|(a) Surgical procedures performed in the facility shall be limited to those emergency procedures that are approved by the governing body upon the recommendation of medical staff. (b) Adequate supervision of surgical procedures conducted in the facility shall be a responsibility of the governing body, shall be recommended by medical staff, and shall be provided by appropriate medical staff. (c) Surgical procedures shall be performed only by physicians or practitioners who are licensed to perform surgical procedures in Texas and who have been granted privileges to perform those procedures by the governing body, upon the recommendation of the medical staff, and after medical review of the physician's or practitioner's documented education, training, experience, and current competence. (d) Surgical procedures to be performed in the facility shall be reviewed periodically as part of the peer review portion of the facility's quality assessment and performance improvement program. (e) An appropriate history, physical examination, and pertinent preoperative diagnostic studies shall be incorporated into the patient's medical record prior to surgical procedures. (f) Unless otherwise provided by law, the necessity or appropriateness of the proposed surgical procedure, as well as any available alternative treatment techniques, shall be discussed with the patient, or if applicable, with the patient's legal representative before the surgical procedure. (g) Licensed nurses and other personnel assisting in the provision of surgical services shall be appropriately trained and supervised and shall be available in sufficient numbers for the surgical care provided. (h) Each treatment/examination room shall be designed and equipped so that the types of surgical procedures conducted can be performed in a manner that protects the lives and ensures the physical safety of all persons in the area. (1) If flammable agents are present in a treatment/examination room, the room shall be constructed and equipped in compliance with standards established by the National Fire Protection Association (NFPA 99, Annex 2, Flammable Anesthetizing Locations, 1999) and with applicable state and local fire codes. (2) If nonflammable agents are present in a treatment/examination room, the room shall be constructed and equipped in compliance with standards established by the National Fire Protection Association (NFPA 99, Chapters 4 and 8, 1999) and with applicable state and local fire codes. (i) With the exception of those tissues exempted by the governing body after medical review, tissues removed shall be examined by a pathologist, whose signed or authenticated report of the examination shall be made a part of the patient's medical record. (j) A description of the findings and techniques of surgical procedures shall be accurately and completely incorporated into the patient's medical record immediately after the procedure by the physician or practitioner who performed the procedure. If the description is dictated, an accurate written summary shall be immediately available to the physicians and practitioners providing patient care and shall become a part of the patient's medical record. (k) The facility shall provide adequate space, equipment, and personnel to ensure a safe environment for treating patients during surgical procedures, including adequate safeguards to protect the patient from cross infection. (1) The facility shall isolate patients with communicable diseases. (2) Acceptable aseptic techniques shall be used by all persons. (3) Suitable equipment for rapid and routine sterilization shall be available. (4) The facility shall implement environmental controls that ensure a safe and sanitary environment. (l) Written policies and procedures for decontamination, disinfection, sterilization, and storage of sterile supplies shall be adopted, implemented, and enforced as described in §131.56 of this title (relating to Sterilization). (m) Emergency power adequate for the type of surgical procedures performed shall be available. (n) Periodic calibration and/or preventive maintenance of all equipment shall be provided in accordance with manufacturer's guidelines. (o) Unless otherwise provided by law, the informed consent of the patient or, if applicable, of the patient's legal representative shall be obtained before a surgical procedure is performed. (p) A written procedure shall be established for observation and care of the patient during and after surgical procedures. (q) Written protocols shall be established for instructing patients in self-care after surgical procedures, including written instructions to be given to patients who receive conscious sedation and/or regional anesthesia. (r) Patients who have received anesthesia, other than solely topical anesthesia, shall be allowed to leave the facility only in the company of a responsible adult, unless the physician, physician assistant, or an advanced practice registered nurse writes an order that the patient may leave without the company of a responsible adult. (s) The facility shall develop an effective written procedure for the immediate transfer to a hospital of patients requiring emergency care beyond the capabilities of the facility. The facility shall have a written transfer agreement with a hospital as set forth in §131.66 of this title (relating to Patient Transfer Policy).