(1)
General. In general, all plumbing installed in
hospitals shall comply with the requirements of
248 CMR
3.00 through
10.00 and the Massachusetts
Department of Environmental Protection (DEP).
(2)
Definitions.
Aspirator. An aspirator is a fitting
or device supplied with water or other fluid under positive pressure which
passes through an integral orifice or "constriction" causing a vacuum.
Aspirators are often referred to as "suction" apparatus and are similar in
operation to an ejector.
Autopsy Table. An autopsy table is a
fixture or table used for the post-mortem examination of a body.
Bedpan Hopper (Clinic Sink). A bedpan
hopper is a fixture meeting the design requirements of fixture, sometimes
called a clinic sink.
Bedpan Steamer. A bedpan steamer is a
fixture used for scalding bedpans or urinals by direct application of
steam.
Bedpan Washer. A bedpan washer is a
fixture designed to wash bedpans and to flush the contents into the soil
drainage system. It may also be provided for steaming the utensils with steam
or hot water.
Bedpan Washer Hose. A bedpan washer
hose is a device supplied with hot and/or cold water and located adjacent to a
toilet or clinic sink to be used for cleansing bedpans.
Clinic Sink. See
Bedpan Hopper and
248
CMR 10.18(3)(b).
Flushing Type Floor Drain. A flushing
type floor drain is a floor drain which is equipped with an integral water
supply, enabling flushing of the drain receptor and trap.
Local Vent Stack. A local vent stack
is a vertical pipe to which connections are made from the fixture side of traps
and through which vapor and/or foul air may be removed from the fixture or
device used on bedpan washers.
Sterilizer, Boiling Type. A boiling
type "sterilizer" is a fixture (non-pressure type) used for boiling
instruments, utensils, and/or other equipment (used for disinfection). Some
devices are portable, others are connected to the plumbing system.
Sterilizer Instrument.
See
Sterilizer, Boiling
Type.
Sterilizer, Pressure Instrument
Washer-sterilizer. A pressure instrument washer-sterilizer is a
fixture (pressure vessel) designed to both wash and sterilize instruments
during the operating cycle of the fixture.
Sterilizer, Pressure (Autoclave). A
pressure sterilizer is a fixture (pressure vessel) designed to use steam under
pressure for sterilizing. A pressure sterilizer is also called an
Autoclave.
Sterilizer, Utensil.
See
Sterilizer, Boiling
Type.
Sterilizer Vent. A sterilizer vent is
a separate pipe or stack, indirectly connected to the building drainage system
at the lower terminal, which receives the vapors from non-pressure sterilizers,
or the exhaust vapors from pressure sterilizers, and conducts the vapors
directly to the outer air, sometimes called vapor, steam, atmospheric or
exhaust vent.
Sterilizer Water. A water sterilizer
is a device for sterilizing water and storing sterile water.
Still. A still is a device used in
distilling liquids.
(3)
Fixtures.
(a)
General. Product-accepted flush rim bedpan hoppers
(clinic sinks), bedpan washers, and/or other acceptable fixtures and equipment
shall be provided for:
1. the disposing of
bedpan contents; and
2. the
cleansing and disinfection of bedpans in soiled utility (hopper)
rooms.
(b)
Clinic Sink.
1. A
clinic sink shall have an integral trap in which the upper portion of a visible
trap seal provides a water surface.
2. The fixture shall be so designed as to
permit complete removal of the contents by siphon and/or blowout action, and to
reseal the trap.
3. A flushing rim
shall provide water to cleanse the interior surface.
4. The fixtures shall have flushing and
cleansing characteristics similar to a toilet.
(c)
Prohibited Use of Clinic
Sinks and Service Sinks.
1. A
clinic sink serving a soiled utility room shall not be considered as a
substitute for, nor shall it be used as a janitor's service sink.
2. A janitor's service sink shall not be used
for the disposal of urine, fecal matter, or other human wastes.
(d)
Ice Prohibited in
Soiled Utility Rooms.
1. No
machine for manufacturing ice, or any device for the handling or storage of ice
shall be located in a soiled utility room.
2. Machines for manufacturing ice, or devices
for handling or storage of ice intended for either human consumption or packs
may be located in clean utility room, floor pantry, or diet kitchen.
(4)
Sterilizer Equipment Requirements.
(a)
De-scaling of Equipment
Prohibited. It shall be unlawful to de-scale or otherwise submit
the interior of water sterilizers, stills, or similar equipment to acid or
other chemical solutions while the equipment is connected to the water and/or
drainage system.
