|(a) The design of the mechanical systems must be done
by or under the direction of a licensed professional mechanical engineer
approved by the Texas Board of Professional Engineers to operate in
Texas, and the parts of the plans and specifications covering mechanical
design must bear the legible seal of the engineer.
(1) Building services pertaining to utilities; heating,
ventilating, and air-conditioning systems; vertical conveyors; and
chutes must be according to NFPA 101.
(2) Required plumbing fixtures must be according to
NFPA 101 and §19.354 of this division (relating to Architectural
Space Planning and Utilization for New Facilities) in specific use
(1) All plumbing systems must be designed and installed
according to the requirements of the locally adopted plumbing code.
In the absence of a locally-adopted plumbing code, a nationally recognized
model plumbing code must be used. Any discrepancy between an applicable
code and the requirements of this section must be called to the attention
of HHSC for resolution.
(2) Supply systems must ensure adequate hot and cold
water. In addition to hot water for kitchen and laundry use, a rule-of-thumb
for hot water for resident use at 110 degrees Fahrenheit is to provide
6-1/2 gallons per hour per resident.
(3) Water must be supplied from a system approved by
the Water Supply Division of TCEQ, or from a system regulated by
an entity responsible for water quality in that jurisdiction as approved
by the Water Supply Division of TCEQ.
(4) The sewage system must connect to a system permitted
by the Water Quality Division of TCEQ, or to a system regulated by
an entity responsible for water quality in that jurisdiction as approved
by the Water Quality Division of TCEQ.
(5) The minimum ratio of fixtures to residents shall
be as required in §19.354(c) of this division.
(6) For design calculation purposes, resident-use hot
water must not exceed 110 degrees Fahrenheit at the fixture. For purposes
of conforming to licensure requirements, an operating system providing
water from 100 degrees Fahrenheit to 115 degrees Fahrenheit is acceptable.
Hot water for laundry and kitchen use must be normally 140 degrees
Fahrenheit. Hot water for dish sanitizing must be 180 degrees Fahrenheit.
(7) A facility must provide water closets with a seat
height 17 inches to 19 inches from the floor for persons with disabilities.
(8) Showers for wheelchair residents must not have
curbs. Tub and shower bottoms must have a slip-resistant surface.
Shower and tub enclosures, other than curtains, must be of tempered
glass, plastic, or other safe material.
(9) Drinking fountains must not extend into exit corridors.
(10) A facility must provide fixture controls easily
operable by residents, such as lever-type controls.
(11) Plumbing fixtures for residents must be vitreous
china or porcelain finished cast iron or steel unless otherwise approved
by HHSC. Fiberglass bathing units are acceptable if they have a Class
B flame spread rating when tested according to ASTM E84.
(12) Hand-washing sinks for staff use must be according
to §19.354 of this division. A facility must provide lavatories
adjacent to all water closets.
(13) A soiled utility room must be provided with a
flushing device, such as a water closet with bedpan lugs; a spray
hose with a siphon breaker or similar device, such as a high neck
faucet with lever controls; and a deep sink that is large enough to
submerse a bedpan. A sterilizer may be used for sanitizing in place
of a deep sink.
(14) A facility must install a siphon breaker or back-flow
preventer with any water supply fixture if the outlet or attachments
may be submerged.
(15) A facility must provide clean-outs for waste piping
lines located so there is the least physical and sanitary hazard to
residents. To avoid contamination, clean-outs must open to the exterior,
(16) A facility with a boiler must meet all applicable
requirements of Texas Health and Safety Code Chapter 755.
(c) Heating, Ventilating, and Air-Conditioning (HVAC)
and Exhaust Systems
(1) General Requirements.
(A) HVAC systems must be designed and installed in
accordance with ASHRAE standards, except as may be modified by this
(B) HVAC systems serving spaces or providing health
functions covered by NFPA 99 must be commissioned as required by NFPA
(C) HVAC systems must meet the requirements of NFPA
90A and NFPA 99.
(D) Mechanical plans must bear a statement verifying
that the systems are designed according to NFPA 90A and NFPA 99.
(E) All air-supply and air-exhaust systems must be
(F) Ducts must be of metal or other approved noncombustible
material. Cooling ducts must be insulated against condensation.
(G) Static pressures of systems must be within limits
recommended by ASHRAE and the equipment manufacturer, both upstream
(2) Heating and Cooling.
(A) A facility must provide heating and cooling by
a central air conditioning system, or a substantially similar air
conditioning system. Air conditioning systems must be designed, installed
and functioning to maintain temperatures suitable for resident comfort
within all areas used by residents.
(B) Design temperatures for heating and cooling must
be as required by NFPA 99.
(C) A heating system must be able to maintain a temperature
of at least 75 degrees Fahrenheit for all areas occupied by residents.
For all other occupied areas, a heating system must be able to maintain
a temperature of at least 72 degrees Fahrenheit.
(D) A cooling system must be able to maintain a temperature
of not more than 78 degrees Fahrenheit.
(E) Occupied areas generating high heat, such as kitchens,
must be provided with a sufficient cool air supply to maintain a temperature
not exceeding 85 degrees Fahrenheit at the five-foot level. Supply
air volume must be approximately equal to the air volume exhausted
to the exterior for these areas.
(F) The location and design of air diffusers, registers,
and return air grilles must ensure that residents are not in harmful
or excessive drafts in their normal usage of the room.
(G) In geographic locations or interior room areas
where extreme humidity levels are likely to occur for extended periods
of time, apparatus for controlling humidity levels with automatic
humidistat controls, preferably at 40-60% relative humidity, are recommended
as part of central systems.
