Header:
TEXAS ADMINISTRATIVE CODE
TITLE 25. HEALTH SERVICES
PART 1. DEPARTMENT OF STATE HEALTH SERVICES
CHAPTER 117. END STAGE RENAL DISEASE FACILITIES
SUBCHAPTER H. PHYSICAL PLANT AND CONSTRUCTION REQUIREMENTS
Date:
08/31/2009
Document:
§ 117.102. Construction Requirements for a New End Stage Renal Disease Facility
(a) Any proposed new ESRD facility shall be easily accessible to the community and to service vehicles such as delivery trucks, ambulances, and fire protection apparatus. No building may be converted for use as an ESRD facility which, because of its location, physical condition, state of repair, or arrangement of facilities, would be hazardous to the health and safety of the patients.
(1) An ESRD facility shall have at least two exits remotely located in accordance with National Fire Protection Association (NFPA) 101, Life Safety Code, 2003 Edition (NFPA 101), § 20.2.4.1. When a required means of egress from the ESRD facility is through another portion of the building, that means of egress shall comply with the requirements of NFPA 101 which are applicable to the occupancy of that other building. Such means of egress shall be open, available, unlocked, unrestricted, and lighted at all times during the ESRD facility hours of operation. All documents published by National Fire Protection Association (NFPA) as referenced in this section may be obtained by writing or calling the NFPA at the following address or telephone number: National Fire Protection Association, 1 Batterymarch Park, Quincy, Massachusetts 02269-9101 or (800) 344-3555.
(2) Hazardous locations.
(A) A new ESRD facility or an addition to an existing ESRD facility shall not be constructed within 150 feet of easement boundaries or setbacks of hazardous underground locations including but not limited to liquid butane or propane, liquid petroleum or natural gas transmission lines, high pressure lines, and not within the easement of high voltage electrical lines. Municipality's main natural gas lines in right-of-ways serving dwellings and gas lines on property servicing gas meter(s) under this provision are not consider natural high pressure lines.
(B) A new ESRD facility and an addition to an existing ESRD facility shall not be built within 300 feet of above ground or underground storage tanks containing liquid petroleum or other flammable liquids used in connection with a bulk plant, marine terminal, aircraft refueling, bottling plant of a liquefied petroleum gas installation, or near other hazardous or hazard producing plants.
(3) Undesirable locations.
(A) In lieu of local codes, a new ESRD facility shall not be located closer than 1500 feet to nuisance producing industrial sites, feed lots, sanitary landfills, or manufacturing plants producing excessive noise or air pollution.
(B) Flood plains. (i) When a new ESRD facility is constructed in a designated 100-year flood plain, the building finished floor elevation shall be one foot above the set base flood plain elevation. The building shall meet all local flood code ordinances and local flood control requirements. (ii) To obtain a license as an ESRD facility, a previously licensed ESRD facility and an existing building or a portion of an existing building located in a designated 100-year flood plain shall meet the requirement of clause (i) of this subparagraph. (iii) ESRD facility required functional components shall be constructed above the designated flood plain in a new addition to an existing ESRD facility located in a designated 100-year flood plain. The new addition shall meet the requirement of clause (i) of this subparagraph. (iv) Currently licensed ESRD facilities located within a designated 100-year flood plain are exempt from these requirements for renovations and repairs.
(b) The ESRD facility site shall include paved roads, walkways, and parking in accordance with the requirements set out in this subsection.
(1) Paved roads and walkways.
(A) Paved roads shall be provided within lot lines for access from public roads to the main entrance and to service entrances.
(B) Finished surface walkways shall be provided for pedestrians. When public transportation or walkways serve the site, finished surface walkways or paved roads shall extend from the public conveyance to the building entrance.
(2) Parking and disability requirements.
(A) Off-street parking shall be available for visitors, employees, and staff. Parking structures directly accessible from an ESRD facility shall be separated with two-hour fire rated noncombustible construction. When used as required means of egress for ESRD facility occupants, parking structures shall comply with National Fire Protection Association 88A, Standard for Parking Structures, 2002 edition. This requirement does not apply to freestanding parking structures. All documents published by National Fire Protection Association (NFPA) as referenced in this section may be obtained by writing or calling the NFPA at the following address or telephone number: National Fire Protection Association, 1 Batterymarch Park, P.O. Box 9101, Quincy, MA 02269-9101 or (800) 344-3555.
(B) In the absence of local code, one parking space shall be provided for each staff member on duty, plus one space for each four treatment stations, and one visitor's space for every five treatment stations. This ratio may be reduced in an area convenient to a public transportation system or to public parking facilities. Parking facilities shall be increased accordingly when the size of existing facilities is increased.
(C) When on-street parking is available and acceptable to the local authorities having jurisdiction, the numbers of parking spaces may be reduced accordingly and shall meet the requirement of subparagraph (B) of this paragraph.
(D) Special considerations benefiting disabled staff, visitors, and patients shall be provided. Each ESRD facility shall comply with the Americans with Disabilities Act (ADA) of 1990, Public Law 101 - 336, 42 United States Code, Chapter 126, and Title 36 Code of Federal Regulations, Part 1191, Appendix A, Accessibility Guidelines for Buildings and Facilities or 16 Texas Administrative Code, Part 4, Chapter 68, § 68.20 (relating to Buildings and Facilities Subject to Compliance with the Texas Accessibility Standards), Texas Accessibility Standards (TAS), April 1, 1994 edition, issued by the Texas Department of Licensing and Regulation, under the Texas Architectural Barriers Act, Texas Government Code, Chapter 469.
(c) Every building and every portion thereof shall be designed and constructed to sustain all dead and live loads in accordance with accepted engineering practices and standards and the local governing building codes. Where there is no local governing building code, the ESRD facility shall be constructed in accordance with the International Building Code, 2003 edition, published by the International Code Council, 500 New Jersey Avenue, Northwest, 6th Floor, Washington, District of Columbia 20001-2070, (800) 344-3555.
(1) All new construction, including conversion of an existing building to an ESRD facility or establishing a separately licensed ESRD facility within another existing building, shall comply with NFPA 101, Chapter 20, New Ambulatory Health Care Occupancies, of the National Fire Protection Association 101, Life Safety Code, 2003 edition (NFPA 101), and subchapters G and H of this chapter (relating to Fire Prevention and Safety Requirements, and Physical Plant and Construction Requirements, respectively). Construction documents shall be submitted to the department in accordance with § 117.104 of this title (relating to Preparation, Submittal, Review and Approval of Plans, and Retention of Records).
(A) Construction types for multiple building occupancy. (i) When an ESRD facility is part of a larger building which complies with NFPA 101, § 20.1.6, Minimum Construction Requirements for (fire resistance) construction type, the designated ESRD facility shall be separated from the remainder of the building with a minimum of one-hour fire rated construction. (ii) When an ESRD facility is located in a multistory building of two or more stories, the entire building shall meet the construction requirements of NFPA 101, § 20.1.6.3. An ESRD facility shall not be located in a multistory building which does not comply with the minimum construction requirements of NFPA 101, § 20.1.6.3. (iii) When an ESRD facility is part of a one-story building that does not comply with the construction requirements of NFPA 101, § 20.1.6.2, the ESRD facility shall be separated from the remainder of the building with a 2-hour fire rated construction. The designated ESRD facility portion shall have the construction type upgraded to comply with NFPA 101, § 20.1.6.2.
