| (C) Electrical circuit(s) to equipment in wet areas
shall be provided with five milliampere GFCI.
(y) Radiotherapy suite. When radiotherapy services
are provided, the suite may contain equipment for electron beam therapy,
radiation therapy, or both. The following facilities shall be provided.
(1) Architectural requirements.
(A) Cobalt, linear accelerators, and simulation rooms
require radiation protection. A medical physicist licensed under the
Texas Medical Physics Practice Act, Occupations Code, Chapter 602,
shall specify the type, location, and amount of radiation protection
to be installed for the layout and equipment selections. Room layouts
and construction shall prevent the escape of radioactive particles.
Openings into the room, including doors, ductwork, vents, and electrical
raceways and conduits, shall be baffled to prevent direct exposure
to other areas of the facility.
(B) Cobalt, linear accelerator, and simulator rooms
shall be sized in accordance with the installed equipment requirements,
patient access on a stretcher, medical staff access to the equipment
and patient, and access for servicing the equipment.
(C) When a mold room is provided, it shall contain
a ventilation hood exhausted to the exterior and a hand washing fixture
with hands-free operable controls.
(D) A block room with storage for the linear accelerator
may be combined with the mold room.
(E) A hot laboratory in support of cobalt therapy shall
be provided.
(F) The following service areas shall be provided unless
these are accessible from other departments such as imaging or outpatient
areas:
(i) a stretcher hold area adjacent to the treatment
rooms, screened for privacy, and combined with a seating area for
outpatients
(ii) exam rooms for each treatment room. The rooms
shall be a minimum of 100 square feet and shall be provided with hand
washing facilities;
(iii) a patient gowning area with provisions for safe
storage of valuables and clothing. At least one space shall be sized
to allow for staff-assisted dressing;
(iv) convenient access to a housekeeping room;
(v) film file area;
(vi) film storage area for unprocessed film; and
(vii) a radioisotope decay room. This room may be combined
with the hot lab.
(2) Details and finishes. Details and finishes shall
be in accordance with §133.162(d)(2) of this title and this paragraph.
(A) Details.
(i) Radiation protection shall be designed, tested
and approved by a medical physicist licensed under the Texas Civil
Statutes, Occupations Code, Chapter 602.
(ii) Room shielding calculations for linear accelerators,
cobalt and simulation rooms shall be submitted to the Department of
State Health Services' Radiation Control (RC) for approval prior to
use. Shielding in diagnostic radiographic rooms will be reviewed by
inspectors, in the field, subsequent to use. Any changes in design
or shielding, which affects radiation exposure levels adjacent to
those rooms, requires prior approval by RC.
(iii) The cobalt, simulation and linear accelerator
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.
(iv) Properly designed rigid support structures for
ceiling-mounted equipment shall be located above the finished ceiling.
(B) Finishes.
(i) Flooring in the soiled workroom and any work or
treatment areas in the radiotherapy suite where radioactive materials
are handled shall be of the seamless type as required by §133.162(d)(2)(B)(iii)(III)
of this title.
(ii) Walls shall be constructed of materials that are
easily decontaminated from accidental radioactive spills and finished
in accordance with §133.162(d)(2)(B)(iv) of this title.
(iii) Ceilings in the hot laboratory and soiled workroom
shall be monolithic as required by §133.162(d)(2)(B)(vi)(III)
of this title.
(3) Mechanical requirements. Mechanical requirements
shall be in accordance with §133.162(d)(3) of this title and
this paragraph.
(A) Where fume hoods are used, the design should consider
the placement and types of air distribution devices to avoid the disturbance
of a uniform velocity across the face of the hood.
(B) Each hood used to process radioactive materials
shall have a minimum face velocity of 90-110 feet per minute, be connected
to an independent exhaust system, with suitable pressure-independent
air modulating devices and alarms to alert staff of fan shutdown or
loss of airflow. Each hood shall also have filters with a 99.97% efficiency
(based on the dioctyl-phthalate (DOP) test method) in the exhaust
stream, and be designed and equipped to permit the safe removal, disposal,
and replacement of contaminated filters. Filters shall be as close
to the hood as practical to minimize duct contamination.
(4) Plumbing fixtures and piping systems. Piping systems
and plumbing fixtures shall comply with the requirements of §133.162(d)(4)
of this title.
(5) Electrical requirements. Each radiotherapy suite
shall comply with the requirements of §133.162(d)(5) of this
title and this paragraph.
(A) Each radiotherapy procedure room shall have at
least four electrical receptacles.
(B) Ground fault circuit interrupters shall not be
used in radiotherapy procedure rooms.
(C) Nurses calling system. The nurse call shall be
in accordance with §133.162(d)(5)(L) and Table 7 of §133.169(g)
of this title.
(z) Rehabilitation nursing unit.
(1) Architectural requirements. When provided, each
rehabilitation nursing unit shall comply with the requirements contained
in subsection (t)(1) of this section and the following requirements.
(A) Accessibility requirements. All patient rooms,
bathing units and toilets in each rehabilitation nursing unit and
all public and common use areas shall be designed and constructed
to be handicapped accessible in accordance with §133.162(d)(1)(D)
of this title. These requirements shall apply in all new construction
and when an existing nursing unit or a portion thereof is converted
to rehabilitation nursing care from other nursing care, e.g. mental
health care to rehabilitation care.
(B) Patient room suites. Patient room suites shall
comply with the requirements of subsection (t)(1)(B) and the following
requirements.
(i) Multi-bed patient room. The clearance between the
side of a bed and a wall/partition shall be a minimum of five feet.
The clearance between sides of beds shall be a minimum of four feet.
The minimum distance at the foot of the bed shall not be less than
four feet for single load area/room or seven feet for double load
area/room. Four feet of the passage space at the foot of the bed may
be shared between two beds. The fixed and moveable cabinets and shelves
shall not encroach upon the bed clear floor space/area. The requirements
of this clause are illustrated in Table 8, Diagram H of §133.169(h)
of this title.
(ii) Training toilet room. When a training toilet room
is provided, there shall be three feet of clearance on both sides
and front of the water closet fixture. The room shall be designed
to comply with accessibility requirements of §133.162(d)(1)(D)
of this title.
(2) Details and finishes. Details and finishes shall
be in accordance with §133.162(d)(2) of this title.
(3) Mechanical requirements. Mechanical requirements
shall be in accordance with §133.162(d)(3) of this title.
(4) Piping systems and plumbing fixtures. Piping systems
and plumbing fixtures shall be in accordance with subsection (t)(4)
of this section. All plumbing fixtures shall comply with the requirements
for the handicapped in accordance with §133.162(d)(1)(D) of this
title.
(5) Electrical requirements. Electrical requirements
shall be in accordance with §133.162(d)(5) of this title and
this paragraph. The nurse call shall be in accordance with §133.162(d)(5)(L)
and Table 7 of §133.169(g) of this title.
(aa) Rehabilitation therapy suite. Rehabilitation therapy
may include one or more categories of services. Where two or more
rehabilitation services are provided, the services may share common
areas when appropriate.
(1) Architectural requirements.
(A) Occupational therapy. When occupational therapy
services are provided, the following rooms or areas shall be included:
(i) an activity area with work areas, counters and
a hand washing fixture with hands-free operable controls. Work areas
and counters shall be suitable for wheel chairs;
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