose procedure is used, there shall be additional space and equipment for supplies, packaging, labeling and for storing the carts.
8. If intravenous solutions are prepared in the pharmacy, there shall be an area for a laminar flow bench and hood. The laminar flow system shall include a non-hygroscopic filter rated at 99.97 percent efficiency, HEPA, per DOP test. A visible pressure gauge shall be provided which measures the pressure drop across the filter.
(17) Dietary Facilities.
(a) Food service facilities and equipment shall be provided as needed to meet the dietary requirements of the hospital. A conventional or convenience food preparation system or any appropriate combination thereof is acceptable.
(b) The following facilities shall be provided in the size required to meet the needs and to implement the type of food service selected.
1. There shall be a control station for receiving and controlling food supplies.
2. There shall be storage, including cold storage space.
3. There shall be food preparation facilities.
4. There shall be hand washing facilities.
5. There shall be facilities for assembling and distributing patient meals. This is not required in psychiatric facilities.
6. There shall be a dining room for ambulatory patients, staff and visitors.
7. There shall be facilities for ware washing located in a room or an alcove that is separate from the food preparation area. Commercial type ware washing equipment shall be provided. There shall be separation between the receiving, scraping, sorting and stacking of soiled tableware and the clean tableware collecting area. Hand washing facilities shall be conveniently available in the soiled tableware side.
8. There shall be facilities for pot washing.
9. There shall be a storage area and sanitizing facilities for cans, carts and mobile tray conveyors.
10. There shall be facilities for waste storage which are located in a separate room easily accessible to the outside for direct pick up or disposal.
11. There shall be an office for the dietary service manager with additional space or a separate office provided for the dietitian.
12. There shall be toilets with hand washing facilities within the dietary department. Such toilets shall have a separate vestibule.
13. There shall be a janitor closet within the dietary department which shall include a floor receptor and storage space for janitorial supplies and equipment.
14. There shall be ice making equipment either within the food preparation area or in a separate room.
(18) Administration and Public Areas.
(a) All public waiting areas shall be provided with male and female toilets designed to accommodate the handicapped. Such facilities shall be within 75 feet of the waiting area and may serve more than one such area.
(b) The entrance shall be at grade level and shall be sheltered from inclement weather and accessible to the handicapped.
(c) A lobby shall be provided which includes a counter or desk for reception and information, public waiting areas, public telephones and drinking fountains.
(d) Interview space shall be provided which allows for private interviews relating to social services, credit and admissions.
(e) There shall be an admissions area with a separate waiting area for patients and accompanying persons. This area shall include a work counter or desk for staff and a storage area for wheelchairs which is out of the path of normal traffic.
(f) There shall be general business offices for hospital business transactions, medical and financial records and offices for the administrative and professional staff.
(g) There shall be a minimum of one multipurpose room for conferences, meetings and health education purposes, including provisions for using visual aids.
(h) There shall be a medical library. The library may be an area within the physicians' lounge or the medical records department.
(i) There shall be space for storing office equipment and supplies.
(19) Mobile Testing and Treatment Facilities.
(a) There shall be sturdy walls, fences or bollards around the immediate site to prevent collisions with the unit by other vehicles.
(b) Electrical connection to the hospital electrical system shall be permitted only when the mobile facility complies with appropriate requirements of NFPA-70, National Electrical Code.
(c) There shall be a rain-free passage from the hospital to the entrance to the mobile facility.
(d) A fire alarm system shall be provided. An alarm initiated in the mobile facility shall activate the hospital system, and an in-house alarm shall sound an alarm in the facility.
(e) The mobile facility shall not diminish egress from the hospital.
(f) Mobile facilities shall be approved in advance by the Office of Plans and Construction and the Office of Licensure and Certification.
(g) Egress from the mobile facility shall conform with health care occupancy standards of the Life Safety Code.
(h) There shall be a telephone which shall be connected to the hospital communication system.
(20) Medical Records. There shall be rooms, areas and offices for the medical records administrator or technician for purposes of review and dictation, for sorting, recording and microfilming records and for records storage.
(21) Central Sterile Supply Services. Each hospital, except psychiatric hospitals, shall provide a central sterile supply services department comprised of the following elements.
(a) There shall be a receiving and decontamination room. At a minimum, this room shall contain work space and equipment for cleaning medical and surgical equipment and for disposing of used and soiled material. This room shall include facilities for hand washing.
(b) There shall be a clean workroom which shall contain facilities for hand washing and work space and equipment for terminal sterilization and sanitation of medical and surgical equipment and supplies.
(c) There shall be a storage area for clean medical, surgical supplies and for sterile supplies. This area may be part of the clean workroom.
(d) There shall be a room for storage of equipment used in the delivery of patient care.
(22) General Storage.
(a) There shall be a general storage facility with a minimum total area of 20 square feet per inpatient bed. In psychiatric and rehabilitation hospitals, general storage shall be provided with a minimum total area of 5 square feet per inpatient bed.
1. There shall be receiving areas.
2. There shall be off-street unloading facilities.
(b) If the general storage areas are located in a separate building on the site, provisions shall be made for protecting supplies against inclement weather during transfer. At a minimum, a covered walkway may be used for this purpose. The off-street loading facilities and receiving areas for the general stores shall not be part of the general means of egress for the building.
(23) Linen Services.
(a) Each hospital shall have provisions for storing and processing clean and soiled linens as required for appropriate patient care. Processing may be done within the facility in a separate building on or off site, or in a commercial or shared laundry.
(b) At a minimum, the following facilities shall be included.
1. There shall be a separate room for receiving and holding soiled linen until it is ready for pickup or processing.
2. There shall be a central storage room issuing clean linen. The central storage capacity shall be sufficient for four day's operation or two normal deliveries, whichever is greater.
3. There shall be a cart storage area for separate out-of-traffic parking of clean and soiled linen carts.
4. There shall be a clean linen inspection and mending room or area.
5. Hand washing facilities shall be provided in each area where unbagged soiled linen is handled.
6. If linen is processed outside the building, provisions shall be made for a service entrance which is protected from inclement weather during loading and unloading of linen.
7. If linen is processed in a laundry facility which is part of the hospital, the following shall be provided.
a. There shall be a receiving, holding and sorting room for the control and distribution of soiled linen. Discharge from soiled linen chutes may occur within this room or into a separate room.
b. There shall be a laundry processing room. The equipment shall be arranged so as to permit an orderly flow with minimum cross traffic that would mix clean and soiled operations.
c. There shall be a storage area for laundry supplies.
d. There shall be hand washing facilities for employees in each separate room where clean or soiled linen is processed and handled.
(24) Employee Facilities. Lockers, lounges and toilets shall be provided for employees and volunteers. These shall be in addition to and separate from those required for the medical staff and the public.
(25) Janitor Closets. In addition to the janitor closets specifically required in certain departments, sufficient janitor closets shall be provided throughout the facility as required to maintain a clean and sanitary environment. Each janitor closet shall contain a floor receptor or service sink and storage space for janitorial equipment and supplies. There shall be a minimum of one janitor closet on each floor.
(26) Engineering Service and Equipment Areas.
(a) There shall be a room or separate building for boilers, fire pumps, and mechanical and electrical equipment.
(b) There shall be an office for the building engineer with file space and provision for the protected storage of the facility's drawings, records and manuals.
(c) There shall be a general maintenance shop for repair and maintenance with a separate area for building maintenance supplies. Special care shall be taken in designing and constructing spaces used for storing solvents and flammable liquids to ensure conformance with applicable NFPA codes. This is also required for the carpentry shops and other dust producing areas.
(d) There shall be a separate area or room specifically for storing, repairing and testing electronic and other medical equipment. This is not required in psychiatric hospitals.
(e) A storage room shall be provided for yard equipment which is located so that the equipment may be moved directly to the exterior.
(27) Waste Processing Services. Facilities shall be provided for the sanitary storage and disposal of waste by incineration, mechanical destruction, compacting, containerization removal, or sterilization or by a combination of these techniques. Biohazardous waste disposal shall comply with the requirements contained in Chapter 64E-16, F.A.C.
(28) There shall be public toilet rooms on each floor which are designed to accommodate the handicapped.
(29) Rehabilitation Hospitals. New rehabilitation hospitals shall be required to meet all of the requirements as stated in Rule 59A-3.081, F.A.C. for general hospitals except as modified herein.
(a) Surgical, and obstetrical and emergency room facilities are not required.
(b) In hospitals with a bed capacity of 200 or less, the requirements for diagnostic radiology and laboratory are not required if outside contractual arrangements are made to provide these services.
(c) Physical Therapy Unit.
1. There shall be an office for the physical therapist.
2. There shall be waiting areas.
3. There shall be facilities for hand washing. These facilities may serve more than one cubicle.
4. There shall be a group exercise area.
5. There shall be a room for storing linen supplies and equipment.
6. There shall be patient dressing areas with shower, lockers and toilet rooms.
7. There shall be a janitor closet with floor receptor.
(30) Psychiatric Hospitals. New psychiatric hospitals and new psychiatric sections in general hospitals shall comply with all of the minimum standards set forth in subsections 59A-3.081(1) through (28), F.A.C. for general hospitals except for the requirements for isolation facilities and surgical and obstetrical services. Diagnostic x-rays and laboratory services may be provided by contract if such services are available locally.
