902 KAR 20:009. Facility specifications; hospitals.

 

      RELATES TO: KRS 216B.010-216B.130, 216B.990(1), (2)

      STATUTORY AUTHORITY: KRS 216B.042

      NECESSITY, FUNCTION, AND CONFORMITY: KRS 216B.042 requires the Kentucky Cabinet for Health and Family Services to promulgate administrative regulations necessary for the proper administration of licensure of health facilities. This administrative regulation establishes licensure requirements for plan submission and the structural specifications and plant requirements for new construction, renovation, and maintenance of hospital facilities.

 

      Section 1. Definitions. (1) "License" means an authorization issued by the Cabinet for Health and Family Services for the purpose of operating a hospital facility.

      (2) "Licensure agency" means the of Inspector General, Cabinet for Health and Family Services.

      (3) "Relocatable unit" means a structure that is not on wheels and which is built in such a manner that it may be relocated at any time.

      (4) "Transportable unit" means any pre-manufactured structure, trailer, or self-propelled unit, equipped with a chassis or on wheels.

 

      Section 2. Preparation and Approval of Plans and Specifications. After receiving a certificate of need, if required, and before beginning new construction or renovation, or making a change in function of a facility, the following procedures shall be followed:

      (1) The licensee or applicant shall complete the planning and design requirements established in Chapter 1.5, Sections 1.1 through 2.3.3.2, of the "Guidelines for Design and Construction of Health Care Facilities", 2006 edition, published by the Facility Guidelines Institute and the American Institute of Architects, Academy of Architecture for Health.

      (2) The licensee or applicant shall submit a functional program for each project to the licensure agency. The functional program shall meet the requirements established in Chapter 1.2, Sections 2.1 through 2.3.2, of the "Guidelines for Design and Construction of Health Care Facilities", 2006 edition.

      (3) architectural, mechanical, and electrical drawings shall bear the seal of an architect or engineer registered in the Commonwealth of Kentucky.

      (4) Drawings shall not exceed thirty-six (36) inches by forty-six (46) inches when trimmed.

      (5) Plans and specifications must be submitted to and approved by the licensure agency prior to commencement of new construction, renovation, or a change in function of a facility.

      (6) Plans and specifications must be approved by the Office of Housing, Buildings and Construction. Appropriate local building permits shall be obtained prior to commencement of new construction or renovation.

      (7) The architect or engineer of record shall provide evidence that facilities where sources of radiation are used or stored shall comply with the requirements of the Radiation Health Branch, Division of Public Health Protection and Safety, Department for Public Health, Cabinet for Health and Family Services.

 

      Section 3. Submission of Plans and Specifications for Hospitals. (1) First stage, schematic plans.

      (a) Single line drawings of each floor shall show the relationship of the various departments or services to each other and the room arrangement in each department. The name of each room shall be noted. Drawings shall include typical patient room layouts scaled (one-half (1/2) inch = one (1) foot) with dimensions noted. The proposed roads and walks, service and entrance courts, parking, and orientation shall be shown in a plot plan.

      (b) If the project is an addition, or is otherwise related to existing buildings on the site, plans shall show the facilities and general arrangement of those buildings.

      (2) Second stage, design development plans. Design development plans shall include the following:

      (a) Architectural.

      1. Plans of basement, floors, and roof showing space assignment, sizes, and outlines of fixed and movable equipment;

      2. Elevations and typical sections;

      3. Plot plan showing roads, parking, and sidewalks; and

      4. Areas and bed capacities by floors.

      (b) Mechanical.

      1. Single line layout of duct and piping systems;

      2. Riser diagrams for multistory construction; and

      3. Scale layout of boilers and major associated equipment and central heating, cooling, and ventilating units.

      (c) Electrical.

      1. Plans showing space assignment, size, and outline of transformers, main switch, switchboards, generator sets and other fixed equipment; and

      2. Simple riser diagram for multistory building construction, showing arrangement of feeders, subfeeders, bus work, load centers, and branch circuit panels.

      (d) Outline specifications.

      1. General description of the construction, including interior finishes, types and locations of acoustical material, and special floor covering;

      2. Description of the air-conditioning, heating, and ventilation systems and their controls; duct and piping systems; and dietary, laundry, sterilizing, and other special equipment; and

      3. General description of electrical service including voltage, number of feeders, and whether feeders are overhead or underground.

      (3) Third stage, contract documents.

      (a) Working drawings. Working drawings shall be complete and adequate for bid, contract, and construction purposes. Drawings shall be prepared for each of the following disciplines of the work: architectural, structural, mechanical, and electrical. Drawings shall include the following:

      1. Architectural drawings.

      a. Approach plan showing new topography, newly established levels and grades, existing structures on the site, new building structures, roadways, walks, and parking areas;

      b. Plan of each basement, floor, and roof;

      c. Elevations of each facade;

      d. Sections through building;

      e. Required scale and full-size details;

      f. Schedule of doors, windows, and room finishes;

      g. Layout of typical and special rooms indicating fixed equipment and major items of movable equipment. Equipment not included in the construction contract shall be so indicated; and

      h. Conveying systems. Details of construction, machine and control spaces necessary, size and type of equipment, and utility requirements for the following:

      (i) Dumbwaiters: electric, hand, or hydraulic;

      (ii) Elevators: freight, passenger, or patient;

      (iii) Loading dock devices; and

      (iv) Pneumatic tube systems.

      2. Structural drawings.

      a. Plans for foundations, floors, roofs, and intermediate levels with sizes, sections, and the relative location of the various structural members;

      b. Dimensions of special openings; and

      c. Details of special connections, assemblies, and expansion joints.

      3. Mechanical drawings.

      a. Heating, steam piping, and air-conditioning systems:

      (i) Radiators and steam heated equipment such as sterilizers, warmers, and steam tables;

      (ii) Heating and steam mains and branches with pipe sizes;

      (iii) Diagram of heating and steam risers with pipe sizes;

      (iv) Sizes, types, and capacities of boilers, furnaces, hot water heaters with stokers, oil burners, or gas burners;

      (v) Pumps, tanks, boiler breeching, and piping and boiler room accessories;

      (vi) Air-conditioning systems with required equipment, water and refrigerant piping, and ducts;

      (vii) Supply and exhaust ventilation systems with heating/cooling connections and piping; and

      (viii) Air quantities for room supply and exhaust ventilating duct openings.

      b. Plumbing, drainage, and standpipe systems:

      (i) Size and elevation of street sewer, house sewer, house drains, street water main, and water service into the building;

      (ii) Location and size of soil, waste, and water service with connections to house drains, clean-outs, fixtures, and equipment;

      (iii) Size and location of hot, cold, and circulating branches, and risers from the service entrance, and tanks;

      (iv) Riser diagram for plumbing stacks with vents, water risers, and fixture connections;

      (v) Gas, oxygen, and vacuum systems;

      (vi) Standpipe and sprinkler systems where required; and

      (vii) Fixtures and equipment that require water and drain connections.

      4. Electrical drawings.

      a. Electric service entrance with switches and feeders to the public service feeders, characteristics of the light and power current, transformers and their connections if located in the building;

      b. Location of main switchboard, power panels, light panels, and equipment, and diagram of feeders and conduits with schedule of feeder breakers or switches;

      c. Light outlets, receptacles, switches, power outlets, and circuits;

      d. Telephone layout showing service entrance, telephone switchboard, strip boxes, telephone outlets, and branch conduits;

      e. Nurses' call systems with outlets for beds, duty stations, door signal light, annunciators, and wiring diagrams;

      f. Emergency electrical system with outlets, transfer switch, sources of supply, feeders, and circuits; and

      g. All other electrically operated systems and equipment.

