| (a) Administration and public suite.
(1) Architectural requirements. The following rooms
or areas shall be provided.
(A) 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.
(B) Lobby. 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, public telephones,
drinking fountain(s), and storage room or alcove for wheelchairs.
(C) 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.
The admission area may be omitted if exclusive bedside registration
is used.
(D) General or individual office(s). Office space shall
be provided for business transactions, medical and financial records,
and administrative and professional staffs.
(E) Multipurpose room(s). Room(s) shall be provided
for conferences, meetings, and health education purposes including
provisions for showing visual aids.
(F) 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, Life Safety Code, 2003 edition (NFPA 101), §18.3.2. All
documents published by the NFPA as referenced in this section may
be obtained by writing or calling the NFPA at the following address
and telephone number: Post Office Box 9101, 1 Batterymarch Park, Quincy,
Massachusetts 02269-9101, (800) 344-3555; the NFPA website address
is http://catalog.nfpa.org.
(2) Details and finishes. Details and finishes shall
be in accordance with §133.162(d)(2) of this title (relating
to New Construction Requirements).
(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.
(5) Electrical requirements. Electrical requirements
shall be in accordance with §133.162(d)(5) of this title.
(b) Cart cleaning and sanitizing unit.
(1) Architectural requirements.
(A) Cart cleaning, sanitizing and storage facilities
shall be provided for carts serving central services, 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. When interior cart cleaning
facilities are provided, details and finishes shall be in accordance
with §133.162(d)(2) of this title 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 §133.162(d)(2)(B)(iii)(III) or (IV) of this title.
(B) Ceilings in the cart cleaning and sanitizing unit
shall be the monolithic type 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.
(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) 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 regardless of whether or not they
are interior or exterior.
(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.
(5) Electrical requirements. Electrical requirements
shall be in accordance with §133.162(d)(5) of this title.
(c) Central sterile supply suite.
(1) Architectural requirements.
(A) General. When obstetrical or surgical services
are provided, the following rooms or areas shall be provided.
(i) Decontamination room. This room shall be physically
separated from all other areas of the suite. The room shall include
work counters or tables, flush type utility sink, equipment for initial
disinfection, and hand washing facilities with hands-free operable
controls. Materials shall be transferred from the decontamination
room to the clean assembly room by way of pass-through doors, windows
or washer equipment. The dirty side of the decontamination room may
be combined with a soiled utility room if all functions for each space
are provided within the room.
(ii) Clean and assembly room. The room shall include
counters or tables, equipment for sterilizing and hand washing facilities
with hands-free operable controls. Clean and soiled work areas shall
be physically separated.
(iii) Breakdown storage room. A storage room for breakdown
of supplies shall be provided. The storage room shall have adequate
areas and counters for breakdown of prepackaged supplies.
(iv) Sterile and clean supply room. A sterile and clean
supply room shall be provided. Storage of sterile and clean supplies
shall not occur within the breakdown room.
(v) Equipment storage. An equipment storage room shall
be provided.
(vi) Cart storage room. The storage room for distribution
carts shall be adjacent to clean and sterile storage and close to
main distribution points.
(vii) Multipurpose room. The equipment storage and
cart storage room can be combined into a multipurpose room.
(B) Service areas. The central supply suite shall provide
the following.
(i) Office space. Office space for director of central
services.
(ii) Staff toilets. Facilities may be outside the unit
but must be convenient for staff use and shall contain hand washing
fixtures with hands-free operable controls.
(iii) Locker room. When provided, the locker room for
staff shall include lockers, toilets, lavatories, showers, and male
and female dressing rooms or cubicles. A central changing locker room
may be shared and made available within the immediate area of the
central sterile supply suite.
(iv) Housekeeping room. A housekeeping room shall
be provided and contain a floor receptor or service sink and storage
space for housekeeping supplies and equipment. The housekeeping room
shall be located on the decontamination/soiled side of the central
sterile supply suite.
(2) Details and finishes. Details and finishes shall
be in accordance with §133.162(d)(2) of this title and this paragraph.
(A) Details. Mirrors shall not be installed at hand
washing fixtures in clean and sterile supply areas.
(B) Finishes.
(i) Flooring used in the decontamination room and the
clean assembly room shall be of the seamless type as required by §133.162(d)(2)(B)(iii)(III)
of this title.