(b)
ASME Standard. New pressure sterilizers and pressure
instruments washer-sterilizers hereafter installed, shall always display in a
location to be clearly visible, the ASME Standard symbol and data
plate.
(c)
Sterilizer
Piping. All sterilizer piping and/or devices necessary for the
operation of sterilizers shall be accessible for inspection and
maintenance.
(d)
Condensers.
1.
Pressure sterilizers shall be equipped with an acceptable means of condensing
and cooling the exhaust steam vapors.
2. Non-pressure sterilizers should be
equipped with an acceptable device which shall automatically control the vapors
in a manner to confine them within the vessel, or equipped with an acceptable
means of condensing and cooling of vapors.
(e)
Gas Fired
Equipment. Gas fired equipment or apparatus shall be installed in
accordance with the requirements of the Massachusetts Fuel Gas Code
248 CMR
4.00 through
7.00.
(f) Discharge from sterilizers into the
sanitary drainage system shall be at a temperature of no more than 150
°F.
(5)
Special Elevations.
(a) Control valves, vacuum outlets, and
devices which protrude from a wall of an operating, emergency, recovery,
examining, or delivery room, or a corridor and/or other locations where
patients may be transported on a wheeled stretcher, shall be located at an
elevation which will preclude bumping the patient or stretcher against the
device.
(b) When necessary to
install at a lower elevation, safety precautions should be taken to protect the
personnel.
(6)
Plumbing in Hospitals for the Psychologically
Impaired.
(a) In
hospitals/facilities for the psychologically impaired exceptional consideration
should be given to piping, controls, and fittings of plumbing fixtures given
the nature of the patients.
(b) No
pipes or traps shall be exposed and fixtures shall be substantially secured to
walls.
(7)
Drainage and Venting.
(a)
Ice Storage Chest
Drains.
1. Any drain serving an
ice chest or box shall discharge over an indirect waste receptor separate from
all other fixture wastes.
2. Each
terminal shall discharge through an air gap above the receptor.
3. The end shall be covered with a removable
screen of not less than ten-mesh per inch, and if discharging vertically, the
terminal shall be cut at an angle of 45°.
(b)
Bedpan Washers and Clinic
Sinks. Bedpan washers and clinic sinks shall be:
1. connected to the soil pipe system;
and
2. vented following the
requirements as applied to toilets, except that bedpan washers require
additional local vents.
(8)
Sterilizer
Wastes.
(a)
Indirect
Wastes Required.
1. All
sterilizers shall be provided with individual and separate indirect wastes,
with air gaps of not less than two diameters of the waste tailpiece.
2. The upper rim of the receptor, funnel, or
basket type waste fitting shall be not less than two inches below the vessel or
piping, whichever is lower.
3.
Except as provided in
248
CMR
10.18(8)(c) and (8)(e)
a p-trap shall be installed on the discharge side of, and immediately below,
the indirect waste connection serving each sterilizer.
(b)
Floor Drain
Required. In all recess rooms containing the recessed, or
concealed portions of sterilizers, not less than one acceptable floor drain,
connecting to the drainage system, shall be installed in a manner to drain the
entire floor area.
(c)
Recess Room Floor Drains, Trap Seal Maintenance.
1. The recess room floor drain waste and trap
shall be a minimum diameter of three inches.
2. It shall receive the drainage from at
least one sterilizer within the recess room to assure maintenance of the floor
drain trap seal.
3. The sterilizer
drain shall be installed on a branch taken off between the floor drain trap and
the drain head.
4. No individual
sterilizer waste trap shall be required on this type of installation.
(d)
Prohibited
Connections.
1. Branch funnel and
branch basket type fittings, except as provided in
248
CMR
10.18(8)(e) are
prohibited on any new installation or when relocating existing
equipment.
2. Existing branch
funnel or branch basket type installations shall be provided with an acceptable
indirect waste below the branch connections.
(e)
Battery
Assemblies. A battery assembly of not more than three sterilizer
wastes may drain to one trap, provided:
1. The
trap and waste are sized according to the combined fixture unit
rating.
2. The trap is located
immediately below one of the indirect waste connections.
3. The developed distance of a branch does
not exceed eight feet.
4. The
branches change direction through a tee-wye or wye pattern fitting.
(f)
Bedpan Steamers -
Additional Trap Required. A trap with a minimum seal of three
inches shall be provided in a bedpan steamer drain located between the fixture
and the indirect waste connection.
(g)
Pressure
Sterilizer.
1. Except when an
exhaust condenser is used a pressure sterilizer chamber drain may be connected
to the exhaust drip tube before terminating at the indirect waste
connection.