      (b) Specifications. Specifications shall supplement the drawings to fully describe type, size capacity workmanship, finish and other characteristics of materials and equipment. Specifications shall include:

      1. Cover or title sheet;

      2. Index; and

      3. Detailed description of materials and workmanship for each class of work.

      (c) Access to work. Representatives of the appropriate state agencies shall have access at reasonable times to the work and the contractor shall provide proper facilities for such access and inspection.

 

      Section 4. Compliance with Building Codes, Ordinances, and Administrative Regulations. (1) General. Nothing stated herein shall relieve the license or applicant from compliance with building codes, ordinances, and administrative regulations which are enforced by city, county, or state jurisdictions.

      (2) The following requirements shall apply if applicable:

      (a) Safety pursuant to 815 KAR 10:060;

      (b) Plumbing pursuant to 815 KAR Chapter 20.;

      (c) Air contaminants for incinerators pursuant to 401 KAR 59:020 and 401 KAR 61:010;

      (d) Elevators pursuant to 815 KAR 4:010; and

      (e) Making buildings and facilities accessible to and usable by the physically handicapped pursuant to KRS 198B.260 and administrative regulations promulgated thereunder.

 

      Section 5. Existing Facility Requirements. Licensure requirements for the structural specifications, plant requirements, and maintenance of a licensed hospital's physical structure which existed before the effective date of this regulation, and hospital construction and renovation plans approved by the licensure agency before the effective date of this regulation shall meet the requirements in Sections 6 through 33 of this administrative regulation.

 

      Section 6. Nursing Unit. (1) Patient rooms. Each patient room shall meet the following requirements:

      (a) Maximum room capacity shall be four (4) patients.

      (b) Minimum room area exclusive of toilet rooms, closets, lockers, wardrobes, and vestibules shall be 100 square feet in a one (1) bed room and eighty (80) square feet per bed in a multibed room.

      (c) A multibed room shall be designed to permit no more than two (2) beds side by side parallel to the window wall with not less than a four (4) foot space provided between beds, and at least a three (3) foot space between the side of a bed and the nearest wall, fixed cabinet, or heating/cooling element. A minimum of four (4) feet is required between the foot of a bed and the opposite wall, or foot of the opposite bed in a multibed room.

      (d) Window. A patient room shall have windows operable without the use of tools and shall have sills not more than three (3) feet above the floor. The window area shall be at least eight (8) percent of the patient room floor area.

      (e) Nurses' calling system. See Section 32(7) of this administrative regulation.

      (f) Lavatory. In a single or a two (2) bed room with private toilet room, the lavatory may be located in the toilet room. If two (2) patient rooms share a common toilet, a lavatory shall be provided in each patient room.

      (g) Wardrobe or closet for each patient. Minimum clear dimensions shall be eight (8) inches deep by one (1) foot and eight (8) inches wide with full length hanging space, clothes rod and shelf.

      (h) Cubicle curtains or equivalent built-in devices shall be provided to furnish complete privacy for each patient in multibed rooms.

      (i) No patient room shall be located more than 120 feet from the nurses' station, the clean workroom, and the soiled workroom. No room shall be used as a patient room if the access is through another patient's room. At least sixty (60) percent of the beds in a nursing unit shall be located in rooms designed for one (1) or two (2) beds.

      (2) Service areas in each nursing unit. The size of each service area shall depend on the number and types of beds within the unit and shall include:

      (a) Nurses' station for charting, doctors' charting, communications, and storage for supplies and nurses' personal effects.

      (b) Clean workroom or clean holding area. The clean workroom shall contain a work counter, hand-washing lavatory or sink, and storage facilities. The clean holding room shall be part of a system for storage and distribution of clean and sterile supplies and shall be similar to the clean workroom except that the work counter and hand-washing facilities may be omitted.

      (c) Soiled workroom or soiled holding room.

      1. A soiled workroom shall contain a clinical sink or equivalent flushing rim fixture, sink equipped for hand washing, work counter, waste receptacle, and linen receptacle.

      2. A soiled holding room shall be part of a system for collection and disposal of soiled materials and shall be similar to the soiled workroom except that the clinical sink and work counter may be omitted.

      (d) Lounge and toilet rooms for staff including lockers for storage of personal effects. These rooms may serve more than one (1) nursing unit.

      (e) Multipurpose room for conferences, demonstrations, and consultation. This room may serve more than one (1) nursing unit.

      (f) Examination and treatment room. The examination and treatment room shall have a minimum floor area of 120 square feet with a minimum dimension of ten (10) feet. This room may serve more than one (1) nursing unit. The examination and treatment room may be eliminated if all patient rooms are single-bed rooms. The room shall contain a lavatory or sink equipped for hand washing, a work counter, storage facilities, and an examination table. The emergency treatment room may be used for this purpose, if it is conveniently located on the same floor as the patient rooms.

      (g) Medicine area. Provision shall be made for convenient and prompt twenty-four (24) hour distribution of medicine to patients. This may be from a medicine preparation room or unit, a self-contained medicine dispensing unit, or by another approved system.

      1. If used, a medicine preparation room or unit shall be under the nursing staff's visual control and shall contain a work counter, refrigerator, and locked storage for biologicals and drugs.

      2. A medicine dispensing unit may be located at the nurses' station, in the clean workroom, or in an alcove or other space under direct control of the nursing or pharmacy staff.

      3. A controlled substances locker must be under double lock.

      4. A hand-washing facility shall be provided in the medicine area.

      (h) Clean linen storage. An enclosed storage space or a designated area within the clean workroom shall be provided for storage of clean linen. If a closed cart system is used, storage may be in an alcove.

      (i) Nourishment station. The nourishment state shall contain a sink equipped for hand washing, equipment for serving between scheduled meals, refrigerator, storage cabinets, and a self-dispensing ice maker. A nourishment station may serve more than one (1) nursing unit on the same floor.

      (j) Patients' bathing facilities. Bathing facilities shall include at least one (1) shower stall or one (1) bathtub for each twelve (12) patients not individually served. At least one (1) bathing facility on each patient floor shall have space for a wheelchair patient and an assisting attendant. At least one (1) sitz bath shall be provided in post partum units.

      (k) Stretcher and wheelchair parking area or alcove. The stretcher and wheelchair parking area or alcove may serve more than one (1) nursing unit on the same floor.

      (l) Janitor's closet. A janitor's closet shall be provided for storage of housekeeping supplies and equipment. The closet shall have a floor receptor or service sink. The closet may serve more than one (1) nursing unit on the same floor.

      (m) Equipment storage room. The equipment storage room shall have sufficient space for equipment. The equipment storage room may serve more than one (1) nursing unit on the same floor.

      (n) Emergency equipment storage. Space for emergency equipment shall be located in close proximity to the nurses' station and out of traffic. The emergency equipment storage space may serve more than one (1) nursing unit on the same floor.

      (3) Patient toilet rooms. A toilet room shall be directly accessible from each patient room without going through the general corridor. One (1) toilet room may serve two (2) patient rooms, but not more than four (4) beds. The lavatory may be omitted from the toilet room if a lavatory is provided in each patient room.

