26 Tex. Admin. Code § 510.123 - Spatial Requirements for New Construction
(a) Administration and public suite. The
following rooms or areas shall be provided.
(1) Primary entrance. An entrance at grade
level shall be accessible and protected from inclement weather with a
drive-under canopy for loading and unloading passengers.
(2) Lobby. A main lobby shall be located at
the primary entrance and shall include a reception and information counter or
desk, waiting spaces, public toilet facilities, public telephones, drinking
fountains, and storage room or alcove for wheelchairs.
(3) Admissions area. An admissions area shall
include a waiting area, work counters or desk, private interview spaces, and
storage room or alcove for wheelchairs. The waiting area and wheelchair storage
may be shared with similar areas located in the main lobby.
(4) General or individual offices. Office
space shall be provided for business transactions, medical and financial
records, and administrative and professional staffs.
(5) Multipurpose rooms. Rooms shall be
provided for conferences, meetings, and health education purposes including
provisions for showing visual aids.
(6) Storage. Storage for office equipment and
supplies shall be provided. The construction protection for the storage room or
area shall be in accordance with the National Fire Protection Association 101,
Code for Safety to Life from Fire in Buildings and Structures, 1997 edition
(NFPA 101) §18-3.1.
(b) Cart cleaning and sanitizing unit. A cart
cleaning and sanitizing unit is optional for crisis stabilization units.
(1) Architectural requirements.
(A) Cart cleaning, sanitizing and storage
shall be provided for carts serving dietary services and linen
services.
(B) Cart facilities may
be provided for each service or be centrally located.
(C) Hand washing fixtures shall be provided
in cart cleaning, sanitizing and storage areas.
(2) Details and finishes. Details and
finishes shall be in accordance with §
510.122(d)(2) of
this subchapter (relating to New Construction Requirements) and this paragraph.
(A) Flooring in the cart cleaning and
sanitizing unit shall be of the seamless type, or ceramic or quarry tile as
required by §
510.122(d)(2)(B)(iii)(III) or
(IV) of this subchapter.
(B) Ceilings in the cart cleaning and
sanitizing unit shall be the monolithic type as required by §
510.122(d)(2)(B)(vi)(III)
of this subchapter.
(3) Piping systems and plumbing fixtures.
Piping systems and plumbing fixtures shall be in accordance with §
510.122(d)(4) of
this subchapter and this paragraph.
(A) Hand
washing fixtures shall be provided with hot and cold water. Hot and cold water
fixtures shall be provided in cart cleaning and sanitizing locations.
(B) Where floor drains or floor sinks are
installed, they shall be of a type that can be easily cleaned by removal of the
cover. Removable stainless steel mesh shall be provided in addition to a
grilled drain cover to prevent entry of large particles of waste which might
cause stoppages. Floor drains and floor sinks shall be located to avoid
conditions where removal of covers for cleaning is difficult.
(c) Central sterile
supply suite. A central sterile supply suite is optional for crisis
stabilization units.
(1) Architectural
requirements.
(A) Supply storage. A storage
room for clean and sterile supplies shall be provided. The storage room shall
have adequate areas and counters for breakdown of prepackaged
supplies.
(B) Equipment storage. An
equipment storage room shall be provided.
(2) Details and finishes. Details and
finishes shall be in accordance with §
510.122(d)(2) of
this subchapter and this paragraph. Ceilings in supply storage room shall be
monolithic type in accordance with §
510.122(d)(2)(B)(vi)(III)
of this subchapter.
(3) Mechanical Requirements. Mechanical
requirements shall be in accordance with §
510.122(d)(3) of
this subchapter and this paragraph.
(A) The
sterile supply room shall include provisions for ventilation, humidity, and
temperature control.
(B) Filtration
requirements for air handling units serving the central sterile supply suite
shall be equipped with filters having efficiencies equal to, or greater than
specified in Table 4 of §
510.131(d) of
this subchapter (relating to Tables).
(C) Duct linings exposed to air movement
shall not be used in ducts serving the central sterile supply suite unless
terminal filters of at least 90% efficiency are installed downstream of
linings. This requirement shall not apply to mixing boxes and acoustical traps
that have special coverings over such lining.
(d) Dietary suite.
(1) Architectural requirements.
(A) General. Construction, equipment, and
installation shall comply with the standards specified in 25 TAC Chapter 228
(relating to Retail Food Establishments).
(B) Food service facilities. Food services
shall be provided by an on-site food preparation system or an off-site food
service system or a combination of the two. The following minimum functional
elements shall be provided on-site regardless of the type of dietary services.
(i) Dining area. Provide dining space for
ambulatory patients, staff, and visitors with a minimum floor space of 15
square feet per person to be seated. The footage requirement does not include
serving areas. The dining area and service areas shall be separate from the
food preparation and distribution areas.
(ii) Receiving area. This receiving area
shall have direct access to the outside for incoming dietary supplies or
off-site food preparation service and shall be separate from the general
receiving area. The receiving area shall contain a control station and an area
for breakout for loading, unloading, uncrating, and weighing supplies. The
entrance area to the receiving area shall be covered from the
weather.
(iii) Storage spaces.
Storage spaces shall be convenient to receiving area and food preparation area
and shall be located to exclude traffic through the food preparation area.
Regardless of the type of food services provided, the facility shall provide
storage of food for emergency use for a minimum of four calendar days.
(I) Storage space. Storage space shall be
provided for bulk, refrigerated, and frozen foods.
(II) Cleaning supply storage. This room or
closet shall be used to store non-food items that might contaminate edibles.
This storage area may be combined with the housekeeping room.
(iv) Food preparation area.
Counter space shall be provided for food prep work, equipment, and an area to
assemble trays for distribution for patient meals.
(v) Ice making equipment. Ice making
equipment shall be provided for both drinks and food products (self-dispensing
equipment) and for general use (storage-bin type equipment).
(vi) Hand washing. Hand washing fixtures with
hands-free operable controls shall be conveniently located at all food
preparation areas and serving areas.
(vii) Food service carts. When a cart
distribution system is provided, space shall be provided for storage, loading,
distribution, receiving, and sanitizing of the food service carts. The cart
traffic shall be designed to eliminate any danger of cross-circulation between
outgoing food carts and incoming soiled carts, and the cleaning and sanitizing
process. Cart circulation shall not be through food processing areas.
(viii) Ware washing room. A ware washing room
equipped with commercial type dishwasher equipment shall be located separate
from the food preparation and serving areas. Space shall be provided for
receiving, scraping, sorting, and stacking soiled tableware and for
transferring clean tableware to the using areas. Hand washing facilities with
hands-free operable controls shall be located within the soiled dish wash area.
A physical separation to prevent cross traffic between the dirty side and clean
side of the dish wash areas shall be provided.
(ix) Pot washing facilities. A three
compartmented sink of adequate size for intended use shall be provided
convenient to the food preparation area. Supplemental heat for hot water to
clean pots and pans shall be by booster heater or by steam jet.
(x) Waste storage room. A food waste storage
room shall be conveniently located to the food preparation and ware washing
areas but not within the food preparation area. It shall have direct access to
the facility's waste collection and disposal facilities. A waste storage room
is optional for crisis stabilization units.
(xi) Sanitizing facilities. Storage areas and
sanitizing facilities for garbage or refuse cans, carts, and mobile tray
conveyors shall be provided. All containers for trash storage shall have
tight-fitting lids.
(xii)
Housekeeping room. A housekeeping room shall be provided for the exclusive use
of the dietary department. Where hot water or steam is used for general
cleaning, additional space within the room shall be provided for the storage of
hoses and nozzles.
(xiii) Office
spaces. An office shall be provided for the use of the food service manager or
the dietary service manager. In smaller facilities, a designated alcove may be
located in an area that is part of the food preparation area.
(xiv) Toilets and locker spaces. A toilet
room shall be provided for the exclusive use of the dietary staff. Toilets
shall not open directly into the food preparation areas but must be in close
proximity to them. For larger facilities, a locker room or space for lockers
shall be provided for staff belongings.
(C) Additional service areas, rooms, and
facilities. When an on-site food preparation system is used, in addition to the
items required in subparagraph (B), the following service areas, rooms, and
facilities shall be provided.
(i) Food
preparation facilities. When food preparation systems are provided, there shall
be space and equipment for preparing, cooking, and baking.
