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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

    (I) 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.

  (3) 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.

  (4) 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.

  (5) 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 (d) of this section and throughout the center where patient care services are provided.

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

  (7) 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.

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

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

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

    (A) Rooms containing ceiling-mounted light fixtures or equipment. Trauma rooms or other rooms containing ceiling-mounted light fixtures or equipment shall have a ceiling height of not less than 9 feet. Additional ceiling height may be required to accommodate special fixtures or equipment.

    (B) Ceilings in storage rooms, toilet rooms, and other minor rooms shall be not less than 7 feet 6 inches.

    (C) Boiler rooms shall have ceiling clearances not less than 2 feet 6 inches above the main boiler header and connecting piping.

    (D) 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.

  (11) Areas producing impact noises like recreation rooms, exercise rooms, and similar spaces shall not be located directly over trauma or treatment rooms/area unless special provisions are made to minimize noise.

  (12) Rooms containing heat-producing equipment, such as mechanical and electrical equipment and laundry rooms, shall be insulated and ventilated to prevent floors of any occupied room located above it from exceeding a temperature differential of 10 degrees Fahrenheit above the ambient room temperature.

  (13) When the entire facility is provided with digital imaging system capabilities, a minimum of 2 X-ray film illuminators viewers shall be provided in a central location.

  (14) 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 new construction projects, including additions and alterations, shall comply with this subsection, with NFPA 101, Chapter 20, and with local building codes.

  (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 and shall pass both the small-scale and the large-scale tests of National Fire Protection Association 701, Standard Methods of Fire Tests for Flame-Resistant Textiles and Films, 1999 Edition. Copies of laboratory test reports for installed materials shall be submitted to the department at the time of the final construction inspection.

  (2) Flame spread, smoke development and noxious gases. Flame spread and smoke developed limitations of interior finishes shall comply with Table 4 of §131.148(d) of this title and NFPA 101, §10.2. The use of materials known to produce large or concentrated amounts of noxious or toxic gases shall not be used in exit accesses or in patient areas. Copies of laboratory test reports for installed materials tested in accordance with National Fire Protection Association 255, Standard Method of Test of Surface Burning Characteristics of Building Materials, 2000 Edition, and National Fire Protection Association 258, Standard Research Test Method for Determining Smoke Generation of Solid Materials, 2001 Edition, shall be provided.

  (3) Floor finishes.

    (A) Flooring shall be easy to clean and have wear resistance appropriate for the location involved. Floors that are subject to traffic while wet (such as shower and bath areas and similar work areas) shall have a nonslip surface. In all areas frequently subject to wet cleaning methods, floor materials shall not be physically affected by germicidal and cleaning solutions. The following are acceptable floor finishes:

      (i) painted concrete for mechanical, electrical, communication rooms, and janitor's closets;

      (ii) vinyl and vinyl composition tiles and sheets tiles for offices, lobbies, administrative areas, storage, staff and public toilet rooms, support spaces, and non-treatment areas. The joints shall be sealed to prevent moisture penetration between the joints and under the tile;

      (iii) monolithic or seamless flooring shall be provided for all treatment rooms/areas, exam rooms/areas, patient toilet rooms, and soiled workrooms. Seamless flooring shall be impervious to water, coved and installed integral with the base, tightly sealed to the wall, and without voids that can harbor insects or retain dirt particles. The base shall not be less then six inches in height. Welded joint flooring is acceptable;

      (iv) marble, ceramic and quarry tile for offices, lobbies, staff and public toilet rooms, administrative areas, wet areas, and similar spaces;

      (v) carpet flooring for offices, lobbies, and administrative areas. Carpeting shall not be installed in any holding rooms, toilet rooms, treatment rooms, examination rooms, diagnostic, imaging, and similar spaces; and

      (vi) terrazzo for offices, lobbies, administrative areas, and similar spaces.

    (B) 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.

  (4) Wall finishes. Wall finishes in patient exam, treatment, or diagnostic rooms, toilet rooms, soiled work room, clean work/storage rooms, and laboratory, shall be smooth, washable, moisture resistant, and cleanable by standard housekeeping practices. Wall finishes shall be in compliance with the requirements of NFPA 101, §38.3.3, relating to flame spread.

    (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.

  (5) 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. Three types of ceilings that are required in various areas of the facility are:

    (A) ordinary ceilings are required in all areas or rooms in the facility unless otherwise noted. This includes ceilings such as acoustical tiles installed in a metal grid which are dry cleanable with equipment used in daily housekeeping activities such as dusters and vacuum cleaners;

    (B) washable ceilings that dictate this type of cleaning or protection for these spaces (such as soil utility or soil workroom). The ceilings shall be made of washable, smooth, moisture impervious materials such as painted lay-in gypsum wallboard or vinyl faced acoustic tile in a metal grid; and

    (C) monolithic ceilings which are monolithic from wall to wall (painted solid gypsum wallboard), smooth and without fissures, open joints, or crevices, and with a washable and moisture impervious finish shall be provided in the airborne isolation rooms, soiled workrooms, trauma rooms, and sterilizing facilities when provided.

    (D) Nonfinished ceilings may be omitted in mechanical, electrical, communication rooms, shops, and similar spaces unless required for fire-resistive purposes.

  (6) 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.

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

(g) General mechanical requirements. This subsection contains requirements for mechanical systems; air conditioning, heating and ventilating systems; steam and hot and cold water systems; and thermal and acoustical insulation.

  (1) Cost. All mechanical systems shall be designed for overall efficiency and life cycle costing, including operational costs. Recognized engineering practices shall be followed to achieve the most economical and effective results except that in no case shall patient care or safety be sacrificed for conservation.

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

  (3) Vibration isolation. Mechanical equipment shall be mounted on vibration isolators as required 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.

  (4) Performance and acceptance. Prior to completion and acceptance of the facility to the owner/operator, all mechanical systems shall be tested, balanced, and operated to demonstrate to the design engineer or their representative that the installation and performance of these systems conform to the requirements of the plans and specifications.

    (A) Upon completion of the contract, the facility owner/operator shall obtain from the construction contractor parts lists and procurement information with numbers and descriptions for each piece of equipment.

    (B) Upon completion of the contract, the facility owner/operator shall obtain from the construction contractor instructions in the operational use and maintenance of systems and equipment as required.

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

    (A) All central HVAC systems shall comply with and shall be installed in accordance with the requirements of 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 Cont'd...

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