2. If a vapor trap is
used, it shall be designed and installed to prevent moisture being aspirated
into the sterilizer chamber.
3. The
jacket steam condensate return, if not connected to a gravity steam condensate
return, shall be separately and indirectly wasted.
4. If necessary, to cool a high temperature
discharge, a cooling receiver, trapped on its discharge side may serve as the
fixture trap.
(h)
Pressure Sterilizer Exhaust Condensers.
1. The drain from the condenser shall be
installed with an indirect waste as prescribed in
248 CMR
3.00 through
10.00.
2. If condensers are used on pressure
sterilizers, the chamber drain shall have a separate indirect waste
connection.
(i)
Water Sterilizer. All water sterilizer drains,
including tank, valve leakage, condenser, filter and cooling shall be installed
with indirect waste or according to
248
CMR
10.18(8)(b).
(j)
Pressure Instrument
Washer-sterilizer.
1. The
pressure instrument washer-sterilizer chamber drain, and overflow may be
interconnected. They also may be interconnected with the condenser.
2. The indirect waste shall follow the
provision set forth in
248 CMR
3.00 through
10.00.
(k)
Aspirators.
1. In operating rooms, emergency rooms,
recovery rooms, delivery rooms, examining rooms, autopsy rooms, and other
locations except laboratories where aspirators are installed for removing
blood, pus and/or other fluids, the discharge from any aspirator shall be
indirectly connected to the drainage system.
2. The suction line of an aspirator shall be
provided with a bottle or similar trap to protect the water supply.
(9)
Central
Vacuum and/or Disposal Systems.
(a)
Wastes. The
waste from a central vacuum (fluid suction) system of the disposal type and/or
which is connected to the drainage system whether the disposal be by barometric
leg, collecting tanks, or bottles shall be directly connected to the sanitary
drainage system through a trapped waste.
(b)
Piping.
1. The piping of a central vacuum (fluid
suction) system shall be of corrosion resistant material having a smooth
interior surface.
2. No branches
shall be less than one inch for one outlet and sized according to the number of
vacuum outlets, and no main shall be less than one inch.
3. The pipe sizing shall be increased
according to the manufacturer's recommendation as stations are
increased.
4. All piping shall be
provided with adequate and accessible clean-out facilities on mains and
branches, and shall be accessible for inspection, maintenance, and
replacements.
(c)
Water Systems for Space Cooling and Heating Condensate
Drains.
1. The lowest point of a
condensate riser or risers shall be trapped and discharged over an indirect
waste sink.
2. The trap may be
either "P" or a "running trap" with a clean-out.
3. A branch shall be installed upstream from
the condensate drain trap for flushing and resealing purposes.
4. The condensate drain and trap shall be
located above the lowest floor level of the building.
(10)
Vent
Material. Material for local vents serving bedpan washers and
sterilizer vents serving sterilizers, shall be sufficiently rust proof, erosion
and corrosion resistant to withstand:
(a)
intermittent wetting and drying from steam vapors;
(b) the distilled water solvent action of the
steam vapors; and
(c) frequent and
immediate changes of temperatures.
(11)
Vent Connections
Prohibited.
(a) Connections
between local vents serving bedpan washers, sterilizer vents serving
sterilizing apparatus, and/or normal sanitary plumbing systems, are
prohibited.
(b) Only one type of
apparatus shall be served by a given vent.
(12)
Local Vents and
Stacks.
Bedpan Washers.
(a) Bedpan washers shall be vented to the
outer atmosphere above the roof by means of one or more local vents.
(b) The local vent for a bedpan washer shall
be not less than a two-inch diameter pipe.
(c) A local vent serving a single bedpan
washer may drain to the fixture served.
(13)
Multiple
Installations.
(a) Where bedpan
washers are located above each other on more than one floor, a local vent stack
may be installed to receive the local vent on the various floors.
(b) Not more than three bedpan washers shall
be connected to a two-inch local vent stack, six to a three-inch local vent
stack, and 12 to a four-inch local vent stack.
(c) In multiple installations, the
connections between a bedpan washer local vent and local vent stack shall be
made by use of the tee or tee-wye sanitary pattern drainage fittings, installed
in an upright position.
(d)
Trap Required.
1.
The bottom of the local vent stack, except when serving only one bedpan washer,
shall be drained by means of a trapped and vented waste connection to the
plumbing sanitary drainage system.
2. The trap and waste shall be the same size
as the local vent stack.
(14)
Trap Seal
Maintenance.