(ii) Tray assembly line. A patient tray
assembly and distribution area shall be located within close proximity to the
food preparation and distribution areas.
(iii) Food storage. The food storage room
shall be adequate in size to accommodate food for a seven calendar day menu
cycle.
(iv) Additional storage
areas. Additional areas shall be provided for the storage of cooking wares,
extra trays, flatware, plastic and paper products, and portable
equipment.
(v) Drying storage area.
Provisions shall be made for drying and storage of pots and pans from the pot
washing room.
(D)
Equipment. Equipment for use in the dietary suite shall meet the following
requirements.
(i) Mechanical devices shall be
heavy duty, suitable for the use intended, and easily cleaned. Where equipment
is movable, provide heavy duty locking casters. Equipment with fixed utility
connections shall not be equipped with casters.
(ii) Floor, wall, and top panels of walk-in
coolers, refrigerators, and freezers shall be insulated. Coolers and
refrigerators shall be capable of maintaining a temperature down to freezing.
Freezers shall be capable of maintaining a temperature of 20 degrees below 0
degrees Fahrenheit. Coolers, refrigerators, and freezers shall be
thermostatically controlled to maintain desired temperature settings in
increments of two degrees or less. Interior temperatures shall be indicated
digitally and visible from the exterior. Controls shall include audible and
visible high and low temperature alarm. The time of alarm shall be
automatically recorded.
(iii)
Walk-in units may be lockable from the outside but must have a release
mechanism for exit from inside at all times. The interior shall be lighted. All
shelving shall be corrosion resistant, easily cleaned, and constructed and
anchored to support a loading of at least 100 pounds per linear foot.
(iv) All cooking equipment shall be equipped
with automatic shut-off devices to prevent excessive heat buildup.
(E) Vending services. When vending
machines are provided, a dedicated room or an alcove shall be located so that
access is available at all times.
(2) Details and finishes. Details and
finishes shall be in accordance with §
510.122(d)(2) of
this subchapter and this paragraph.
(A)
Details.
(i) Food storage shelves shall not be
less than six inches above the finished floor and the space below the bottom
shelf shall be closed in and sealed tight for ease of cleaning.
(ii) Operable windows and doors not equipped
with automatic closing devices shall be equipped with insect screens.
(iii) Food processing areas in the central
dietary kitchen shall have ceiling heights not less than nine feet. Ceiling
mounted equipment shall be supported from rigid structures located above the
finished ceiling.
(iv) Mirrors
shall not be installed at hand washing fixtures in the food preparation
areas.
(B) Finishes.
(i) Floors in areas used for food
preparation, food assembly, soiled and clean ware cleaning shall be
water-resistant and grease-proof. Floor surfaces, including tile joints, shall
be resistant to food acids.
(ii)
Wall bases in food preparation, food assembly, soiled and clean ware cleaning
and other areas which are frequently subject to wet cleaning methods shall be
made integral and coved with the floor, tightly sealed to the wall, constructed
without voids that can harbor insects, retain dirt particles, and be impervious
to water.
(iii) In the dietary and
food preparation areas, the wall construction, finishes, and trim, including
the joints between the walls and the floors, shall be free of voids, cracks,
and crevices.
(iv) The ceiling in
food preparation and food assembly areas shall be washable as required by
§
510.122(d)(2)(B)(vi)(II)
of this subchapter.
(v) The ceiling in the food storage room and
soiled and clean ware cleaning area shall be of the monolithic type as required
by §
510.122(d)(2)(B)(vi)(III)
of this
subchapter.
(3)
Mechanical Requirements. Mechanical requirements shall be in accordance with
§
510.122(d)(3) of
this subchapter and this paragraph.
(A)
Exhaust hoods handling grease-laden vapors in food preparation centers shall
comply with National Fire Protection Association 96, Standard for Ventilation
Control and Fire Protection of Commercial Cooking Operations, 1998 edition. All
hoods over cooking ranges shall be equipped with grease filters, fire
extinguishing systems, and heat-actuated fan controls. Clean out openings shall
be provided every 20 feet and at any changes in direction in the horizontal
exhaust duct systems serving these hoods. (Horizontal runs of ducts serving
range hoods should be kept to a minimum.)
(B) When air change standards in Table 3 of
§
510.131(c) of
this subchapter do not provide sufficient air for proper operation of exhaust
hoods (when in use), supplementary filtered makeup air shall be provided in
these rooms to maintain the required airflow direction and exhaust velocity.
Makeup systems for hoods shall be arranged to minimize "short circuiting" of
air and to avoid reduction in air velocity at the point of contaminant
capture.
(C) Air handling units
serving the dietary suite shall be equipped with filters having efficiencies
equal to, or greater than specified in Table 4 of §
510.131(d) of
this subchapter.
(4)
Piping systems and plumbing fixtures. Piping systems and plumbing fixtures
shall be in accordance with §
510.122(d)(4) of
this subchapter and this paragraph.
(A) The
kitchen grease traps shall be located and arranged to permit easy access
without the need to enter food preparation or storage areas. Grease traps shall
be of capacity required and shall be accessible from outside of the building
without need to interrupt any services.
(B) Grease traps or grease interceptors shall
be located outside the food preparation area and shall comply with the
requirements in the International Association of Plumbing and Mechanical
Officials National Standard Plumbing Code, 2000 edition.
(C) The material used for plumbing fixtures
shall be non-absorptive and acid-resistant.
(D) Water spouts used at lavatories and sinks
shall have clearances adequate to avoid contaminating utensils and
containers.
(E) Hand washing
fixtures used by food handlers shall be trimmed with valves that can be
operated without hands. Single lever or wrist blade devices may be used. Blade
handles used for this purpose shall not be less than four inches in
length.
(F) Drainage and waste
piping shall not be installed in the space above the ceiling or installed in an
exposed location in food preparation centers, food serving facilities and food
storage areas unless special precautions are taken to protect the space below
from leakage and condensation from necessary overhead piping.
(G) No plumbing lines may be exposed overhead
or on walls where possible leaks would create a potential for food
contamination.
(5)
Electrical requirements. Electrical requirements shall be in accordance with
§
510.122(d)(5) of
this subchapter and this paragraph.
(A)
Exhaust hoods shall have an indicator light indicating that the exhaust fan is
in operation.
(B) The electrical
circuits to equipment in wet areas shall be provided with five milliampere
GFCI.
(e)
Emergency treatment room.
(1) Architectural
requirements.
(A) Emergency treatment room. As
a minimum requirement, a facility shall provide at least one emergency
treatment room to handle emergencies. The emergency treatment room may be
located anywhere in the facility and shall meet the following requirements.
(i) The emergency treatment room shall have a
minimum clear area of 120 square feet clear floor area exclusive of fixed and
movable cabinets and shelves. The minimum clear room dimension exclusive of
fixed cabinets and built-in shelves shall be 10 feet. The emergency treatment
room shall contain cabinets, medication storage, work counter, examination
light, and hand washing fixtures with hands-free operable controls. Exception:
Crisis stabilization units are not required to have medication storage in the
emergency treatment room.
(ii)
Storage space shall be provided within the room or on an emergency cart and be
under staff control for general medical emergency supplies and medications.
Adequate space shall be provided for emergency equipment.
(B) Secured holding room. When provided, this
room shall be constructed to allow for security, patient and staff safety,
patient observation, and sound proofing.
(C) Service areas. The following service
areas shall be provided.
(i) Soiled workroom.
The workroom shall contain a work counter, a clinical sink or equivalent
flushing type fixture, hand washing fixture with hands-free operable controls,
waste receptacles, and soiled linen receptacles. The soiled workroom in the
nursing suite may be shared with the emergency treatment room if it is located
conveniently nearby.
(ii)
Housekeeping room. The housekeeping room shall be located nearby.
(iii) Patient toilet. A toilet room shall be
provided and located nearby.
(2) Details and finishes. Details and
finishes shall be in accordance with §
510.122(d)(2) of
this subchapter and this paragraph.
(A)
Flooring used in the treatment room, secure holding area, and soiled workroom
shall be of the seamless type as required by §
510.122(d)(2)(B)(iii)(III)
of this subchapter.
(B) Ceilings in soiled workrooms and secure
holding rooms shall be of the monolithic type as required by §
510.122(d)(2)(B)(vi)(III)
of this subchapter.
