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every four holding/observation beds or fraction thereof. Fixtures
shall be uniformly distributed. The fixed and moveable cabinets and
shelves shall not encroach upon the bed/gurney clear floor space/area.
The requirements of this subclause are illustrated in Table 8, Diagram
D of §133.169(h) of this title.
(IV) In a multiple-bed holding/observation room/area,
a patient toilet room with a hand washing fixture with hands-free
operable controls shall be provided within the room or area.
(ii) When a multiple-bed gurney holding or observation
room is not within or adjacent to the emergency suite, the following
additional spaces shall be provided:
(I) stretcher and wheelchair storage alcove. The alcove
provided for stretcher and wheelchair storage shall be located out
of the line of traffic;
(II) clean storage room. A clean storage room shall
be provided within or adjacent to the holding or observation room.
The clean storage room shall be provided for clean supplies, linen
and medication as needed. A hand washing fixture shall be provided
with hands-free operable controls;
(III) soiled workroom. A soiled workroom shall be provided
within or adjacent to the holding or observation room. 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; and
(IV) housekeeping room. A housekeeping room shall be
provided within or near the holding or observation room. The housekeeping
room shall contain a floor receptor or service sink and storage space
for housekeeping supplies and equipment.
(C) Trauma center. When provided, a trauma center shall
comply with subparagraph (B) of this paragraph and in addition contain
the following.
(i) Trauma room. A minimum of one trauma room shall
be provided with 250 square feet of clear floor area exclusive of
aisles and fixed and moveable cabinets and shelves. The minimum clear
dimension between fixed cabinets and built-in shelves shall be 12
feet. The trauma room shall contain a work counter, cabinets, medication
storage, and examination light.
(ii) Multiple-station trauma room. When multiple-patient
stations are provided, the clearance between the head of the bed/gurney
to the wall/partition shall be a minimum of three feet. The clearance
between the side of a bed/gurney and a wall/partition shall be a minimum
of six feet. The clearance between the sides of beds/gurneys shall
be a minimum of twelve feet. The minimum distance at the foot of the
bed/gurney shall not be less than seven feet for single load area/room
or ten feet for double load area/room. Four feet of the passage space
at the foot of the bed may be shared between two beds/gurneys. The
multiple-bed trauma room shall contain cabinets, medication storage,
work counter, examination light, and scrub sink with hands-free operable
controls. The fixed and moveable cabinets and shelves shall not encroach
upon the bed/gurney clear floor space/area. The requirements of this
clause are illustrated in Table 8, Diagrams E of §133.169(h)
of this title. Provisions shall be made for visual privacy between
multiple stations.
(iii) Scrub facilities. A scrub station shall be located
at the entrance to each trauma room either inside or outside of the
room. One scrub station may serve two trauma beds/gurneys. Scrub facilities
shall be arranged to minimize any incidental splatter on nearby personnel
or supply carts. The scrub sinks shall be recessed out of the main
line of traffic.
(iv) Doorways. All doorways openings from the ambulance
entrance to the trauma room shall be a minimum of five feet wide.
(D) Emergency clinic. When an emergency clinic (which
may also be referred to as "urgent care", "fast track", "express care",
"minor care", etc.) is provided, the clinic shall be separate and
distinct from the emergency treatment area and trauma center and shall
meet all the requirements of subparagraph (A) of this paragraph. All
facilities required by subparagraph (A) of this paragraph may be shared
with the emergency treatment area and trauma center except for the
emergency treatment room. The emergency treatment room(s) in the emergency
clinic shall not be less than 100 square feet. The emergency exam
room(s) in the emergency clinic shall not be less than 80 square feet.
(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) Trauma rooms shall have ceiling heights not less
than nine feet.
(ii) The decontamination room shall be equipped with
two hand-held showerheads with temperature controls and a dedicated
holding tank with a floor drain.
(B) Finishes.
(i) Flooring used in a trauma room, treatment room,
examination room, holding area, and soiled workroom shall be of the
seamless type as required by §133.162(d)(2)(B)(iii)(III) of this
title. Seamless type flooring is not required in the examination room
in the emergency clinic.
(ii) Ceilings in soiled workrooms, isolation rooms,
and trauma rooms shall be of the monolithic type as required by §133.162(d)(2)(B)(vi)(III)
of this title.
(iii) The decontamination room floor shall be self-coved
to a height of six inches. The room shall have all smooth, nonporous,
scrubable, nonabsorbent and nonperforated surfaces.
(3) Mechanical requirements. Mechanical requirements
shall be in accordance with §133.162(d)(3) of this title and
this paragraph.
(A) Duct linings exposed to air movement shall not
be used in ducts serving any trauma rooms, treatment rooms, examination
rooms, holding areas, and clean room. This requirement shall not apply
to mixing boxes and acoustical traps that have special coverings over
such lining.
(B) When a trauma room is provided under paragraph
(1)(C)(i) of this subsection, the air supply for the trauma/surgical
room shall be from ceiling outlets that are as near the work centers
as possible, and a minimum of two low return inlets shall be located
diagonally opposite from one another.
(C) Return air inlets shall be not lower than four
inches nor higher than 12 inches from floor level.
(4) Piping systems and plumbing fixtures. Piping systems
and plumbing fixtures shall be in accordance with §133.162(d)(4)
of this title and this paragraph.
(A) Medical gas systems. Medical gas systems shall
be provided in accordance with §133.162(d)(4)(A)(iii) of this
title.
(B) Ice machine. An ice machine shall be provided for
therapeutic purposes and shall be located in the clean utility room.
A self-dispensing ice machine shall be provided for ice for human
consumption.
(5) Electrical requirements. Electrical requirements
shall be in accordance with §133.162(d)(5) of this title and
this paragraph.
(A) General.
(i) Each treatment and examination room in the emergency
treatment area and trauma center shall have a minimum of six duplex
electrical receptacles located convenient to the head of each bed.
(ii) Each treatment and examination room in the emergency
clinic suite shall have a minimum of four duplex electrical receptacles
located convenient to the head of each bed/table.
(iii) Each work counter and table shall have access
to at least one duplex receptacle connected to the critical branch
of the emergency electrical system.
(iv) The hospital shall provide X-ray film illuminators
for handling at least four films simultaneously in all treatment,
examination, and trauma rooms in the emergency treatment area. When
the entire emergency treatment area is provided with digital imaging,
a minimum of two X-ray film illuminators shall be provided within
a central location within the emergency treatment area.
(B) Nurses calling systems. The nurse call system shall
be in accordance with §133.162(d)(5)(L) and Table 7 of §133.169(g)
of this title.
(g) Employees suite.
(1) Architectural requirements.
(A) Architectural requirements shall be in accordance
with §133.162(d)(1) of this title and this paragraph.
(B) Lockers, lounges, toilets and showers shall be
provided within the hospital for employees and volunteers. These facilities
are in addition to, and separate from, those required for the medical
staff and the public.
(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 §133.162(d)(4)
of this title.
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