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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 §131.143Construction Requirements for a New Facility

    (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 or other similar 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 suite 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) When radioactive materials are employed, safe storage facilities shall be provided.

    (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).

  (10) Isolation room. The need for an airborne infection isolation room in the emergency suite shall be determined by the governing body and the infection risk assessment.

    (A) When the facility provides treatment rooms to perform procedures on persons who are known or suspected of having an airborne infectious disease, these procedures shall be performed in a designated emergency airborne infection isolation treatment rooms and meeting airborne infection isolation ventilation requirements. The isolation room shall meet the ventilation requirements contained in Table 1 of §131.148(a) of this title.

    (B) The emergency airborne infection isolation treatment room for a single patient shall have a minimum clear area of 120 square feet clear floor area exclusive of fixed and movable cabinets and shelves. The minimum clear room dimension exclusive of fixed cabinets and built-in shelves shall be 10 feet. The emergency treatment room shall contain cabinets, medication storage, work counter, examination light, and a hand washing fixture with hands-free operable controls.

    (C) The emergency airborne infection isolation room shall be provided with an enclosed anteroom. The enclosed anteroom shall open to directly into the emergency airborne infection isolation treatment room. The enclosed anteroom shall have facilities for hand washing, gowning, and storage of clean and soiled materials. One enclosed anteroom may serve multiple isolation rooms.

    (D) The door from the enclosed anteroom to the emergency airborne infection isolation room shall be provided with a self-closing device.

    (E) Pressure differential monitors or air flow devices shall be installed outside the isolation room and anteroom. Devices shall be installed in corridors, passageways, etc.

  (11) Secured holding room. When provided, this room shall be constructed to allow for security, patient and staff safety, patient observation, and sound mitigation. The secure holding room shall have a minimum clear area of 100 square feet clear floor area exclusive of fixed cabinets. The minimum clear room dimension exclusive of fixed cabinets shall be 10 feet.

  (12) Orthopedic and cast room. When provided, the room(s) may be in separate room(s) or in the trauma room. The room(s) shall contain a work counter, storage for splints and orthopedic supplies, traction hooks, medication storage, examination light, and a hand washing fixture with hands-free operable controls. When a cast room is provided it shall be equipped with hand washing facilities, storage, and other provisions required for cast procedures.

  (13) Film processing room. When a radiographic (X-ray) room is provided, a darkroom for processing film shall be provided unless the processing equipment does not require a darkroom for loading and transfer. When daylight processing is used, the darkroom may be minimal for emergency and special uses. Film processing shall be located convenient to the darkroom.

  (14) Housekeeping room. 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 1 housekeeping room for the entire facility there shall be policies and procedures in place, as describe in §131.55 of this title for proper use of cleaning up body fluids versus general cleaning, and the use of separate equipment and supplies.

  (15) 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.

  (16) Decontamination room.

    (A) When a decontamination room is provided, the exterior entry point shall be far as practical from any other entry point to the emergency treatment area.

    (B) The internal door from the decontamination room shall open directly to the corridor into the emergency treatment area.

    (C) The door shall swing into the room and be lockable against ingress from the corridor.

    (D) The room shall be a minimum of 80 square feet of clear floor area with a hand washing fixture with hands-free operable controls.

    (E) The decontamination room shall be equipped with 2 hand-held showerheads with temperature controls and a dedicated holding tank with a floor drain.

    (F) The decontamination room floor shall be self-coved to a height of 6 inches. The room shall have all smooth, nonporous, scrubable, nonabsorbent and nonperforated surfaces.

  (17) 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.

  (18) Laundry and linen may be processed within the facility or off site at a commercial laundry.

    (A) When on-site linen processing is provided, soiled and clean processing operations shall be separated and arranged to provide a one-way traffic pattern from soiled to clean areas. The following rooms and items shall be provided:

      (i) a soiled linen processing room that includes areas for receiving, holding, sorting, and washing;

      (ii) a clean linen processing room that includes areas for drying, sorting, folding, and holding before distribution;

      (iii) supply storage cabinets in the soiled and clean linen processing rooms;

      (iv) hand washing sink within the soiled linen processing room; and

      (v) a storage room for clean linen. Clean linen storage may be combined with the clean work room.