(3) Mechanical requirements. Mechanical
requirements shall be in accordance with §
510.122(d)(3) of
this subchapter and this paragraph. Duct linings exposed to air movement shall
not be used in ducts serving any treatment rooms and secure holding rooms. This
requirement shall not apply to mixing boxes and acoustical traps that have
special coverings over such lining.
(4) Piping systems and plumbing fixtures.
Piping systems and plumbing fixtures shall be in accordance with §
510.122(d)(4) of
this subchapter. When provided, medical gas systems shall be in accordance with
§
510.122(d)(4)(A)(iii)
of this subchapter.
(5) Electrical requirements. Electrical
requirements shall be in accordance with §
510.122(d)(5) of
this subchapter and this paragraph.
(A)
General.
(i) Each treatment room shall have a
minimum of six duplex electrical receptacles. Two duplex electrical receptacles
shall be located convenient to the head of the bed.
(ii) Each work counter and table shall have
access to two duplex receptacles connected to the critical branch of the
emergency electrical system and be labeled with panel and circuit
number.
(B) Nurses
calling systems. A nurses regular calling system shall be provided for the
treatment room in accordance with §
510.122(d)(5)(K)(i)
of this
subchapter.
(f)
Employees suite. Lockers, lounges, toilets, and other amenities as determined
by the facility shall be provided throughout the facility for employees and
volunteers. These amenities are in addition to, and separate from, those
required for the medical staff and the public.
(g) Engineering suite and equipment areas.
(1) General. The following areas or rooms
shall be provided:
(A) an engineer's office
with file space and provisions for protected storage of facility drawings,
records, manuals, etc.;
(B) a
general maintenance shop for repair and maintenance;
(C) a separate room for building maintenance
supplies and equipment and storage of bulk solvents and flammable liquids shall
be in a separate building and not within the facility building;
(D) a medical equipment room which includes
provisions for the storage, repair, and testing of electronic and other medical
equipment;
(E) a separate room or
building for yard maintenance equipment and supplies. When a separate room is
within the physical plant the room shall be located so that equipment may be
moved directly to the exterior. Yard equipment or vehicles using flammable
liquid fuels shall not be stored or housed within the facility building;
and
(F) sufficient space in all
mechanical and electrical equipment rooms for proper maintenance of equipment.
Provisions shall also be made for removal and replacement of
equipment.
(2)
Additional areas or rooms. Additional areas or rooms for mechanical, and
electrical equipment shall be provided within the physical plant or installed
in separate buildings or weatherproof enclosures with the following exceptions.
(A) An area shall be provided for cooling
towers and heat rejection equipment when such equipment is used.
(B) An area for the medical gas park and
equipment shall be provided. For smaller medical gas systems, the equipment may
be housed in a room within the physical plant in accordance with National Fire
Protection Association 99, Standard for Health Care Facilities, 1999 edition
(NFPA 99), Chapters 4 and 8.
(C)
When provided, compactors, dumpsters, and incinerators shall be located in an
area remote from public entrances.
(h) General stores.
(1) General. In addition to storage rooms in
individual departments, a central storage room shall also be provided. General
stores may be located in a separate building on-site with provisions for
protection against inclement weather during transfer of supplies.
(2) Receiving. Central storage areas shall be
provided with an off-street unloading and receiving area protected from
inclement weather.
(3) General
storage room. General storage room with a total area of not less than 12 square
feet per inpatient bed shall be provided. The storage room may be within the
facility, or separate building on-site. A portion of the storage may be
provided off-site.
(4) Outpatient
suite storage room. A storage room for the outpatient services shall be
provided at least equal to five percent of the total area of the outpatient
suite. This required storage room area may be combined with general
stores.
(i) Geriatric,
Alzheimer, and other dementia nursing suites. When geriatric, Alzheimer, or
other dementia nursing suites are provided, the nursing suite shall comply with
the requirements in subsection (o) of this section with the following
exceptions.
(1) A patient bedroom suite shall
be 120 square feet in a single patient bedroom suite and 200 square feet in
multiple-bed room suites.
(2) Each
patient bedroom shall have storage for extra blankets, pillows, and
linen.
(3) Patient bedroom doors
shall be a minimum of three feet eight inches in width.
(4) Patients shall have access to at least
one bathtub in each nursing suite.
(5) A minimum of two separate social spaces,
one appropriate for noisy activities and the other for quiet activities, shall
be provided. The combined total area shall be not less than 30 square feet per
bed space with not less than 140 square feet for each of the two spaces,
whichever is greater. This space may be shared with the dining area or
room.
(6) Storage space for
wheelchairs shall be provided in the nursing unit.
(j) Imaging suite.
(1) Architectural requirements.
(A) General. When diagnostic imaging services
are provided, the minimum the facility shall provide is a diagnostic
radiographic (X-ray) room.
(i) Diagnostic
radiographic (x-ray) room sizes shall be in compliance with manufacturer's
recommendation. When portable x-ray equipment is used, the portable unit shall
be stored in a secured room.
(ii)
When radiation protection is required for any diagnostic imaging room, a
medical physicist licensed under Texas Occupations Code Chapter 602, shall
specify the type, location, and amount of radiation protection to be installed
for the layout and equipment selections.
(iii) Each X-ray room shall include a
shielded control alcove. The control alcove shall be provided with a view
window designed to permit full view of the examination table and the patient at
all times.
(iv) Warning signs
capable of indicating that the equipment is in use shall be provided.
(B) Service areas. The following
service areas shall be provided.
(i) Patient
waiting area. The area shall be out of traffic and under direct staff visual
control.
(ii) Patient toilet rooms.
Toilet rooms with hand washing amenities shall be located convenient to the
waiting area.
(iii) Patient
dressing rooms. Dressing rooms shall be convenient to the waiting areas and
X-ray rooms.
(iv) Hand washing
facilities. A freestanding hand washing fixture with hands-free controls shall
be provided in or near the entrance to each diagnostic and procedure room
unless noted otherwise. Hand washing facilities shall be arranged to minimize
any incidental splatter on nearby personnel or equipment.
(v) Contrast media preparation. This room
shall include a work counter, a sink with hands-free operable controls, and
storage. One preparation room may serve any number of rooms. When prepared
media is used, this area may be omitted, but storage shall be provided for the
media.
(vi) Film processing room. A
darkroom shall be provided for processing film unless the processing equipment
normally used does not require a darkroom for loading and transfer. When
daylight processing is used, the darkroom may be minimal for emergency and
special uses. Film processing shall be located convenient to the procedure
rooms and to the quality control area.
(vii) Quality control area or room. An area
or room for film viewing shall be located near the film processor. All view
boxes shall be illuminated to provide light of the same color value and
intensity.
(viii) Film storage
(active). A room shall include a cabinet or shelves for filing patient film for
immediate retrieval.
(ix) Film
storage (inactive). A room for inactive film storage shall be provided. It may
be outside the imaging suite but must be under the administrative control of
imaging suite personnel and be properly secured to protect films against loss
or damage.
(x) Storage for
unexposed film. Storage amenities for unexposed film shall include protection
of film against exposure or damage.
(xi) Storage of cellulose nitrate film. When
used, cellulose nitrate film shall be stored in accordance with the
requirements of National Fire Protection Association 40, Standard for the
Storage and Handling of Cellulose Nitrate Motion Picture Film, 1994
edition.
(xii) Housekeeping room.
The room may serve multiple departments when conveniently located.
(2) Details and
finishes. Details and finishes shall be in accordance with §
510.122(d)(2) of
this subchapter and this paragraph.
(A)
Details.
(i) Radiation protection shall be
designed, tested, and approved by a medical physicist licensed under Texas
Occupations Code Chapter 602.
(ii)
The design and environmental controls associated with licensable quantities of
radioactive material in laboratories, imaging rooms, or both shall be approved
by the Texas Department of State Health Services Radiation Control Program
prior to licensed authorizations.
(iii) Where protected alcoves with view
windows are required, provide a minimum of 1 foot 6 inches between the view
window edge or frame and the outside partition edge.
(iv) Imaging procedure rooms shall have
ceiling heights not less than nine feet. Ceilings containing ceiling-mounted
equipment shall be of sufficient height to accommodate the equipment of
fixtures and their normal movement.
(B) Finishes.