      (4) Isolation room. An isolation room shall be provided which shall have:

      (a) One (1) patient per room;

      (b) A separate toilet room, with direct entry from the patient bed area, with bath or shower, and lavatory; and

      (c) Facilities outside and immediately adjacent to the patient room for maintaining aseptic conditions.

 

      Section 7. Intensive Care Unit. Hospitals that have intensive care units shall meet the following requirements:

      (1) Patient rooms. A Cardiac intensive care patient shall be placed in a single-bed room. A medical or surgical intensive care patient may be housed in a single-bed room or in a multibed room. At least one (1) single-bed room shall be provided in each medical or surgical care unit. Beds shall be arranged to permit direct visual observation by nursing staff. Each patient room shall meet the following requirements:

      (a) Clearance between beds in a multibed room shall not be less than seven (7) feet with a minimum of three (3) feet to the side of beds and at least four (4) feet from the foot of the beds. A single-bed room or cubicle shall have a minimum clear area of 120 square feet with a minimum dimension of ten (10) feet.

      (b) View panels shall be provided in the doors and walls for nursing staff observation of patients. A means shall be provided to obstruct the view panels when the patient requires visual privacy. Glazing for view panels shall be safety glass, wire glass or clear plastic unless wire glass is required for fire safety purposes.

      (c) An I.V. solution support shall be provided for each patient and shall be positioned to prevent the suspension of the solution directly over the patient.

      (d) A lavatory equipped for hand washing shall be provided in each private patient room. In multibed rooms there shall be at least one (1) lavatory for each six (6) beds.

      (e) Nurses' calling system. See Section 32(7) of this administrative regulation.

      (f) Each cardiac intensive care patient shall be provided a toilet facility which is directly accessible from the bed area.

      1. A water closet shall have sufficient clearance around it to facilitate its use by a patient needing assistance.

      2. A portable water closet is permitted within the patient room. If a portable unit is used, facilities for servicing and storing the unit shall be located convenient to the cardiac care unit.

      (g) Each room shall have a window or each bed shall have visual access to a window. one (1) window may serve more than one (1) patient by use of vision panels in partitions. The window sill height shall not exceed three (3) feet above the floor.

      (2) Service areas. The size and location of each service area shall depend upon the number of beds to be served. One (1) service area may serve two (2) or more intensive care units. The following service areas shall be located in or be readily available to each intensive care unit:

      (a) Nurses' station. The nurses' station shall be located to permit direct visual observation of each patient served.

      (b) Hand-washing facilities. Hand-washing facilities shall be located convenient to the nurses' station and medicine area.

      (c) Charting facilities. Charting facilities shall be separated from the monitoring service.

      (d) Staff's toilet room. The toilet room shall contain a water closet and lavatory equipped for hand washing.

      (e) Closets. Individual closets or compartments for the safekeeping of coats and personal effects belonging to the nursing staff shall be located at or near the nurses' station.

      (f) Clean workroom or a system for storage and distribution of clean and sterile supplies. The clean workroom shall contain a work counter, hand-washing facility, and storage facilities.

      (g) Soiled workroom or soiled holding room.

      1. A soiled workroom shall contain a clinical sink or equivalent flushing rim fixture, sink equipped for hand washing, work counter, waste receptacle, and soiled linen receptacles.

      2. A soiled holding room shall be part of a system for collection and disposal of soiled materials and shall be similar to the soiled workroom except that the clinical sink and work counter may be omitted.

      (h) Facilities for washing or flushing bedpans. Facilities for washing or flushing bedpans shall be provided within the unit.

      (i) Medicine area. Provision shall be made for convenient and prompt twenty-four (24) hour distribution of medicine to patients. This may be from a medicine preparation room or unit, a self-contained medicine dispensing unit, or by another approved system.

      1. A medicine preparation room or unit shall be under the nursing staff's visual control and shall contain a work counter, refrigerator, and locked storage for biologicals and drugs. A medicine preparation room shall contain a minimum floor area of fifty (50) square feet.

      2. A medicine dispensing unit may be located at the nurses' station, in the clean workroom, or in an alcove or other space under direct control of the nursing or pharmacy staff.

      3. Controlled substances shall be under double lock and a hand-washing facility shall be provided.

      (j) Clean linen storage. A separate closet or designated area within the clean workroom shall be provided for clean linen storage. If a closed cart system is used, storage may be in an alcove.

      (k) Nourishment station. The nourishment station shall contain a sink equipped for hand washing, equipment for serving between- scheduled meals, refrigerator, storage cabinets, and a self-dispensing ice maker to provide ice for patient service and treatment.

      (l) Emergency equipment storage. Space shall be provided for a crash cart and other necessary emergency equipment.

      (m) Equipment storage room. Space shall be provided for necessary equipment.

      (n) Patient storage facilities. Individual lockers shall be provided for the storage of a patient's clothing and personal effects. The lockers may be located outside the intensive care unit. Lockers shall be of a size to permit hanging of full length garments.

      (o) Waiting room. A separate waiting room shall be provided for the intensive care unit. A toilet room, public telephone, and seating accommodations for long waiting periods shall be provided.

 

      Section 8. Obstetrical Suite. (1) General. If an obstetrical suite is included in the functional program, it shall be located and arranged to preclude unrelated traffic through the suite. The number of delivery rooms, labor rooms, recovery beds, and the size of the service areas shall depend upon the estimated obstetrical workload.

      (2) Delivery room. Each room shall have a minimum clear floor area of 300 square feet exclusive of fixed and movable cabinets and shelves. The room shall have a minimum dimension of sixteen (16) feet.

      (3) Labor room. Each room shall be a single-bed or two (2) bed room with a minimum clear area of 100 square feet per bed.

      (a) Labor beds shall be provided at the rate of two (2) for each delivery room.

      (b) Each labor room shall contain a lavatory equipped for hand washing and have direct access to a toilet room. One (1) toilet room may serve two (2) labor rooms.

      (c) The labor room shall be arranged so that the door is visible from a nurses' work station and shall be directly accessible to facilities for medication, hand washing, charting, and storage for supplies and equipment.

      (d) At least one (1) shower shall be provided for use by labor room patients.

      (e) Controls shall be located outside of the wet area for use by nursing staff.

      (4) Recovery room. The recovery room shall contain not less than two (2) beds, charting facilities located to permit staff surveillance of all beds, facilities for medicine dispensing, hand washing facilities, clinical sink with bedpan flushing device, and storage for equipment and supplies. The recovery room may be omitted in hospitals with an annual birth rate of less than 1,500.

      (5) Service areas. The service areas in each obstetrical suite shall include:

      (a) Control station located to permit visual surveillance of all traffic which enters the obstetrical suite.

      (b) Supervisor's office or station.

      (c) Sterilizing equipment conveniently located to serve delivery rooms.

      (d) Drug distribution station for storage and preparation of medication for patients. The drug distribution station shall contain a work counter, storage facilities, and a sink equipped for hand washing. Controlled substances shall be under double lock.

      (e) Scrub facilities. Two (2) scrub stations shall be provided near the entrance to each delivery room. Two (2) scrub stations may serve two (2) delivery rooms if the scrub stations are located adjacent to the entrance to each delivery room.

      (f) Soiled workroom for the exclusive use of the obstetrical suite staff or a soiled holding area that is part of a system used for the collection and disposal of soiled materials.

      1. A soiled workroom shall contain a clinical sink or equivalent flushing type fixture, work counter, sink equipped for hand washing, waste receptacle, and linen receptacle.

