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TITLE 25HEALTH SERVICES
PART 1DEPARTMENT OF STATE HEALTH SERVICES
CHAPTER 131FREESTANDING EMERGENCY MEDICAL CARE FACILITIES
SUBCHAPTER GPHYSICAL PLANT AND CONSTRUCTION REQUIREMENTS
RULE §131.141Construction Requirements for a Pre-Existing Facility

(a) A facility that is operating before the effective date of this chapter is considered to be a pre-existing facility and shall meet the physical plant and construction requirements under this chapter.

(b) A pre-existing facility shall complete all major remodeling, renovations, additions, and alterations in accordance with the requirements for new construction in §131.143 of this title (relating to Construction Requirements for a New Facility). All areas of a pre-existing facility that are not part of a major remodel, renovation, addition or alteration to the facility, are not required to meet these new construction requirements as long as the existing portion met the codes that were in effect when it was originally constructed and licensed. When existing conditions make such changes impractical, the department may grant a conditional approval of minor deviations from the requirements of §131.143 of this title, if the intent of the requirements is met and if the care, safety and welfare of patients will not be jeopardized. The operation of the facility, accessibility of individuals with disabilities, and safety of the patients shall not be jeopardized by a condition(s) which is not in compliance with this subchapter.

  (1) Any alteration, modification, replacement, or installation of new building equipment (such as mechanical, electrical, emergency power equipment, energy/utility management, conveying systems, plumbing, fire protection, or other equipment), with a primary function of building service that affects life safety, infection control, functional operation, or the health, safety, and welfare of patients and staff shall comply with the requirements for new construction and shall not be replaced, materially altered, or extended in a pre-existing licensed facility until complete plans and specifications have been submitted to the department, and the department has reviewed and approved the plans and specifications in accordance with §131.146 of this title (relating to Preparation, Submittal, Review and Approval of Plans, and Retention of Records).

  (2) Minor remodeling or alterations within an existing facility which do not involve alterations to load-bearing members and partitions, change functional operation, affect fire safety, or involve any of the major changes listed in paragraph (1) of this subsection are considered to be minor projects and require evaluation and approval by the department. A pre-existing licensed facility shall submit by mail or fax a written request and floor plan for evaluation, a brief description of the proposed changes, floor plan, and sketches of the area being remodeled. Based on such submittal, the department shall evaluate and determine whether any additional submittals or inspections are required. The department shall notify the facility of its decision. The patching, restoration, or painting of materials, elements, equipment, or fixtures for the purpose of maintaining such materials, elements, equipment, or fixtures in good or sound condition would not require submission to the department for approval.

  (3) All remodeling or alterations which involve alterations to load-bearing members or partitions, change functional operation, or affect fire safety are considered major projects. A facility shall comply with this section before beginning construction of major projects.

    (A) Plans shall be submitted in accordance with this section for all major remodeling or alterations.

    (B) Construction projects involving alterations of or additions to existing buildings shall be programmed and phased so that on-site construction shall minimize disruptions of existing functions.

      (i) Access, exit access, and fire protection shall be maintained so that the safety of the occupants shall not be jeopardized during construction.

      (ii) A noncombustible or limited combustible dust and vapor barrier shall be provided to separate areas undergoing demolition and construction from occupied areas. When a fire retardant plastic material is used for temporary daily usage, it shall be removed at the end of each day.

      (iii) The air inside the construction area shall be protected by mechanical filtration that recirculates inside the space or is exhausted directly to the exterior.

      (iv) The area shall be properly ventilated and maintained. The area under construction shall have a negative air pressure differential to the adjoining areas and shall continue to operate as long as construction dust and odors are present.

      (v) Temporary sound barriers shall be provided where intense prolonged construction noises will disturb patients or staff in the occupied portions of the building during patient treatment times.

      (vi) When construction occurs after hours or on weekends, the facility shall thoroughly clean all areas of construction and provide a clean safe environment before treating patients. The facility shall ensure that all fire safety protection and building systems are in place and working properly.

(c) Pre-existing facilities shall be easily accessible to the community and to service vehicles such as delivery trucks, ambulances, and fire protection apparatus.

  (1) The facility site shall include paved roads, walkways, and parking in accordance with local building codes and ordinances.

  (2) Pre-existing licensed facilities shall comply with the Americans with Disabilities Act (ADA) of 1990, Public Law 101 - 336, 42 United States Code, Chapter 126, and Title 36, Code of Federal Regulations, Part 1191, Appendix A, Accessibility Guidelines for Buildings and Facilities or 16 TAC, §68.20 (relating to Buildings and Facilities Subject to Compliance with the Texas Accessibility Standards), Texas Accessibility Standards (TAS), April 1, 1994 edition, issued by the Texas Department of Licensing and Regulation, under the Texas Architectural Barriers Act, Government Code, Chapter 469.

(d) Spatial requirements.

  (1) Administration and public areas.

    (A) A primary entrance at grade level shall be accessible.

    (B) A main lobby shall be located at the primary entrance and shall include a reception and information counter or desk, waiting space(s), public toilet facilities located convenient to the lobby/waiting area, and storage room or alcove for wheelchairs. Private interview area may be omitted if all interviews occur in treatment or exam rooms.