(B) Special provisions shall be made in the design of a facility if located in a region where local experience shows loss of life or extensive damage to buildings resulting from hurricanes, tornadoes, or floods.
(2) A physical environment that protects the health and safety of patients, personnel, and the public shall be provided in each facility. The physical premises of the facility and those areas of the facility's physical structure that are used by the patients (including all stairwells, corridors, and passageways) shall meet the local building and fire safety codes and the requirements of this chapter.
(3) The more stringent standard, code or requirement shall apply when a difference in requirements for construction exists.
(4) Nothing in this subchapter shall be construed to prohibit a better type of building construction, more exits, or otherwise safer conditions than the minimum requirements specified in this subchapter.
(5) Nothing in this subchapter is intended to prevent the use of systems, methods, or devices of equivalent or superior quality, strength, fire resistance, effectiveness, durability, safety to health and welfare of individuals, and safety to those prescribed by this subchapter, provided technical documentation which demonstrates equivalency is submitted to the department for approval.
(6) Separate freestanding buildings for nonpatient use such as the heating plant, boiler plant, laundry, repair workshops, or general storage may be of unprotected noncombustible construction, protected noncombustible construction, or fire-resistive construction and be designed and constructed in accordance with other occupancy classifications requirements listed in NFPA 101.
(d) Spatial requirements.
(1) Administration and public areas.
(A) Patient entrances shall be located at grade level, be accessible to individuals with disabilities, and provide exterior covered protection against inclement weather. The minimum exterior protection covering shall be no smaller than 4 feet by 6 feet wide. A covered area for patients in wheelchairs shall be provided next to the opening area of the door swing and door swing shall not interfere within this area. When an ESRD is located on a floor above grade level, elevators shall be accessible and shall meet the requirements of § 117.103 of this title (relating to Elevators, Escalators, and Conveyors).
(B) A waiting area or lobby shall be provided within the ESRD facility and include having the following rooms and items: (i) public toilet facilities; and (ii) telephone(s) for public use.
(C) A designated reception area with desk or counter shall be provided.
(D) Space shall be provided for private interviews for family members relating to social services, credit, or admission.
(E) An office(s) shall be provided for business transactions, records, and administrative and professional staff.
(F) The facility shall provide an area for storage of clinical records which is separate from all patient treatment areas, and shall be secured from unauthorized access. The facility shall store the active clinical record of each patient currently treated by the facility on site.
(G) A general storage room with a minimum of 2 square feet per treatment station shall be provided. General storage may be located in one or more rooms or closets, and shall be located outside of the patient treatment areas.
(H) Storage space for wheelchairs shall be provided, and shall be out of the direct line of traffic.
(2) Equipment rooms with adequate space shall be provided for mechanical and electrical equipment. These areas shall be separate from public, patient, and staff areas.
(3) An exam room shall be provided for medical examinations. The room shall have a minimum clear floor space of 80 square feet area exclusive of fixed cabinets and shelves and contain a counter for writing and a hand washing sink with hands-free operable controls.
(4) When a patient is hepatitis B positive, the treatment shall be in a separated dedicated isolation room. All treatment in the isolation room shall be for hepatitis B patients only.
(A) A single hepatitis B patient isolation room shall be a minimum of 120 square feet clear area exclusive of fixed and movable cabinets and shelves.
(B) When multiple-treatment stations for hepatitis B patients are treated in a single isolation room, each individual patient treatment area shall be 80 square feet with a minimum of 8 feet clear dimension exclusive of fixed or wall mounted cabinets and built-in shelves. The clearance between the side of a station/chair and a wall/partition shall be a minimum of 3 feet. The clearance between sides of stations/chairs shall be a minimum of 4 feet.
(C) The isolation treatment room shall include a work counter and a hand washing sink with hands-free operable controls, and space for patient care supplies and equipment. The fixed and moveable cabinets and shelves shall not encroach upon the patient treatment station/chair clear floor space/area.
(D) The isolation treatment room shall have viewing panels in doors and/or walls for continuous direct visual monitoring of the patient in the room.
(E) The dialysis equipment shall be designated, reserved, and used for hepatitis B positive patients only.
(F) Disinfection of dialysis equipment shall occur in the hepatitis B treatment isolation room and shall meet the requirements of § 117.33(d)(2)(C) of this title (relating to Sanitary Conditions and Hygienic Practices).
(G) As of February 9, 2009, all new facilities or increasing the number of in-center dialysis treatment stations in existing facilities shall have an isolation room or be granted a waiver by Centers for Medicare and Medicaid Services. The waiver shall demonstrate that there is sufficient capacity in the geographic area for isolation rooms for hepatitis B positive patients. A written request for waiver shall be made through the Texas Department of State Health Services, Health Facility Compliance Group, Mail Code 1979, P.O. Box 149347, Austin, Texas, 78714-9347 for transmission to CMS.
(5) When home training is provided in the facility, a private treatment area of at least 120 square feet exclusive of fixed and movable cabinets and shelves shall be provided. This room shall contain a work counter, a hand washing sink with hands-free operable controls, and a separate drain for fluid disposal.
(6) A sufficient number of janitor's closets shall be provided throughout the facility to maintain a clean and sanitary environment. The closet shall contain a floor receptor or service sink and storage space for housekeeping supplies and equipment.
(7) When laboratory services are provided on site the following shall be provided and meet the requirements of § 117.45(l) of this title (relating to Provision and Coordination of Treatment and Services).
(A) The laboratory workroom/area shall include a counter and a sink with hands-free operable controls. Laboratory services and medication preparation and dispensing shall not be done within the same designated space.
(B) Cabinets or closets shall be provided for supplies and equipment used in obtaining samples for testing.
(C) Refrigerated specimen storage shall be provided for specimens waiting for transfer to off-site testing. The refrigerators shall be maintained with documentation of the appropriate temperature for such storage.
(8) When laundry and linen is provided, processing may be done within the center or off site at a commercial laundry.
(A) When on-site linen processing is provided, soiled and clean processing operations shall be separated and arranged to provide a one-way traffic pattern from soiled to clean areas. The following rooms and items shall be provided: (i) a soiled linen processing room which includes areas for receiving, holding, sorting, and washing; (ii) a clean linen processing room which includes areas for drying, sorting, folding, and holding prior to distribution; (iii) supply storage cabinets in the soiled and clean linen processing rooms; (iv) hand washing sink within the soiled linen processing room; and (v) a storage room for clean linen. Clean linen storage may be combined with the clean work room.
(B) When linen is processed off site, the following areas shall be provided: (i) clean linen shall be stored within the clean supply area; and (ii) soiled linen shall be stored in a designated space in the facility.
(9) Space shall be provided for the safe storage and disposal of waste as appropriate for the material being handled and in compliance with all applicable rules and regulations.
(10) At a minimum, the medication area shall include a counter, a refrigerator, and a hand washing sink with hands-free operable controls. Storage and preparation of medication shall be done from a medication area and shall be under visual control of nursing staff. Medication preparation, dispensing and laboratory services shall not be done within the same designated areas. The refrigerators used for storage of medications shall be maintained with documentation of the appropriate temperatures for such storage.