(a) Each patient sleeping room intended for occupancy for 24 hours or longer shall have an outside window or outside door arranged and located so that it can be opened from the inside to permit venting products of combustion and to provide fresh air to any occupant in case of emergency.
(b) In buildings housing high risk of patients or having detention rooms or security sections, it will be necessary to provide detention screens or polycarbonate glazing to confine and protect building inhabitants.
1. Where windows require the use of tools and keys for operation because of detention screens, the tools or keys shall be located on the floor or area involved at a prominent location which is accessible to staff.
2. Where glass fragments may create a hazard, safety glazing and other appropriate security features shall be incorporated.
3. The degree of security required in the window opening to inhibit the possible tendency for suicide or escape shall be determined by the hospital.
(c) A nurse call system is not required; however, a voice activated and switchable emergency calling system shall be provided in seclusion rooms. If a nurse call system is included, provisions shall be made to permit the removal of call buttons or for the use of blank plates as required for security.
(d) Each patient shall have access to a toilet room without entering the general corridor area.
1. One toilet room shall serve no more than four beds and no more than two patient rooms.
2. The lavatory may be in either the patient bedroom or in the toilet room. A tub or shower may be added to the toilet room as required by the hospital. All mirrors shall be non-breakable.
3. Psychiatric services for children which require the observation and control of patient activity may vary from these requirements.
(e) The 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 a minimum of one such service area shall be provided on each nursing floor.
1. There shall be an administrative center or nurse station.
2. There shall be a staff lounge and/or a conference room.
3. There shall be facilities for hand washing which are located near the nurse station and the drug distribution station. One lavatory may serve both areas.
4. A charting area shall be provided with adequate space for the function. There shall be acoustical privacy.
5. A viewing window to permit observation of the patient area by the charting nurse or physician may be used if it is located so that the patient files cannot be read from outside the charting space.
6. A minimum of two separate social areas shall be provided, one appropriate for noisy activities and the other for quiet activities. The combined total area shall be a minimum of 40 square feet per bed space or a minimum of 160 square feet for each of the two areas, whichever is greater. The noisy activity areas may be combined and may be remotely located.
7. There shall be a room for group therapy. The area of the room shall be a minimum of 250 square feet. The group therapy room may be combined with the area for quiet activities, provided the total area is a minimum of 400 square feet if used for both functions.
8. Patient laundry facilities with automatic washers and dryers may be provided.
9. Separate consultation rooms, each with a minimum floor space of 100 square feet, shall be provided at a rate of one consultation room for the first 24 beds or any portion thereof. For each additional 24 beds or any portion thereof, there shall be one additional consultation room. The rooms shall be arranged for acoustical and visual privacy.
10. Space for occupational therapy shall be provided with a minimum area of 375 square feet or at a rate of 4 square feet per bed, whichever is greater. This space shall include provisions for hand washing, work counters, storage and displays.
11. Where psychiatric facilities contain fewer than 25 beds, the occupational therapy function may be performed within the noisy activities area if a minimum space of 495 square feet is available for both the noisy activity area and the occupational therapy activities. If the occupational therapy function is performed within the noisy activities area, that space shall contain provisions for hand washing, work counters, storage and displays.
12. There shall be a lounge and toilet rooms for staff.
13. There shall be individual closets or compartments for the safekeeping of personal belongings of the nursing personnel. These shall be located so as to be convenient to the duty station of the personnel or in a central location.
14. There shall be space for examination and treatment of patients which shall contain a minimum floor area of 120 square feet excluding space for vestibules, toilet and closets. The minimum room dimension shall be 10 feet. The room shall contain a lavatory or sink equipped for hand washing, a work counter, storage facilities and a desk counter or shelf space for writing. The emergency treatment room may be used for this purpose if it is conveniently located on the same floor as the patient rooms.
(f) There shall be a clean linen area for the storage and distribution of clean linen. The required area may be concentrated in one central room or divided into several rooms throughout the facility.
(g) There shall be a soiled linen area. The area shall be part of the system for collecting and disposing of soiled materials and shall include a holding room for soiled linens. The required area may be concentrated in one room or divided into several rooms throughout the facility. There shall be a lavatory for hand washing in each soiled linen area.
(h) There shall be a drug distribution station which shall contain a minimum area of 30 square feet. Provisions shall be made for convenient and prompt 24-hour distribution of medicine to patients. This may be from a medicine preparation room or from a self-contained medicine dispensing unit. The area may be located at the nurse station and shall be under the visual control of the nursing staff. It shall contain a work counter and sink, a refrigerator and locked storage for biologicals and drugs. The drug distribution station shall be under the direct control of the nursing or pharmacy staff, and provisions for security against unauthorized access must be assured.
(i) There shall be a small kitchen for patient use.
(j) There shall be patient bathing facilities. Bathtubs or showers shall be provided at a rate of one for every four bed spaces which are not otherwise served by bathing facilities within the patients' rooms. Each tub or shower shall be in an individual room or enclosure which provides space for the private use of the bathing fixture and for drying and dressing.
(k) There shall be space for storing emergency equipment which shall be under the direct control of the nursing staff and in close proximity to the nurse station and out of traffic.
(l) There shall be a seclusion room for patients requiring security and protection from either themselves or others. The room area shall be a minimum of 60 square feet and the room dimension shall be a minimum of 6 feet.
1. The room shall be located and designed in such a manner as to afford direct supervision and observation of the patient and the entire room by the nursing staff. It shall be a single room and shall be constructed to minimize the patient's hiding, escape, injury or suicide. Rooms may be grouped together or placed in every psychiatric nursing unit.
2. The seclusion room is intended for short-term occupancy by patients who become violent or may be suicidal; therefore, special fixtures, hardware, and tamper-proof screws shall be used. Doors shall open out and shall have provision for staff observation while maintaining privacy from the public and other patients. The seclusion room shall have natural light--skylight, window or small thick glass opening to the exterior--to maintain a therapeutic environment.
(m) In facilities designed for geriatric psychiatric patients, there shall be soiled workrooms which comply with the requirements for medical-surgical beds.
(n) Multi-storied psychiatric hospitals shall have elevators.
1. In multi-storied facilities, a minimum of one elevator shall be provided which is hospital size with 4,000 pound capacity. The other elevators may be normal passenger elevators with 2, 500 pound capacity. If appropriately located, a freight elevator may be substituted for the hospital size elevator.
2. The quantity of elevators shall be as required by paragraphs 59A-3.081(37)(a) through (e), F.A.C.
(o) Televisions in psychiatric patient rooms are optional. Where televisions are not provided, associated electrical services may likewise be omitted.
(31) Details and Finishes. The following describes the requirements for details and finishes in new hospitals and for additions, alterations and renovations to existing hospitals.
(a) Corridors in patient care and treatment areas must be a minimum of 8 feet in clear and unobstructed width except in psychiatric facilities where 6-foot corridors are acceptable. In psychiatric facilities housing geriatric patients, corridors in patient care and treatment areas must be a minimum of 8 feet in clear and unobstructed width. Equipment such as drinking fountains, telephone booths and time clocks shall be located in alcoves or in other locations so as not to infringe on the corridor space and not reduce the corridor width below the required minimum. Corridors in non-patient care areas shall be a minimum of 44 inches in clear width.
(b) Smaller rooms which may be occupied by patients and which contain bathtubs, sitz baths, showers and water closets shall have doors which open away from the room. When such rooms are necessarily on corridors, the corridors shall be equipped with alcoves to accommodate the door swinging outward. These alcoves must be designed to allow a minimum of 1 foot from the latch side of the door frame to allow opening by persons in wheelchairs. In non-corridor locations where doors opening outward are not feasible, the door and frame shall be fitted with rescue-type hardware.
(c) Doors to patient sleeping rooms, treatment rooms, examination rooms and exits shall be a minimum of 44 inches wide and a minimum of 80 inches high. Doors to other rooms and spaces shall be a minimum of 34 inches wide. In patient areas of rehabilitation hospitals, there shall be a minimum clearance of 1 foot at the strike side of the door to accommodate wheelchair accessibility. Patient room doors in psychiatric hospitals shall be a minimum of 36 inches wide except doors to patient rooms in geriatric psychiatric areas shall be a minimum width of 44 inches.
(d) Doors shall not swing into corridors except those in spaces that are not subject to occupancy such as small closets. Large walk-in closets are considered occupiable spaces.
(e) Patient charting desks that fold down from the wall are not permitted to intrude on the required corridor space, and if used, must be placed in an alcove of sufficient depth to eliminate any intrusion on the corridor space.
(f) Patient sleeping rooms shall be provided with operable windows to the exterior sized to equal at least 8 percent of the gross floor area of the room. All windows shall have a minimum 20-foot unobstructed vista. This vista is measured perpendicularly from the plane of the window. Other than in intensive care units, the maximum stool height in patient sleeping rooms may not exceed 3 feet above the finished floor. Window locking and operating mechanisms may not be more than 72 inches above the finished floor. Window stools in intensive care units may not exceed 5 feet above the finished floor.
