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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

    (I) Each laboratory unit shall meet the requirements of Chapter 11 of NFPA 99 (relating to Laboratories), and Chapter 20 of NFPA 101 (relating to New Ambulatory Health Care Occupancies).

  (8) Housekeeping room. A sufficient number of janitor's closets shall be provided throughout the facility to maintain a clean and sanitary environment. The closet shall contain a floor receptor or service sink and storage space for housekeeping supplies and equipment. When there is only one housekeeping room for the entire facility there shall be policies and procedures in place, as described in §131.55 of this title (relating to Sanitary Conditions and Hygienic Practices) for proper use of cleaning body fluids versus general cleaning, and the use of separate equipment and supplies.

  (9) Medical waste. Space and facilities shall be provided for the safe storage and disposal of medical waste as appropriate for the material being handled and in compliance with all applicable federal, state, or local laws, codes, rules, regulations and ordinances.

  (10) Supply rooms.

    (A) A storage room/area for breakdown of supplies shall be provided. The storage room/area shall have adequate space for breakdown of prepackaged supplies to be loaded on cart(s) to transport to the appropriate storage spaces. The breakdown area shall not reduce the clear unobstructive width in the egress corridor.

    (B) Sterile/clean supply room. A sterile/clean supply room shall be provided. Storage of sterile/clean supplies shall not occur within the breakdown room.

    (C) An equipment storage room shall be provided. The equipment room may be in the emergency suite.

  (11) Employee facilities. A lounge, lockers and staff toilets shall be provided for employees and volunteers. The toilet room(s) may be unisex.

  (12) Engineering suite and equipment areas shall be provided.

    (A) Provisions shall be made for protected storage of facility drawings, records, manuals, etc.

    (B) All mechanical and electrical equipment rooms shall provide sufficient space for proper maintenance of equipment. Provisions shall be made for removal and replacement of equipment.

    (C) Additional areas or room(s) for mechanical and electrical equipment shall be provided within the physical plant or installed in separate buildings or weatherproof enclosures with the following exceptions.

      (i) An area shall be provided for cooling towers and heat rejection equipment when such equipment is used.

      (ii) Medical gas systems shall be housed in accordance with National Fire Protection Association 99, Standard for Health Care Facilities, 2002 edition (NFPA 99), Chapters 4 and 8.

      (iii) When provided, compactors, dumpsters, and incinerators shall be located in an area remote from public entrances.

(e) General detail requirements. Details in pre-existing facilities shall comply with this subsection, local building codes, and local ordinances.

  (1) Exits, corridors and doors.

    (A) A facility shall provide two exits remote from each other. At least one exit door shall be accessible by an ambulance from the outside.

    (B) Encroachment into the means of egress. Such items as drinking fountains, telephone booths or stations, and vending machines shall not project into or restrict exit corridor traffic or reduce the exit corridor width below the required minimum. Portable equipment, when stored, shall not project into and restrict exit corridor traffic or reduce the exit corridor width below the required minimum.

    (C) The unobstructed width of a corridor shall be at least four feet.

    (D) Doors at all openings between corridors and rooms or spaces subject to occupancy shall be swing type. Elevator doors are excluded from this requirement.

    (E) The minimum width of doors for patient access to treatment, examination, diagnostic, and imaging rooms requiring access for beds and gurneys shall be three feet.

    (F) All fire doors shall be listed by an independent testing laboratory and shall meet the construction requirements for fire doors in National Fire Protection Association 80, Standard for Fire Doors and Fire Windows, 1999 Edition. Reference to a labeled door shall be construed to include labeled frame and hardware.

  (2) Glazing for glass doors, lights, sidelights, borrowed lights, and windows located within 12 inches of a door jamb or with a bottom-frame height of less than 18 inches and a top-frame height of more than 36 inches above the finished floor which may be broken accidentally by pedestrian traffic shall be glazed with safety glass or plastic glazing material that will resist breaking and will not create dangerous cutting edges when broken. Similar materials shall be used for wall openings in activity areas such as recreation and exercise rooms, unless otherwise required for fire safety. Safety glass, tempered or plastic glazing materials shall be used for shower doors and bath enclosures, interior windows and doors. Plastic and similar materials used for glazing shall comply with the flame spread ratings of NFPA 101, §18.3.3.

  (3) Grab bars shall be provided at patient toilets and showers. The bars shall be one and one-half inches in diameter, shall have either one and one-fourth or one and one-half inches clearance to walls, and shall have sufficient strength and anchorage to sustain a concentrated vertical or horizontal load of 250 pounds. Grab bars intended for use by the disabled shall also comply with ADA requirements.

  (4) Location and arrangement of fittings for hand washing facilities shall permit their proper use and operation. Hand washing fixtures with hands-free controls shall be provided in each examination, treatment, trauma, diagnostic, imaging, holding/observation room/area, soiled utility room, clean work room, and toilet room. Particular care shall be given to the clearances required for blade-type operating handles. Lavatories and hand washing facilities shall be securely anchored to withstand an applied vertical load of not less than 250 pounds on the front of the fixture. In addition to the specific areas noted, hand washing facilities shall be conveniently located for staff use in rooms and areas noted under spatial requirements in subsection (c) of this section and throughout the center where patient care services are provided.

  (5) A liquid or foam soap dispenser shall be located at each hand washing facility.

  (6) Provisions for hand drying shall be included at all hand washing facilities. Hot air dryers or individual paper or cloth units shall be enclosed to provide protection against dust or soil and shall provide single-unit dispensing.

  (7) A sign shall be posted at the entrance to each toilet/restroom to identify the facility for public, staff, or patient use.

  (8) Emergency eyewash shall be provided conveniently located within the emergency suite for staff use and comply with ANSI Z358.1.

