19 CSR 30-30.110 - General Design and Construction Standards for Existing Birthing Centers

PURPOSE: Section 197.225, RSMo authorizes the Department of Health to establish physical standards for birthing centers in order to provide care in a safe environment. Birthing centers are considered ambulatory surgical centers as defined by section 197.200(1), RSMo and are subject to licensure as required by 197.205, RSMo. This rule establishes physical plant requirements for licensing existing birthing centers. Existing birthing centers are those birthing facilities already in operation at the time these rules are adopted.

PUBLISHER'S NOTE: The publication of the full text of the material that the adopting agency has incorporated by reference in this rule would be unduly cumbersome or expensive. Therefore, the full text of that material will be made available to any interested person at both the Office of the Secretary of State and the office of the adopting agency, pursuant to section 536.031.4, RSMo. Such material will be provided at the cost established by state law.

(1) General Standards.

(A) Any birthing center existing and in continuous operation prior to the date of the adoption of this rule will be inspected by the Department of Health to determine compliance with this rule. Existing birthing centers shall comply with all applicable local regulations and codes and shall hold a certificate of occupancy from the local building authority.

(B) Requests for deviations from requirements on physical facilities shall be requested in writing to the Department of Health and must contain information which determines that the respective intent or objectives of this rule have been met. Approvals for deviations shall be requested in writing and both requests and approvals shall be made a part of the permanent Department of Health records for the birthing center.

(C) References in this rule to, National Fire Protection Association (NFPA), publications are those contained in the twelve (12)-volume 1994 compilation of National Fire Codes. Where there are discrepancies between referenced NFPA publication requirements and this rule, the requirements of this rule shall apply.

(2) Access for the Physically Handicapped. Existing birthing centers are required by the United States Department of Justice to currently comply with the federal requirements for accessible design established under the Americans With Disabilities Act. Evidence of compliance as determined by a local authority or other independent third party shall be provided to the department by the owner of the facility.

(3) Site.

(A) Adequate vehicular and pedestrian access shall be provided to the main entrance, emergency vehicular entrance and service entrance.

(B) Adequate parking shall be available in proportion to the number of patients and staff normally occupying the facility.

(C) Means of immediate access to the building for fire fighting and ambulance service personnel and equipment shall be provided.

(4) Administrative/public areas shall include business office with staff telephone and administrator's office, medical records storage for at least two (2) years of active patient records, public lobby and waiting room, telephone, toilet, at least one (1) room for education and training and at least one (1) examination room. In existing birthing centers having only one (1) regular birthing room, one (1) examination room shall be sized and equipped to serve as a stand-by birthing room.

(5) Birthing rooms shall include at least one (1) birthing room sized to accommodate the equipment, personnel and circulation area necessary to accomplish infant delivery; each birthing room door shall be ample in width and conformation to accommodate ambulance stretchers or infant transport warmer.

(A) Hand washing facilities operable without the use of hands shall be accessible within each birthing room and each examination room.

(B) Each birthing room shall be equipped with a bed or delivery chair, storage facilities for supplies, and sufficient tables to hold emergency and other necessary equipment.

(C) A toilet with lavatory and shower shall be easily accessible from the birthing rooms without traversing public areas.

(D) Piped-in or portable oxygen and vacuum service shall be available to each birthing room.

(6) Service and Staff Support Facilities for the Birthing Suite. These facilities shall include:

(A) A clean work and sterile storage area, and storage space for clean supplies;

(B) A separate soiled/decontamination utility area equipped with a counter and sink;

(C) A separate toilet with lavatory for staff;

(D) An area shall be provided for the preparation and storage of medication; and

(E) A staff work area for charting located to permit visual supervision of the birthing suite.

(7) General Support Facilities. These facilities shall include:

(A) Adequate space for the housing and maintenance of mechanical, plumbing and electrical equipment;

(B) Medical gas shall be stored and distributed in accordance with "NFPA 99, Standard for Health Care Facilities, 1993 Edition," in 1994 National Fire Code, Volume 5; and

(C) Housekeeping supply and general storage areas appropriate to fulfill the needs of the facility.

(8) Details and Finishes.

(A) A continuous system of unobstructed corridors and aisles shall extend through the enclosed portion of each story of the birthing facility, connecting all rooms and spaces with each other and with all entrances, exitways and elevators. Mechanical equipment space need not be connected to the corridor system. Corridors shall be separated from all other areas by partitions constructed to resist the passage of smoke.

(B) At least two (2) remote exits shall be provided for each patient floor. Each exit shall discharge to the outside or through an enclosed stairway or passageway to the outside.

(C) Required exit stairs shall discharge directly to the outside or into an enclosed corridor which extends from the stair discharge to the outside. The fire-resistance rating of the enclosure of a corridor extension of a stair shall be not less than the rating required for the stair enclosure as stated in subsection (9)(D) of this rule.

(D) Corridors serving as a means of access to exit for patients in the birthing suite shall be arranged and of sufficient width to facilitate the movement of patients on stretchers.

(E) Exit doors shall swing in the direction of exit travel.