(g) Flat plates, if used as sills under A-labeled doors and expansion joint covers, shall be flush with the adjacent finished floor covering and the surface shall be smooth.
(h) Ceiling heights shall be as follows.
1. Ceilings in rooms with ceiling-mounted surgical light fixtures and in kitchens shall be a minimum height of 9 feet.
2. In psychiatric facilities, ceilings in patient bedrooms and seclusion rooms shall be a minimum height of 9 feet.
3. Ceilings in corridors and patient toilet room shall be a minimum height of 7 feet 6 inches. Lighting fixtures, signs and other equipment shall not extend below a height of 6 feet 8 inches above the finished floor. Ceilings in all other rooms shall be a minimum height of 8 feet.
4. When remodeling existing facilities, written approval by the Office of Plans and Construction shall be required in advance for ceiling heights which are lower than the above minimums.
(i) Ceilings shall be acoustically treated in corridors in patient areas, nurse stations and dining rooms. Ceilings in kitchens, operating rooms and delivery rooms, including LDR and LDRP rooms, shall be washable.
(j) Dispensers for single-service paper towels and soap dispensers shall be provided at all hand washing facilities.
(k) The walls in patient treatment areas and sleeping areas shall be washable; and in the immediate area of plumbing fixtures, the finish shall be moisture resistant.
(l) Toilet compartment partitions and urinal screens in the men's toilet rooms shall not be constructed of enameled steel.
(m) Wall bases in operating rooms and Cesarean section/delivery rooms shall be integral with the floor surface material and shall be without voids that can harbor harmful bacteria.
(n) All smoke partitions, horizontal exits and exit passageway partitions shall be constructed prior to the construction of intervening walls.
1. Smoke partitions shall be constructed so as to provide a continuous smoke-tight membrane from exterior wall to exterior wall and from the floor to the underside of the deck above. This includes interstitial space and the area above solid fire tested membranes.
2. Where it is not possible to inspect smoke partitions because of the fire tested membrane, fire-rated access panels shall be installed adjacent to each side of the smoke partitions at intervals not exceeding 30 feet and in such locations as necessary to view all surfaces of the partition.
3. No items shall be recessed in smoke partitions, horizontal exits and exit passageway walls which will compromise the fire integrity.
4. Where plaster or gypsum wallboard are used to construct such partitions, each side of the partition shall be continuous from outside wall to outside wall and from the floor to the underside of the deck above, interrupted only by doors and ventilation duct work which has been dampered properly to prevent the passage of smoke.
5. Where electrical conduits, cable trays, ducts and utility pipes pass through the smoke partitions, the utilities shall be located so that access is maintained to adjacent wall surfaces and to all damper access panels. The details shall show the studs and reinforcing half studs so that proper support is provided for the wall surfacing material. There shall be a minimum clearance of 6 inches between all conduits, piping and duct work at corridor walls to facilitate the inspection of these walls.
(o) The design and construction of linen and refuse chutes shall be in accordance with NFPA-82, Standard on Incinerators, Waste and Linen Handling Systems and Equipment as prescribed by Rule Chapter 4A-3, F.A.C.
1. Dumbwaiters, conveyors and other material handling systems shall not open directly into a corridor or exit way but shall open into a room enclosed by construction having a minimum fire resistance of 1 hour and provided with Class B-labeled, 1-hour fire-rated doors.
2. Service entry doors to vertical shafts containing dumbwaiters, conveyors and material handling systems shall be not less than Class B-labeled, 11/2-hour fire-rated doors. Material handling systems designed to open directly to the service area without the use of doors shall be fitted with tight closing smoke dampers. The doors of smoke dampers used in these systems shall close upon activation of a local smoke detector.
(p) In general hospitals and rehabilitation hospitals, and in those areas designed for handicapped people, grab bars shall be provided at patient use toilets, showers and tubs. The bars shall be 1 1/2 inches in diameter, shall have 1 1/2 inch clearance to walls and shall be of sufficient strength and anchorage to sustain a concentrated load of 250 pounds for 5 minutes. Fully recessed soap dishes shall be provided for all tubs and showers.
(q) Mirrors shall not be installed at hand washing facilities in food preparation areas and in clean utility rooms.
(32) Recreation rooms, exercise rooms and similar spaces where impact noises may be generated shall not be located directly over patient bed areas unless special provisions are made to minimize noise.
(33) Floor materials shall be easily cleanable and shall have wear resistance appropriate for the location involved. Floors in areas used for food preparation and food assembly shall be water resistant and grease proof. Joints in ceramic tile, quarry tile and similar materials in food preparation, food assembly, ware washing and other areas subject to harsh chemicals shall be of a material not affected by such chemicals. In all areas frequently subject to wet cleaning methods, floor materials shall not be physically affected by germicides and cleaning solutions. Floors that are subject to traffic while wet, such as assisted and non-assisted shower and bath areas, kitchens and similar work areas, shall have a nonslip surface.
(34) Wall bases in kitchens, toilets and other areas which are frequently subject to wet cleaning methods shall be made integral and cove with the floor, tightly sealed within the wall and constructed without voids that can harbor insects.
(35) The finished ceiling in the dietary and food preparation areas shall enclose all overhead duct work and piping.
(36) Finished ceilings may be omitted in mechanical and equipment spaces, repair workshops, general storage areas and similar spaces unless the ceiling is required for structural fire protection purposes.
(37) Elevators Where Required. All hospitals where either patient beds or a critical service facility such as operating, delivery, diagnostic, recreation, patient dining or therapy rooms are located on more than one floor shall have electric or electrohydraulic elevators and shall be in compliance with the requirements of Rule Chapter 4A-47, F.A.C., (Florida Elevator Safety Code) as follows:
(a) At least one hospital type elevator shall be installed where 1 to 59 patient beds are located on any floor other than the first floor. For purposes of these requirements, the first floor is that floor first reached from the main front entrance.
(b) At least two hospital type elevators shall be installed:
1. Where 60 to 200 patient beds are located on floors other than the first; or
2. Where service facilities are located on a floor other than that containing the patient beds.
(c) A minimum of three hospital type elevators shall be installed:
1. Where 201 to 350 patient beds are located on a floor other than the first floor;
2. Where service facilities are located on a floor other than the first; or
3. Where service facilities are located on a floor other than that containing the patient beds.
(d) For hospitals with more than 350 beds, the number of elevators shall be determined by an independent study of the hospital plan and the estimated vertical transportation requirements. In no case shall there be fewer than three elevators.
(e) Hospital type elevator cars shall have inside dimensions that will accommodate a standard patient bed and attendants. The car door shall have a minimum clear opening of 4 feet wide by 7 feet high. The minimum capacity of the elevator shall be 4,000 pounds. Additional elevators installed for visitors and material handling may be of a size less than noted above, but they shall be subject to the standards for access by the handicapped.
1. Leveling. Elevators shall be equipped with a 1-way automatic level maintaining device with an accuracy of + or - 1/4 inch.
2. Operation. Except those dedicated for material handling, each elevator shall be equipped with a two-way special service switch for staff use to permit cars to bypass all landing button calls and be dispatched directly to any floor. The fireman's service function may be used.
3. Elevator controls, landing calls, alarm buttons and telephones shall be accessible to wheelchair occupants.
4. Elevator call buttons and controls shall be of the type that will not be activated by heat or smoke. If used for operation of door reopening devices without physical contact, light beams shall be provided in addition to door edge safety devices. The light beams shall be interconnected with a system of smoke detectors so that in case of smoke at any landing, the light control feature will be overridden or disengaged.
(38) Water Supply and Sewage Disposal.
(a) Water Supply. An approved, accessible, adequate, safe and potable supply of water shall be available at all times for drinking, culinary, bathing, cleaning and laundry purposes. Hot water shall be supplied to all lavatory and sink plumbing fixtures available for use by patients and staff.
(b) Sewage Disposal. An approved, adequate and safe method of sewage collection, treatment and disposal shall be provided for each hospital.
(39) Heating, Ventilating and Air Conditioning Systems. Air handling equipment shall be located in mechanical equipment rooms unless it serves only one room and is located in that room.
(a) Ventilation. Ventilation shall be provided by mechanical means in all rooms in new facilities and in all remodeled rooms. The minimum quantities and filtrations shall be met as set forth in the Minimum Hospital Ventilation Rate Tables for those spaces that are listed. These requirements apply to inpatient areas and outpatient areas within the hospital. Detached outpatient facilities shall comply with subsection (3) below except that outpatient surgery, outpatient cardiac catheterization and any other treatment or diagnostic procedure involving invasive procedures shall comply with the requirements for patient areas within the hospital.