(i) Flooring used in contrast media
preparation and soiled workroom shall be of the seamless type as required by
§
510.122(d)(2)(B)(iii)(III)
of this subchapter.
(ii) A lay-in type ceiling is acceptable for
the diagnostic room.
(3) Mechanical Requirements.
(A) Mechanical requirements shall be in
accordance with §
510.122(d)(3) of
this subchapter and this paragraph.
(B) Air handling units serving the imaging
suite shall be equipped with filters having efficiencies equal to, or greater
than specified in Table 4 of §
510.131(d) of
this subchapter.
(4)
Piping systems and plumbing fixtures. Piping systems and plumbing fixtures
shall be in accordance with §
510.122(d)(4) of
this subchapter and this paragraph. When automatic film processors are used, a
receptacle of adequate size with hot and cold water for cleaning the processor
racks shall be provided.
(5)
Electrical requirements. Electrical requirements shall be in accordance with
§
510.122(d)(5) of
this subchapter and this paragraph.
(A)
General.
(i) Each imaging procedure room shall
have at least four duplex electrical receptacles.
(ii) A special grounding system in areas such
as imaging procedures rooms where a patient may be treated with an internal
probe or catheter shall comply with Chapter 9 of NFPA 99 and Article 517 of
NFPA 70.
(iii) General lighting
with at least one light fixture powered from a normal circuit shall be provided
in imaging procedures rooms in addition to special lighting units at the
procedure or diagnostic tables.
(B) Nurses calling system.
(i) Nurses regular calling system. The nurses
regular calling system shall be provided for patient dressing rooms in
accordance with §
510.122(d)(5)(K)(i)
of this subchapter.
(ii) Nurses emergency calling system. In
toilet rooms used by inpatients and outpatients, a nurses emergency call
station shall be provided in accordance with §
510.122(d)(5)(K)(ii)
of this subchapter.
(iii) Staff emergency assistance calling
system. A staff emergency assistance calling system (code blue) shall be
provided for staff to summon additional assistance for each imaging procedure
room in accordance with §
510.122(d)(5)(K)(iii)
of this
subchapter.
(k) Laboratory suite.
(1) Architectural requirements.
(A) General. The required laboratory testing
shall be performed on-site or provided through a contractual arrangement with a
laboratory service.
(i) Provisions for
laboratory services shall be provided within the facility for urinalysis, blood
glucose and electrolytes.
(ii) Each
laboratory unit shall meet the requirements of Chapter 10 of NFPA 99 and
Chapter 18 of NFPA 101.
(B) Minimum laboratory. When laboratory
services are provided off-site by contract, the following minimum areas or
rooms shall be provided within the facility.
(i) Laboratory work room. The laboratory
workroom shall include a counter and a sink with hands-free operable
controls.
(ii) General storage.
Cabinets or closets shall be provided for supplies and equipment used in
obtaining samples for testing. A refrigerator or other similar equipment shall
be provided for specimen storage waiting for transfer to off-site
testing.
(iii) Specimen collection
room. A blood collection room shall be provided with a counter, space for
seating, and hand washing fixture with hands-free operable controls. A toilet
and lavatory with hands-free operable controls shall be provided for specimen
collection. This room may be outside the laboratory suite if conveniently
located.
(C) On-site
laboratory. When the facility provides on-site laboratory services, the
following areas or rooms shall be provided in addition to the requirements in
paragraph (1)(A) and (1)(B) of this subsection.
(i) Laboratory workrooms. The laboratory work
room shall include counters, space appropriately designed for laboratory
equipment, sinks with hands-free operable controls, vacuum, gases, air, and
electrical services as needed.
(ii)
General storage. Storage, including refrigeration for reagents, standards,
supplies, and stained specimen microscope slides, etc. shall be provided.
Separate spaces shall be provided for such incompatible materials as acids and
bases, and vented storage shall be provided for volatile solvents.
(iii) Chemical safety. When chemical safety
is a requirement, provisions shall be made for an emergency shower and eye
flushing devices.
(iv) Flammable
liquids. When flammable or combustible liquids are used, the liquids shall be
stored in approved containers, in accordance with National Fire Protection
Association 30, Flammable and Combustible Liquids Code, 1996 edition.
(v) Radioactive materials. When radioactive
materials are employed, storage amenities shall be provided.
(D) Service areas or rooms. The
following service areas or rooms shall be provided.
(i) Hand washing amenities. Each laboratory
room or work area shall be provided with a hand washing fixture with hands-free
operable controls.
(ii) Office
spaces. The scope of laboratory services shall determine the size and quantity
for administrative areas including offices as well as space for clerical work,
filing, and record maintenance. At a minimum, an office space shall be provided
for the use of the laboratory service director.
(iii) Staff facilities. Lounge, locker, and
toilet amenities shall be conveniently located for male and female laboratory
staff. These may be outside the laboratory area and shared with other
departments.
(iv) Housekeeping
room. A housekeeping room shall be located nearby.
(2) Details and finishes. Details
and finishes shall be in accordance with §
510.122(d)(2) of
this subchapter. Floors in laboratories shall comply with the requirements of
§
510.122(d)(2)(B)(iii)
of this subchapter except that carpet
flooring shall not be used.
(3)
Mechanical requirements. Mechanical requirements shall be in accordance with
§
510.122(d)(3) of
this subchapter and this paragraph.
(A) No air
from the laboratory areas shall be recirculated to other parts of the facility.
Recirculation of air within the laboratory suite is allowed.
(B) When laboratory hoods are provided, they
shall meet the following general requirements.
(i) The average face velocity of each exhaust
hood shall be at least 75 feet per minute.
(ii) The exhaust shall be connected to an
exhaust system to the outside which is separate from the building exhaust
system.
(iii) The exhaust fan shall
be located at the discharge end of the system.
(iv) The exhaust duct system shall be of
noncombustible and corrosion resistant material.
(C) Filtration requirements for air handling
units serving the laboratory suite shall be equipped with filters having
efficiencies equal to, or greater than specified in Table 4 of §
510.131(d) of
this subchapter.
(D) Duct linings
exposed to air movement shall not be used in ducts serving any laboratory room
and clean room unless terminal filters of at least 80% efficiency are installed
downstream of linings. This requirement shall not apply to mixing boxes and
acoustical traps that have special coverings over such lining.
(4) Piping systems and plumbing
fixtures. Piping systems and plumbing fixtures shall be in accordance with
§
510.122(d)(4) of
this subchapter and this paragraph.
(A)
General.
(i) Faucet spouts at lavatories and
sinks shall have clearances adequate to avoid contaminating utensils and the
contents of beakers, test tubes, etc.
(ii) Drain lines from sinks used for acid
waste disposal shall be made of acid-resistant material.
(iii) Drain lines serving some types of
automatic blood-cell counters must be of carefully selected material that will
eliminate potential for undesirable chemical reactions (or explosions) between
sodium azide wastes and copper, lead, brass, and solder, etc.
(B) Medical gas systems. When
provided, medical gas systems shall comply with §
510.122(d)(4)(A)(iii)
of this subchapter. The number of outlets in
the laboratory for vacuum, gases, and air shall be determined by the functional
program requirements.
(l) Laundry suite. Laundry amenities may be
provided on-site or off-site. On-site laundry services may be within the
facility or in a separate building.
(1)
Architectural requirements.
(A) General. The
following amenities are required for both on-site or off-site commercial
laundry services.
(i) The laundry room shall
be equipped and ventilated so as to minimize the dissemination of
contaminants.
(ii) Soiled and clean
linen processing areas shall be physically separated.
(iii) An adequate amount of hand washing
fixtures shall be provided in both the soiled and clean processing
areas.
(B) On-site
laundry processing. When linen is processed within the facility or in a
separate building located on-site, the following minimum requirements shall be
provided.
(i) A receiving, holding, and
sorting room for control and distribution of soiled linen shall be provided.
This area may be combined with the soiled linens processing room. Discharge
from soiled linen chutes may be received within this room or in a separate
dedicated room.
(ii) A laundry
processing room shall be provided which shall contain commercial type equipment
capable of processing at least a seven-day laundry supply within the regular
scheduled work week.
(iii) A clean
linen processing room shall be provided and shall include built-in dryers and
folding counters or tables. This area shall have provisions for inspections,
folding, packing, and mending of linen.
(iv) A holding room or area for storage and
issuing of clean linen shall be provided but may be combined with clean linen
processing room.