      2. A soiled holding room shall be similar to the soiled workroom except that the clinical sink may be omitted.

      (g) Clean workroom or clean supply room.

      1. A clean workroom is required if clean materials are assembled within the obstetrical suite prior to use. A clean workroom shall contain a work counter, sink equipped for hand washing, and space for clean and sterile supplies.

      2. A clean supply room shall be provided if the facility utilizes a central system for the cleanup, distribution of clean and sterile supplies, and central storage.

      (h) Anesthesia workroom. A workroom for cleaning, testing and storage of anesthesia equipment shall contain a work counter and sink.

      (i) Anesthesia storage facilities.

      (j) Medical gas supply with storage space for reserve medical gas cylinders shall be provided.

      (k) Equipment storage room for equipment used in the obstetrical suite.

      (l) Staff clothing change areas.

      1. Appropriate areas shall be provided for male and female personnel working within the obstetrical suite.

      2. Each area shall contain lockers, showers, toilets, lavatories equipped for hand washing and space for putting on scrub suits and boots.

      3. Each area shall be arranged to provide a one (1) way traffic pattern, so that personnel entering from outside the obstetrical suite can shower, change and go directly into the obstetrical suite.

      4. Space for removal of scrub suits and boots in the change area shall be designed so that personnel using it will avoid physical contact with clean personnel.

      (m) Lounge and toilet facilities for obstetrical staff. A nurses' toilet room shall be provided near the labor rooms and recovery rooms.

      (n) Janitor's closet. A closet containing a floor receptor or service sink and storage space for housekeeping supplies and equipment shall be provided exclusively for the obstetrical suite.

      (o) Stretcher storage area. This area shall be out of the direct line of traffic.

 

      Section 9. Newborn Nursery Unit. (1) General. Each nursery shall provide:

      (a) One (1) Lavatory for hand washing for each eight (8) infants;

      (b) Emergency nurses' call system;

      (c) Oxygen;

      (d) Isolation nursery; and

      (e) Glazed observation windows to permit viewing of infants from public areas, from workrooms, and between adjacent nurseries.

      (2) Nursery. Each room shall contain not more than eight (8) bassinets, or up to sixteen (16) bassinets if the extra bassinets are of the isolation type. The room shall have a minimum area of twenty-four (24) square feet per regular bassinet and forty (40) square feet per isolation type bassinet. No nursery shall open directly into another nursery.

      (3) Workroom. Each nursery shall be served by a connecting workroom. It shall contain gowning facilities at the entrance for staff and housekeeping personnel, work space with counter, refrigerator, lavatory or sinks equipped for hand washing, and storage. One (1) workroom may serve a number of full-term nurseries if required services are convenient to each.

      (4) Examination and treatment room. The examination and treatment room shall contain a work counter, storage, and lavatory equipped for hand washing.

      (5) Continuing care nursery. If a continuing care nursery is provided, each nursery shall have a minimum area of forty (40) square feet per bassinet. The continuing care nursery shall have its own workroom including lavatory. A work area within the continuing care nursery may be used for the workroom, but this area shall be in addition to the required bassinet area.

      (6) Formula room. This room shall be used solely for preparing the infant formula and shall have no direct access to the nursery or workroom. The formula room may be located elsewhere in the hospital. The following shall be provided unless commercially prepared formula is used:

      (a) Work counter with built-in sink with gooseneck-type spout and knee or foot control;

      (b) Lavatory;

      (c) Hot plate;

      (d) Refrigerator;

      (e) Sterilizer; and

      (f) Bottle washer.

      (7) If commercially prepared formula is to be used or other modifications are proposed in formula preparation and processing, the formula room shall include such space and equipment as necessary to accommodate formula processing, handling, and storage requirements.

      (8) Janitor's closet. A closet containing a floor receptor or service sink and storage space for housekeeping supplies and equipment shall be provided exclusively for the newborn nursery unit.

 

      Section 10. Pediatric Unit. If provided as a separate unit, the pediatric unit shall include:

      (1) Patient rooms. Each pediatric patient room shall conform to the same requirements as Section 6(1)(b) and (c) of this administrative regulation except that a patient room used for cribs shall contain at least sixty (60) square feet of clear area for each crib and shall have no more than six (6) cribs in a room.

      (2) Nursery. Each nursery serving pediatric patients shall contain no more than eight (8) bassinets. The minimum clear floor area per bassinet shall be forty (40) square feet. Each room shall contain a lavatory equipped for hand washing, nurses' emergency calling system and glazed view windows for observation of infants from public areas and the workroom.

      (3) Nursery workroom. Each nursery shall be served by a connecting workroom. The workroom shall contain gowning facilities at the entrance for staff and housekeeping personnel, work space with counter, storage facilities, and a lavatory or sink equipped for hand washing. One (1) workroom may serve more than one (1) nursery.

      (4) The examination and treatment room for a nursery may be located in a separate room or a designated part of the workroom. The examination and treatment room shall contain a work counter, storage facilities, and a lavatory equipped for hand washing.

      (5) Service areas. The service areas shall conform to the requirements in Section 6(2) of this administrative regulation and shall meet the following additional conditions:

      (a) Multipurpose or individual room shall be provided for dining, educational, and play purposes. A total floor area of twenty (20) square feet per pediatric patient based on fifty (50) percent of the total number of pediatric patients shall be provided. Special provisions shall be made to minimize impact noise transmission through the floor of the multipurpose room to occupied space below.

      (b) Space for preparation and storage of infant formula shall be provided in the unit or in a convenient location nearby.

      (c) A toilet room shall be provided for each sex, with a minimum ratio of one (1) toilet for each eight (8) beds excluding bassinets.

      (d) Storage closets or cabinets for toys and for educational and recreational equipment shall be provided.

      (e) Storage space shall be provided for replacement of cribs and adult beds to provide flexibility for interchange of patient accommodations.

 

      Section 11. Psychiatric Unit. If included as a separate unit, the psychiatric unit shall be designed as other nursing units except that care shall be taken to provide for patients needing close supervision to prevent the patient's escape, suicide, or hiding. The unit shall contain:

      (1) Patient room.

      (a) Each patient room shall meet the following requirements:

      1. Minimum floor area of 100 square feet in a one (1) bed room and eighty (80) square feet per patient in a multibed room; and

      2. Maximum of two (2) patients per room.

      (b) Patient toilet room. A toilet room shall be directly accessible from each patient room without going through the general corridor. One (1) toilet room may serve two (2) patient rooms.

      (c) Lavatory. A lavatory shall be provided in each patient room. If the patient room is served by its own private toilet room, the lavatory may be located in the toilet room.

      (d) Window.

      1. Sill height shall not be higher than three (3) feet above the floor.

      2. Windows in a psychiatric unit shall be security windows or a type that can only be opened by keys or tools that are under the control of staff. The degree of security required shall be as determined by the program, but operation of the sashes shall be restricted to prevent escape or suicide.

      3. Safety glazing or other appropriate security features shall be incorporated if glass fragments may create a hazard.

      (e) A nurses' calling system is not required. If a call system is included, provisions shall be made to permit removal of call buttons or use of blank plates as appropriate.

      (f) The visual privacy provided each patient shall isolate patients from one another but not from observation by staff.

      (g) Bedpan flushing devices may be omitted from patient room toilets.