    (B) When linen is processed off site, the following areas shall be provided:

      (i) clean linen shall be stored within the clean supply area; and

      (ii) soiled linen shall be stored in a designated space in the facility.

  (19) Employee facilities. An employee suite shall be provided containing lockers, a lounge, and staff toilets for employees and volunteers. The toilet room(s) may be unisex.

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

    (A) An engineer's office/area with file space and provisions for protected storage of facility drawings, records, manuals, etc. .

    (B) A general maintenance shop(s) for repair, maintenance, supplies and equipment. An area for medical equipment which includes provisions for the storage, repair, and testing of electronic and other medical equipment.

    (C) When necessary, a separate room or building for yard maintenance equipment and supplies. When a separate room is within the physical plant, the room shall be located so that equipment may be moved directly to the exterior. Yard equipment or vehicles using flammable liquid fuels shall not be stored or housed within the facility.

    (D) Sufficient space shall be provided in all mechanical and electrical equipment rooms for proper maintenance of equipment. Provisions shall also be made for removal and replacement of equipment.

    (E) 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) An area for the medical gas park and equipment shall be provided. For smaller medical gas systems, the equipment may be housed in a room within the physical plant 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 new construction projects, including additions and alterations, shall comply with this subsection, with NFPA 101, Chapter 20, and with local building codes.

  (1) Fire safety features, including smoke compartmentation, means of egress, automatic extinguishing systems, inspections, smoking regulations, and other details relating to fire prevention and fire protection shall comply with NFPA 101, Chapter 20. The Fire Safety Evaluation System for Health Care Occupancies contained in the National Fire Protection Association 101A, Alternative Approaches to Life Safety, 2001 Edition, Chapter 3, shall not be used in new building construction, renovations, or additions to existing facilities.

  (2) Exits, corridors and doors.

    (A) A facility shall provide 2 exits remote from each other in accordance with NFPA 101, §20.2.4.1. At least 1 exit door shall be accessible by an ambulance from the outside. This door may also serve as an entry for loading or receiving goods.

    (B) Encroachment into the means of egress. Such items as drinking fountains, telephone booths or stations, and vending machines shall not project into and 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) Corridors.

      (i) The minimum clear and unobstructed width of a public corridor shall be at least 4 feet.

      (ii) The communicating corridor shall be used to convey patients by stretcher, gurney, or bed.

      (iii) The communicating corridor shall link the treatment room/area, exam room/area, and holding room/area and shall be continuous to at least 1 exit.

      (iv) The minimum clear and unobstructed width of the communicating corridor shall be 6 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) Doors, except doors to spaces such as small closets which are not subject to occupancy, shall not swing into corridors in a manner that might obstruct traffic flow or reduce the required corridor width. Large walk-in type closets are considered as occupiable spaces.

    (F) The minimum width of doors for patient access to treatment, examination, diagnostic, and imaging rooms requiring access for beds and gurneys shall be 3 feet 8 inches.

    (G) Emergency access rooms containing a restroom, intended for patient use, shall be provided with at least one door having hardware which will permit access from the outside in any emergency. Door leaf width of such doors shall not be less than 36 inches.

    (H) Horizontal sliding doors serving an occupant load of fewer than 10 shall be permitted. The area served by the door shall have no high hazard contents. The door shall be readily operable from either side without special knowledge or effort. The force required to operate the door in the direction of door travel shall be not more than 30 pounds per foot to set the door in motion, and shall be not more than 15 pounds per foot to close the door or open in the minimum required width. The door assembly shall comply with any required fire protection rating, and, where rated, shall be self-closing or automatic closing. The sliding doors opening to the egress corridor doors shall have a latch or other mechanism that ensures that the doors will not rebound into a partially open position if forcefully closed. The sliding doors shall be installed to resist passage of smoke and may have breakaway provisions. The latching sliding panel shall have a minimum clear opening of 36 inches in the fully open position. The fixed panels may have recessed tracks.

Cont'd...

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