(C)
Off-site laundry processing. When linen is processed off the facility site, the
following minimum requirements shall be provided on-site:
(i) a service entrance which shall have
protection from inclement weather, for loading and unloading of
linen;
(ii) control station for
pickup and receiving;
(iii) soiled
linen holding room;
(iv) a central
clean linen storage room and issuing room in addition to linen storage required
at the individual patient suites. This central holding area shall include
provisions for inspecting, sorting, and mending; and
(v) cart storage areas, which shall be
located out of pedestrian traffic and shall be provided separately for clean
and soiled linen.
(D)
Service areas for on-site laundry processing. The laundry shall be separated
from patient rooms, areas of food preparation and storage, and areas in which
clean supplies and equipment are stored. An on-site laundry shall have the
following services areas and facilities.
(i)
Office space. Office space for director of laundry services.
(ii) Equipment layout for soiled and clean
linen. The laundry equipment processing shall be arranged to permit an orderly
work flow and minimize cross-traffic that might mix clean and soiled
operations.
(iii) Storage. Storage
space and cabinets for soaps, stain removers, and other laundry processing
agents shall be located in the soiled and clean processing rooms.
(iv) Cart sanitizing. Cart sanitizing shall
comply with subsection (b) of this section.
(v) Staff toilets. Toilets may be outside the
unit but shall be convenient for staff use and shall contain hand washing
fixtures with hands-free operable controls.
(vi) Staff lockers. Lockers may be in laundry
suite or part of a central locker area when convenient to the
laundry.
(vii) Housekeeping
room.
(2)
Mechanical Requirements. Mechanical requirements shall be in accordance with
§
510.122(d)(3) of
this chapter and this paragraph.
(A) The
ventilation system shall include adequate intake, filtration, exchange rate,
and exhaust in accordance with Table 3 and Table 4 of §
510.131(c) and
(d) of this subchapter.
(B) Filtration requirements for air handling
units serving the laundry suite shall be equipped with filters having
efficiencies equal to, or greater than specified in Table 4 of §
510.131(d) of
this subchapter.
(C) Direction of
air flow of the HVAC systems shall be from clean to soiled areas.
(D) The ventilation system for soiled
processing area shall have negative air pressure while the clean processing
area shall have positive pressure.
(m) Medical records suite. The following
rooms, areas, or offices shall be provided in the medical records suite:
(1) medical records administrator or
technician office;
(2) review and
dictating rooms or spaces;
(3) work
area which includes provisions for sorting, recording, or microfilming records;
and
(4) file storage room. Rooms
containing open file systems or moveable filing storage systems shall be
considered as hazardous. The construction protection for the storage room or
area shall comply with NFPA 101 §18-3.2.
(n) Nursing suite. The nursing suite shall be
designed to facilitate care of ambulatory and non-ambulatory inpatients.
(1) Physical environment. A nursing suite
shall provide a safe environment for patients and staff.
(A) The environment of the unit shall be
characterized by a feeling of openness with emphasis on natural light and
exterior views and with the organization of various functions accessible to
common spaces while not jeopardizing desirable levels of patient
privacy.
(B) Interior finishes,
lighting, and furnishings shall present an atmosphere which is as
noninstitutional as possible, consistent with applicable fire safety
requirements. Security and safety devices should not be present in a manner to
attract or challenge tampering by patients.
(2) Architectural requirements. Architectural
requirements shall be in accordance with §
510.122(d)(1) of
this subchapter and this paragraph.
(A)
Handicapped accessibility requirements. At least 10 percent of patient room
suites, bathing units and toilets, and all public and common use areas shall be
designed and constructed to be handicapped accessible. These requirements shall
apply in all new construction and when an existing nursing suite or a portion
thereof is converted from one service to another.
(B) Patient room suites. A patient room suite
shall consist of the patient room and a toilet room or bathroom. Patient room
suites shall comply with the following requirements.
(i) Maximum patient room capacity. The
maximum patient room capacity shall be two patients. In existing facilities
where renovation work is undertaken and the present capacity is more than two
patients, the maximum room capacity shall be no more than the present capacity
with a maximum of four patients.
(ii) Single-bed patient room. In a single-bed
patient room, the minimum clear floor area shall be 100 square feet. The
minimum clear floor area in an accessible private patient room shall be 120
square feet. The minimum room dimension shall be not less than 10
feet.
(iii) Multi-bed patient room.
In a multi-bed patient room, the minimum clear floor area shall be 80 square
feet per bed. Minimum clear floor space in an accessible multi-bed room shall
be 110 square feet per bed. Design of multi-bed patient rooms shall not
restrict independent patient access to the corridor, lavatory, or
bathroom.
(iv) Arrangement of
patient rooms. Minor encroachments including columns and wall hung lavatories
that do not interfere with functions may be ignored when determining space
requirements for patient rooms.
(I) Required
clear floor space in patient rooms shall be exclusive of toilet rooms, closets,
lockers, built-in cabinets, wardrobes, alcoves, or vestibules.
(II) A clearance of 3 feet 8 inches shall be
available at the foot of each bed in multi-bed patient rooms to permit the
passage of equipment and beds. A minimum distance of three feet between a wall
and the side of a bed and four feet between beds shall be provided. A minimum
distance of five feet between a wall and the side of a bed and four feet
between beds shall be provided in an accessible semi-private room or one
intended for rehabilitation patients. Arrangement of beds shall be such that
sufficient space is provided for a bed and maneuvering space for a
wheelchair.
(III) Sleeping areas
shall have doors for privacy. Design for visual privacy in multi-bed rooms
shall not restrict patient access to the room, toilet, or observation by
staff.
(v) Patient
bathroom. Each patient shall have access to a bathroom without having to enter
the general corridor area. Each bathroom shall contain a toilet, hand washing
fixtures, and storage shelf or cabinet and serve not more than four patient
beds or two patient rooms. Hand washing fixtures may be located in the patient
room.
(vi) Bathing rooms. One
bathtub or shower shall be provided for each four patient beds or space which
is not otherwise served by bathing rooms within patients' rooms. Each tub or
shower shall be in an individual room or enclosure which provides space for the
private use of the bathing fixture and for drying and dressing.
(vii) Patient storage. Each patient shall
have a separate wardrobe, locker, or closet that is suitable for hanging
full-length garments and for storing personal effects. A minimum of 12 lineal
inches of hanging space shall be provided per patient.
(C) Security rooms. When security rooms are
provided by the treatment program narrative, the security rooms shall be single
patient suite rooms designed to minimize potential for escape, hiding, injury
to self or others, or suicide. Access to toilets, showers, and wardrobes shall
be restricted. The patient room suite shall be in accordance with subparagraph
(B)(ii) of this paragraph. Security rooms may be centralized on one unit or
decentralized among units.
(D)
Seclusion suite. There shall be a seclusion suite in each nursing suite
intended for short-term occupancy by a single person requiring security and
protection from self or others. The seclusion suite shall consist of seclusion
rooms, an anteroom or a vestibule, a toilet, and hand washing fixtures.
(i) Each seclusion room shall be located and
designed in a manner affording direct visual supervision by nursing staff and
shall be constructed to prevent patient hiding, escape, injury, or suicide.
There shall be a minimum of one seclusion room for each 24 beds or any portion
thereof.
(I) The floor area of each seclusion
room shall be not less than 60 square feet. The minimum room dimension shall be
six feet.
(II) The seclusion room
shall have a minimum ceiling height of nine feet.
(III) The door to each seclusion room shall
have no hardware on the room side and shall open out. A vision panel shall be
provided in each door to permit staff observation of the entire room while
maintaining privacy from the public and other patients. The seclusion room door
shall swing out.
(IV) Each
seclusion room shall have natural light (skylight or window) in order to
maintain a therapeutic environment. Skylight wells or windows shall be not less
than 400 square inches in area.
(ii) Access to the seclusion room from any
public space such as a corridor shall be through an anteroom. When the
seclusion suite is directly accessible from the nurse station, a vestibule may
be provided in place of an anteroom. A cased opening to the vestibule in lieu
of a door may be provided as long as the arrangement assures privacy from the
public and other patients.
(I) The minimum
dimension of the anteroom or vestibule shall be eight feet.
(II) The door to the anteroom shall swing
in.