  (2) Emergency Entrance and Signage.

    (A) An ambulance entrance at grade level shall be well-illuminated.

    (B) Emergency entry signage. An emergency sign shall be provided at the entry from the public road(s) or street(s) serving the site.

    (C) A facility that is not in continuous operation 24 hours per day and 7 days per week shall display clearly visible signage at the main entry and ambulance entry points of the facility. The signage letter size shall be readable and not smaller than half an inch in height. The signage shall provide the information required under §131.22(c) of this title (relating to Classifications of Facilities).

    (D) A facility that is not in continuous operation shall comply with the requirements under §133.22(d) of this title.

  (3) Emergency suite.

    (A) Control station/nurse station shall be located to permit staff observation and control of access to treatment room(s), exam rooms, pedestrian and ambulance entrances, and public waiting area(s). The nurse station shall contain cabinets, work counter, and a hand washing fixture with hands-free operable controls.

    (B) A medical staff work area and charting area(s) shall be provided. The area may be combined with the control station/nurse station.

    (C) As a minimum requirement, all pre-existing facilities shall provide at least one emergency treatment room to handle emergencies. The emergency treatment room shall contain cabinets, work counter, examination light, and a hand washing fixture with hands-free operable controls.

    (D) As a minimum requirement, all pre-existing facilities shall provide at least one exam room. The examination room shall contain cabinets, work counter, examination light, and a hand washing fixture with hands-free operable controls.

    (E) Storage space shall be provided within the room or suite and be under staff control for general medical-surgical emergency supplies and medications. Adequate space shall be provided for emergency equipment such as emergency treatment trays, ventilator, defibrillator, splints, cardiac monitor, etc.

    (F) An area or alcove located out of traffic and convenient to the treatment and exam room(s) shall be provided for an emergency crash cart.

    (G) An alcove shall be provided for stretcher and wheelchair storage. The storage for stretchers and wheelchairs shall be located out of the line of traffic.

    (H) A nourishment station shall be provided containing a work counter with sink, microwave, refrigerator and storage cabinets and not located in the clean workroom. When the patient nourishment refrigerator is located in the staff lounge, the refrigerator shall be labeled "patient refrigerator."

    (I) An ice machine supplying ice for therapeutic purposes, when provided, shall be located in the clean utility room or similar clean space. A self-dispensing ice machine shall be provided for ice for human consumption.

    (J) Patient toilet room(s) shall be provided and shall be convenient to treatment rooms, examination rooms, and trauma rooms a hand washing fixture with hands-free operable controls.

    (K) Staff toilets shall be provided and may be outside the suite but shall be convenient for staff use and include hand washing fixtures with hands-free operable controls.

    (L) A clean storage room shall be provided for clean supplies, linens and medications as needed. A hand washing fixture shall be provided within the room with hands-free operable controls.

    (M) Soiled workroom shall be provided and 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.

  (4) Medication storage. A medication work room or alcove shall be provided and located separate from patient and public areas and under the direct supervision of staff. A work counter, refrigerator, medication storage, and locked storage for biologicals and drugs shall be provided. A hand washing fixture with hands-free operable controls shall be located in the medication storage room or alcove.

    (A) Functional space shall be provided and areas required for records, reports, and accounting activities.

    (B) Space for the poison control center shall be provided with storage facilities for reaction data and drug information centers.

  (5) Diagnostic radiographic (X-ray). A diagnostic radiographic (X-ray) room shall be provided and be readily available to the emergency suite.

    (A) Clearance and unobstructed space shall not be less than three feet around the diagnostic equipment.

    (B) When the facility is equipped with digital imaging system capabilities, a minimum of two X-ray film illuminators viewers shall be provided and mounted in a central location.

  (6) Computed tomography (CT) scanning. A CT room shall be provided and be readily available to the emergency suite. Clearance and unobstructed space shall be not less than three feet on each side of the diagnostic table.

    (A) A control room shall be provided with a view window permitting view of the patient. The control room shall be located to allow convenient film processing.

    (B) A patient toilet shall be provided convenient to the CT room. The toilet room shall have a hand washing fixture with hands-free operable controls.

  (7) Laboratory services. Laboratory room or work area shall be provided with the following minimum facilities.

    (A) The laboratory work room(s) shall include counter(s), space appropriately designed for laboratory equipment, and sink(s) with hands-free operable controls.

    (B) Each laboratory room or work area shall be provided with a hand washing fixture(s) with hands-free operable controls.

    (C) General storage, including refrigeration for reagents, standards, supplies, and stained specimen microscope slides, etc. shall be provided. Separate facilities shall be provided for such incompatible materials as acids and bases, and vented storage shall be provided for volatile solvents.

    (D) A refrigerator and other necessary equipment shall be provided for specimen storage waiting for transfer to off-site testing.

    (E) Specimen room/area for blood collection 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 facility may be outside the laboratory area if conveniently located.

    (F) When chemical safety is a requirement, an emergency shower and eye flushing devices shall be provided.

    (G) Flammable or combustible liquids, when used, shall be stored in approved containers, in accordance with National Fire Protection Association 30, Flammable and Combustible Liquids Code, 2003 edition.

    (H) Radioactive materials, when employed, shall be stored in safe storage facilities.

Cont'd...

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