(11) When peritoneal dialysis (PD) training is provided within the ESRD facility, a patient treatment training room shall have a minimum of 120 square feet of clear floor area exclusive of fixed and movable cabinets and shelves.
(A) The PD treatment room shall contain cabinets, a work counter, and a hand washing sink with hands-free operable controls.
(B) An additional clinical sink or equivalent flushing rim sink with hands-free operable controls shall be provided. The clinical sink or equivalent flushing rim sink and the hand washing sink shall have a minimum separation of 6 feet.
(C) A physical partition between the clinical sink or equivalent flushing rim sink and the hand washing sink may be constructed in-lieu-of the 6 foot separation. The partition shall be a minimum of 5 feet in height from the finished floor and 2 feet in width from the wall or from the wall to the front edge of the countertop whichever is greater.
(12) When a reuse room is provided, the room shall be sufficiently sized to house dialyzers reprocessing area, breakdown area, a storage area/room and work area. All fixed and moveable equipment shall require a minimum of three feet of clear and unobstructed working space on all sides of fixed or moveable equipment that require access for staff. The reuse room shall include a work counter, deep utility service sink and separate hand washing sink with hands-free operable controls, refrigerator and storage space and shall meet the requirements of § 117.32(d) of this title (relating to Water Treatment, Dialysate Concentrates, and Reuse).
(A) Dialyzers reprocessing area shall be arranged for the one-way movement from soiled dialyzers and materials to cleaning and storage.
(B) Breakdown of dialyzers shall be processed in the soiled processing area of the reprocessing area. The deep utility service sink with hands-free operable controls shall be located within the soiled processing area. There shall be adequate storage space to store the soiled/used dialyzers before processing occurs. The minimum depth of the utility sink shall not be less than 14 inches.
(C) The reuse room shall provide either a separate storage room or within the reuse room storage space to store all reprocessed cleaned dialyzers. There shall be a definitive separation between storing used and reprocessed dialyzers, and the temperature in the storage areas shall be maintained in accordance with the manufacturer's direction for use.
(13) The treatment area(s) or rooms shall be separate from the administrative area(s).
(A) When individual hemodialysis patient treatment room(s) is provided, the room shall have a minimum of 120 square feet of clear floor area exclusive of fixed and movable cabinets and shelves. The patient treatment room shall contain cabinets, work counter, and a hand washing sink with hands-free operable controls.
(B) In multiple-treatment stations, each individual patient treatment area shall be 80 square feet exclusive of fixed or wall mounted cabinets and built-in shelves. A minimum of 8 feet width shall be provided for the head wall for each station. The clearance between the side of a chair and a wall shall be a minimum of 3 feet, and the back of the extended chair and a wall shall be a minimum of 1 foot. A clear unobstructed width of 3 feet 8 inches shall be available at the foot of each treatment area(s) outside of the 80 square feet treatment area for passage of equipment, gurneys, and personnel.
(C) The multiple-treatment station area shall contain cabinets, work counters, and hand washing sinks with hands-free operable controls. The fixed and moveable cabinets and shelves shall not encroach upon the patient treatment station.
(D) A nurse station shall be located within the dialysis treatment area(s) and designed to provide visual observation of all patient stations. The nurse station shall have counters for storage and access to a hand washing sink(s) with hands-free operable controls.
(E) One hand washing sink with hands-free operable controls shall be provided for every six stations. Sinks shall be uniformly distributed.
(F) When required or requested, privacy shall be provided for each patient in the open treatment area with portable moveable screens.
(e) Service areas.
(1) A clean storage room or closet shall be provided for patient care items, clean and sterile supplies.
(2) Emergency eyewash shall be provided conveniently for staff use and comply with ANSI Z358.1.
(3) Dialysis solutions may be processed from a central batch delivery system or prepared in an on-site mixing room. When provided, a mixing room shall include a sink, storage space, and holding tanks.
(4) Patient toilet rooms shall be located within the treatment area(s) and include hand washing sink(s) with hands-free operable controls. Patient toilet room shall be at a ratio of 1 toilet room for every 40 treatment stations or fraction thereof.
(5) Staff toilet room(s) shall be provided and include hand washing sink(s) with hands-free operable controls. The toilet room shall be outside the treatment area but convenient for staff use only.
(6) The water treatment and equipment for the dialysis shall be located in a room not accessible to unauthorized persons. The water room shall be designed and house the water treatment system and meet the requirements of § 117.32(b) of this title.
(f) Details and finishes in new construction projects, including additions and alterations, shall be in compliance with this subsection, with NFPA 101, Chapter 20, and with local building codes.
(1) General detail requirements.
(A) Fire safety features, including compartmentation, means of egress, automatic extinguishing systems, inspections, smoking regulations, and other details relating to fire prevention and fire protection shall comply with § 117.101 of this title (relating to Construction Requirements for an Existing End Stage Renal Disease Facility), and NFPA 101, Chapter 20. The Fire Safety Evaluation System for Health Care Occupancies contained in the National Fire Protection Association 101A, Alternative Approaches to Life Safety, 2001 Edition, Chapter 4, shall not be used in new building construction, renovations or additions to existing ESRD facilities.
(B) Exits, corridors and doors. (i) A facility shall provide two exits remote from each other in accordance with NFPA 101, § 20.2.4.1. At least one exit door shall be accessible by an ambulance from the outside. This door may also serve as an entry for loading or receiving goods. (ii) Corridors providing access to all patient treatment area(s) and exits shall be at least three feet eight inches in clear and unobstructed width, not less than seven feet six inches in height, and constructed in accordance with requirements listed in NFPA 101, § 20.2.1. (iii) Items such as drinking fountains and vending machines shall be so located as to not project into and restrict exit corridor traffic or reduce the exit corridor width below the required minimum. Portable equipment shall not be stored so as to project into and restrict exit corridor traffic or reduce the exit corridor width below the required minimum. (iv) Doors at all openings between corridors and rooms or spaces subject to occupancy shall be swing type. Elevator doors are excluded from this requirement. (v) Doors, except doors to spaces such as small closets which are not subject to occupancy, shall not swing into corridors in a manner that might obstruct traffic flow or reduce the required corridor width. Large walk-in type closets are considered as occupiable spaces. (vi) All doors in the means of egress shall be not less than 36 inches in clear width. (vii) The minimum width of doors for patient access to treatment, examination, and consultation areas/rooms shall be 36 inches in clear width. (viii) Rooms containing a toilet, intended for patient use, shall be provided with at least one door having hardware which will permit access from the outside in any emergency. (ix) Horizontal sliding doors serving an occupant load of fewer than 10 shall be permitted. The area served by the door shall have no high hazard contents. The door shall be readily operable from either side without special knowledge or effort. The force required to operate the door in the direction of door travel shall be not more than 30 pounds per foot to set the door in motion, and shall be not more than 15 pounds per foot to close the door or open in the minimum required width. The door assembly shall comply with any required fire protection rating, and, where rated, shall be self-closing or automatic closing. The sliding doors opening to the egress corridor doors shall have a latch or other mechanism that ensures that the doors will not rebound into a partially open position if forcefully closed. The sliding doors may have breakaway provisions and shall be installed to resist passage of smoke. The latching sliding panel shall have a minimum clear opening of 36 inches in the fully open position. The fixed panels may have recessed tracks. (x) Doors shall not open immediately onto a stair without a landing. The landing shall be 44 inches deep or have a depth at least equal to the door width, whichever is greater. (xi) All fire doors shall be listed by an independent testing laboratory and shall meet the construction requirements for fire doors in National Fire Protection Association 80, Standard for Fire Doors and Fire Windows, 1999 Edition. Reference to a labeled door shall be construed to include labeled frame and hardware.
