| (3) The more stringent standard, code or requirement shall apply when a difference in requirements for construction exists. (4) Nothing in this subchapter shall be construed to prohibit a better type of building construction, more exits, or otherwise safer conditions than the minimum requirements specified in this subchapter. (5) Nothing in this subchapter is intended to prevent the use of systems, methods, or devices of equivalent or superior quality, strength, fire resistance, effectiveness, durability, safety to health and welfare of individuals, and safety to those prescribed by this subchapter, provided technical documentation which demonstrates equivalency is submitted to the department for approval. (6) Separate freestanding buildings for nonpatient use such as the heating plant, boiler plant, laundry, repair workshops, or general storage may be of unprotected noncombustible construction, protected noncombustible construction, or fire-resistive construction and be designed and constructed in accordance with other occupancy classifications requirements listed in NFPA 101. (d) Spatial requirements. (1) Administration and public areas. (A) Patient entrances shall be located at grade level, be accessible to individuals with disabilities, and provide exterior covered protection against inclement weather. The minimum exterior protection covering shall be no smaller than 4 feet by 6 feet wide. A covered area for patients in wheelchairs shall be provided next to the opening area of the door swing and door swing shall not interfere within this area. When an ESRD is located on a floor above grade level, elevators shall be accessible and shall meet the requirements of §117.103 of this title (relating to Elevators, Escalators, and Conveyors). (B) A waiting area or lobby shall be provided within the ESRD facility and include having the following rooms and items: (i) public toilet facilities; and (ii) telephone(s) for public use. (C) A designated reception area with desk or counter shall be provided. (D) Space shall be provided for private interviews for family members relating to social services, credit, or admission. (E) An office(s) shall be provided for business transactions, records, and administrative and professional staff. (F) The facility shall provide an area for storage of clinical records which is separate from all patient treatment areas, and shall be secured from unauthorized access. The facility shall store the active clinical record of each patient currently treated by the facility on site. (G) A general storage room with a minimum of 2 square feet per treatment station shall be provided. General storage may be located in one or more rooms or closets, and shall be located outside of the patient treatment areas. (H) Storage space for wheelchairs shall be provided, and shall be out of the direct line of traffic. (2) Equipment rooms with adequate space shall be provided for mechanical and electrical equipment. These areas shall be separate from public, patient, and staff areas. (3) An exam room shall be provided for medical examinations. The room shall have a minimum clear floor space of 80 square feet area exclusive of fixed cabinets and shelves and contain a counter for writing and a hand washing sink with hands-free operable controls. (4) When a patient is hepatitis B positive, the treatment shall be in a separated dedicated isolation room. All treatment in the isolation room shall be for hepatitis B patients only. (A) A single hepatitis B patient isolation room shall be a minimum of 120 square feet clear area exclusive of fixed and movable cabinets and shelves. (B) When multiple-treatment stations for hepatitis B patients are treated in a single isolation room, each individual patient treatment area shall be 80 square feet with a minimum of 8 feet clear dimension exclusive of fixed or wall mounted cabinets and built-in shelves. The clearance between the side of a station/chair and a wall/partition shall be a minimum of 3 feet. The clearance between sides of stations/chairs shall be a minimum of 4 feet. (C) The isolation treatment room shall include a work counter and a hand washing sink with hands-free operable controls, and space for patient care supplies and equipment. The fixed and moveable cabinets and shelves shall not encroach upon the patient treatment station/chair clear floor space/area. (D) The isolation treatment room shall have viewing panels in doors and/or walls for continuous direct visual monitoring of the patient in the room. (E) The dialysis equipment shall be designated, reserved, and used for hepatitis B positive patients only. (F) Disinfection of dialysis equipment shall occur in the hepatitis B treatment isolation room and shall meet the requirements of §117.33(d)(2)(C) of this title (relating to Sanitary Conditions and Hygienic Practices). (G) As of February 9, 2009, all new facilities or increasing the number of in-center dialysis treatment stations in existing facilities shall have an isolation room or be granted a waiver by Centers for Medicare and Medicaid Services. The waiver shall demonstrate that there is sufficient capacity in the geographic area for isolation rooms for hepatitis B positive patients. A written request for waiver shall be made through the Texas Department of State Health Services, Health Facility Compliance Group, Mail Code 1979, P.O. Box 149347, Austin, Texas, 78714-9347 for transmission to CMS. (5) When home training is provided in the facility, a private treatment area of at least 120 square feet exclusive of fixed and movable cabinets and shelves shall be provided. This room shall contain a work counter, a hand washing sink with hands-free operable controls, and a separate drain for fluid disposal. (6) 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. (7) When laboratory services are provided on site the following shall be provided and meet the requirements of §117.45(l) of this title (relating to Provision and Coordination of Treatment and Services). (A) The laboratory workroom/area shall include a counter and a sink with hands-free operable controls. Laboratory services and medication preparation and dispensing shall not be done within the same designated space. (B) Cabinets or closets shall be provided for supplies and equipment used in obtaining samples for testing. (C) Refrigerated specimen storage shall be provided for specimens waiting for transfer to off-site testing. The refrigerators shall be maintained with documentation of the appropriate temperature for such storage. (8) When laundry and linen is provided, processing may be done within the center 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 which includes areas for receiving, holding, sorting, and washing; (ii) a clean linen processing room which includes areas for drying, sorting, folding, and holding prior to 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. (9) Space shall be provided for the safe storage and disposal of waste as appropriate for the material being handled and in compliance with all applicable rules and regulations. (10) At a minimum, the medication area shall include a counter, a refrigerator, and a hand washing sink with hands-free operable controls. Storage and preparation of medication shall be done from a medication area and shall be under visual control of nursing staff. Medication preparation, dispensing and laboratory services shall not be done within the same designated areas. The refrigerators used for storage of medications shall be maintained with documentation of the appropriate temperatures for such storage. (11) When peritoneal dialysis (PD) training is provided within the ESRD facility, a patient treatment training room shall have a minimum of 120 square feet of clear floor area exclusive of fixed and movable cabinets and shelves. Cont'd... |