      (2) Service areas. Service areas shall conform to the requirements in Section 6(2) of this administrative regulation and shall meet the following additional conditions:

      (a) Provide separate space for occupational therapy at the rate of fifteen (15) square feet per patient and a minimum area of 400 square feet.

      (b) Provide a minimum of two (2) separate social spaces, one (1) appropriate for noisy activities and the other for quiet activities. The combined area shall be a minimum of thirty (30) square feet per patient or a minimum of 120 square feet for each of the two (2) spaces, whichever is greater. This space may be shared by dining activities.

      (c) Provide storage for recreational and occupational therapy equipment.

      (d) Provide storage for patients' belongings.

      (e) Provide bathtubs or showers at the rate of one (1) for each four (4) beds which are not individually served. At least one (1) bathing facility shall have space for a wheelchair patient and an assisting attendant.

      (3) Seclusion room. A seclusion room shall be provided for a patient requiring security and protection from himself or others.

      (a) The room shall be located in a manner affording direct supervision of the patient by the nursing staff.

      (b) The room shall be a single room and shall be constructed to minimize the possibility of a patient's hiding, escape, injury, or suicide.

      (c) There shall be a minimum of one (1) seclusion room for every twenty-four (24) beds.

      (d) Ground fault interrupters for electrical circuits and tamper-proof screws shall be used.

      (e) Doors shall swing outward and shall have provisions for staff observation while maintaining privacy from the public and other patients.

 

      Section 12. Surgical Suite. (1) General. If a surgical suite is included in the functional program, the surgical suite shall be located and arranged to preclude unrelated traffic through the suite. The number of operating rooms and recovery beds, including the size of the service areas, shall be based on the expected surgical workload.

      (2) Operating room. Each operating room shall have a minimum clear floor area of 360 square feet, exclusive of fixed and movable cabinets and shelves, with a minimum dimension of eighteen (18) feet. Storage space for splints and traction equipment shall be provided for rooms equipped for orthopedic surgery. At least two (2) x-ray film illuminators or a monitor for displaying at least two (2) films or images simultaneously shall be provided in each operating room.

      (3) Room for surgical cystoscopy and other endoscopic procedures. The procedure room shall have a minimum clear area of 250 square feet, exclusive of fixed and movable cabinets and shelves, with a minimum dimension of fifteen (15) feet. Facilities shall be provided for the disposal of liquid wastes.

      (4) Recovery room. A room shall be provided for post anesthesia recovery of surgical patients and shall contain a drug distribution station, hand-washing facilities, charting facilities, clinical sink, and storage space for supplies and equipment. The design shall provide for a minimum three (3) foot clearance to each side of the recovery bed.

      (5) Medical preparation and holding area. A room shall be provided for medical preparation of patients and holding prior to surgery. The room shall contain a drug distribution station, hand-washing facilities, and charting facilities. The design shall provide for a minimum three (3) foot clearance to each side of the bed. This area may be eliminated if the medical preparation of a patient prior to surgery is done in the patient room.

      (6) Service areas in each surgical suite. The service areas shall include:

      (a) A control station located to permit visual surveillance of traffic that enters the surgical suite;

      (b) Sterilizing facilities with high speed autoclaves located near the operating room;

      (c) A drug distribution station for storage and preparation of medication for patients. The station shall contain a work counter, storage facilities, and a sink equipped for hand washing. Controlled substances shall be under double lock;

      (d) Two (2) scrub stations near the entrance to each operating room or two (2) scrub stations for two (2) operating rooms if the scrub stations are located adjacent to the entrance to each operating room;

      (e)1. A soiled workroom for the exclusive use of the surgical suite staff that contains a clinical sink or equivalent flushing type fixture, work counter, sink equipped for hand washing, waste receptacle, and linen receptacle; or

      2. A soiled holding area that is part of a system used for the collection and disposal of soiled materials and that is similar to a soiled workroom except that the clinical sink and work counter may be omitted;

      (f)1. If clean materials are assembled within the surgical suite prior to use, a clean workroom that contains a work counter, sink equipped for hand washing, and storage space for clean and sterile supplies; or

      2. If the facility utilizes a central system for the cleanup, distribution of clean and sterile supplies, and central storage, a clean supply room;

      (g) Anesthesia workroom for cleaning, testing, and storage of anesthesia equipment that contains a work counter and sink;

      (h) Anesthesia storage facilities;

      (i) Medical gas supply with storage space for reserve medical gas cylinders shall be provided;

      (j) Storage room for equipment and supplies used in the surgical suite;

      (k) Staff clothing change areas for male and female personnel working within the surgical suite that:

      1. Contain lockers, showers, toilets, lavatories equipped for hand washing and space for putting on scrub suits and boots; and

      2. Are arranged to provide a one (1) way traffic pattern so that personnel entering from outside the surgical suite can shower, change, and go directly into the surgical suite;

      3. Are designed so that personnel using it for removal of scrub suits and boots will avoid physical contact with clean personnel;

      (l) If the functional program includes outpatient surgical services:

      1. An outpatient surgery change area for an outpatient to change for street clothing into a hospital gown, with a waiting room lockers, toilets, and clothing change or gowning area with a traffic pattern similar to that of the staff clothing change area; and

      2. A separate recovery area for outpatients;

      (m) In facilities with two (2) or more operating rooms unless a separate room for medical preparation of patients is provided as called for under Section 12(5) of this administrative regulation, a patient's holding area that:

      1. Is a room or alcove to accommodate stretcher patients waiting for surgery; and

      2. Is under the visual control of the surgical suite control station;

      (n) Stretcher storage areas out of the direct line of traffic;

      (o) Lounge and toilet facilities for surgical staff that are located to permit use without leaving the surgical suite and include a toilet room near the recovery rooms; and

      (p) A janitor's closet containing a floor receptor or service sink and storage space for housekeeping supplies and equipment for exclusive use in the surgical suite.

 

      Section 13. Outpatient and Emergency Suite. (1) General. Facilities for emergency and outpatient clinic care shall be provided if included in the functional program.

      (2) Emergency patient care services. The extent of the emergency services to be provided in the hospital shall depend upon the community needs and the availability of other organized programs for emergency care within the community. The facilities shall be located to prevent outpatients from traversing inpatient areas and shall include the areas described in paragraphs (a) through (n) of this subsection.

      (a) Entrance at grade level which is sheltered from the weather and has convenient access for ambulances and wheelchairs.

      (b) Reception and control area located near the entrance, waiting area, and treatment room.

      (c) Public waiting area with toilet facilities, public telephone, and drinking fountain.

      (d) Examination and treatment room. Hand-washing facilities shall be provided in each room. Each room shall have a minimum floor area of 120 square feet with a minimum dimension of ten (10) feet.

      (e) Emergency room for minor surgical procedures. The minor surgical procedures room shall contain a hand-washing facility and shall have a minimum floor area of 240 square feet. The minimum dimension shall be fifteen (15) feet.

      (f) Clean workroom. The clean workroom shall contain a work counter, sink equipped for hand washing, and storage space for clean and sterile supplies.

      (g) Soiled workroom. The soiled workroom shall contain a clinical sink or equivalent flushing type fixture, work counter, sink equipped for hand washing, waste receptacle, and linen receptacle.

      (h) Drug distribution station for storage and preparation of medication. The drug distribution station shall contain a work counter, storage facilities, and sink equipped for hand washing. Controlled substances shall be under double lock.

      (i) Nurses' station for nurses' charting, doctors' charting, communications and storage for supplies and nurses' personal effects.