(C) Glass doors, lights, sidelights, borrowed lights, and windows located within 12 inches of a door jamb or with a bottom-frame height of less than 18 inches and a top-frame height of more than 36 inches above the finished floor which may be broken accidentally by pedestrian traffic shall be glazed with safety glass or plastic glazing material that will resist breaking and will not create dangerous cutting edges when broken. Similar materials shall be used for wall openings in activity areas such as recreation and exercise rooms, unless otherwise required for fire safety. Safety glass, tempered or plastic glazing materials shall be used for shower doors and bath enclosures, interior windows and doors. Plastic and similar materials used for glazing shall comply with the flame spread ratings of NFPA 101, § 18.3.3.
(D) Grab bars shall be provided at patient toilets and at the weight scales. The bars shall be one and one-half inches in diameter, shall have either one and one-fourth or one and one-half inches clearance to walls, and shall have sufficient strength and anchorage to sustain a concentrated vertical or horizontal load of 250 pounds. Grab bars intended for use by the disabled shall also comply with ADA requirements.
(E) Location and arrangement of fittings for hand washing sinks shall permit their proper use and operation. Hand washing sinks with hands-free operable controls shall be provided within each workroom, examination, treatment room, and toilet room. Hands-free includes blade-type handles, and foot, knee, or sensor operated controls. Particular care shall be given to the clearances required for blade-type operating handles. Lavatories and hand washing sinks shall be securely anchored to withstand an applied vertical load of not less than 250 pounds on the front of the sink. In addition to the specific areas noted, hand washing sinks shall be provided and conveniently located for staff use throughout the ESRD facility where patient care contact occurs and services are provided.
(F) A liquid or foam soap dispenser shall be located at each hand washing sink.
(G) Provisions for hand drying shall be included at all hand washing sinks. There shall be hot air dryers or individual paper towel dispensers enclosed in such a way as to provide protection against dust or soil and ensure single-unit dispensing.
(H) The minimum ceiling height shall be eight feet with the following exceptions. (i) Boiler rooms shall have ceiling clearances not less than two feet six inches above the main boiler header and connecting piping. (ii) Rooms containing ceiling-mounted equipment shall have the ceiling height clearance increased to accommodate the equipment or fixtures. (iii) Suspended tracks, rails, pipes, signs, lights, door closers, exit signs, and other fixtures that protrude into the path of normal traffic shall not be less than six feet eight inches above the finished floor.
(I) The dialysis facility shall not be located directly under recreation rooms, exercise rooms, and similar spaces where impact noises may be generated unless special provisions are made to minimize noise.
(J) Rooms containing heat-producing equipment such as heater rooms, laundries, etc. shall be insulated and ventilated to prevent any occupied floor surface above from exceeding a temperature differential of 10 degrees Fahrenheit above the ambient room temperature.
(K) Thresholds and expansion joint covers shall be flush or not more than one-half inch above the floor surface to facilitate the use of wheelchairs and carts. Expansion and seismic joints shall be constructed to restrict the passage of smoke and fire and shall be listed by a nationally recognized testing laboratory.
(2) General finish requirements.
(A) Portable privacy screens shall be provided to assure patient privacy when required or requested by a patient. When not in use the screens shall be stored conveniently within the treatment area for immediate use.
(B) Flame spread and smoke developed limitations of interior finishes shall comply with NFPA 101, § 10.2. The use of materials known to produce large or concentrated amounts of noxious or toxic gases shall not be used in exit accesses or in patient areas. Copies of laboratory test reports for installed materials tested in accordance with National Fire Protection Association 255, Standard Method of Test of Surface Burning Characteristics of Building Materials, 2000 Edition, and National Fire Protection Association 258, Standard Research Test Method for Determining Smoke Generation of Solid Materials, 2001 Edition, shall be provided.
(C) Flooring shall be easy to clean and have wear resistance appropriate for the location involved. Floors that are subject to traffic while wet shall have a nonslip surface. In all areas frequently subject to wet cleaning methods, floor materials shall not be physically affected by germicidal and cleaning solutions. The following are acceptable floor finishes: (i) painted concrete for water treatment areas, mechanical, electrical, janitor's closets and general storage; (ii) exposed concrete shall be sealed for water treatment areas, mechanical, electrical, janitor's closets and general storage; (iii) vinyl sheets and vinyl composition tiles for offices, lobbies, administrative areas, storage, toilet rooms, treatment areas/rooms, isolation treatment room, exam rooms, training room, reprocessing rooms, support spaces and nontreatment areas; (iv) when monolithic or seamless flooring is installed it shall be impervious to water, coved and installed integral with the base, tightly sealed to the wall, and without voids that can harbor insects or retain dirt particles. The base shall not be less than six inches in height. Welded joint flooring is acceptable; (v) marble, ceramic and quarry tile for offices, lobbies, waiting, toilet rooms, administrative areas, wet areas, and similar spaces; (vi) carpet flooring for offices, administrative areas, and similar spaces; and (vii) terrazzo for offices, lobbies, administrative areas, and similar spaces.
(D) Wall finishes shall be smooth, washable, moisture resistant, and cleanable. (i) Wall finishes shall be water-resistant in the immediate area of plumbing fixtures. (ii) Wall finishes subject to frequent wet cleaning methods shall be impervious to water, tightly sealed and without voids.
(E) Ceilings which are a part of a rated roof/ceiling assembly or a floor/ceiling assembly shall be constructed of listed components and installed in accordance with the listing. Three types of ceilings that are required in various areas of the ESRD facility are: (i) ordinary ceilings are required in all areas or rooms in the ESRD facility unless a requirement requires a specific type of ceiling for such space. This includes ceilings such as acoustical tiles installed in a metal grid which are dry cleanable with equipment used in daily housekeeping activities such as dusters and vacuum cleaners; (ii) washable ceilings are ceilings that are made of washable, smooth, moisture impervious materials such as painted lay-in gypsum wallboard or vinyl faced acoustic tile in a metal grid when installed in the water treatment room and reuse room; (iii) monolithic ceilings which are monolithic from wall to wall (painted solid gypsum wallboard), smooth and without fissures, open joints, or crevices and with a washable and moisture impervious finish shall be provided for the isolation room and reuse room; and (iv) no finished ceiling is required in mechanical, electrical, general storage, and water treatment rooms.
(F) Floor, wall and ceiling penetrations by pipes, ducts, and conduits, or any direct openings shall be tightly sealed to minimize entry of dirt particles, rodents and insects. Joints of structural elements shall be similarly sealed.
(G) Materials known to produce noxious gases when burned shall not be used for mattresses, upholstery, and wall finishes.
(H) A sign shall be posted at the entrance to each toilet/restroom to identify the facility for public, staff or patient use.
(I) When vinyl sheets and vinyl composition tiles are used for toilet rooms, treatment areas/rooms, isolation treatment rooms, exam rooms, training rooms, and reprocessing rooms the joints shall be sealed to prevent moisture and blood from seeping into the joints and under the tile.