(a) A water supply
of not less than A-inch minimum tubing shall be taken from the flush supply of
each bedpan washer on the discharge or fixture side of the vacuum breaker,
trapped to form not less than a three-inch seal and connected to the local vent
stack on each floor.
(b) The water
supply shall be so installed as to provide a supply of water to the local vent
stack for cleansing and drain trap seal maintenance each time a bedpan washer
is flushed.
(15)
Sterilizer, Vents and Stacks.
(a)
Connections.
1. Multiple installations of pressure and
non-pressure sterilizers shall have their vent connections to the sterilizer
vent stack made by means of inverted wye fittings.
2. Such vent connections shall be accessible
for inspection and maintenance.
(b)
Drainage.
1. The connection between the sterilizer vent
stack shall be designed and installed to drain to the funnel or basket-type
waste fitting.
2. In multiple
installations, the sterilizer vent stack shall be drained separately to the
lowest sterilizer funnel or basket-type waste fitting or receptor.
(16)
Sterilizer Vent Stack Sizes.
(a)
Bedpan Steamers.
1. The minimum size of a sterilizer vent
serving a bedpan steamer shall be 1A inches in diameter.
2. Multiple installations shall be sized
according to
248
CMR
10.18(16):
Table
1:
Stack Sizes for Bedpan Steamers and Boiling Type
Sterilizers, (number of connections of various sizes sterilizer vent
stacks).
Table 1
Stack Sizes for Bedpan Steamers and Boiling Type
Sterilizers
Stack Size
|
Connection Size
|
1A inches
|
2 inches
|
1½ -
inch1
|
1 or 0
|
2 - inch1
|
2 or 1
|
2 - inch2
|
1 and 1
|
3 - inch1
|
4 or 2
|
3 - inch2
|
2 and 2
|
4 - inch1
|
8 or 4
|
4 - inch2
|
4 and 4
|
Note 1: Total of each size
Note 2: Combination of sizes
(b)
Boiling
Type Sterilizers.
1. The minimum
size of a sterilizer vent stack shall be two inches in diameter when serving a
utensil sterilizer, and one inch in diameter when serving an instrument
sterilizer.
2. Combinations of
building type sterilizer vent connections shall be based on
248
CMR
10.18(16):
Table
1:
Stack Sizes for Bedpan Steamers and Boiling Type
Sterilizers.
(c)
Pressure Sterilizers. Sterilizer vent stacks shall be
2½ inches minimum; those serving combinations of pressure sterilizer
exhaust connections shall be sized according to
248
CMR
10.18(16):
Table
2:
Stack Sizes for Pressure Sterilizers.
(d)
Pressure Instrument
Washer-sterilizer Sizes.
1. The
minimum size of a sterilizer vent stack serving an instrument
washer-sterilizer, shall be two inches in diameter.
2. Not more than two sterilizers shall be
installed on a two-inch stack, and not more than four on a three-inch stack.
Table 2
Stack Sizes for Pressure Sterilizers
Number of Connections of Various Sizes
Permitted to Various Size Vent Stacks
|
|
Stack Size
|
Connection Size
|
¾
|
1 inch
|
1¼ inch
|
1½ inch
|
1½ -
inch1
|
3
|
or
|
2
|
or
|
1
|
1½ -
inch2
|
2
|
and
|
1
|
2 - inch1
|
6
|
or
|
3
|
or
|
2
|
or
|
1
|
2 - Inch2
|
3
|
and
|
2
|
2 - inch2
|
2
|
and
|
1
|
and
|
1
|
2 - inch2
|
1
|
and
|
1
|
and
|
1
|
3 - inch1
|
15
|
or
|
7
|
or
|
5
|
or
|
3
|
3 - inch2
|
1
|
and
|
2
|
and
|
2
|
3 - inch2
|
1
|
and
|
5
|
and
|
1
|
Note 1: Combination of sizes
Note 2: Total of each size
(17)
Radioactive Materials.
(a) All radioactive materials shall be
disposed of in a manner so as to create no hazard to operation and maintenance
personnel of the institution or to the public.
(b) Specific permission shall be secured from
the State Department of Public Health to dispose of any radioactive material to
the drainage system.
(18)
Water Supply.
(a)
Water Service. All hospitals shall have dual services
installed in a manner to provide an uninterrupted supply of water in case of a
water main break.
(b)
Hot Water Heater and Tanks.
1. The hot water equipment shall have enough
capacity to supply water at 125 °F for hospital fixtures; water at
180°F for kitchens and laundries.
2. Where direct fired hot water heaters are
used, they shall be of an accepted high-pressure type.
3. Submerged steam heating coils should be of
copper. Storage tanks shall be fabricated of non-corrosive metal or be lined
with non-corrosive material.