MINIMUM HOSPITAL VENTILATION RATE TABLE (See Note 2)
GENERAL ACUTE CARE HOSPITALS
Outdoor 100% System*
Room or Relative Total Air Exhaust &
Function Pressure Air Quant- Quant- Filtra
ities ities tion**
Operating,
Emergency
Operating Rooms,
Cystology + 20 5 NO 1A, 2A
Delivery + 12 5 NO 1A, 2A
Recovery 0 6 2 NO 1A, 2A
Nursery + 12 2.8 NO 1A, 2A
Intensive Care + 6 2 NO 1A, 2A
Patient 0 4 1.5 NO 1A, 2B, 3D
Labor, LDR and 0 4 1.5 NO 1A, 2B
LDRP Room
Magnetic Resonance + 6 2 NO 1A, 2B
Imaging, Lithotripter
Patient Area Corridor 0 2 1.5 NO 1A, 2B
Immunosuppressant + 2 1 NO 1E
Patient Room
Patient Isolation - 6 2 YES 1A, 2B
Room Without
Anteroom
Patient Isolation 0 6 2 YES 1A, 2B
Room With
Walk-Through
Anteroom as the
Only Entrance
Anteroom - 6 2 YES 1A, 2B
Endoscopy 0 6 2 NO 1A, 2B
*
Exam and Treatment 0 6 2 NO 1A, 2B
Nourishment Pantry 0 6 1 NO 1A, 2B
Medicine Preparation 0 6 1 NO 1A, 2B
Clean Workroom + 4 2 NO 1A, 2B
Soiled Workroom - 10 2 YES 1A, 2B
Therapy (Physical - 4 2.25 NO 1A, 2B
and Hydro)
Respiratory Therapy + 6 2.25 NO 1A, 2B
Radiology 0 6 2 NO 1A, 2B
Fluoroscopic - 6 2 YES 1A, 2B
Toilets, Janitor - 10 - YES -
Closets, Baths, Showers and
Bedpan Rooms
Autopsy and - 15 - YES -
Darkroom
Sterilizer Equipment - 10 - YES -
Room
Laboratory (see Note 4) - 6 2 YES 1A, 2B
Sterile Packaging + 4 2 NO 1A, 2B
Clean Storage + 2 1.1 NO 1A, 2B
Anesthesia Storage 0 8 0 YES 1C
Decontamination or - 6 - YES -
Soiled Workroom
Storage, Medical 0 2 - NO 1C
Kitchen 0 20 7 NO 1C
Dish Storage + 2 1 NO 1C
Dish Washing - 10 - YES -
Food Service Center 0 6 1.3 NO 1C
and Dining
Dietary Storage 0 2 1 NO 1C
Laundry 0 10 3.3 YES 1C
Clean Linen Storage 0 6 2 NO 1C
and Handling
Soiled Linen Storage - 10 - YES -
and Handling
Storage, General 0 2 - NO 1C
Corridors 0 2 1 NO 1C
(Non-patient)
Body Handling (see Note 2) - 10 - YES -
* AIR HANDLING SYSTEM TYPES
1. Central system recirculating and redistributing air to other rooms or spaces.
2. Central system distributing 100 percent outside air.
3. Individual units with no recirculation to other rooms or spaces.
** AIR HANDLING FILTRATION LEVELS
A. 90 percent by the ASHRAE atmospheric dust spot test method.
B. 80 percent by the ASHRAE atmospheric dust spot test method.
C. 25 percent by the ASHRAE atmospheric dust spot test method.
D. Low efficiency, throw away.
E. 99.97 percent DOP
Note 1: Administrative and other staff-only areas shall be provided with outside air at the minimum rate of 20 cubic feet per minute per person, and the central system shall have a minimum of 25 percent ASHRAE dust spot efficiency filter.
Note 2: Holding rooms without body boxes must meet these requirements and be designed for a room temperature not to exceed 70 degrees Fahrenheit.
Note 3: Certain functional areas may require special ventilation consideration.
Note 4: May be recirculated to the lab but not to other parts of the hospital except for Bacteriology and Histology which must be 100 percent exhausted.
(b) Variable volume systems are permitted in all hospitals except in sensitive areas which are defined as surgical departments, obstetrical departments, laboratories, isolation rooms and critical care units and rooms.
(c) Where variable volume systems are utilized, space relative pressure requirements shall be maintained throughout the entire system control range.
(d) All air supplied to sensitive areas shall be delivered at or near the ceiling of the area served. All air removed from operating rooms, delivery rooms and nurseries shall be removed laterally near the floor level. Laminar flow systems are not to be prohibited by this requirement. At least two return or exhaust outlets shall be used in all operating rooms and delivery rooms. The bottom of the exhaust or return outlet shall be located not less than 3 inches nor more than 12 inches above the finished floor.
(e) All space having large volume exhaust hoods shall have sufficient make-up supply such that the required pressure relationship will not be adversely affected by the operation of the hood.
(f) Outdoor air intakes shall be located a minimum of 36 inches above surrounding surfaces and a minimum of 10 feet horizontally from any exhaust air and plumbing vent. Air intakes for through-the-wall air conditioners serving no more than one room are an exception to the 36-inch requirement.
(g) Unless protected by an impervious surface, acoustical and thermal internal linings composed of fibrous materials with spray-on, foil, mylar or other such surface coating materials shall not be used in ducts, air terminal devices, air handling units or other equipment serving operating rooms, delivery rooms, birthing rooms, recovery rooms, nurseries, isolation rooms and intensive care units.
(h) Smoke dampers shall be capable of being reset automatically.
(i) Condensate shall be piped to a roof drain or floor drain or shall spill onto the ground. Filters containing multimedia components shall be provided with a differential pressure gauge for each media.
(j) All filters in systems in excess of 1000 cubic feet per minute capacity shall be installed with differential pressure gauges. Multi-bank filters shall have the capability to measure differential pressure for each filter bank. Each filter gauge shall have the range of acceptable operation clearly indicated.
(k) Filters of 90 and 80 percent efficiency ratings shall be located on the discharge side of fan systems.
(l) Filter housings for 90 and 80 percent efficiency filters shall be fully gasketed and sealed with mechanical latching devices capable of exerting and maintaining a continuous, uniform sealing pressure on the filter media when in the latched, closed position.
(m) For spaces requiring positive or negative relative pressures, there shall be a minimum of 75 cubic feet per minute between the supply, return or exhaust air quantities.
(40) Psychiatric and rehabilitation hospitals shall comply with the requirements for general hospitals except as follows:
(a) Total air quantities shall be a minimum of 75 cubic feet per minute for each room.
(b) Outdoor air shall be supplied in sufficient quantities to balance air exhausted but not less than 25 cubic feet per minute per occupant.
(c) Air handler system types and filtration levels may be 1C, 2C or 3C as noted in paragraph 59A-3.081(39)(a), F.A.C.
(41) Exhaust. All fans serving exhaust systems shall be located at the discharge end of the system in all new and remodeled facilities. Fans located immediately within the building at the end of exhaust ducts shall be permitted. Existing, nonconforming systems need not be brought into compliance except in remodeling but should strive for compliance when equipment is replaced.
(a) All halon extinguishing systems shall be provided with a manually operated purge system. The purge system shall exhaust where there is no possible re-entry into the building.
(b) Each space used for administering inhalation anesthesia shall be provided with a scavenging system to vent waste gases. The system may be connected to the room exhaust system but must be exhausted to the outside.
(c) Exhaust for autopsy tables and rooms and body boxes shall be on a dedicated duct system(s) and shall discharge where re-entry into the building will be prevented.
(42) Hoods. Laboratory and Nuclear Medicine Hoods. Exhaust ducts shall be installed without fire or smoke dampers. All exhaust air ducts shall be terminated above the roof with the fan mounted on the roof. Exhaust hoods in central food preparation centers shall be listed or certified by a nationally recognized independent testing laboratory.
(43) Ducts. Except as noted in subparagraph (a) below, all new hospital outpatient surgery and cardiac catheterization facility construction shall have completely ducted air supply, return, outside air and exhaust systems including areas of other occupancies.
(a) Outpatient diagnostic and treatment facilities in buildings detached from the hospital may have plenum returns. The use of plenums does not relax the requirement of space relative pressure maintenance or smoke/fire compartment/zone neutrality.
(b) In new construction, duct system risers penetrating more than one floor shall be installed in vertical fire-rated shafts. Horizontal offsets of the risers shall not be allowed. Fire/smoke dampers shall be installed at duct penetrations of the chase.
(c) Fan and Damper Control During Fire Alarm.
1. During a fire alarm, fan systems and fan equipment shall be stopped or controlled to prevent the movement of smoke by mechanical means from the zone in alarm.
2. Fan control shall be designed so as to minimize the interruption of heating, ventilating and air conditioning in compartments remote from the compartment in alarm.
3. Fan control shall not interfere with the continuous operation of exhaust systems conveying ethylene oxide or other hazardous chemicals and fumes or systems required to operate continuously for the health and safety of occupants. Such systems shall include fume hood exhaust deemed by the governing body of the hospital to present a hazard to occupants if exhaust airflow is stopped. Air handling systems shall be designed to allow for continuous operation of all such systems and to minimize movement of smoke by mechanical means from the zone in alarm.
(44) Plumbing. All fixtures used by medical and nursing staff and all lavatories for use by patients and food handlers shall be trimmed with valves which can be operated without the use of hands and shall have a water supply spout mounted so that its discharge point is a minimum of 5 inches above the rim of the fixture. Where blade handles are used, they shall not be less than 31/2 inches or more than 4 1/2 inches in length, except that handles on clinical sinks shall not be less than 6 inches long. Scrub sinks shall have foot, knee or timer operated control valves.