(g) This subsection contains common requirements for mechanical systems; steam and hot and cold water systems; air conditioning, heating and ventilating systems; and thermal and acoustical insulation.
(1) When mechanical equipment is exposed to weather, it shall be protected by weatherproof construction or weather protected.
(2) Mechanical equipment shall be mounted on vibration isolators as required to prevent unacceptable structure-borne vibration. Ducts, pipes, etc. connected to mechanical equipment which is a source of vibration shall be isolated from the equipment with vibration isolators.
(3) Prior to completion and acceptance of the facility, all mechanical systems shall be tested, balanced, and operated to demonstrate to the design engineer or his representative that the installation and performance of these systems conform to the requirements of the plans and specifications.
(A) Upon acceptance of the mechanical system, the owner shall be provided with parts lists and procurement information with numbers and description for each piece of equipment.
(B) Upon acceptance of the mechanical system, the owner shall be provided with instructions in the operational use of systems and equipment as required.
(4) All heating, ventilating and air conditioning (HVAC) systems shall comply with and shall be installed in accordance with the requirements of National Fire Protection Association 90A, Standard for the Installation of Air Conditioning and Ventilating Systems, 2002 edition (NFPA 90A), NFPA 99, Chapter 6 and the requirements contained in this subsection.
(5) All rooms and areas in the ESRD facility shall have provision for positive ventilation. Fans serving exhaust systems shall be located at the discharge end and shall be conveniently accessible for service. Exhaust systems may be combined, unless otherwise noted, for efficient use of recovery devices required for energy conservation. Supply air to the building and exhaust air from the building shall be regulated to provide a positive pressure within the building with respect to the exterior.
(A) The systems serving all treatment areas/rooms, exam rooms, and isolation rooms, shall be capable of maintaining a temperature range between 68 and 78 degrees Fahrenheit and a relative humidity range between 45% and 60%.
(B) The indoor design temperature in all other areas shall be between 68 and 75 degrees Fahrenheit with relative humidity of not less than 30%.
(6) Ventilation systems for the reuse room and airborne isolation room shall be connected to an air exhaust system to the outdoors which is separate from the building exhaust system, have an exhaust fan located at the discharge end of the system, and have an exhaust duct system of noncombustible corrosion-resistant material as needed to meet the planned usage of the system.
(A) The bottoms of wall-mounted return and exhaust air openings shall be at least six inches above the floor. All exhaust air openings and return air openings located higher than six inches but less than seven feet above the floor shall be protected with grilles or screens having openings through which a one-half inch sphere will not pass.
(B) Exhaust outlets shall be above the roof level and arranged to minimize recirculation of exhaust air into the building. Exhaust outlets shall be located at least 25 feet from any fresh air intake of ventilating systems. (Prevailing winds and proximity to other structures may require more stringent requirements.) Plumbing and vacuum vents that terminate five feet above the level of the top of the air intake may be located as close as 10 feet.
(C) If applicable, the reuse room and the airborne isolation room exhaust systems shall be connected to the emergency electrical system and shall meet the requirements of paragraph (10) of this subsection.
(7) All toilet exhaust ventilation shall be exhausted to the outdoors. Exhaust systems may be combined, unless otherwise noted, for efficient use of recovery devices required for energy conservation.
(8) To reduce utility costs, facility design may utilize energy conserving procedures including recovery devices, variable air volume, load shedding, systems shutdown, or reduction of ventilation rates (when specifically permitted) in certain areas when unoccupied. In no case shall patient care be jeopardized.
(9) Mechanical systems shall be arranged to take advantage of outside air conditions by using an economizer cycle when appropriate to reduce heating and cooling systems loads. Innovative design that provides for additional energy conservation while meeting the intent of this subsection for acceptable patient care may be presented to the department for consideration.
(10) Outside air intakes shall be located at least 25 feet from exhaust outlets of ventilating systems, combustion equipment stacks, plumbing vents, or areas which may collect vehicular exhaust or other noxious fumes. (Prevailing winds and proximity to other structures may require more stringent requirements). Plumbing vents that terminate five feet above the level of the top of the air intake may be located as close as 10 feet.
(11) Fully ducted supply, return and exhaust air for HVAC systems shall be provided for all patient treatment care areas, storage rooms, and where required for fire safety purposes. Combination systems, utilizing both ducts and plenums for movement of air in these areas, shall not be permitted.
(12) Air handling systems shall not be started or operated without 30% or equal minimum efficient rating value (merv) of 8 and the filters installed in place. Ducts shall be cleaned thoroughly and throughout by a certified air duct cleaning contractor when the air handling systems have been operating without the required filters in place. When ducts are determined to be dirty or dusty, the department shall require a written report assuring cleanliness of duct and clean air quality.
(13) Ductwork with duct-mounted humidifiers shall be provided with a means of removing water accumulation. An adjustable high-limit humidistat shall be located downstream of the humidifier to reduce the potential of condensation inside the duct. All duct take-offs shall be sufficiently downstream of the humidifier to ensure complete moisture absorption. Reservoir-type water spray or evaporative pan humidifiers shall not be used.
(14) All central air handling systems shall be equipped with filters having efficiencies 30% or equal to 8 merv. Filter efficiencies shall be average efficiencies tested in accordance with American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE), Inc., Standard 52.2, 1999 edition, Method of Testing General Ventilation Air-Cleaning Devices for Removal Efficiency by Particle Size. All joints between filter segments, and between filter segments and the enclosing ductwork, shall have gaskets and seals to provide a positive seal against air leakage. Air handlers serving more than one room shall be considered as central air handlers. All documents published by ASHRAE as referenced in this section may be obtained by writing or calling the ASHRAE, Inc. at the following address or telephone number: ASHRAE, Inc., 1791 Tullie Circle, Northeast, Atlanta, Georgia 30329; telephone (404) 636-8400.
(A) Filtration requirements for air handling units serving single rooms. Dedicated air handlers serving single rooms shall be equipped with nominal filters installed at the return air system.
(B) A filter bed shall be located upstream of the supply fan. Filter frames shall be durable and constructed to provide an airtight fit with the enclosing ductwork.
(15) Thermal and acoustical insulation for air handling systems. Asbestos insulation shall not be used.
(A) Air ducts and casings with outside surface temperature below ambient dew point or temperature above 80 degrees Fahrenheit shall be provided with thermal insulation.
(B) Linings in air ducts and equipment shall meet the Erosion Test Method described in Underwriters Laboratories (UL), Inc., Standard Number 181 (relating to Factory-Made Duct Materials and Air Duct Connectors), April 4, 1996 edition. This document may be obtained from the Underwriters Laboratories, Inc., 333 Pfingsten Road, Northbrook, Illinois 60062-2096.
(C) Interior and exterior insulation, including finishes and adhesives on the exterior surfaces of ducts and equipment, shall have a flame spread rating of 25 or less and a smoke developed rating of 50 or less as required by NFPA 90A, Chapters 4 and 5.
(D) Insulation of soft and spray-on types shall not be used where it is subject to air currents or mechanical erosion or where loose particles may create a maintenance problem.