(c)
Hot Water Supply
System.
1. Hot water circulating
mains and risers should be run from the hot water storage tank to a point
directly below the highest fixture at the end of each branch main.
2. Where the building is higher than three
stories, each riser shall be circulated.
3. Each main, branch main, riser and branch
to a group of fixtures of the water system shall be provided with
valves.
(19)
Vacuum Breaker Installation.
(a)
Hose
Connections. For ordinary hose connections the maximum height at
which any hose is to be used shall be treated at its flood level.
(b)
Low Volume
Flows.
1. Where low volume flows
might cause leaking or spitting at the vacuum breaker parts, back pressure may
be developed by installing an acceptable minimum orifice valve on the discharge
side of the vacuum breaker. This shall be in addition to the regular control
valve.
2. Low volume flow
installation shall be subject to review and acceptance by the
Inspector.
(c)
Prohibited Toilet and Clinic Sink Supply.
1. No jet or water supplied orifices, except
those supplied by the flush connection, shall be located in and/or connected
with a toilet bowl or clinic sink.
2.
248
CMR
10.18 shall not prohibit an acceptable
bidet installation.
(d)
Special Equipment, Water Supply Protection.
248
CMR
10.18(19):
Table
3:
Hospital Fixtures and Their Water Supply
Protection, sets forth the requirements which shall be followed in
protecting the water supply for hospital fixtures against backflow or back
siphonage.
Table 3
Hospital Fixtures and Their Water Supply
Protection
Fixtures
|
Type of
Protection1
|
Remarks
|
Aspirators:
|
Laboratory
|
Vacuum breaker
|
Portable
|
Vacuum breaker
|
Vacuum system
|
Vacuum breaker
|
Bedpan:
|
Washers
|
Vacuum breaker
|
Washer hose
|
Vacuum breaker
|
Locate five feet above floor.
|
Boiling type sterilizer
|
Air gap
|
Not less than twice the effective opening of the
water supply.
|
Exhaust condenser
|
Vacuum breaker
|
Flush floor drain
|
Vacuum breaker
|
Hose connection
|
Vacuum breaker
|
Locate six feet above floor.
|
Pressure instrument washersterilizer
|
Vacuum breaker
|
Pressure Sterilizer
|
Vacuum breaker
|
(rubber Tube Testers-Washers)
|
Vacuum breaker
|
Vacuum systems
|
Cleaning
|
Air gap or vacuum breaker
|
Fluid suction
|
Air gap or vacuum breaker
|
Note 1: Where vacuum breakers are used, they shall be installed
after the last control valve.
(20)
Clinical, Hydrotherapeutic
and Radiological Equipment. All clinical, hydrotherapeutic,
radiological, or any equipment, whether mentioned or not, which is water
supplied and/or discharges to the waste system, shall meet the requirements of
248
CMR
10.18 and the regulations covering
cross-connections, air gaps, vacuum breakers, and check valves.
Special Equipment and Devices Found under These Classes
Include:
Clinical
|
Hydrotherapeutic
|
Radiological
|
Dental cuspidors
|
Control units
|
Violet X-Ray
|
Surgical cuspidors
|
Arm bath
|
Diagnostic X-Ray
|
Dental (flush rim) lavatories
|
Leg bath
|
Therapy X-Ray
|
Colonic irrigation
|
Foot bath
|
X-Ray target
|
Sitz bath
|
Tub bath
|
X-Ray transformers
|
Emergency bath
|
Immersion bath
|
X-Ray oil tank
|
Receiving bath
|
Shower bath
|
Diffraction
|
Prenatal bath
|
Needle bath
|
X-Ray developing
|
Infant bath
|
Tank
|
Photographic developing
|
Prophylaxis
|
Pool
|
Film developing
|
Shampoo
|
Hose
|
Microscopic
|
Massage
|
Syringe
|
Douche
|
(21)
Condensate Drain Trap Seal.
(a) A water supply shall be provided for
cleaning, flushing, and resealing the condensate trap.
(b) The source of the water supply shall be a
refrigerator condenser discharge, a drinking water station waste, or other
acceptable method of flushing and resealing the trap.
(c) The water supply shall be not less than A
inch diameter pipe.
(d) The water
supply shall discharge through an air gap not less than twice the diameter of
the supply pipe.
(22)
Valve Leakage Diverter. Each water sterilizer which
may be filled with water through directly connected piping, shall be equipped
with an acceptable leakage diverter and/or bleed-line on the water supply
control valve to indicate and conduct any leakage of unsterile water away from
the sterile zone.