      (j) Staff toilet room.

      (k) Patient's toilet room located convenient to the treatment room.

      (l) Wheelchair and stretcher alcove located convenient to the entrance to the department.

      (m) Janitor's closet. The janitor's closet shall contain a floor receptor or service sink with storage space for housekeeping supplies and equipment for exclusive use in the emergency department.

      (n) Equipment storage room.

      (3) Outpatient department. If outpatient services are provided, the extent of the administrative, clinical, and diagnostic facilities provided shall depend on the estimated patient load as described in the functional program. Outpatient facilities shall provide for the privacy and dignity of the patient during interview, examination, and treatment. Facilities shall be located so that outpatients do not traverse inpatient areas and shall include the areas described in paragraphs (a) through (s) of this subsection.

      (a) Entrance at grade level which is sheltered from weather and able to accommodate wheelchair access.

      (b) Reception and control area located near the entrance and waiting area.

      (c) Wheelchair storage out of the line of direct traffic.

      (d) Public waiting area with toilet facilities, public telephone, and drinking fountain.

      (e) Interview space for private interviews relating to social service, credit and admissions.

      (f) General or individual office for business transaction, records, administrative, and professional staff.

      (g) Multipurpose room for conferences, meetings, and health education purposes. The multipurpose room shall be equipped for the use of visual aids.

      (h) General purpose examination room for medical, obstetrical, and similar examinations. Each room shall have a minimum floor area of eighty (80) square feet, excluding such spaces as the vestibule, toilet, closet, and work counter. An examination table shall be placed to provide at least thirty (30) inches clearance to each side and at the foot of the table. A lavatory or sink equipped for hand washing shall be provided in each room.

      (i) Special purpose examination rooms. Room sizes for special clinics shall be determined by the types of equipment used but shall be not less than eighty (80) square feet. A lavatory or sink equipped for hand washing shall be provided in each room.

      (j) Observation room for handling of isolation, suspect, or disturbed patients. The observation room shall be located convenient to the nurses' station to permit close observation of patients. In facilities having 15,000 or less annual outpatients, a separate room shall not be required if an examination room is modified to accommodate this function.

      (k) Patient toilet facilities.

      (l) Nurses' station for nurses' charting, doctors' charting, communications, and storage for supplies and nurses' personal effects.

      (m) Staff toilet room located convenient to the nurses' station.

      (n) Clean workroom. The clean workroom shall contain a work counter, sink equipped for hand washing, and storage space for clean and sterile supplies.

      (o) Soiled workroom. The soiled workroom shall contain a clinical sink or equivalent flushing type fixture, work counter, sink equipped for hand washing, waste receptacle, and linen receptacle.

      (p) Drug distribution station for storage and preparation of medication. The drug distribution station shall contain a work counter, sink equipped for hand washing, and storage facilities. Controlled substances shall be under double lock.

      (q) Wheelchair and stretcher alcove located convenient to the entrance to the department.

      (r) Janitor's closet. The janitor's closet shall contain a floor receptor or service sink with storage space for housekeeping supplies and equipment for exclusive use in the outpatient department.

      (s) Equipment storage room.

 

      Section 14. Radiology Suite. The radiology suite shall contain the following:

      (1) Radiographic room;

      (2) Film processing facilities;

      (3) Viewing and administrative area;

      (4) Film storage facilities;

      (5) Toilet room with hand-washing facility, which shall be accessible from each fluoroscopy room without entering the general corridor area;

      (6) Dressing area for ambulatory patients with convenient access to toilets;

      (7) Waiting room or alcove for ambulatory patients;

      (8) Holding area for stretcher patients, which shall be located out of the direct line of normal traffic; and

      (9) Hand-washing facilities in each radiographic room unless the room is used only for routine diagnostic screening.

 

      Section 15. Laboratory Suite. Facilities shall be provided for the following and the size of the areas including equipment shall depend on the patient workload:

      (1) Hematology;

      (2) Clinical chemistry with acid-shower and eye washing facility provided nearby;

      (3) Urinalysis with specimen toilet and hand-washing facility provided nearby;

      (4) Cytology;

      (5) Bacteriology;

      (6) Waiting area for ambulatory patients;

      (7) Administrative support areas;

      (8) Blood storage facilities;

      (9) Blood specimen collection area with a work counter, hand-washing facilities, and space for patient seating;

      (10) Glass-washing and sterilizing facilities; and

      (11) Recording and filing facilities.

 

      Section 16. Physical Therapy Suite. If a physical therapy suite is addressed in the functional program, the following items shall be provided:

      (1) Office space;

      (2) Waiting space;

      (3) Treatment areas for thermotherapy, diathermy, ultrasonics, and hydrotherapy with:

      (a) Cubicle curtains around each individual treatment area for privacy purposes;

      (b) Hand-washing facilities, but one (1) lavatory or sink may serve more than one (1) treatment cubicle; and

      (c) Facilities for collection of wet and soiled linen or other material;

      (4) Exercise area;

      (5) Storage for clean linen, supplies, and equipment;

      (6) Patient dressing areas, showers, lockers, and toilet rooms;

      (7) Janitor's closet with floor receptor or service sink and storage space for housekeeping supplies and equipment; and

      (8) Wheelchair and stretcher storage area.

 

      Section 17. Morgue and Autopsy. (1) If autopsies are performed within the hospital, the following shall be provided:

      (a) Refrigerated facilities for body-holding.

      (b) Autopsy room that contains the following:

      1. Work counter with sink equipped for hand washing;

      2. Storage space for supplies, equipment, and specimens;

      3. Autopsy table;

      4. Clothing change area with shower, toilet, and lockers; and

      5. A janitor's closet containing a floor receptor or service sink with storage for housekeeping supplies and equipment for exclusive use in this area.

      (2) If autopsies will be performed outside the hospital, only a well-ventilated body-holding room shall be provided.

 

      Section 18. Pharmacy or Drug Room. An adequate supply of drugs and other medicinal agents shall be available at all times to meet the requirements of the hospital. Drugs shall be stored in a safe manner and shall be kept properly labeled and accessible. Controlled substances and other dangerous or poisonous drugs shall be handled in a safe manner to protect against unauthorized use. Controlled substances shall be under double lock. There shall be adequate refrigeration for biologicals and drugs which require refrigeration. The existing laws, rules, and administrative regulations governing drugs and poisons shall be complied with.

 

      Section 19. Dietary Department. Food service facilities shall be designed and equipped to meet the requirements of the functional program. If a commercial service will be used, dietary areas and equipment shall be designed to accommodate the requirements for sanitary storage, processing, and handling. If on-site conventional food preparation is used, the department shall include the following facilities:

      (1) Control station for the receiving of food supplies;

      (2) Food preparation facilities. Conventional food preparation systems shall have space and equipment for food preparation, cooking, and baking. Convenience food service systems or systems using contractual commissary services shall have space and equipment for thawing, portioning, cooking, and baking;

      (3) Hand-washing facilities located conveniently accessible in the food preparation area;

      (4) Patient meal service facilities required for tray assembly and distribution;

      (5) Dishwashing space:

      (a) With commercial-type dishwashing equipment that is located in a room or alcove separate from the food preparation and serving area;

      (b) With space provided for receiving, scraping, sorting, and stacking soiled dishware and tableware prior to cleanup;

      (c) That is designed to allow clean dishware and tableware to be removed at a different location than the one used for the soiled dishware and tableware; and

      (d) With a conveniently-located hand-washing lavatory;

      (6) Pot-washing facilities;

      (7) Refrigerated storage to accommodate a three (3) day minimum supply;

      (8) Dry storage to accommodate a three (3) day minimum supply;

      (9) Storage areas and sanitizing facilities for cans, carts, and mobile tray conveyors;

      (10) Waste storage facilities located in a separate room easily accessible to the outside for direct pickup or disposal;

      (11) Dining space for ambulatory patients, staff, and visitors;

      (12) Offices or desk spaces for dieticians or the dietary service manager;

      (13) Conveniently-located toilets with hand-washing facilities for use by the dietary staff; and

      (14) Janitor's closet located within the department that contains a floor receptor or service sink with storage for housekeeping supplies and equipment to be used exclusively in this area.

