| (a) Flammable germicides. If flammable germicides,
including alcohol-based products, are used for preoperative surgical
skin preparation in a limited services rural hospital (LSRH), the
LSRH must:
(1) use only self-contained, single-use, pre-measured
applicators to apply the surgical skin preparations;
(2) follow all manufacturer product safety warnings
and guidelines;
(3) develop, implement, and enforce written policies
and procedures outlining the safety precautions required related to
the use of the products, which, at a minimum, must include minimum
drying times, prevention and management of product pooling, parameters
related to draping and the use of ignition sources, staff responsibilities
related to ensuring safe use of the product, and documentation requirements
sufficient to evaluate compliance with the written policies and procedures;
(4) ensure that all staff working in the surgical environment
where flammable surgical skin preparation products are in use have
received training on product safety and the facility policies and
procedures related to the use of the product;
(5) develop, implement, and enforce an interdisciplinary
team process for the investigation and analysis of all surgical suite
fires and alleged violations of the policies; and
(6) report all occurrences of surgical suite fires
to the Texas Health and Human Services Commission as soon as possible
but not later than 10 calendar days after the occurrence, and complete
an investigation of the occurrence and develop and implement a corrective
action plan within 30 days after a surgical suite fire.
(b) Flammable and nonflammable gases and liquids. Flammability
of liquids and gases shall be determined by National Fire Protection
Association (NFPA) 329, Recommended Practice for Handling Releases
of Flammable and Combustible Liquids and Gases, 2010 edition.
(1) Nonflammable gases (examples including oxygen and
nitrous oxide) shall be stored and distributed in accordance with
Chapter 5 of the NFPA 99, Standard for Health Care Facilities, 2012
edition.
(A) Medical gases and liquefied medical gases shall
be handled in accordance with the requirements of NFPA 99 Chapter
9.
(B) Oxygen shall be administered in accordance with
NFPA 99 §9.6.
(2) Piped flammable gas systems intended for use in
laboratories and piping systems for fuel gases shall comply with requirements
of NFPA 99 §11.11.
(3) Flammable gases shall be stored in accordance with
NFPA 99 §11.10.
(4) Flammable and combustible liquids used in laboratories
shall be handled and stored in accordance with NFPA 99 §11.7,
and National Fire Protection Association 101, Life Safety Code, 2012
edition, §18.3.2.2.
(5) Other flammable agents shall be stored in accordance
with NFPA 99 Chapter 7.
(c) Gasoline and gasoline powered equipment. No motor
vehicles including gasoline powered standby generators or any amount
of gasoline shall be located within the LSRH building. Other devices
that may cause or communicate fire, and that are not necessary for
patient treatment or care, shall not be stored within the LSRH building.
All such devices and materials when necessary shall be used within
the building only with precautions ensuring a reasonable degree of
safety from fire.
(d) Gas-fired appliances. The installation, use, and
maintenance of gas-fired appliances and gas piping installations shall
comply with the National Fire Protection Association 54, National
Fuel Gas Code, 2012 edition. The use of portable gas heaters and unvented
open flame heaters is specifically prohibited.
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