(16) Fire dampers shall be located and installed in all ducts at the point of penetration of a required two-hour or higher fire rated wall or floor in accordance with the requirements of NFPA 101, § 20.1.
(17) Smoke dampers shall be located and installed in accordance with the requirements of NFPA 101, and NFPA 90A, Chapter 5.
(A) Smoke dampers shall close on activation of the fire alarm system by smoke detectors installed and located as required by National Fire Protection Association 72, National Fire Alarm Code, 2002 Edition (NFPA 72), Chapter 8; NFPA 90A, Chapter 6; and NFPA 101, § 18.3.7; the fire sprinkler system; and upon loss of power. Smoke dampers shall not close by fan shutdown alone unless it is a part of an engineered smoke removal system.
(B) Air handling fans and smoke damper controls may be interconnected so that closing of smoke dampers will not damage the ducts.
(C) Use of frangible devices for shutting smoke dampers is not permitted.
(18) Only fire damper and smoke damper assemblies integral with sleeves and listed for the intended purpose shall be acceptable.
(19) Unobstructed access to duct openings in accordance with NFPA 90A, § 4.3.4, shall be provided in ducts within reach and sight of every fire damper, smoke damper and smoke detector. Each opening shall be protected by an internally insulated door which shall be labeled externally to indicate the fire protection device located within.
(20) Controls for restarting fans may be installed for convenient fire department use to assist in evacuation of smoke after a fire is controlled, provided that provisions are made to avoid possible damage to the system because of closed dampers. To accomplish this, smoke dampers shall be equipped with remote control devices.
(h) All piping systems and plumbing fixtures shall be designed and installed in accordance with the requirements of the National Standard Plumbing Code Illustrated published by the National Association of Plumbing-Heating-Cooling Contractors (PHCC), 2003 edition, and this paragraph. The National Standard Plumbing Code may be obtained by writing or calling the PHCC at the following address or telephone number: Plumbing-Heating-Cooling Contractors, Post Office Box 6808, Falls Church, Virginia 22046; telephone (800) 533-7694.
(1) Piping systems.
(A) Water service pipe to point of entrance to the building shall be brass pipe, copper tube (not less than type M when buried directly), copper pipe, cast iron water pipe, galvanized steel pipe, or approved plastic pipe. Domestic water distribution system piping within buildings shall be brass pipe, copper pipe, copper tube, or galvanized steel pipe. Piping systems shall be designed to supply water at sufficient pressure to operate all fixtures and equipment during maximum demand. (i) Each water service main, branch main, riser, and branch to a group of fixtures shall be equipped with accessible and readily identifiable shutoff valves. Stop valves shall be provided at each fixture. (ii) Backflow preventers (vacuum breakers) shall be installed on hose bibbs, laboratory sinks, janitor sinks, and on all other fixtures to which hoses or tubing can be attached. Backflow preventers are not required for hoses that are directly connected to the dialysis machines. (iii) Flush valves installed on plumbing fixtures shall be of a quiet operating type, equipped with silencers. (iv) Hot water distribution systems for patient care areas shall be under constant recirculation to provide continuous hot water at each hot water outlet. Nonrecirculated fixtures branch piping shall not exceed 25 feet in length. Tankless water system may be used at point of use. (v) Water heating equipment shall have sufficient capacity to supply water for clinical, use. (vi) Water temperatures shall be measured at hot water point of use, and shall be between 105 - 120 degrees Fahrenheit. (vii) The domestic hot water system shall make provisions to limit the amount of Legionella bacteria and opportunistic waterborne pathogens. (viii) Domestic water storage tank(s) shall be fabricated of corrosion-resistant metal or lined with noncorrosive material. When potable water storage tanks (hot and cold) are used, the water shall be used and replenished. Water shall not be stored in tanks for future use unless the water is tested weekly for contaminates/bacteria. (ix) Purified water distribution system piping shall be task specific and include, but not necessarily be limited to, polypropylene (PP), polyvinylidene fluoride (PVDF) or polyvinyl chloride (PVC) pipe. Final installed purified water system piping assemblies shall be UL approved and fully comply with applicable American Society for Testing and Materials (ASTM) Fire Resistant/Smoke Density requirements. The applicable documents are available from ASTM International, 100 Barr Harbor Drive, Post Office Box C700, West Conshohocken, Pennsylvania 19428-2959.
(B) When fire sprinkler systems are required and provided in an ESRD facility, the fire sprinkler systems shall be designed, installed, and maintained in accordance with the requirements of NFPA 13, and shall be certified as required by § 117.105(c)(1)(C) of this title (relating to Construction, Inspections, and Approval of Project).
(C) Main storage of medical gases may be outside or inside the ESRD facility in accordance with NFPA 99, § 5.1.
(D) Steam and hot water systems. (i) When boilers are used the boilers shall have the capacity, based upon the net ratings as published in The I-B-R Ratings Book for Boilers, Baseboard Radiation and Finned Tube (commercial) by the Hydronics Institute Division of GAMA, to supply the normal requirements of all systems and equipment. The document published by the Hydronics Institute Division of GAMA as referenced in this rule may be obtained by writing or calling the Hydronics Institute Division of GAMA at 35 Russo Place, P.O. Box 218, Berkeley Heights, New Jersey 07922, telephone (908) 464-8200. (ii) Boiler feed pumps, heating circulating pumps, condensate return pumps, and fuel oil pumps shall be connected and installed to provide normal and standby service. (iii) Supply and return mains and risers of cooling, heating, and process steam systems shall be valved to isolate the various sections of each system. Each piece of equipment shall be valved at the supply and return ends except that vacuum condensate returns need not be valved at each piece of equipment.
(E) Drainage systems. (i) All underground building drains shall be: cast iron soil pipe, hard temper copper tube (drain-waste-vent (DWV) or heavier), acrylonitrile-butodiene-styrene (ABS) plastic pipe (DWV Schedule 40 or heavier), polyvinyl chloride (PVC) plastic pipe (DWV Schedule 40 or heavier), or extra strength vitrified clay pipe (VCP) with compression joints or couplings with at least 12 inches of earth cover. (ii) Soil stacks, drains, vents, waste lines, and leaders installed above ground within buildings shall be DWV weight or heavier and shall be: copper pipe, copper tube, plastic pipe (DWV scheduled 40 or heavier) cast iron pipe, or galvanized iron pipe. (iii) Drainage systems for chemical wastes (acids and other corrosive materials) shall be provided. Materials acceptable for chemical waste drainage systems shall include chemically resistant glass pipe, high silicone content cast iron pipe, VCP, CPVC plastic pipe, or plastic lined pipe. (iv) Thermal insulation for piping systems and equipment shall be provided for the following:
(I) boilers, smoke breeching, and stacks;
(II) steam supply and condensate return piping;
(III) hot water piping and all hot water heaters, generators, converters, and storage tanks;
(IV) chilled water, refrigerant, other process piping, equipment operating with fluid temperatures below ambient dew point, and water supply and drainage piping on which condensation may occur. Insulation on cold surfaces shall include an exterior vapor barrier; and
(V) other piping, ducts, and equipment as necessary to maintain the efficiency of the system. (v) Flame spread shall not exceed 25 and smoke development rating shall not exceed 50 for pipe insulation as determined by an independent testing laboratory in accordance with National Fire Protection Association 255, Standard Method of Test of Surface Burning Characteristics of Building Materials, 2000 Edition. Smoke development rating for pipe insulation located in environmental air areas shall not exceed 50. (vi) Asbestos insulation shall not be used.