 

      Section 20. Administrative and Public Areas. The following shall be provided:

      (1) Lobby that includes:

      (a) Storage space for wheelchairs;

      (b) Reception and information counter or desk;

      (c) Waiting space; and

      (d) Public toilet facilities designed for use by the physically handicapped.

      (2) Interview space for private interviews relating to social services, credit, and admissions;

      (3) Director of nurses' office;

      (4) Staff toilet rooms;

      (5) Medical library facilities;

      (6) General or individual offices for business transactions, medical and financial records, administrative, and professional staff use;

      (7) Administrator's office;

      (8) Multipurpose room for conferences, meetings, and health education purposes, including provisions for showing visual aids; and

      (9) Storage for office equipment and supplies.

 

      Section 21. Medical Records Unit. This unit shall include:

      (1) Medical records administrator or technician office or space;

      (2) Active record storage area;

      (3) Record review and dictating room; and

      (4) Work area for sorting, recording, or microfilming.

 

      Section 22. Central Medical and Surgical Supply Department. The following areas shall be permanently separated from each other:

      (1) Receiving and decontamination room. The room shall contain work space and equipment for cleaning medical and surgical equipment and for the disposal or processing of unclean material. Hand-washing facilities shall be provided.

      (2) Clean workroom. This room shall be divided into work space, clean storage area, and sterilizing and sanitizing facilities. Hand-washing facilities shall be provided.

      (3) Storage area for clean supplies and sterile supplies. The storage area may be in a designated area in the clean workroom.

      (4) Equipment storage.

      (5) Cart storage, if this type of system is utilized.

      (6) Janitor's closet. The janitor's closet shall contain a floor receptor or service sink with storage space for housekeeping supplies and equipment to be utilized exclusively in this department.

 

      Section 23. Central Stores. The following shall be provided:

      (1) Off-street unloading facilities;

      (2) Control station for receiving supplies; and

      (3) General storage rooms which are adequate in size to meet the needs of the facility.

 

      Section 24. Laundry. On-site processing and off-site processing.

      (1) If linen is to be processed in the hospital, the following shall be provided:

      (a) Soiled linen receiving, holding and sorting room with hand-washing facilities;

      (b) Laundry processing room with hand-washing facilities and commercial-type equipment which can process seven (7) days of linen needs within a regularly scheduled work week;

      (c) Storage for laundry supplies;

      (d) Clean linen inspection and mending room;

      (e) Clean linen storage, issuing and holding room or area;

      (f) Janitor's closet that contains a floor receptor or service sink with storage space for housekeeping supplies and equipment to be utilized exclusively in this department; and

      (g) Cart storage and cart sanitizing facilities.

      (2) Arrangement of equipment and procedures shall permit an orderly work flow with a minimum of cross traffic to maintain separation of clean and soiled operations.

      (3) If linen is to be processed off the hospital site, the following shall be provided:

      (a) Soiled linen holding room with a hand-washing facility conveniently accessible; and

      (b) Clean linen receiving, holding, inspection, and storage room.

 

      Section 25. Employee Facilities. (1) Female locker room. This room shall have lounge space, lockers for personal effects, and a separate toilet room. The area shall be designed for use by the physically handicapped. Shower facilities may be appropriate depending on the size of the facility.

      (2) Male locker room. This room shall have lockers and a separate toilet room. The area shall be designed for use by the physically handicapped. Shower facilities may be appropriate depending on the size of the facility.

 

      Section 26. Engineering Service and Equipment Areas. The following shall be provided:

      (1) Room or separate buildings for boilers, mechanical equipment and electrical equipment;

      (2) Engineer's office;

      (3) Maintenance shop;

      (4) Storage room for building maintenance supplies;

      (5) Storage room for central housekeeping equipment and supplies;

      (6) Office and administrative support space for the person in charge of central housekeeping; and

      (7) Yard equipment storage.

 

      Section 27. Waste Processing Services. (1) The following shall be provided:

      (a) Space and facilities shall be provided for the sanitary storage and disposal of waste by incineration, mechanical destruction, compaction, containerization, removal, or by a combination of these techniques; and

      (b) A gas, electric, or oil-fired incinerator for the complete destruction of pathological and infectious waste, which includes dressing and material from open wounds, laboratory specimens, and all waste material from isolation patient rooms;

      (2) Waste tissue and contaminated combustible solids shall be rendered safe by sterilization or incineration.

      (3) Culture plates, tubes, sputum cups, contaminated sponges, and swabs shall be sterilized before they are washed or discarded.

      (4) Unpreserved tissue specimens from surgical or necropsy material shall be disposed of by incineration.

 

      Section 28. Details and Finishes. details and finishes shall meet the following requirements:

      (1) Details.

      (a) Doors to patient toilet rooms and other rooms needing access for wheelchairs shall have a minimum width of two (2) feet and ten (10) inches.

      (b) doors to patient-room toilets and patient-room bathrooms shall swing outward or be equipped with hardware that will permit access in an emergency.

      (c) If required by the functional program, suitable hardware shall be provided on doors to patient toilet rooms in psychiatric nursing units so that access to these rooms can be controlled by the nursing staff.

      (d) Windows and outer doors which may be frequently left in an open position shall be provided with screens.

      (e) Thresholds and expansion joint covers shall be made flush with the floor surface to facilitate use by wheelchairs and carts.

      (f) lavatories and sinks shall be equipped with blade handles which shall have a minimum of sixteen (16) inches clearance to each side of the centerline of the fixture.

      (g) Towel dispensers or other hand-drying equipment shall be provided at lavatories and sinks equipped for hand washing, except scrub sinks.

      (h) Grab bars shall be provided at patient toilets, showers, tubs, and sitz baths. The bars shall have one and one-half (1 1/2) inches clearance to walls and shall be of sufficient strength and anchorage to sustain a concentrated load of 250 pounds for a period of five (5) minutes.

      (i) Recessed soap dishes shall be provided at showers and bathtubs.

      (j) Mirrors shall not be installed at hand-washing fixtures in food preparation areas, nurseries, clean and sterile supply rooms, or scrub sink areas.

      (k) Radiation protection requirements of facilities where sources of radiation are used or stored shall be approved by the Radiation Health Branch, Division of Public Health Protection and Safety, Department for Public Health, Cabinet for Health and Family Services.

      (l) Ceiling heights shall be as follows:

      1. Boiler room ceiling height shall be at least two (2) feet and six (6) inches above the main boiler header and connecting piping with a minimum height of nine (9) feet.

      2. Ceiling height of corridors, storage rooms, patient toilet rooms, and other minor rooms shall be at least seven (7) feet and six (6) inches.