(iii) There shall be
at least one toilet room directly accessible from the anteroom or vestibule.
(I) The toilet room shall be large enough to
safely manage the patient.
(II) The
toilet room door shall swing out into the anteroom or vestibule.
(III) A water closet and hand washing
fixtures shall be provided in the toilet room. An unbreakable wall hung mirror
may be provided.
(IV) Doors for the
seclusion room and anteroom shall be not less than 3 feet 8 inches in
width.
(V) When the interior of the
seclusion room is padded, the padding shall be a Class "A." The flame spread
rating shall be 0-25 and the smoke development rating shall be 0-450 in
accordance with NFPA 101 Chapter 8.
(E) Airborne infection isolation suites. When
an isolation suite is provided, the suite may be located within a nursing suite
or in a separate isolation unit. Each airborne infection isolation suite shall
consist of a work area, a patient room, and a patient bathroom.
(i) The work area may be a separately
enclosed anteroom or a vestibule that is open to and is located immediately
inside the door to the patient room. It shall have amenities for hand washing,
gowning, and storage of clean and soiled materials. One enclosed anteroom may
serve multiple isolation rooms.
(ii) Each patient room shall have a clear
floor area of 120 square feet exclusive of the work area and shall contain only
one bed.
(iii) Each bathroom shall
be designed for the use of the handicapped and shall contain bathing fixtures,
toilet fixtures and hand washing fixtures. Each bathroom shall be arranged to
provide access from the patient room without entering or passing through the
work area.
(iv) At least one
airborne infection isolation suite with an enclosed anteroom shall be
provided.
(v) Ventilation
requirements for the isolation rooms shall be in accordance with Table 3 of
§
510.131(c) of
this subchapter.
(vi) Doors to
airborne infection isolation rooms shall be provided with self-closing
devices.
(F) Social
spaces. A minimum of two separate social spaces, one appropriate for noisy
activities and the other for quiet activities, shall be provided. The combined
total area shall be not less than 40 square feet per bed space with not less
than 160 square feet for each of the two spaces, whichever is greater. This
space may be shared with the dining area or room.
(G) Group therapy room. A room for group
therapy shall be included. The room shall not be less than 250 square feet. The
group therapy room may be combined with the quiet space required in
subparagraph (F) of this paragraph provided that a space of not less than 370
square feet is available for both the quiet activity room and group therapy
activities.
(H) Activity service
space. Space for activity services (e.g., music therapy, recreational therapy,
art, dance, vocational therapy, educational therapy, etc.) shall be provided at
the rate of 15 square feet per occupant of the room and a minimum area of not
less than 375 square feet, whichever is greater. Space shall include provisions
for hand washing, work counters, storage and displays. Where facilities contain
less than 25 beds, the activity services therapy functions may be provided
within the noisy activities area as required in subparagraph (F) of this
paragraph if a space of not less than 485 square feet is available for both the
noisy activity area and activity services area.
(I) Service areas. Service areas shall be
located in, or readily available to, each nursing suite. Each service area may
be arranged and located to serve more than one nursing suite but at least one
service area shall be provided on each nursing floor. A service area is
composed of the following.
(i) An
administrative center or nurses station with an adjacent but separate dictation
space.
(ii) A nurses
office.
(iii) An area for charting.
The charting area shall be provided with separation needed for acoustical
privacy as well as space required for the function. A view window to permit
observation of the patient area by the charting nurse or physician may be used
provided that it is so located that patient files cannot be read from outside
the charting space.
(iv) A
medication room, medicine alcove area, or a self-contained medicine dispensing
unit under visual control of nursing staff. The room shall have a minimum area
of 30 square feet under direct control of the nursing or pharmacy staff. The
room, area or unit shall contain a work counter, hand washing fixture with
hands-free operable controls, and refrigerator. Provisions for security against
unauthorized access shall be assured. Standard cup-sinks provided in many
self-contained units are not adequate for hand washing.
(v) A small kitchen for patient use. The room
shall contain a sink, refrigerator, ice dispenser, microwave, and storage
cabinets. This room is to provide nourishment for patients between scheduled
meals.
(vi) A multipurpose room for
staff and patient conferences, education and demonstrations. The room shall be
conveniently accessible to each nursing suite and may serve several nursing
suites or departments. The room may be located on another floor if convenient
for regular use.
(vii) An
examination or treatment room. The room shall have a minimum floor area of 120
square feet excluding space for vestibule, toilet, and closets. The minimum
room dimension shall be 10 feet. The room shall contain a lavatory or sink
equipped for hand washing, work counter, storage facilities, and a desk,
counter, or shelf space for writing. The emergency treatment room may be used
for this purpose if it is conveniently located on the same floor as the patient
rooms.
(viii) Patient laundry
facilities. An automatic washer and an electric dryer shall be provided. This
requirement may be omitted in nursing units intended only for adolescents and
gero-psychiatric patients.
(ix)
Staff lounge with separate female and male dressing areas containing lockers,
showers, toilets, and hand washing facilities. These facilities may be on
another floor.
(x) Securable
closets or cabinet compartments for personal articles of nursing unit staff.
The closets or lockers shall be located at or near the nurse station. At a
minimum, these shall be large enough for purses and billfolds. Coats may be
stored in closets or cabinets on each floor or in a central staff locker
area.
(xi) Secured storage area for
patients' effects determined potentially harmful (razors, nail files, cigarette
lighters, etc.). This area shall be controlled by staff.
(xii) Clean workroom or clean supply room.
When used for preparing patient care items, it shall contain a work counter,
hand washing facilities, and storage facilities for clean and sterile supplies.
When used only for storage and holding as part of a distribution system of
clean and sterile supplies, the work counter and hand washing facilities may be
omitted.
(xiii) Clean linen storage
for each nursing unit. The clean linen area shall contain a work counter and
storage space for clean linen. The area shall be a part of the storage and
distribution of clean linen. Minimum area for clean linen shall be three square
feet of room area per patient bed space. The required area may be concentrated
in one central room or divided in several rooms throughout the
facility.
(xiv) A soiled workroom
or soiled holding room. The room shall contain a clinical sink or equivalent
flushing rim fixture, hand washing facilities, both with hot and cold water.
The room shall have a work counter and space for separate covered containers
for soiled linen and waste. Minimum area for soiled linen shall be three square
feet of room area per patient bed space.
(xv) An equipment storage room and storage
room for administrative supplies located on each floor which may serve multiple
nursing suites.
(xvi) An emergency
equipment storage room or alcove under direct visual control of the nursing
staff and out of normal traffic.
(xvii) A housekeeping room which may also
serve adjacent nursing suites.
(xviii) Stretcher and wheelchair storage
space which is located without restricting normal traffic. The space may be
located outside the nursing suite.
(xix) An accessible public toilet with hand
washing fixtures. The toilets shall be located on each floor containing a
nursing suite.
(xx) Staff toilet
conveniently located to each nursing suite. At least one staff toilet shall be
located on each patient sleeping floor. Toilet may be unisex.
(xxi) An ice dispensing machine for each
nursing suite which is located at the nourishment station or the clean work
room.
(xxii) Adequate number of
drinking fountain fixtures.
(xxiii)
Adequate number of telephones available for patients' private
conversations.
(xxiv) A visitor
room for patients to meet with friends or family with a minimum floor space of
100 square feet.
(xxv) A quiet room
for a patient who needs to be alone for a short period of time but does not
require a seclusion room. Each quite room shall be not less than 80 square
feet. The visitor room may serve this purpose.
(xxvi) Separate consultation room. The room
shall have a minimum floor space of 100 square feet, and provided at a
room-to-bed ratio of one consultation room for each 12 patient beds. The
room(s) shall be designed for acoustical and visual privacy and constructed to
achieve a level of voice privacy of 50 STC (which in terms of vocal privacy
means that some loud or raised speech is heard only by straining, but is not
intelligible).
(xxvii) A conference
and treatment planning room for use for patient care planning. This room may be
combined with the charting room or use of the multipurpose room.
(3) Details and
finishes. Details and finishes shall be in accordance with §
510.122(d)(2) of
this chapter and this paragraph.
(A) Details.
(i) Egress. Means of egress from each patient
suite shall comply with the requirements of NFPA 101 §18-2.
(ii) Patient bathroom and toilet room doors.