(H) Unvented space heaters and portable heating units
must not be used. Heating devices or appliances must not be a burn
hazard to residents.
(I) Gas-fired Heating Equipment.
(i) Systems using liquefied petroleum gas fuel must
meet the requirements of the Railroad Commission of Texas and NFPA
(ii) A combustion fresh air inlet must be provided
to all gas or fossil fuel operated equipment in steel ducts or passages
from outside the building according to NFPA 54. Combustion air must
be provided through two permanent openings, one commencing within
12 inches of the floor and one commencing within 12 inches of the
(iii) A room where gas-fired heating equipment is located
must be vented to the exterior to exhaust heated ambient air in the
(A) Air systems must provide for mixing at least 10%
outside air for the supply distribution. Blowers for central heating
and cooling systems must be designed so that they may run continuously.
(B) A facility must locate an outdoor air intake according
to NFPA 99 and as far as practical, but not less than 10 feet, from
exhaust outlets or ventilating systems, combustion equipment stacks,
medical vacuum systems, plumbing vent stacks, or areas which may collect
vehicular exhaust and other noxious fumes.
(C) Fresh air inlets must be appropriately screened
to prevent entry of debris, rodents, and animals. A facility must
provide access to such screens for periodic inspection and cleaning
to eliminate clogging or air stoppage.
(D) A facility must incorporate natural ventilation
using windows or louvers, if possible and practical. Windows or louvers
must have insect screens.
(E) The design of ventilation systems must provide
air movement that is from clean to less clean areas. The ventilation
systems must be designed and balanced to provide the pressure relationships
to adjacent spaces as required by NFPA 99. The installer must furnish
and certify a final engineered system air balance report for the completed
system. The report must demonstrate the pressure relationships required
by NFPA 99.
(F) Air supply to food preparation areas must not be
from air that has circulated through places such as resident bedrooms
(G) Ventilation rates for all areas of a facility must
be as required by NFPA 99. These rates are the minimum acceptable
rates, but do not preclude the use of higher ventilation rates.
(H) The bottoms of ventilation openings must be at
least three inches above the floor of any room.
(I) A door protecting a corridor or way of egress must
not include an air transfer grille or louver. A corridor must not
be used to supply air to or exhaust air from any room except that
air from a corridor may be used as make-up air to ventilate a small
toilet room, a janitor's closet, or a small electrical or telephone
closet opening directly on a corridor, provided the ventilation can
be accomplished by door undercuts not exceeding 3/4 inches.
(A) A facility must provide forced air exhaust of all
room air directly to the outdoors according to NFPA 99.
(i) Areas such as laundries, kitchens, and dishwashing
areas must exhaust all room air to the outdoors to remove excess
heat and moisture and to maintain air flow in the direction of clean
to soiled areas.
(ii) Unsanitary areas, including janitor’s closets,
soiled linen areas, soiled workroom and utility areas, and soiled
areas of laundry rooms, must exhaust all room air outdoors.
(B) All exhaust must be continuously ducted to the
exterior. Exhausting air into attics or other spaces is not permitted.
Exhaust duct material must be metal.
(C) Exhaust hoods, ducts, and automatic extinguishers
for kitchen cooking equipment must be according to NFPA 96, when required
by NFPA 101.
(5) Integration with Building Construction.
(A) Smoke compartmentation must meet the requirements
of §19.356 of this division (relating to Smoke Compartments (Subdivision
of Building Spaces) for New Facilities).
(B) An air system must be designed as much as possible
to avoid having ducts passing through fire walls or smoke barrier
walls. All openings or duct penetrations in these walls must be according
to NFPA 101.
(C) A smoke damper at a smoke barrier must close automatically
upon activation of the fire alarm system to prevent the flow of air
or smoke in either direction, when required by NFPA 101.
(D) A duct with a smoke damper must have maintenance
panels for inspection. A maintenance panel must be removable without
tools. A facility must provide access in the ceiling or side wall
to facilitate smoke damper inspection. A facility must identify the
location of dampers on the wall or ceiling of the occupied area below.
(E) A central air supply system or a system serving
a means of egress must automatically and immediately shut down upon
activation of the fire alarm system, except when such a system is
part of an engineered smoke-removal system approved by HHSC.
(6) All ventilation or air-conditioning systems must
be equipped with filters as required by NFPA 99. Filters must be of
sufficient efficiency to minimize dust and lint accumulations throughout
the system and building, including in supply and return plenums and
ductwork. Filters must be easily accessible for routine changing or
(d) Sprinkler systems. The following requirements are
applicable to sprinkler systems:
(1) Sprinkler systems must be according to NFPA 13
and this subchapter.
(2) The design and installation of sprinkler systems
must meet any applicable state laws pertaining to these systems and
one of the following criteria:
(A) A sprinkler system must be designed by a qualified
licensed professional engineer approved by the Texas Board of Professional
Engineers to operate in Texas. The engineer must supervise the installation
and provide written approval of the completed installation.
(B) A sprinkler system must be planned and installed
according to NFPA 13 by a firm with a certificate of registration
issued by the State Fire Marshal’s Office. The RME's license
number and signature must be included on the prepared sprinkler drawings.
(3) A facility must ensure all sprinkler piping is
protected against freezing. The design of freeze protection must minimize
the need for dependence on staff action or intervention to provide
(e) Piped gas and vacuum systems. A piped medical gas
or medical vacuum system, including a piped oxygen system, a vacuum
system, or a drive gas system such as a compressed air system, must
be designed, installed, operated and managed according to the requirements
of NFPA 99 for new health care facilities, and based on the risk category
determined by the assessment required by §19.300(i) of this
subchapter (relating to General Requirements).