(F) All doors through which birthing patients pass to access birthing rooms and exits shall be of ample width to accommodate ambulance stretchers and warmers.

(G) Where outside windows exist in the birthing room, washable window treatments shall be installed to control light and glare.

(H) Where outside windows are provided in other areas of the facility, window treatments shall be installed to control light and glare.

(I) At least one (1) ABC-type fire, extinguisher, compliant with "NFPA 10, Standard for Portable Fire Extinguishers, 1990 Edition" 1994 National Fire Code, Volume 1, shall be located on each floor occupied by the birthing center, including the basement.

(J) A paper towel dispenser and soap dispenser shall be provided at all lavatories used for hand washing.

(K) Ceiling, wall and floor finishes in toilets, bath facilities and utility and storage rooms designed for washing, sterilizing and storage shall be easily cleanable.

(L) Finish materials installed on the walls, floors, and ceilings in the birthing rooms shall be washable. The floors shall not be physically affected by frequent wet cleaning with cleaning and germicidal cleaning agents.

(M) Floor and wall penetrations by pipes, ducts and conduits shall be tightly sealed to minimize entry of rodents and insects. Joints of structural elements shall be similarly sealed.

(9) Construction, Including Fire-Resistive Requirements.

(A) Construction of freestanding birthing centers shall comply with "NFPA 101, Section 13-6, Existing Ambulatory Health Care Centers, 1994 Edition," in 1994 National Fire Codes, Volume 5 and to the minimum requirements of this rule.

(B) Multistoried buildings rated combustible Type V shall be protected throughout by an approved automatic sprinkler system.

(C) Birthing centers shall be separated from other tenants and occupancies by walls having at least a one (1)-hour fire-resistance rating. These walls shall extend from the floor slab below to the floor or roof slab above.

(D) The number of stories in a building housing a birthing center shall be determined by counting all patient care areas in the building.

(E) Every stairway, elevator shaft, light and ventilation shaft, chute and other openings between stories shall be enclosed or protected to prevent the spread of fire or smoke from one (1) floor to another. The fire-resistance rating of the enclosure or protection shall be not less than the structural floor separation requirements of "NFPA 220, Standard on Types of Building Construction, 1992 Edition," in 1994 National Fire Codes, Volume 5 for the fire-resistive building type classification required by subsection (9)(A) of this section.

(10) Elevators.

(A) Multistory buildings shall have at least one (1) elevator if patient services are located on any floor other than the grade level (birthing center's main entrance) floor.

(B) The elevator cab and door opening shall be of sufficient size to facilitate the movement of a patient on an ambulance stretcher.

(11) Mechanical Requirements.

(A) Heating, ventilating and cooling equipment shall be provided, maintained and operated to provide ambient temperatures of sixty-eight to eighty-five degrees Fahrenheit (68-85^oF).

(B) All toilets and soiled materials holding/workrooms shall be exhausted to the outside by exhaust fans.

(12) Plumbing and Other Piping Systems.

(A) Systems shall be designed to supply water to the fixtures and equipment on every floor at an adequate pressure for their practical use.

(B) Reduced pressure backflow preventers shall be installed where the water service enters the building and on hose bibbs and on all fixtures, such as janitors' sinks and laboratory fixtures, to which hoses or tubing can be attached.

(C) Hot water distribution systems shall be delivered to each fixture at a temperature which precludes the hazard of scalding.

(13) Electrical Requirements.

(A) Every room, including storage rooms, corridor and all other areas shall be sufficiently illuminated to facilitate efficient performance of all necessary tasks.

(B) Trickle charge battery pack units, complying with the standards of "Article 700, NFPA 70, National Electrical Code, 1994 Edition," in National Fire Codes, Volume 3 shall be located to provide emergency lighting in the birthing rooms, exit corridors, exit signs, electrical branch panel rooms and exit stairs to point of discharge at grade. These fixtures shall be tested at least quarterly with the tests documented in writing. An emergency stand-by power system is not required in birthing centers.

(C) There shall be one (1) electrical outlet for the emergency light and at least two (2) additional duplex outlets in each birthing room.

(D) The fire alarm system in existing birthing rooms may consist of the local alarms from the required smoke detectors provided the alarm from any one (1) of the detectors may be heard throughout the occupied areas of the birthing center. Existing birthing centers with building configurations which preclude a local alarm from alerting all birthing center occupants must have an electrically powered fire alarm system which will alert all areas of the facility when activated.

(E) Existing birthing centers shall have smoke detectors installed at thirty-foot (30') intervals in all rooms and in corridors. All required smoke detectors in existing birthing centers may be battery powered. Battery-powered smoke detectors shall be tested at least quarterly with the tests documented in writing.

Notes

19 CSR 30-30.110

AUTHORITY: section 197.225, RSMo 1994.* Emergency rule filed May 1, 1995, effective May 10, 1995, expired Sept. 7, 1995. Original rule filed May 1, 1995, effective Nov. 30, 1995. Emergency amendment filed June 19, 1998, effective July 1, 1998, expired Feb. 25, 1999. Amended: Filed June 19, 1998, effective Jan. 30, 1999.

*Original authority 1975, amended 1986.