(a) Clinical sinks shall be installed in all soiled utility rooms and shall have an integral trap in which the upper portion of a visible trap seal provides a water surface. Each clinical sink shall be equipped with a flush valve, a water faucet with both hot and cold water, and a bedpan rinsing device.
(b) Bedpan rinsing devices shall be provided in each patient toilet room.
(c) The above valves, spouts and bedpan rinsing devices are not required in psychiatric patient rooms except for geriatric or medical patient sleeping and treatment areas.
(d) Floor drains shall not be permitted in operating, cystoscopy and delivery rooms. Enamel finish flushing rim floor sinks may be installed in rooms used for cystoscopy procedures only.
(e) Hot water for patient use shall be maintained at a maximum temperature of 120 degrees Fahrenheit at the storage points.
(f) The location and arrangement of hand washing facilities shall permit their proper use and operation and shall not interfere with movement of the bed. Proper care should be given to the clearances required for blade type operating handles when and if they are used.
(g) Wall-mounted lavatories and hand washing facilities shall be attached to floor-mounted carriers and shall withstand an applied vertical load of a minimum of 250 pounds on the front of the fixture.
(h) There shall be a lavatory in each exam treatment room.
(i) Grease interceptors shall be located outside of the building.
(j) In nurseries where the admission/observation function is performed in the Level I nursery, there must be a medical gas alarm panel as required for critical care areas.
(k) A minimum of 4 inches of space shall be provided between the sides of wall-mounted fixtures and surfaces to either side of the fixture.
(45) Fire Pump. Where required in new construction, fire pumps and ancillary equipment shall be separated from other functions by construction having a 2-hour fire resistance rating.
(a) The fire pump normal service disconnect shall be rated to hold locked rotor current indefinitely and shall be located in compliance with National Electric Code 230-70(a) and NFPA-20, Centrifugal Fire Pumps as prescribed by Rule Chapter 4A-3, F.A.C. If the approved normal service disconnect is located on the exterior, the disconnect shall be padlocked in the "on" position. The position of the disconnect shall be supervised by connection to the fire pump remote annunciator and shall provide a separate fire alarm system trouble indication.
(b) When the fire pump is placed on the emergency system in addition to the normal supply, the emergency feeder protective device shall be sized in accordance with maximum rating or settings of NFPA-70 as prescribed by Rule Chapter 4A-3, F.A.C.
(c) The fire pump transfer switch may be either manual or automatic. If located on the line side of the controller as a separate unit, the switch must be rated for the pump motor locked rotor current indefinitely and must be located in the pump room.
(d) Combination fire pump controller and transfer switch units listed by the Underwriter's Laboratories, Inc., as prescribed by Rule Chapter 4A-3, F.A.C., are acceptable when the transfer switch has exposable and replaceable contacts, not circuit breaker types, rated for the available short-circuit current.
(e) The fire pump shall be installed in a readily accessible location with direct access from the exterior.
(46) Electrical Requirements. General. All material, including equipment, conductors, controls, and signaling devices, shall be installed to provide a complete electrical system with the necessary characteristics and capacity to supply the electrical facility requirements as shown in the specifications and as indicated on the plans. All materials and equipment shall be listed as complying with applicable standards of Underwriter's Laboratories, Inc., or other established standards.
(a) Nonmetallic sheathed cable or similar systems are not permitted for power and lighting wiring in any facility.
(b) Panel boards located in spaces subject to storage shall have the clear working space per NFPA-70, National Electric Code. "Electrical Access--Not For Storage" shall be permanently marked on the floor and wall about the panel. Panel boards shall not be located in egress corridors.
1. Nonmetallic raceways shall not be used or reused to serve patient care areas. Renovated patient care area branch circuitry shall be provided with an equipment ground conductor in compliance with the National Electric Code.
2. Critical care area wet locations, including cystology rooms, shall be powered through approved isolated power systems. Wet locations are defined as a patient care area that is normally subject to wet conditions while patients are present. This includes standing fluids on the floor or drenching of the work area, either of which condition is intimate to the patient or staff. Routine housekeeping procedures and incidental spillage of liquids do not define a wet location.
(c) There shall be documentation for equipotential grounding in all patient care areas, building service ground electrode systems, lightning protection ground terminals and special systems such as fire alarm, nurse call, paging, generator, emergency power and breaker coordination.
(47) Lighting. All spaces occupied by people, machinery and equipment within buildings, approaches to buildings and parking lots shall have electric lighting. Emergency lighting shall be supplied as described in NFPA-99 pursuant to Rule Chapter 4A-4, F.A.C. Selected egress emergency lighting shall be provided for the parking area and approaches to the parking area to allow safe exiting from the building area.
(a) Patient bedrooms shall have general lighting and night lighting. A reading light shall be provided for each patient. At least one luminaire for night lighting shall have a switch at the entrance to each patient room. Patient reading lights and other fixed lights not switched at the door shall have switch controls convenient for use at the luminaire. All switches for control of lighting in patient areas shall be of the quiet operating type.
(b) Operating rooms and delivery rooms shall have general lighting for the room in addition to local high intensity, specialized lighting provided by special fixtures at the surgical and obstetrical tables. Each special lighting unit for local lighting at the tables shall be connected to an independent circuit and shall be powered from the critical branch. A minimum of one general purpose lighting fixture shall be powered from a normal circuit in an operating room, delivery or similar room. A minimum of one general purpose lighting fixture in an operating room, delivery room or similar room shall be powered from the critical branch circuit.
(48) Receptacles. Every operating room and delivery room shall have a minimum of six duplex receptacles connected to the critical branch. All emergency operating rooms and outpatient operating rooms shall have a minimum of four duplex receptacles connected to the critical branch. Where mobile equipment is used which requires special electrical considerations, additional receptacles distinctively marked for specific equipment use shall be provided and connected to the critical power.
(a) Each general care patient bedroom shall have two duplex receptacles, one on each side of the head of each bed. Each receptacle shall be on a different circuit, at least one of which shall originate in a normal system panel board. There shall be one additional receptacle for motorized beds, if used, and one general purpose receptacle on another wall. There shall be a receptacle high on the footboard wall for entertainment television power. This receptacle is optional in psychiatric facilities.
(b) A maximum of six duplex receptacles shall be connected to a branch circuit over-current device.
(c) Mount general purpose receptacles at 18 inches and mount switches 48 inches above the finished floor. All dimensions are to the center line of boxes.
(d) Duplex receptacles in critical care areas, in all emergency treatment rooms and other areas - acute care beds, angiographic laboratories, cardiac catheterization laboratories, coronary care units, hemodialysis rooms or areas, emergency room treatment areas, human physiology laboratories, intensive care units and postoperative recovery rooms - shall be provided as follows:
1. There shall be a minimum of six duplex electrical receptacles for each patient station.
a. Four shall be connected to the critical branch of the essential electrical system and two of the required number shall be connected to dedicated circuits.
b. Two shall be connected to a normal power circuit except in anesthetizing locations where two shall be connected to critical power circuits.
c. There shall be no more than two receptacles per circuit.
2. All branch circuits from the emergency system shall be from the same panel board.
3. All branch circuits from the normal system shall be from the same panel board.
4. All receptacles shall have engraved cover plates to indicate the panel board and circuit numbers powering the device.
5. Branch circuit over-current devices shall be readily accessible to nursing staff and other authorized personnel.
6. Receptacles and cover plates shall be identified by a distinctive color. The color selected shall be maintained throughout the facility.
(e) Equipment in critical care areas - acute care beds, angiographic laboratories, cardiac catheterization laboratories, coronary care units, hemodialysis rooms or areas, emergency room treatment areas, human physiology laboratories, intensive care units and postoperative recovery rooms - shall be provided as follows.
1. All branch circuits powering equipment from the emergency system shall be from the same panel board.
2. All branch circuits powering equipment from the normal system shall be from the same panel board.
3. Fixed equipment shall have engraved nameplates to indicate the panel board and circuit numbers powering the equipment. Nameplates shall be permanently attached to such equipment and shall be located so as to be easily read.
4. There shall be critical power receptacles for blood bank refrigerators and a minimum of one receptacle for each pathology laboratory work counter.
(49) Fire Alarm Systems. A fire alarm annunciator panel shall be provided at a 24-hour monitored location. The panel shall indicate the zone of actuation of the alarm and there shall be a trouble signal indicator. Each smoke compartment shall be a separate fire alarm zone. A fire alarm system zone shall not include rooms or spaces in other smoke compartments and shall be limited to a maximum area of 22, 500 square feet.
(50) Nurse Call System. A nurse call system shall be provided that will register a call from each patient bed to the nurse station and activate a visual signal at the patient room door and activate a visual and audible signal in the clean workroom, the soiled workroom, the nourishment station and the master station of the nursing unit. In multi-corridor nursing units, additional visible signals shall be installed at corridor intersections in the vicinity of nurse stations. In rooms containing two or more calling stations, indicating lights shall be provided for each calling station.
(a) Master staff and duty stations may include volume controls provided the minimum setting provides audibility of 15 decibels above normal ambient noise levels where the station is located.
(b) An emergency calling station of the pull cord type shall be provided and shall be conveniently located for patient use at each patient toilet, bath or shower room, but not inside the shower. The call signal shall be canceled only at the emergency calling station. The emergency station shall activate audible and visual signals immediately.