(ii) Ceilings in the decontamination room, clean assembly
room, and supply storage room shall be the monolithic type in accordance
with §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) The sterile supply room and the clean and assembly
room shall include provisions for ventilation, humidity, and temperature
control.
(B) When provided, installations of ethylene oxide
(EO) sterilizers shall comply with the requirements of 30 TAC §106.417
(relating to Ethylene Oxide Sterilizers), administered by the Texas
Commission on Environmental Quality (TCEQ), and the following requirements.
(i) All source areas shall be exhausted, including
the sterilizer equipment room, service and aeration areas, over sterilizer
door, and the aerator. If the EO cylinders are not located in a well-ventilated
unoccupied equipment space, an exhaust hood shall be provided over
the cylinders. The relief valve shall be terminated in a well-ventilated,
unoccupied equipment space, or outside the building.
(ii) General airflow shall be away from sterilizer
operators and towards the sterilizers.
(iii) A dedicated exhaust fan and an exhaust duct system
shall be provided for EO sterilizers. The exhaust outlet to the atmosphere
shall be located on the highest roof, directed upward, and not less
than 25 feet from any air intake. A legible warning sign shall be
provided to identify the exhaust stack on the roof.
(iv) An audible and visual alarm located in sterilizer
work area and a 24-hour staffed location shall be activated upon loss
of airflow in the exhaust system.
(C) 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 §133.169(d) of this title (relating to Tables).
(D) 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.
(4) Piping systems and plumbing fixtures. Piping systems
and plumbing fixtures shall be in accordance with §133.162(d)(4)
of this title. When medical gas systems are provided, the systems
shall comply with §133.162(d)(4) of this title and this paragraph.
(A) Drainage and waste piping shall not be installed
within the ceiling or installed in an exposed location in sterile
areas unless precautions are taken to protect the space below from
leakage and condensation from necessary overhead piping. Any required
secondary protection shall be labeled, "code required secondary drain
system" every 20 feet in a highly visible print or label.
(B) No plumbing lines may be exposed or on walls where
possible leaks would create a potential of contamination of the sterile
areas.
(C) The compressed air required for the decontamination
room shall not be connected to the medical air piping distribution
system such as supporting breathable air for respiratory assistance
needs, anesthesia machines, intermittent positive pressure breathing
machine (IPPB), etc. A separate compressed air supply source shall
be provided for maintenance and equipment needs for facility support
use.
(5) Electrical requirements. Electrical requirements
shall be in accordance with §133.162(d)(5) of this title and
this paragraph. Electrical circuit(s) to equipment in wet areas shall
be provided with ground fault circuit interrupters (GFCIs).
(d) Critical care unit.
(1) Architectural requirements.
(A) General. When a critical care unit(s) (CCU) (also
known as intensive care unit) is provided, the unit(s) may be classified
as general CCU, coronary CCU (CCCU) or pediatric CCU (PCCU). Requirements
for neonatal intensive care units (NCCU) are stated in subsection
(u) of this section.
(i) The CCU(s) shall be a separate suite(s) operated
separately from other units of the hospital. The location shall be
arranged to eliminate the need for through traffic.
(ii) When elevator transport is required for critically
ill patients, the size of the elevator cab, mechanisms and controls
shall meet the specialized needs.
(B) CCU services and facilities. The following services
and facilities shall apply to all classifications of CCUs unless otherwise
noted.
(i) The patient area (whether separate rooms, cubicles,
or multiple-bed space) shall have a minimum clear floor area of 200
square feet per bed exclusive of anterooms, vestibules, toilet rooms,
closets, lockers, wardrobes, and/or alcoves. A minimum of 13 feet
width shall be provided for the head wall for each bed.
(ii) When an open ward plan is used, at least one private
room for every six ward beds shall be provided for medical isolation
or psychological needs.
(iii) A minimum of one airborne infection isolation
room shall be provided for each type of CCU suite. The number of airborne
infection isolation rooms shall be determined based on an infection
control risk assessment. Each room shall comply with requirements
of subsection (t)(1)(C)(iii) and (iv) of this section. In addition,
the isolation room shall comply with clause (i) of this subparagraph.
(iv) When private rooms or cubicles are provided, view
panels in the door or walls of these rooms are required. Curtains
or other means shall be provided to cover the viewing panels when
visual privacy is required.
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