| (v) For open ward environments in adult and pediatric
units, the clearance between a bed and a wall/partition shall be a
minimum of five feet. The clearance between sides of beds shall be
a minimum of eight feet. The minimum distance at the foot of the bed
shall not be less than seven feet for single load area/room or ten
feet for double load area/room. Four feet of the passage space requirement
at the foot of the bed may be shared between two beds. The multiple-bed
CCU wards shall contain cabinets, work counters, and hand washing
fixtures with hands-free operable controls. The fixed and moveable
cabinets and shelves shall not encroach upon the bed/gurney clear
floor space/area. The requirements of this clause are illustrated
in Table 8, Diagrams A and B of §133.169(h) of this title.
(vi) Each room and ward shall be located on an exterior
wall and shall have a window. In a ward, one window may serve more
than one patient. The window sill height shall not exceed five feet
above the floor. Patient beds shall not be located more than 50 feet
from an exterior window. Patients' views to outside windows shall
be direct. When partitions are used, the patient's view to the outside
window(s) may be through no more than two separate clear vision panels.
Windows shall be in accordance with subsection (t)(2)(A)(v) of this
section.
(vii) Hand washing fixtures with hands-free operable
controls shall be located in or adjacent to the nurse station, inside
of each room at the entrance of the room, and at a ratio of one fixture
to each three beds for an open ward layout. Hand washing fixtures
shall be sized to contain splashing and conveniently distributed throughout
the ward. When a combination modular swivel/fixed toilet and hand
washing fixture is provided, hospital administration shall provide
a letter (on hospital letterhead) indicating if the toilet is for
staff convenience (bed pan washing) or for patient use.
(I) If the toilet is for patient use, an additional
hand washing fixture shall be provided in each room at the entrance
of the room. If the modular toilet/hand washing unit is for patient
use, provision shall be made for patient privacy and odor control.
The toilet room exhaust shall be in accordance with Table 3 of §133.169(c)
of this title.
(II) When the modular toilet/hand washing unit is for
staff use, it shall be near the entrance to the room.
(viii) The nurse station shall be located to permit
direct visual observation of each patient served. Video cameras or
mirrors shall not be substituted for direct visual observation. The
nurse station shall have space for counters and storage. The counter
height shall not exceed 42 inches. The nurse station may be combined
with or include centers for reception and communication.
(ix) When individual nurse substations are provided
and located at each patient room(s), they shall be located to permit
direct visual observation of each patient served. The nurse substation
shall have space for a counter, storage space and a recessed sitting
space. The substation shall, at a minimum, be recessed one foot six
inches from the egress corridor.
(x) Storage and preparation of medication may be done
from a room, alcove area or from a self-contained dispensing unit
but must be under visual control of nursing staff. A work counter,
hand washing fixture with hands-free operable controls, refrigerator,
and double-locked storage for controlled substances shall be provided.
Standard cup-sinks are not acceptable for hand washing.
(xi) An intravenous solution support shall be provided
at each patient crib, bed or bassinet. The intravenous solution shall
not be suspended directly over the patient.
(xii) Storage space shall be provided for emergency
equipment in the unit.
(C) CCCU. When a CCCU is provided, the CCCU shall comply
with the requirements contained in subparagraph (B) of this paragraph
and the following.
(i) Each CCCU bed shall be in a separate room. Equipment
for monitoring cardiac patients shall be provided by visual display
both at the bed location and at the nurse station.
(ii) Each coronary patient shall have direct access
to a toilet room and a hand washing fixture. Swivel type commodes
may be utilized in lieu of individual toilet rooms, but provision
must be made for patient privacy and odor control. The toilet room
exhaust rate shall be in accordance with Table 3 of §133.169(c)
of this title.
(iii) When medical, surgical, and coronary critical
care services are combined in one CCU suite, at least 50% of the beds
shall be located in private rooms. (Note: Medical/surgical patients
may utilize open areas or private critical care rooms as needed and
available but, insofar as possible, coronary patients should not be
accommodated in open ward areas.)
(D) PCCU. When a PCCU is provided, the unit shall comply
with the requirements contained in subparagraph (B) of this paragraph
and the following.
(i) The PCCU may be an open ward, private rooms, or
combination of both. When an open ward plan is used, one private room
is required for each 10 beds or fraction thereof.
(ii) In a multiple-bassinet/crib (sleeping unit) room/ward
the clearance between the side of the sleeping unit and a wall/partition
shall be a minimum of five feet. The clearance between sides of sleeping
units shall be a minimum of eight feet. The minimum distance at the
foot of the bassinet shall not be less than ten feet for single load
area/room or sixteen feet for double load area/room. Four feet of
the passage space requirement at the foot of the bassinet may be shared
between two bassinets. The fixed and moveable cabinets and shelves
shall not encroach upon the bassinet/crib clear floor space/area.
The requirements of this clause are illustrated in Table 8, Diagram
K of §133.169(h) of this title.
(iii) A sleeping space shall be provided for parents
who spend long hours with the patient. This space may be within the
patient room or separate from the patient area but shall be in communication
with the PCCU staff.
(iv) Hand washing fixtures with hands-free operable
controls shall be provided in each room near the entrance of the room,
and in open wards at a minimum ratio of one fixture to each three
cribs, beds or bassinets. Hand washing fixtures shall be sized to
contain splashing.
(v) A room shall be provided for private discussions
and shall be located within, or convenient to, the PCCU. The multipurpose
room noted in subparagraph (F)(v) of this paragraph will meet this
requirement if conveniently located.
(vi) Storage space for infant formula shall be provided.
This functional space may be outside the PCCU but shall be available
for use at all times.
(vii) Storage cabinets or closets for toys and games
shall be provided within the unit.
(viii) Storage area for cots, bed linens, and other
items needed for overnight accommodation of parents shall be provided
in the general location of sleeping accommodations.
(ix) An examination/treatment room with a minimum of
120 square feet of clear floor area shall be located in or near the
PCCU suite. The room shall contain a hand washing fixture with hands-free
operable controls, storage facilities, counter, or shelf space for
writing. This requirement does not apply when all patient rooms are
private rooms.
(E) Additional service spaces. The following additional
service spaces shall be immediately available within each type of
CCU(s). These may be shared by more than one CCU (unless otherwise
noted) provided that direct access is available from each.
(i) Securable closets. Securable closets or cabinet
compartments for the personal effects of nursing personnel, located
in or near the nurse station, shall be provided. At a minimum, these
shall be large enough for purses and billfolds. Coats may be stored
in closets or cabinets on each floor or in a central staff locker
area.
(ii) Charting and dictation area(s) for physicians.
Space for recording, record storage and reviews shall be provided
near cribs, beds or bassinets. Dictation space may be in a separate
room or alcove. Suitable space shall be provided when computers are
used for the clinical records.
(iii) X-ray viewing area. Each type of CCU shall be
provided with an X-ray viewing area and film illuminators for handling
at least four films simultaneously. When the entire CCU suite is provided
with digital imaging system capabilities, a minimum of two X-ray film
illuminator viewers shall be provided. The film illuminators shall
be mounted within the central area of the suite.
(iv) Nourishment station. The nourishment station shall
contain a sink with hands-free operable controls, work counter, refrigerator,
cabinets, and not be located in the medication room or the clean workroom.
Space shall be included for temporary holding of unused or soiled
dietary trays.
(v) Ice machine. The ice machine shall provide ice
for treatment and patient use. Ice-making equipment for treatment
may be in the clean workroom or the nourishment station.
Cont'd... |