(c) An emergency resuscitation alarm calling station shall be provided for staff use in each operating, delivery, recovery LDR, LDRP, emergency, cardiac and intensive nursing care rooms, nurseries and similar rooms. Supervised wards for mental patients and pediatric bedrooms require special emergency aid calling stations.
(d) Emergency resuscitative alarm panels (centralized Code Blue) shall be provided at the attending nurse station and at other locations which are staffed 24 hours per day. Audible signals may be silenced temporarily for a call provided subsequent calls automatically reactivate the audible signal immediately. The alarm panel at the 24-hour staffed station may indicate the nurse station/suite where the call originated in lieu of identifying the bed only when a 24-hour station is not one and the same as the attending nurse station.
(51) Emergency Electric Service. An essential electrical system shall be provided in accordance with NFPA-99 (1990), Standards for Health Care Facilities, as prescribed by Rule Chapter 4A-3, F.A.C.
(a) Separate the normal main service equipment from the emergency distribution equipment by a minimum distance of 6 feet, or locate in separate rooms. Transfer switches shall be considered emergency equipment.
(b) Switches for critical branch lighting shall be totally separate from normal switching. The devices or cover plates shall be of a distinctive color. Critical branch switches may be adjacent to normal switches. Switches for life safety lighting are not permitted except as required for dusk-to-dawn automatic control of exterior lighting fixtures.
(c) There shall be selected life safety lighting arranged for automatic dusk-to-dawn operation in the parking lots and along the travel paths from the exits to safe areas. A minimum of 5 footcandles is required.
(d) A minimum of one elevator per bank serving any patient use floor shall be connected to the equipment branch of the essential electric system and arranged for manual or automatic operation during loss of normal power.
(e) There shall be a dedicated low fuel alarm for the day tank supplying the emergency generator driver. A manual pump shall also be provided for the day tank. The alarm shall be located at the generator derangement panel.
(f) Transfer switch contacts shall be of the open type and shall be accessible for inspection and replacement.
(g) There shall be power connected to the equipment branch of the essential electrical system for kitchen refrigerators, freezers and range hood exhaust fans to facilitate emergency food preparation. Selected lighting within the kitchen and dry storage areas shall be connected to the critical branch of the essential electrical system.
(h) Outpatient surgery units which are located in a separate building or on another campus shall have a Type I essential electrical system in compliance with NFPA-99, Chapters 3 and 13, Ambulatory Surgical Centers.
(52) Lightning Protection. A lightning protection system shall be provided for all new buildings and additions in accordance with NFPA-78, Lightning Protection Code, as prescribed by Rule Chapter 4A-3, F.A.C.
(a) Where additions are constructed to existing buildings, the existing building lightning protection system, if any, shall be inspected and brought into compliance with current standards.
(b) When outpatient buildings, either on or off the campus, are constructed or purchased and ambulatory surgical procedures are contemplated, a lightning protection system shall be installed.
(c) There shall be surge protection for all electrical services.
1. Main Building Power.
a. Service entrance surge arresters shall comply with National Electric Code Article 280, as prescribed by Rule Chapter 4A-3, F.A.C., and shall have integral visual indication for surge suppression failure. Additional surge protection shall be provided for all low voltage and power connections to all electronic equipment in critical care areas and life safety systems and equipment such as fire alarm, nurse call and other critical systems as listed in paragraph 59A-3.081(48)(e), F.A.C. Protection shall be in accordance with appropriate IEEE Standards for the type of equipment protected.
b. All low voltage system main or branch circuits entering or exiting the structure shall have surge suppressors installed for each pair of conductors and shall have visual indication for protector failure to the maximum extent feasible.
2. Free-standing, one-story outpatient facilities deemed not to be extraordinarily subject to lightning strikes, as determined by surrounding terrain and structures, will not be required to be provided with a lightning protection system.
(53) Physical Plant Requirements for Inpatient Cardiac Catheterization Service. The following are additional requirements for Inpatient Cardiac Catheterization Service.
(a) The number of procedure rooms and the size of the preparation, holding areas shall be based on the anticipated utilization.
1. The procedure room shall be a minimum of 400 square feet (37.16 meters) exclusive of fixed and movable cabinetry.
2. A patient preparation, holding and recovery room shall be provided and arranged to provide visual observation before and after the procedure.
3. There shall be a control room or an area shall be provided and shall be large enough to contain and provide for the efficient functioning of the X-ray and image recording equipment.
4. There shall be a view window permitting full view of the patient from the control console.
5. There shall be an equipment room or enclosure large enough to contain X-ray transformers, power modules, and associated electronics and electrical gear.
6. There shall be scrub facilities with hands-free operable controls adjacent to the entrance of procedure rooms, and shall be arranged to minimize incidental splatter on nearby personnel, medical equipment, or supplies.
7. There shall be a staff change area(s) arranged to ensure a traffic pattern so that personnel entering from outside the service area can enter, change their clothing and move directly into the cardiac catheterization suite.
8. There shall be a clean workroom or clean supply room. If the room is used for preparing patient care items, it shall contain a work counter and handwashing sink. If the room is used only for storage and holding of clean and sterile supply materials, the work counter and hand washing facilities may be omitted.
9. There shall be a soiled workroom containing a handwashing and clinical sink or equivalent flushing rim fixtures. When the room is used for temporary holding or soiled materials, the clinical sink may be omitted.
10. There shall be a housekeeping closet containing a floor receptor or service sink with provisions for storage of supplies and housekeeping equipment.
(b) The following spaces shall be available for use by the Inpatient Cardiac Catheterization Service:
1. An X-ray viewing room and;
2. An X-ray film file room.
(c) The minimum quantities and filtrations shall be met as set forth in the following table:
INPATIENT CARDIAC CATHETERIZATION SERVICE
MINIMUM VENTILATION RATE TABLE
Outdoor 100% System*
Room or Relative Total Air Exhaust &
Function Pressure Air Quant- Quant- Filtra
ities ities tion**
Preparation Room 0 6 2 NO 1A, 2B
Recovery Room
Holding Room
Cardiac + 15 3 NO 1A, 2B
Catheterization
Procedure Room
Control Room 0 4 2 NO 1A, 2B
Equipment Room 0 4 0 NO 1A, 2B
Staff Changing - 4 2 YES 1A, 1B
Room
Clean Work Room + 4 2 NO 1A, 2B
Clean Supply Room + 4 2 NO 1A, 2B
Soiled Work Room - 10 2 YES 1A, 2B
Soiled Holding Room - 10 2 YES 1A, 2B
* AIR HANDLING SYSTEM TYPES
1. Central system recirculating and redistributing air to other rooms or spaces.
2. Central system distributing 100 percent outside air.
3. Individual units with no recirculation to other rooms or spaces.
** AIR HANDLING FILTRATION LEVELS
A. 90 percent by the ASHRAE atmospheric dust spot test method.
B. 80 percent by the ASHRAE atmospheric dust spot test method.
C. 25 percent by the ASHRAE atmospheric dust spot test method.
D. Low efficiency, throw away.
E. 99.97 percent DOP.
(d) The minimum medical gas station outlets shall be as follows:
INPATIENT CARDIAC CATHETERIZATION SERVICE
MEDICAL GAS STATION OUTLETS
Function Oxygen Vacuum Medical Air
Cardiac Catheterization 1 2 2
Procedure Room
Holding Room*** 1 2 2
Preparation Room*** 1 2 2
Recovery Room*** 1 2 2
*** One (01) outlet per bed
or station
(54) Physical Plant Requirements for Mobile Surgical Facility. The following are additional special requirements for Mobile Surgical Facilities established after July 1, 1998.
(a) Mobile Surgical Facility. A mobile surgical facility is a mobile facility as defined in Chapter 395.003, F.S., and which provides elective surgical care under contract with the Department of Corrections or a private correctional facility operating pursuant to Chapter 957, F.S.
(b) General Requirements: In addition to the codes and standards referenced in this rule, the mobile surgical facility shall comply with the requirements of Ambulatory Health Care Centers, Chapter 12-6, F.A.C., of the National Fire Protection Association (NFPA), 101 Life Safety Code, incorporated by reference and available from NFPA, 1 Batterymarch Park, P. O. Box 9101, Quincy, MA 02269-9904.
1. Site Requirements:
a. There shall be a level concrete pad designed for the structural loads of the facility in accordance with the Standard Building Code Chapter 18 & 19, incorporated by reference and available from Southern Building Code Congress International, 910 Montclair Road, Birmingham, Alabama 35213-1206.
b. There shall be walls, fences or concrete-filled steel bollards around the immediate site to prevent collisions with the unit by other vehicles.
c. The facility shall have a tie-down anchoring system designed by a Florida registered professional engineer or architect in accordance with Section H105.3, Tiedowns, Appendix H, Manufactured Home Tiedown Standards, Southern Building Code Congress International incorporated by reference and available from Southern Building Code Congress International, 910 Montclair Road, Birmingham, Alabama 35213-1206.
d. The facility shall be sited so that it does not diminish egress from the hospital and so that the exhaust from the tractor and/or generator is kept away from all fresh air intakes of the hospital.
e. There shall be a rain-free covered passage from the hospital to the entrance of the mobile facility.