Door leaves to all patient bathrooms and toilet rooms shall be at least 36
inches wide and shall swing outward or be double acting so that nursing staff
may gain access to a patient. Doors lockable from the inside shall have
hardware that allows staff to open the door from the outside.
(iii) Vision panels. Vision panels shall be
provided in the door between an anteroom and an airborne infection isolation
room.
(iv) Windows. Each patient
sleeping room shall have an outside window. The windows shall be restricted.
Where the operation of windows requires the use of tools or keys, the tools or
keys shall be located at each nurses station, on the same floor, and easily
accessible to staff. The bottom of the window opening shall not exceed 36
inches above the floor.
(v)
Location of patient room windows. Windows shall be located on an outside wall.
Windows may face an atrium, an inner court, or an outer court provided the
following requirements are met.
(I) Atria
windows. Atria onto which the required windows face shall comply with the
requirements of NFPA 101 §8-2.5.6.
(II) Outer courts. Outer court (not enclosed
by building on one side) onto which the required windows face shall have a
minimum width, at all levels, of not less than three inches for each foot, or
fraction thereof, of the height (average height of enclosing walls) of such
court, but in no case shall the width be less than five feet. An outer court
shall have a horizontal cross sectional area not greater than four times the
square of its width.
(III) Inner
courts. Inner court (enclosed by building on all sides) onto which the required
windows open shall have minimum width, at all levels, of not less than one foot
for each foot, or fraction thereof, of the height (average height of enclosing
walls) of such courts, but in no case shall the width be less than 10 feet. If
operable windows are provided, a horizontal, unobstructed, and permanently open
air intake or passage having a cross-sectional area of not less than 21 square
feet shall be provided at or near the bottom of the court. Metal decorative
grilles not effectively reducing the open area by more than five percent shall
be permitted at the ends. Walls, partitions, floor, and floor-ceiling
assemblies forming intakes or passages shall be noncombustible and shall be
constructed in accordance with NFPA 101 §18-3.1(b) and (c). An inner court
shall have a horizontal cross sectional area of not less than one and one-half
times the square of its width.
(vi) Visibility. All areas of the nursing
suite, including entrances to patient rooms, shall be visible from the nurse
station. Observation by video cameras of seclusion rooms, entrances, hallways,
and activity areas shall be acceptable.
(vii) Special fixtures, hardware, and
tamper-proof screws. Special fixtures, hardware, and tamper-proof screws shall
be used throughout the patient nursing suites.
(I) All exposed and accessible fasteners
shall be tamper-resistant.
(II)
Suitable hardware shall be provided on doors to toilet rooms so that access to
these rooms can be controlled by staff. Hardware shall be utilized which is
appropriate to prevent patient injury.
(III) Only break-away or collapsible clothes
bars in wardrobes, lockers, towel bars, and closets and shower curtain rods
shall be permitted. Wire coat hangers shall not be permitted in nursing
suites.
(IV) When grab bars are
provided, the space between the grab bar and the wall should be filled to
prevent a cord being tied around it for hanging. Bars, including those which
are part of such fixtures as soap dishes, shall be sufficiently anchored to
sustain a concentrated load of 250 pounds.
(viii) Detention screens.
(I) When operable windows are provided in
patient sleeping rooms, it may be necessary to provide detention screens on
windows or limit the amount of window operation in order to inhibit possible
tendency for suicide or elopement. The type and the degree of security required
shall be determined by the facility administration.
(II) When detention screens are provided,
windows shall be capable of opening with the screens in place. Where glass
fragments may create a hazard, safety glazing or other appropriate security
features shall be incorporated.
(III) In building housing for certain types
of patients, detention rooms, or a security section, the facility shall provide
detention screens to confine or protect building inhabitants, when
necessary.
(ix) Hand
washing amenities. Hand washing amenities shall be conveniently located near
the nurses station and in the medication area. One lavatory in an open
medication area can meet this requirement.
(x) Elevator lobbies. Elevator lobbies shall
be physically separated from the required means of egress with one hour fire
rated construction which resist the passage of smoke on all floors containing
patient rooms.
(B)
Finishes.
(i) Seamless floors with coved wall
bases described in §
510.122(d)(2)(B)(iii)(III)
of this subchapter shall be provided in
soiled workrooms.
(ii) Wall bases
in the soiled workroom shall be made integral and coved with the floor, tightly
sealed to the wall, constructed without voids that can harbor insects, retain
dirt particles, and impervious to water.
(iii) Monolithic ceilings described in §
510.122(d)(2)(B)(vi)(III)
of this subchapter shall be provided in
airborne infection isolation rooms, seclusion rooms, and security
rooms.
(iv) Ceilings of patient
rooms may be acoustically treated; however, they shall be monolithic as
described in §
510.122(d)(2)(B)(vi)(III)
of this subchapter.
(v) Acoustical ceilings shall be provided for
corridors in patient areas, nurses' stations, dayrooms, recreation rooms,
dining areas, and waiting areas.
(4) Mechanical requirements. Mechanical
requirements shall be in accordance with §
510.122(d)(3) of
this subchapter and this paragraph.
(A)
Special consideration shall be given to the type of heating and cooling units,
ventilations outlets, and appurtenances installed in patient-occupied areas of
nursing suites. The following shall apply.
(B) All air grilles and diffusers shall be of
a type that prevents the insertion of foreign objects.
(C) All convector or HVAC enclosures exposed
in the room shall be constructed with rounded corners and shall have enclosures
fastened with tamper-resistant fasteners.
(D) HVAC equipment shall be of a type that
minimizes the need for maintenance within the room.
(E) Outside air shall be supplied to each
patient room by a central air handling unit to provide make-up air for air
exhausted from the bathroom in accordance with Note 3 of Table 3 of §
510.131(c) of
this subchapter.
(F) Each patient
room bathroom shall be exhausted continuously to the exterior in accordance
with Table 3 of §
510.131(c) of
this subchapter.
(5)
Piping systems and plumbing fixtures. Piping systems and plumbing fixtures
shall be in accordance with §
510.122(d)(4) of
this subchapter and this paragraph.
(A) Each
patient bathroom shall contain a water closet and a lavatory. The lavatory may
be located in a single bed patient room instead of in the bathroom.
(B) An additional lavatory shall be placed in
each patient room proper where the bathroom serves more than two
beds.
(C) Hand washing fixtures
shall be located near the nurses' station and the drug distribution station.
One lavatory may serve both areas.
(D) Faucet controls shall not be equipped
with handles that may be easily broken off in the patient care areas.
(E) Bedpan washers are not required in
patient bathrooms.
(F) Piped
medical gas systems are not required unless otherwise noted.
(G) Only special, tamper proof sprinkler
heads from which it is not possible to suspend any objects shall be
installed.
(6) Electrical
requirements. Electrical requirements shall be in accordance with §
510.122(d)(5) of
this subchapter and this paragraph.
(A)
Electric receptacles in nursing units.
(i)
Each receptacle shall be grounded to the reference grounding point by means of
an insulated copper grounding conductor.
(ii) Each patient bed location shall be
supplied by at least two branch circuits, one from the critical branch of the
emergency system as required by NFPA 99, §3-4 and one from the normal
system. All branch circuits from the normal system shall originate in the same
panelboard.
(iii) One duplex
receptacle connected to a normal branch circuit and one duplex outlet connected
to the critical branch circuit shall be located on opposite sides of the head
of each bed. In addition at least one duplex outlet shall be located on each
wall. A dedicated outlet shall be provided at the television
location.
(iv) Each examination
table shall have access to two duplex receptacles.
(v) Each work table or counter shall have
access to two duplex receptacles.
(vi) One duplex receptacle shall be installed
in the bathroom to permit the use of electrical appliances in front of the
mirror.
(vii) Receptacles shall be
protected by GFCI breakers installed in distribution panel enclosures serving
the nursing suite.
(viii) Duplex
receptacles shall be installed not more than 50 feet apart in corridors and
within 25 feet of corridor ends.
(ix) When mobile x-ray equipment is provided,
special receptacles marked for X-ray use shall be installed in corridors so
that mobile equipment may be used anywhere within a patient room using a cord
length of 50 feet or less. Where capacitive discharge or battery powered X-ray
units are used, special X-ray receptacles will not be required in
corridors.
(x) Additional duplex
receptacles shall be installed as required to satisfy operational needs of the
nursing unit.