(2) Plumbing fixtures shall be made of nonabsorptive acid-resistant materials and shall comply with the recommendations of the National Standard Plumbing Code and this paragraph.
(A) All sinks used by medical and nursing staff and all lavatories used by patients shall be trimmed with valves which can be operated without the use of hands. Blade handles used for this purpose shall not be less than four inches in length. Single lever or wrist blade devices may be used.
(B) Clinical sinks shall have an integral trap in which the upper portion of a visible trap seal provides a water surface.
(C) All plumbing fixtures and equipment shall be designed and installed to prevent the back-flow or back-siphonage of any material into the water supply. The over-the-rim type water inlet shall be used wherever possible. Vacuum-breaking devices shall be properly installed when an over-the-rim type water inlet cannot be utilized.
(D) Each drinking fountain shall be designed so that the water issues at an angle from the vertical, the end of the water orifice is above the rim of the bowl, and a guard is located over the orifice to protect it from lip contamination.
(E) All sterilizing equipment shall be designed and installed to prevent not only the contamination of the water supply but also the entrance of contaminating materials into the sterilizing units. Sterilizers shall be designed and installed so that both hot and cold water inlets shall be protected against back-siphonage at maximum water level.
(F) No hose shall be affixed to any faucet if the end of the hose can become submerged in contaminated liquid unless the faucet is equipped with an approved, properly installed vacuum breaker.
(G) The water supply spout for lavatories and sinks required in patient care areas shall be mounted so that its discharge point is a minimum of five inches above the rim of the sink.
(H) Where floor drains or floor sinks are installed, they shall be of a type that can be easily cleaned by removal of the cover. Removable stainless steel mesh shall be provided in addition to grilled drain cover to prevent entry of large particles of waste which might cause stoppages.
(I) Under counter piping and above floor drains shall be arranged (raised) so as not to interfere with cleaning of floor below the equipment.
(J) All ice-making machines used for human consumption shall be of the self-dispensing type. Copper tubing shall be provided for supply connections to ice machines.
(i) This subsection contains common electrical requirements. The ESRD facility shall comply with the requirements of this subsection.
(1) All new electrical material and equipment, including conductors, controls, and signaling devices, shall be installed in compliance with applicable sections of the National Fire Protection Association 70, National Electrical Code, 2002 Edition (NFPA 70), and NFPA 99 and as necessary to provide a complete electrical system. Electrical systems and components shall be listed by nationally recognized listing agencies as complying with available standards and shall be installed in accordance with the listings and with the manufacturer's direction for use.
(A) All fixtures, switches, sockets, and other pieces of apparatus shall be maintained in a safe and working condition.
(B) All electrical heating devices shall be equipped with a pilot light to indicate when the device is in service, unless equipped with a temperature limiting device integral with the heater.
(C) All equipment, fixtures, and appliances shall be properly grounded in accordance with NFPA 70 and NFPA 99, § 4.3.2.2.2.
(D) Under counter receptacles and conduits shall be arranged (raised) to not interfere with cleaning of floor below the equipment.
(2) Installation testing and certification.
(A) The electrical installations, including alarm, nurses calling system and communication systems, shall be tested to demonstrate that equipment installation and operation is appropriate and functional.
(B) The grounding system shall be tested as described in NFPA 99, 4.3.3, for patient care areas in new or renovated work. The testing shall be performed by a qualified electrician or their qualified electrical testing agent. The electrical contractor shall provide a letter stating that the grounding system has been tested in accordance with NFPA 99, the testing device use complies with NFPA 99, and whether the grounding system passed the test. The letter shall be signed by the qualified electrical contractor, or their designated qualified electrical testing agent, certifying that the system has been tested and the results of the test are indicated.
(3) Shielded isolation transformers, voltage regulators, filters, surge suppressors, and other safeguards shall be provided as required where power line disturbances are likely to affect fire alarm components, data processing, equipment used for treatment, and automated laboratory diagnostic equipment.
(4) Electrical service and switchboards serving the required ESRD facility components shall be installed above the designated 100-year flood plain. Main switchboards shall be located in a permanently dry location and the electrical switchgear and distribution panels and shall be accessible to authorized persons only. These rooms or spaces shall be ventilated to provide an environment free of corrosive or explosive fumes and gases, or any flammable and combustible materials. When switchboards are installed in a damp or wet location the enclosure shall be installed in a waterproof cabinet. Switchboards shall be located convenient for use and readily accessible for maintenance as required by NFPA 70, Article 408. Overload protective devices shall operate properly in ambient temperatures.
(5) Panelboards serving normal lighting and appliance circuits shall be located on the same floor as the circuits they serve. Panelboards serving critical branch emergency circuits shall be located on each floor that has major users and may also serve the floor above and the floor below. Panelboards serving life safety branch circuits may serve three floors, the floor where the panelboard is located, and the floors above and below.
(6) All conductors for controls, equipment, lighting and power operating at 100 volts or higher shall be installed in accordance with the requirements of NFPA 70, Article 517. All surface mounted wiring operating at less than 100 volts shall be protected from mechanical injury with metal raceways to a height of seven feet above the floor. Conduits and cables shall be supported in accordance with NFPA 70, Article 300.
(7) The wiring of the emergency system shall be mechanically protected by installation in nonflexible metal raceways in accordance with NFPA 70, § 517.30(C)(3).
(8) Lighting and receptacles.
(A) Lighting intensity for staff and patient needs shall comply with guidelines for health care facilities set forth in the Illuminating Engineering Society of North America (IESNA) Handbook, 2000 edition, published by the IESNA, 120 Wall Street, Floor 17, New York, New York 10005. (i) Consideration shall be given to controlling intensity and wavelength to prevent harm to the patient's eyes (i.e., retina damage to cataracts due to ultraviolet light). (ii) Approaches to buildings and parking lots shall be illuminated. All rooms including storerooms, electrical and mechanical equipment rooms, and all attics shall have sufficient artificial lighting so that all parts of these spaces shall be clearly visible. (iii) Consideration shall be given to the special needs of the elderly. Excessive contrast in lighting levels that makes effective sight adaptation difficult shall be minimized.
(B) Means of egress and exit sign lighting intensity shall comply with NFPA 101, §§ 7.8 - 7.10.
(C) Electric lamps, which may be subject to breakage or which are installed in fixtures in confined locations when near woodwork, paper, clothing, or other combustible materials, shall be protected by wire guards, or plastic shields.
(D) Only listed hospital grade single-grounding or duplex-grounding receptacles shall be used in all patient care areas. This does not apply to special purpose receptacles. (i) Installations of multiple-ganged receptacles shall not be permitted in patient care areas. (ii) Electrical outlets powered from the emergency system shall be provided in all patient care, procedure, and treatment locations in accordance with NFPA 99, § 4.4.2.2.2.3. At least one receptacle at each patient treatment station/room, exam room, or procedure location shall be powered from the emergency electrical system power panel. At least one receptacle at each patient treatment station/room, exam room, or procedure location shall be powered from the normal power panel. (iii) Replacement of malfunctioning receptacles and installation of new receptacles powered from the emergency system in existing facilities shall be accomplished with receptacles of the same distinct color as the existing receptacles. (iv) In locations where other equipment requiring special electrical configuration is used, the additional receptacles shall be distinctively marked for the special use. (v) Each receptacle shall be grounded to the reference grounding point by means of a green insulated copper equipment grounding conductor. (vi) All emergency system receptacles shall be identified. The face plate for the receptacle(s) shall have a nonremovable label or be engraved indicating the panel and circuit number.