2. Architectural Design Requirements:
a. There shall be an operating room with a minimum area of 170 square feet. The minimum room dimension shall be 12 feet.
b. There shall be an operating room service area containing sterilizing facilities, medication preparation and storage areas, scrub facilities, soiled work room with work counter, clean work room with storage for clean and sterile supplies, and janitor's closet with floor receptor or service sink.
c. There shall be a recovery room/Post-Anesthetic Care Unit (PACU) adjacent to the operating room, which shall accommodate a minimum of two recovery beds. The size of this room shall be based on 80 square feet per recovery bed.
d. There shall be a nurse station for charting, communications, and storage.
e. There shall be a recovery service area containing a nourishment station, a hand washing facility, medication preparation area with refrigerator and double locked storage, clean linen storage, soiled linen area with soiled linen receptacles, and clean work area with work counter and sink.
f. There shall be an accessible patient/staff toilet room and hand wash facility adjacent to the recovery room.
g. There shall be a clothing change area for doctors, nurses and other personnel with secured storage and access to toilet room.
3. Mechanical System Requirements:
a. The Heating, Ventilating and Air Conditioning systems shall comply with NFPA 90A, incorporated by reference and available from NFPA, 1 Batterymarch Park, P. O. Box 9101, Quincy, MA 02269-9904
b. The patient gas medical systems shall be Type I as defined by NFPA 99, incorporated by reference and available from NFPA, 1 Batterymarch Park, P. O. Box 9101, Quincy, MA 02269-9904. Medical gas, vacuum, and oxygen supply systems shall comply with Chapter 13, Ambulatory Health Care Center Requirements of NFPA 99, incorporated by reference and available from NFPA, 1 Batterymarch Park, P. O. Box 9101, Quincy, MA 02269-9904.
c. The facility shall provide, as a minimum, the quantity of station outlets per bed position indicated in the following table:
Area Oxygen Vacuum
Recovery room/(PACU) 1 3
Operating Room 2 3
An additional vacuum station outlet shall be provided in the operating room dedicated for connection of an anesthesia machine.
d. The plumbing systems shall comply with the Standard Plumbing Code incorporated by reference and available from Southern Building Code Congress International, 910 Montclair Road Birmingham, Alabama 35213-1206.
e. The facility shall be equipped with fire extinguishers.
4. Electrical System Requirements:
a. The essential electrical system shall comply with a Type I system as defined in Chapter 3 of NFPA 99, incorporated by reference and available from NFPA, 1 Batterymarch Park, P. O. Box 9101, Quincy, MA 02269-9904.
b. The electrical system shall comply with Article 517 of the National Electric Code, NPFA 70, incorporated by reference and available from NFPA, 1 Batterymarch Park, P. O. Box 9101, Quincy, MA 02269-9904 and with subsections 59A-3.081(46), (47), (48), (50), (51), Florid Administrative Code.
c. There shall be an automatic fire alarm system in the facility. An alarm initiated in the mobile facility shall activate the hospital fire alarm system and an alarm in the hospital shall initiate an alarm in the mobile facility.
d. There shall be a telephone connected to the hospital communication system.
e. Electrical connections to the hospital shall not interrupt, diminish or otherwise affect adversely in any way the electrical system of the hospital.
f. There shall be a lightning protection system as defined in NFPA 780, incorporated by reference and available from NFPA, 1 Batterymarch Park, P. O. Box 9101, Quincy, MA 02269-9904, for the rain-free covered connection and the mobile facility, unless the mobile facility is shown to be within the cone of protection of the hospital and bonded to the lightning protection systems of the hospital.
5. Details and Finishes: The mobile facility shall comply with subsection 59A-3.081(31), F.A.C., Sections (i)(j)(k)(l)(m) and (p).
(55) Physical Plant Requirements for Disaster Preparedness of New Hospital Construction.
(a) Definitions. The following definitions shall apply specifically to all new facilities as used in subsection 59A-3.081(55), F.A.C.:
1. "New facility" means a hospital, or an addition of a wing or floor to an existing hospital, which has not received a Stage II Preliminary Plan approval pursuant to Chapter 59A-3, F.A.C., prior to the effective date of this rule. Interior renovation, refurbishing, modifications or conversions inside of an existing structure licensed as a hospital, shall not have to meet the standards contained in this paragraph;
2. "Net square footage" means the clear floor space of an area excluding cabinetry and other fixed furniture or equipment;
3. "During and immediately following" means a period of 72 hours following the loss of normal support utilities to the facility;
4. "Occupied patient area(s)" means the location of patients inside of the new facility or in the addition of a wing or floor to an existing facility during and immediately following a disaster;
5. "Building code" means the building codes as described in Section 553.73, F.S.
6. "Patient support area(s)" means the area(s) required to ensure the health, safety and well-being of patients during and immediately following a disaster, such as a nursing station, clean and soiled utility areas, food preparation area, and other areas as determined by the facility.
7. "On-site" means either in, immediately adjacent to, or on the campus of the facility, or addition of a wing or floor to an existing facility.
(b) New Facility Construction Standards. The following construction standards are in addition to the physical plant requirements described in subsections 079 through 081 of Chapter 59A-3, F.A.C. These minimum standards are intended to increase the ability of the new facility, or new floor or new wing added to an existing facility to be structurally capable of serving as a shelter for patients, staff and the family of patients and staff (as determined by the facility) and equipped to be self-supporting during and immediately following a disaster:
1. Space Standards.
a. For planning purposes, as estimated by the facility, each new facility shall provide a minimum of 30 net square feet per in-patient served in the occupied patient area(s).
b. As determined by the facility, space for administrative and support activities shall be provided for use by facility staff to allow for care of patients in the occupied patient area(s).
c. As determined by the facility, space shall be provided for staff and family members of patients and staff.
2. Site standards.
a. All new facilities and additions to existing facilities shall be located above the 100-year flood plain or hurricane Category 3 (Saffir-Simpson scale) hurricane surge inundation elevation, whichever requires the highest elevation, or;
b. The floor elevation of all new occupied patient area(s) and all patient support area(s) and patient support utilities, including mechanical, electrical except as noted in (55)9.b.(I), and food services shall be located above the 100-year flood plain or hurricane Category 3 (Saffir-Simpson scale) hurricane surge inundation elevations, whichever requires the highest elevation, or
c. New additions or floors added to existing facilities, as determined by their site locations, shall be so designed and constructed as to be in compliance with the current standards of the National Flood Insurance Program (NFIP) of the Federal Emergency Management Agency (FEMA), Technical Bulletins 1-5, 1993; FEMA 213/May 1991; 44 CFR Parts 59-78, October 1, 1997; NFIP Rules and Regulations, October and December, 1997, incorporated by reference and available from Federal Emergency Management Agency, Federal Insurance Administration, Attn. Publications, P. O. Box 70274, Washington, D.C. 20024.
d. Where an off-site public access route is available to the new facility at or above the 100-year flood plain, a minimum of one on-site emergency access route shall be provided that is located at the same elevation as the public access route;
e. New landscaping elements shall be located so if damaged they will not block the on-site emergency access route to the facility. Outdoor signs and their foundations shall be designed to meet the wind load criteria of the applicable building code;
f. New light standards and their foundations used for lighting the on-site emergency access route shall be designed to meet the wind load criteria of the American Society of Civil Engineers (ASCE 7-95), fifty-year recurrence interval of wind velocity with appropriate exposure category dependent on site location, incorporated by reference and available from the American Society of Civil Engineers, United Engineering Center, 345 East 47th Street, New York, NY 10017-2398.
3. Structural Standards. Wind load design of the building structure and exterior envelope including exterior wall systems shall be designed in accordance with the building code.
4. Roofing Standards.
a. Roofing membrane material shall resist the uplift forces specified in the building code. Roof coverings shall be installed according to the specifications provided by the manufacturer.
b. Loose-laid ballasted roofs shall not be permitted;
c. All new roof appendages such as ducts, tanks, ventilators, receivers, dx condensing units and decorative mansard roofs and their attachment systems shall be structurally engineered to meet the wind load requirements of the applicable building code. All of these attachment systems shall be connected directly to the underlying roof structure or roof support structure.