(B) Nurses
calling systems. When a nurses calling system is provided in a nursing suite, a
nurses regular calling system, nurses emergency calling system, and a staff
emergency assistance calling system shall comply with §
510.122(d)(5)(K)
of this subchapter. Provisions shall be made for easy removal of all call
buttons or for covering call buttons as required for security. Pull cords shall
not exceed 18 inches in length.
(i) Each
patient room shall be served by at least one nurses regular calling station for
two-way voice communication. Each patient bed shall be provided with a call
button. Two call buttons serving adjacent beds may be served by one calling
station. In rooms containing two or more calling stations, indicating lights
shall be provided at each station. Nurses calling systems shall be equipped
with an indicating light at each calling station which remains lighted as long
as the voice circuit is operating.
(ii) A nurses emergency calling system shall
be provided at each inpatient water closet, bathtub and shower in accordance
with §
510.122(d)(5)(K)(ii)
of this subchapter. When conveniently
located one emergency call station may serve one bathroom.
(iii) A staff emergency assistance calling
system for staff to summon additional assistance shall be provided in central
bathing facility rooms and exam or treatment rooms in accordance with §
510.122(d)(5)(K)(iii)
of this subchapter.
(iv) All nurse call hardware shall have
tamper resistant fasteners.
(v) A
call system shall be provided at all seclusion anterooms.
(C) Illumination requirements.
(i) General illumination requirements.
Nursing suite corridors shall have general illumination with provisions for
reducing light levels at night. Illumination of corridors for egress purposes
shall comply with NFPA 101 §§18-2.8 and 18-2.9.
(ii) Illumination of the nurses station.
Illumination of the nurses station and all nursing support areas shall be with
fixtures powered from the critical branch of the emergency electrical system
NFPA 99 §3-4.2.2.2(c).
(iii)
Patient suite lighting.
(I) Each patient room
shall be provided with general lighting and night lighting. General lighting
and night lighting shall be controlled at the room entrance. All controls for
lighting in patient areas shall be of the quiet operating type. Control of
night lighting circuits may be achieved by automatic means and in such
instances control of night lighting at the room entrance shall not be required.
At least one general light fixture and night lighting shall be powered from the
critical branch of the essential electrical system.
(II) A reading light shall be provided for
each patient. Reading light control shall be readily accessible from each
patient bed. High heat producing light sources such as incandescent and halogen
shall be avoided to prevent burns to patients and/or bed linen. Light sources
shall be covered by a diffuser or a lens.
(III) A wall or ceiling mounted lighting
fixture shall be provided above each lavatory.
(IV) A ceiling mounted fixture shall be
provided in patient bathrooms where the lighting fixture above the lavatory
does not provide adequate illumination of the entire bathroom. Some form of
fixed illumination shall be powered from the critical branch.
(o)
Pharmacy suite.
(1) Architectural
requirements.
(A) General. The pharmacy room
or suite shall be located for convenient access, staff control, and security
for drugs and personnel.
(B)
Dispensing area. The pharmacy room or suite shall include the following
functional spaces and facilities:
(i) area for
pickup, receiving, reviewing and recording;
(ii) extemporaneous compounding area with
sufficient counter space for drug preparation and sink with hands-free operable
controls;
(iii) work counter space
for automated and manual dispensing activities;
(iv) storage or areas for temporary storage,
exchange, and restocking of carts; and
(v) security provisions for drugs and
personnel in the dispensing counter area.
(C) Manufacturing. The pharmacy room or suite
shall provide the following functional spaces and facilities.
(i) When bulk compounding area is required,
work space and counters shall be provided.
(ii) When packaging, labeling and quality
control is required, an area(s) shall be provided.
(D) Storage. The following spaces shall be
provided in cabinets, shelves, and/or separate rooms or closets:
(i) space for bulk storage, active storage,
and refrigerated storage;
(ii)
storage in a fire safety cabinet or storage room that is constructed under the
requirements for protection from hazardous areas in accordance with NFPA 101
Chapter 12, for alcohol or other volatile fluids, when used; and
(iii) storage space for general supplies and
equipment not in use.
(E)
Administrative area. An administrative area for the pharmacy is optional for
crisis stabilization units. The following functional spaces and facilities
shall be included for the administrative area.
(i) Office area for the chief pharmacist and
any other offices areas required for records, reports, accounting activities,
and patients profiles.
(ii) Poison
control center with storage facilities for reaction data and drug information
centers.
(iii) A room or area for
counseling and instruction when individual medication pick-up is available for
inpatients or outpatients.
(F) Service areas. The following service
areas and items shall be provided.
(i)
Intravenous (IV) solutions area. When IV solutions are prepared in a pharmacy,
a sterile work area with a laminar-flow workstation designed for product
protection shall be provided.
(ii)
Satellite pharmacy. When provided, the room shall include a work counter, a
sink with hands-free operable controls, storage facilities, and refrigerator
for medications.
(iii) Hand washing
amenities. A hand washing fixture with hands-free operable controls shall be
located in each room where open medication is handled.
(iv) Staff toilets. Toilets may be outside
the suite but shall be convenient for staff use.
(2) Mechanical Requirements. Mechanical
requirements shall be in accordance with §
510.122(d)(3) of
this subchapter and this paragraph. When IV solutions are prepared, the
required laminar-flow system shall include a non-hygroscopic filter rated at
99.97% (HEPA). A pressure gauge shall be installed for detection of filter
leaks or defects.
(3) Piping
systems and plumbing fixtures. Piping systems and plumbing fixtures shall be in
accordance with §
510.122(d)(4) of
this subchapter and this paragraph.
(A)
Material used for plumbing fixtures shall be non-absorptive and
acid-resistant.
(B) Water spouts
used at lavatories and sinks shall have clearances adequate to avoid
contaminating utensils and the contents of carafes, etc.
(4) Electrical requirements. Electrical
requirements shall be in accordance with §
510.122(d)(5) of
this subchapter and this paragraph.
(A)
Under-counter receptacles and conduits shall be arranged (raised) to not
interfere with cleaning of the floor below or of the equipment.
(B) Exhaust hoods shall have an indicator
light indicating that the exhaust fan is in operation.
(C) Electrical circuits to equipment in wet
areas shall be provided with five milliampere GFCI.
(p) Rehabilitation therapy suite.
(1) Occupational therapy. When occupational
therapy services are provided, the following shall be included:
(A) an activity room with work areas,
counters and a hand washing fixture. Counters shall be wheel chair
accessible;
(B) a storage room for
supplies and equipment;
(C) secured
storage for potential harmful supplies and equipment; and
(D) remote electrical switching for
potentially harmful equipment.
(2) Physical therapy. When physical therapy
services are provided, the following rooms shall be included.
(A) When services required by the narrative
program for thermotherapy, diathermy, ultrasonics, and hydrotherapy, individual
treatment areas shall be provided.
(B) An individual treatment area shall be a
minimum of 70 square feet of clear floor area exclusive of four foot aisle
space. Privacy screens or curtains shall be provided at each treatment
station.
(C) A hand washing fixture
with hands-free operable controls shall be provided in each treatment room or
space. A hand washing fixture may serve several patient stations when cubicles
or open room concepts are used and when the fixture is conveniently
located.
(D) An area shall be
provided for exercise and may be combined with treatment areas in open plan
concepts.
(E) Provisions for the
collection and storage of wet and soiled linen shall be provided.
(F) A storage area or room for equipment,
clean linen, and supplies shall be provided.
(G) When outpatient physical therapy services
are provided, the suite shall have as a minimum patient dressing areas,
showers, and lockers.
(3)
Service areas. The following areas or items shall be provided in a
rehabilitative therapy suite but may be shared when multiple rehabilitation
services are offered:
(A) patient waiting
area with space for wheelchairs;
(B) patient toilet facilities containing hand
washing fixtures with hands-free operable controls;
(C) reception and control stations shall be
located to provide supervision of activities areas and the control station may
be combined with office and clerical spaces;
(D) office and clerical space;
(E) wheelchair and stretcher storage room or
alcove which shall be in addition to other storage requirements;
(F) lockable closets, lockers or cabinets for
securing staff personal effects;
(G) staff toilets may be outside the suite
but shall be convenient for staff use and contain hand washing fixtures with
hands-free operable controls; and
(H) housekeeping room, conveniently
accessible.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.