(E) Equipment. (i) Equipment required for safe operation of the ESRD facility shall be powered from the critical system in accordance with the requirements contained in NFPA 99, § 4.5.2.2.3. (ii) Boiler accessories including feed pumps, heat-circulating pumps, condensate return pumps, fuel oil pumps, and waste heat boilers shall be connected and installed to provide both normal and standby service.
(F) Ground fault circuit interrupters (GFCI) receptacles shall be provided for all general use receptacles located within three feet of a wash basin or sink. When GFCI receptacles are used, they shall be connected to not affect other devices connected to the circuit in the event of a trip. Receptacles connected to the critical branch that may be used for equipment that should not be interrupted do not have to be GFCI protected. Receptacles in wet locations, as defined by NFPA 70, § 517.20 and § 517.21, shall be GFCI protected regardless of the branch of the electrical system serving the receptacle.
(9) A nurses emergency calling system shall be installed in the patient waiting area, all individual treatment rooms, exam rooms, isolation rooms, hepatitis B rooms, and toilet rooms used by patients to summon nursing staff in an emergency. Activation of the system shall sound a repeating (every 5 seconds or less) distinct audible signal at the nurse station, indicate type and location of call on the system monitor, and activate a distinct visible signal in all areas. The visible and audible signals shall be cancelable only at the patient calling station. A nurses emergency call system shall be accessible to a collapsed patient lying on the floor. Inclusion of a pull cord extending to within 6 inches of the floor will satisfy this requirement.
(10) The ESRD facility shall provide, at submission of construction documents/plans a letter on facility letterhead indicating the method the ESRD facility has chosen for implementation of the emergency contingency plan for the continuity of emergency essential building systems (emergency generator). The contingency plan shall consist of one of the three options as described as follows.
(A) An onsite emergency generator shall be provided with a Type II essential electrical distribution system in accordance with requirements of NFPA 99, § 4.5, and National Fire Protection Association 110, Standard for Emergency and Standby Power Systems, 2002 Edition. (i) An emergency generator standby power system(s) shall require an onsite fuel source and enough fuel capacity in the tank for a period of twenty-four hours or more. When a vapor liquefied petroleum gas (LPG) (natural gas) system is used, the twenty-four hour fuel capacity on site is not required. The vapor withdrawal LPG system shall require a dedicated fuel supply. (ii) The emergency generator shall be installed, tested and maintained in accordance with the National Fire Protection Association 99, § 4.5.4, and National Fire Protection Association 110, Standard for Emergency and Standby Power Systems, 2002 Edition. (iii) When the emergency generator(s) and electrical transformer(s) are located within the same area, they shall be located at least 10 feet apart. (iv) Sufficient quantity of potable water supply shall be on site for the operation of the water treatment system for at least twenty-four hours. A water valve connection shall be provided to allow hook-up for potable water from an outside vendor to supply the water treatment system.
(B) A executed contract with an outside supplier/vendor(s) that will provide a portable emergency generator(s) and potable water on demand. (i) An electrical transfer switch with plug-in device sized to provide emergency power for the patient care areas and the provisions in NFPA 99, § 4.5.2.2.2. (ii) A water valve connection to allow hook-up for potable water from an outside vendor to supply the water treatment system. (iii) An alternate source of power (battery power lighting) shall be provided separate and independent from the normal electrical power source that will be effective for a minimum of 1-1/2 hours after loss of the electrical power. The emergency lighting system shall be capable of providing sufficient illumination to allow safe evacuation from the building. The battery pack systems shall be maintained and tested quarterly. (iv) The facility shall implement the emergency contingency plan upon the loss of electrical power following a natural weather or man-made event when the electrical power may not be restored within 24 hours. The facility shall exercise the contract(s) with the supplier/vendor(s) in order to have portable emergency generator(s) and potable water available within 36 hours after the loss of electrical power.
(C) An executed contract with another licensed ESRD facility within a 100 mile radius to provide emergency contingency care for the patients. (i) The accepting licensed ESRD facility shall meet the requirements of paragraph (1) of this subsection. (ii) An alternate source of power shall be provided separate and independent from the normal electrical power source that will be effective for a minimum of 1-1/2 hours after loss of the electrical power. The emergency lighting system shall be capable of providing sufficient illumination to allow safe evacuation from the building. The battery pack systems shall be maintained and tested quarterly.
(11) A fire alarm system, which complies with NFPA 101, § 18.3.4, and with NFPA 72, Chapter 6 requirements, shall be provided in each facility. The required fire alarm system components are as follows:
(A) A fire alarm control panel (FACP) shall be installed at a visible central location.
(B) Manual fire alarm pull stations shall be installed in accordance with NFPA 101, § 18.3.4.
(C) Smoke detectors for door release service shall be installed on the ceiling at each door opening in the smoke partition in accordance with NFPA 72, § 6.15.6, where the doors are held open with electromagnetic devices conforming with NFPA 101, § 18.2.2.6.
(D) Smoke detectors shall be installed in air ducts in accordance with NFPA 72, § 5.14.4.2 and § 5.14.5 and NFPA 90A, § 6.4.2.
(E) Smoke detectors shall be installed in return air ducts in accordance with requirements of NFPA 72 § 5.14.4.2.2 and § 5.14.5 and NFPA 90A, § 6.4.2.2.
(F) Fire sprinkler system water flow switches shall be installed in accordance with requirements of NFPA 101, § 9.6.2; NFPA 13, § 6.9; and NFPA 72, § 8.5.3.3.3.4.
(G) Sprinkler system valve supervisory switches shall be installed in accordance with the requirements of NFPA 72, § 6.8.5.5.
(H) Audible alarm indicating devices shall be installed in accordance with the requirements of NFPA 101, § 18.3.4, and NFPA 72, § 7.4.
(I) Visual fire alarm indicating devices, which comply with the requirements of NFPA 72, § 7.5, shall be provided.
(J) Devices for transmitting alarm for alerting the local fire brigade or municipal fire department of fire or other emergency shall be provided. The devices shall be listed for the fire alarm service by a nationally recognized laboratory, and be installed in accordance with such listing and the requirements of NFPA 72.
(K) A fire alarm signal notification, which complies with NFPA 101, § 9.6.3, shall be provided to alert occupants of fire or other emergency.
(L) Wiring for fire alarm detection circuits and fire alarm notification circuits shall comply with requirements of NFPA 70, Article 760.
(M) Smoke detector(s) for shutdown of air handling units shall be provided. The detectors shall be installed in accordance with NFPA 90A, § 6.4.3.
(N) Telecommunications and information systems central equipment shall be installed in a separate location designed for the intended purpose. Special air conditioning and voltage regulation shall be provided as recommended by the manufacturer.
(O) When installed, lightning protection systems shall comply with National Fire Protection Association 780, Standard for the Installation of Lightning Protection Systems, 2000 Edition.
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