  (9) The minimum ceiling height shall be eight feet six inches with the following exceptions.

    (A) Ceilings in storage rooms, toilet rooms, and other minor rooms shall be not less than seven feet six inches.

    (B) Boiler rooms shall have ceiling clearances not less than two feet six inches above the main boiler header and connecting piping.

    (C) Overhead clearance for suspended tracks, rails, pipes, signs, lights, door closers, exit signs, and other fixtures that protrude into the path of normal traffic shall not be less than six feet eight inches above the finished floor.

  (10) Radiation shielding shall be designed, tested, and approved by a medical physicist licensed under the Medical Physics Practice Act, Occupations Code, Chapter 602. The facility shall obtain a certificate of registration issued by the Radiation Safety Licensing Branch to use radiation machines.

(f) General finish requirements. Finishes in pre-existing facilities shall comply with this subsection, local building codes, and local ordinances.

  (1) Privacy screens, cubicle curtains, and draperies.

    (A) Cubicle curtains or privacy screens shall be provided to assure patient privacy when required or requested by a patient.

    (B) Cubicle curtains, draperies and other hanging fabrics shall be noncombustible or flame retardant.

  (2) Floor finishes.

    (A) Flooring shall be easy to clean and have wear resistance appropriate for the location involved. In all areas frequently subjected to wet cleaning methods, floor materials shall not be physically affected by germicidal and cleaning solutions.

    (B) Existing flooring in patient treatment/exam rooms in a pre-existing facility that has jointed or seamed flooring material may continue to be used provided there is assurance that no bodily fluids or moisture can harbor in the joints, seams or under the flooring material. If assurance of fluids harboring under the flooring material cannot be made, the flooring material must be sealed with a covering sealant material to prevent fluids from entering the seams and joints. When the existing flooring is replaced, the new flooring shall meet the requirements of §131.143(f)(3)(A)(iii) of this title (relating to Construction Requirements for a New Facility).

    (C) Thresholds at doorways shall not exceed 3/4 inch in height for exterior sliding doors or 1/2 inch for other type doors. Raised thresholds and floor level changes at accessible doorways shall be beveled with a slope no greater than 1:2. Expansion joint covers shall not exceed 1/2 inch in height and shall have beveled edges with a slope no greater than 1:2.

  (3) Wall finishes. Wall finishes shall be washable, moisture resistant, and cleanable by standard housekeeping practices.

    (A) Wall finishes shall be water-resistant in the immediate area of plumbing fixtures.

    (B) Wall finishes in areas subject to frequent, wet cleaning methods shall be impervious to water, tightly sealed, and without voids.

  (4) Ceiling finishes. All occupied rooms and spaces shall be provided with finished ceilings, unless otherwise noted. Ceilings which are a part of a rated roof/ceiling assembly or a floor/ceiling assembly shall be constructed of listed components and installed in accordance with the listing.

  (5) Floor, wall, and ceiling penetrations. Floor, wall, and ceiling penetrations by pipes, ducts, and conduits, or any direct openings shall be tightly sealed to minimize entry of dirt particles, rodents, and insects. Joints of structural elements shall be similarly sealed.

  (6) Material finishes. Materials known to produce noxious gases when burned shall not be used for mattresses, upholstery, and wall finishes.

(g) General mechanical requirements. Mechanical systems, air conditioning, heating, and ventilating systems shall meet the requirements of the local building codes, ordinances and this section.

  (1) Equipment location. Mechanical equipment may be located indoors, outdoors in a weatherproof enclosure, or in a separate building(s).

  (2) Vibration isolation. Mechanical equipment shall be mounted on vibration isolators to prevent unacceptable structure-borne vibration. Ducts, pipes, etc. connected to mechanical equipment which is a source of vibration shall be isolated from the equipment with vibration isolators.

  (3) Heating, ventilating, and air conditioning (HVAC) systems.

    (A) All central HVAC systems shall comply with and shall be installed in accordance with required building codes, ordinances and NFPA 90A, Standard for the Installation of Air Conditioning and Ventilating Systems, 2002 Edition, or NFPA 90B, Standard for the Installation of Warm Air Heating and Air-Conditioning Systems, 2002 Edition, as applicable, and the requirements contained in this paragraph. Air handling units serving two or more rooms are considered to be central units.

    (B) Noncentral air handling systems, i.e., individual room units that are used for heating and cooling purposes (e.g., fan-coil units, heat pump units, and packaged terminal air conditioning units) shall be equipped with permanent (cleanable) or replaceable filters. The filters shall have an average efficiency of 25 - 30% and an average arrestance of 85% based on American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE), Inc., Standard 52.2, 1999 edition, Method of Testing General Ventilation Air Cleaning Devices for Removal Efficiency by Particle Size. These units shall be used as air recirculating units only.

    (C) General ventilation requirements. All rooms and areas in the facility shall have provision for positive ventilation.

      (i) All toilet exhaust ventilation shall be exhausted.

      (ii) Air distribution devices. Design shall consider turbulence and other factors of air movement to minimize airborne particulate matter.

        (I) All supply diffusers grilles shall be located on the ceiling or on a wall within four inches from the ceiling.

        (II) Air supply for the treatment rooms/areas, exam rooms/areas, and trauma rooms/areas shall be from ceiling outlets.

      (iii) Air handling units shall be equipped with filters having efficiencies of 25 - 30% and an average arrestance of 85% or greater based on American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE), Inc., Standard 52.2, 1999 edition, Method of Testing General Ventilation Air Cleaning Devices for Removal Efficiency by Particle Size. All joints between filter segments, and between filter segments and the enclosing ductwork, shall have gaskets and seals to provide a positive seal against air leakage.

Cont'd...

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