5. Exterior Unit Standards.
a. All exterior window units, skylights, exterior louvers and exterior door units including vision panels and their anchoring systems shall be designed to resist the wind load requirements of the building code and the debris impact requirements as specified by Section 2315 of the South Florida Building Code, Dade edition 1994, incorporated by reference and available from the Metropolitan Dade County Building Code Compliance Department, 140 West Flagler Street, Suite 1603, Miami, FL 33130.
b. Permanently attached protective systems such as shutters and baffling shall be designed to meet the wind load requirements and the debris impact requirements as specified by Section 2315 of the South Florida Building Code, Dade edition 1994, incorporated by reference and available from the Metropolitan Dade County Building Code Compliance Department, 140 West Flagler Street, Suite 1603, Miami, FL 33130;
c. Removable protective systems designed to intricately fit with the wall/window system of the facility and stored on-site at the facility and that meet the wind load requirements of the building code, and the debris impact requirements specified by Section 2315 of the South Florida Building Code, Dade edition 1994, incorporated by reference and available from the Metropolitan Dade County Building Code Compliance Department, 140 West Flagler Street, Suite 1603, Miami, FL 33130 may be utilized to protect the exterior units;
d. All anchoring and attachment to the building of both the permanently attached and removable protective systems shall be designed to meet wind load requirements of the building code, and the impact requirements specified by Section 2315 of the South Florida Building Code, Dade edition 1994, incorporated by reference and available from the Metropolitan Dade County Building Code Compliance Department, 140 West Flagler Street, Suite 1603, Miami, FL 33130. These designs shall be signed, sealed and dated by a registered structural engineer;
e. The glazed openings inside or outside of the protective systems shall meet the cyclical loading requirements specified by Section 2315 of the South Florida Building Code, Dade edition 1994, incorporated by reference and available from the Metropolitan Dade County Building Code Compliance Department, 140 West Flagler Street, Suite 1603, Miami, FL 33130;
f. All of the exterior impact protective systems shall be designed and installed so that they do not come in contact with the glazing under uniform, impact or cyclic pressure loading;
g. When not being utilized to protect the windows, the protective system shall not restrict the operability of the windows in the occupied patient bedrooms.
h. When not being utilized to protect the windows, the protective systems shall not reduce the clear window opening below 8% of the gross square footage of the patient room.
6. Heating, Ventilation and Air Conditioning (HVAC) Standards.
a. Air moving equipment, dx condensing units, through-wall units and other HVAC equipment located outside of or on the roof of the new facility or wing or floor addition to an existing facility and providing service to the new facility or wing or floor addition to an existing facility shall be permitted only when either of the following are met:
(I) They are located inside a penthouse designed to meet the wind load requirements of the building code, or;
(II) Their fastening systems are designed to meet the wind load requirements of the building code and they are protected from impact as specified by Section 2315 of the South Florida Building Code, Dade edition 1994, incorporated by reference and available from the Metropolitan Dade County Building Code Compliance Department, 140 West Flagler Street, Suite 1603, Miami, FL 33130.
b. All occupied patient areas and patient support areas shall be supplied with sufficient HVAC as determined by the facility to ensure the health, safety and well being of all patients and staff during and immediately following a disaster.
c. As determined by the facility these selected HVAC systems and their associated support equipment such as a control air compressor essential to the maintenance of the occupied patient and patient support area(s) shall receive their power from the emergency power supply system(s).
d. Ventilation air change rates in occupied patient areas shall be maintained as specified in Chapter 59A-3, F.A.C., during and immediately following a disaster.
e. Auxiliary equipment and specialties such as hydronic supply piping and pneumatic control piping shall be located, routed and protected in such a manner as determined by the facility to ensure the equipment receiving the services will not be interrupted.
7. Plumbing Standards.
a. There shall be an independent on-site supply (i.e., water well) or on-site storage capability of potable water at a minimum quantity of 3 gallons per in-patient served in the new facility or wing or floor addition to an existing facility per day during and immediately following a disaster. For planning purposes the number of patients shall be estimated by the facility.
b. There shall be an independent on-site supply or storage capability of potable water at a minimum quantity of 1 gallon per facility staff, and other personnel in the new facility or wing or floor addition to an existing facility per day during and immediately following a disaster. For planning purposes, the number of these personnel shall be estimated by the facility.
c. The facility shall determine what amount of water will be sufficient to provide for patient services, and shall maintain an on-site supply or on-site storage of the determined amount.
d. When utilized to meet the minimum requirements of this rule, selected system appurtenances such as water pressure maintenance house pumps, and emergency water supply well pumps shall take power from the emergency power supply system(s).
8. Medical Gas Systems Standards. The storage, distribution piping system and appurtenances serving the occupied patient area(s) shall be contained within a protected area(s) designed and constructed to meet the structural and debris impact requirements as specified by Section 2315 of the South Florida Building Code, Dade edition 1994, incorporated by reference and available from the Metropolitan Dade County Building Code Compliance Department, 140 West Flagler Street, Suite 1603, Miami, FL 33130.
9. Emergency Electrical Generator and Essential Electrical System Standards.
a. There shall be an on-site Level I emergency electrical generator system designed to support the occupied patient area(s) and patient support area(s) with at least the following support services:
(I) Ice making equipment to produce ice for the patients served, or freezer storage equipment for the storage of ice for the patients served;
(II) Refrigerator unit(s) and food service equipment if required by the emergency food plan;
(II) Life safety and critical branch lighting and systems as required by Chapter 59A-3.081, F.A.C.;
(IV) Selected HVAC systems as determined by the facility and other systems required by this rule;
b. The emergency generator system shall be fueled by a fuel supply stored on-site sized to fuel the generator for 100 percent load for 64 hours or 72 hours for actual demand load of the occupied patient area(s) and patient support area(s) and patient support utilities during and immediately following a disaster, whichever is greater.
(I) The fuel supply shall either be located below ground or contained within a protected area that is designed and constructed to meet the structural and debris impact requirements as specified by Section 2315 of the South Florida Building Code, Dade edition 1994, incorporated by reference and available from the Metropolitan Dade County Building Code Compliance Department, 140 West Flagler Street, Suite 1603, Miami, FL 33130. If an underground system is utilized, it shall be designed so as to exclude the entrance of any foreign solids or liquids;
(II) All fuel lines supporting the generator system(s) for the occupied patient area(s) and patient support area(s) shall be protected also with a method designed and constructed to meet the structural and debris impact requirements as specified by Section 2315 of the South Florida Building Code, Dade edition 1994, incorporated by reference and available from the Metropolitan Dade County Building Code Compliance Department, 140 West Flagler Street, Suite 1603, Miami, FL 33130.
(III) All panel boards, transfer switches, disconnect switches, enclosed circuit breakers or emergency system raceway systems required to support the occupied patient area(s), patient support area(s) or support utilities shall be contained within a protected area(s) designed and constructed to meet the structural and debris impact requirements as specified by Section 2315 of the South Florida Building Code, Dade edition 1994, incorporated by reference and available from the Metropolitan Dade County Building Code Compliance Department, 140 West Flagler Street, Suite 1603, Miami, FL 33130, and shall not rely on systems or devices outside of this protected area(s) for their reliability or continuation of service.
(IV) The emergency generator(s) shall be air or self-contained liquid cooled and it and other essential electrical equipment shall be installed in a protected area(s) designed and constructed to meet the structural and debris impact requirements as specified by Section 2315 of the South Florida Building Code, Dade edition 1994, incorporated by reference and available from the Metropolitan Dade County Building Code Compliance Department, 140 West Flagler Street, Suite 1603, Miami, FL 33130.
10. Fire Protection Standards.
a. If the facility requires fire sprinklers as part of its fire protection, either of the following shall be met:
(I) On-site water storage capacity to continue sprinkler coverage, in accordance with the requirements of NFPA 13, 1996 edition, incorporated by reference and available from NFPA, 1 Batterymarch Park, P. O. Box 9101, Quincy, MA 02269-9101 or,
(II) If the facility plans to provide a fire watch, it shall use the following procedure as approved by the Office of Plans and Construction for all areas of the facility that are without sprinkler coverage due to interrupted water flow.
(A) Notify the local fire department and document instructions.
(B) Notify the Agency through the Area Office.
(C) Assess the extent of the condition and effect corrective action, with a documented time frame. If the corrective action will take more than four (4) hours, do the following items:
I. Implement a contingency plan to the facility fire plan containing: a description of the problem, specifically what the system is not doing that it normally does, and the projected correction time frame. All staff on shifts involved shall have documented in-servicing and drilling for the contingency.
II. Begin a documented fire watch, until the system is restored. Persons used for fire watch must be trained in what to look for, what to do, and be able to expeditiously contact the fire department. For a fire watch, a facility can use only: public safety persons (i.e., fire service), a guard service, or staff (e.g., a nurse, maintenance, drill or safety coordinator); if the persons are:
A. Off duty from their regular position; in compliance with current state staffing ratios and personnel policies (i.e., not in a condition that would impair performance);
B. Trained and competent in what to look for and what to do;
C. Have a provision for priority communication (i.e., a radio or special telephone).
D. Notify Agency and local authorities, if the time-frame changes or system is restored.
b. If the facility provides a fire watch in lieu of sprinkler on-site water or water storage, then one 4-A type fire extinguisher or equivalent shall be provided for every 3 or less 2-A fire extinguishers required by NFPA 10, 1998 edition, incorporated by reference and available from NFPA, 1 Batterymarch Park, P. O. Box 9101, Quincy, MA 02269-9101, for the area served. These additional extinguishers shall be equally distributed throughout the area they are protecting.
11. External Emergency Communications Standards. Each new facility shall provide for external electronic communication not dependent on terrestrial telephone lines, cellular, radio or microwave towers, such as on-site radio transmitter, satellite communication systems or a written agreement with an amateur radio operator volunteer group(s). This agreement shall provide for a volunteer operator and communication equipment to be re-located into the facility in the event of a disaster until communications are restored. Other methods which can be shown to maintain uninterrupted electronic communications not dependent on land-based transmission shall be pre-approved by the Office of Plans and Construction.
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