      3. Radiographic, operating, and delivery rooms, and other rooms containing ceiling-mounted equipment or ceiling-mounted surgical light fixtures shall have a height as required to accommodate the equipment or fixtures.

      4. Ceilings of other rooms shall be at least eight (8) feet.

      (m) Recreation rooms, exercise rooms, and similar spaces where impact noises may be generated shall not be located directly over patient bed areas, delivery suites, operating suites, or nurseries unless special provisions are made to minimize transmission of noise.

      (n) Boiler rooms, laundries, food preparation areas, and other rooms containing heat-producing equipment shall be insulated and ventilated to prevent any floor surface from exceeding a temperature of ten (10) degrees Fahrenheit above the ambient room temperature.

      (o) Noise reduction criteria. Partition, floor, and ceiling construction in patient areas shall comply with Table 1, Section 33(1) of this administrative regulation.

      (2) Finishes.

      (a) Floor materials shall be easily cleanable and shall have wear resistance appropriate for the location involved. Floors in areas used for food preparation or food assembly shall be water-resistant and grease-proof. Joints in tile and similar material in food preparation areas shall be resistant to food acids. In areas subject to frequent wet cleaning methods, floor materials shall not be physically affected by germicidal and cleaning solutions. Floors that are subject to traffic while wet shall have a nonslip finish.

      (b) Adjacent dissimilar floor materials shall be flush with each other to provide an unbroken surface.

      (c) Walls generally shall be washable, and in the immediate area of plumbing fixtures the finish shall be smooth and moisture-resistant. Finish, trim, and floor and wall construction in dietary and food preparation areas shall be free of spaces that may harbor rodents and insects.

      (d) Wall bases in kitchens, operating rooms, delivery rooms, and other areas subject to frequent wet cleaning methods shall be made integral and coved with the floor, tightly sealed within the wall, and constructed without voids that may harbor harmful bacteria.

      (e) Ceilings shall be cleanable. Ceilings in surgical, delivery, nursery, and isolation rooms shall be readily washable and without crevices that may retain dirt particles. Surgical, delivery, nursery, and isolation rooms and dietary and food preparation areas shall have a finished ceiling covering overhead piping and ductwork. Finished ceilings may be omitted in mechanical and equipment spaces, shops, general storage areas, and similar spaces, unless required for fire-resistive purposes.

      (f) Acoustical type ceilings shall be provided for corridors in patient areas, nurses' stations, labor rooms, dayrooms, recreation rooms, dining areas, and waiting areas.

      (g) Ceilings of patient rooms in psychiatric nursing units shall be of monolithic or bonded construction.

 

      Section 29. Elevators. Hospitals having bedrooms, dining rooms, recreation areas, operating rooms, delivery rooms, diagnostic, or therapy areas, located on other than the main entrance floor, shall have elevators.

      (1) Number of elevators.

      (a) At least one (1) hospital-type elevator shall be installed if one (1) to fifty-nine (59) patient beds are located on any floor other than the main entrance floor.

      (b) At least two (2) hospital-type elevators shall be installed if sixty (60) to 200 patient beds are located on floors other than the main entrance floor, or if the major inpatient services are located on a floor other than those containing patient beds.

      (c) At least three (3) hospital-type elevators shall be installed if 201 to 350 patient beds are located on floors other than the main entrance floor, or if the inpatient services are located on a floor other than those containing patient beds.

      (d) If a hospital has more than 350 beds, the number of elevators shall be determined from a study of the hospital plan and the estimated vertical transportation requirements.

      (2) Cars and platforms. Cars of hospital-type elevators shall have inside dimensions that will accommodate a hospital bed and attendant and shall be at least five (5) feet wide by seven (7) feet and six (6) inches deep. The car door shall have a minimum clear opening of at least three (3) feet and eight (8) inches.

      (3) Leveling. Elevators shall have automatic leveling of the two (2) way automatic maintaining type with accuracy within plus or minus one-half (1/2) inch.

      (4) Operation. Elevators, except freight elevators, shall be equipped with a two (2) way special service switch to permit cars to bypass landing button calls and be dispatched directly to any floor.

 

      Section 30. Construction. (1) Design. Every building and every portion thereof shall be designed and constructed to sustain dead and live loads in accordance with accepted engineering practices and standards, including seismic forces if applicable.

      (2) Foundations. Foundations shall rest on natural solid bearing if a satisfactory bearing is available at reasonable depths. Proper soil-bearing values shall be established in accordance with recognized standards. If solid bearing is not encountered at practical depths, the structure shall be supported on driven piles, augured piles, poured caissons, or an equivalent designed to support the intended load without detrimental settlement, except that one (1) story buildings may rest on a fill designed by a soils engineer. If engineered fill is used, site preparation and placement of fill shall be done under the direct full-time supervision of the soils engineer. The soils engineer shall issue a final report on the compacted fill operation and a certification of compliance with the job specifications. Footings shall extend to a depth not less than one (1) foot below the estimated frost line.

      (3) Natural disasters. Special provisions shall be made in the design of buildings in geographic areas where local experience reflects loss of life or extensive damage to buildings resulting from tornadoes or floods.

 

      Section 31. Mechanical Requirements. (1) General. Prior to completion of the contract and final acceptance of the facility, the architect or engineer shall obtain from the contractor, certification in writing that mechanical systems have been tested and that the installation and performance of these systems conform with the final plans and specifications.

      (2) Incinerators. The design and installation shall comply with the applicable state regulations for control of air contaminants for incinerators.

      (3) Steam and hot water systems.

      (a) Boilers. If boilers are used, a minimum of two (2) shall be provided and the combined capacity of the boilers shall be able to supply 150 percent of the normal requirements for systems and equipment in the facility.

      (b) Boiler accessories. Boiler feed pumps, condensate return pumps, fuel oil pumps, and circulation pumps shall be connected and installed to provide normal and standby service.

      (c) Valves. Supply and return mains and risers of cooling, heating, and process steam systems shall be valved to isolate the various sections of each system. Each piece of equipment shall be valved at the supply and return ends, except that vacuum condensate returns need not be valved at each piece of equipment.

      (4) Thermal and acoustical installation.

      (a) Insulation shall be provided on the following within the building:

      1. Boilers, smoke breeching, and stacks;

      2. Steam supply and condensate return piping;

      3. Hot water piping above 120 degrees Fahrenheit at hot water heaters, generators, and converters;

      4. Chilled water, refrigerant, other process piping, and equipment operating with fluid temperatures below ambient dew point;

      5. Water supply and drainage piping on which condensation may occur;

      6. Air ducts and casings with outside surface temperature below ambient dew point or temperature above eighty (80) degrees Fahrenheit; and

      7. Other piping, ducts, and equipment as necessary to maintain the efficiency of the system.

      (b) Insulation on cold surfaces shall include an exterior vapor barrier.

      (c) Duct linings shall not be used in systems supplying operating rooms, delivery rooms, recovery rooms, nurseries, isolation rooms of intensive care units unless terminal filters of at least ninety (90) percent efficiency are installed downstream of the lining.

      (5) Air-conditioning, heating, and ventilation systems.

      (a) Temperatures and humidities.

      1. The designed capacity of the systems shall provide the following temperatures and humidities in the areas noted below:

Area Designation

Temperature

 

F.

Relative

Humidity %

(Min)

Relative

Humidity

% (Max)

Operating Rooms

68-76*

50**

60

Delivery Rooms

70-76*

50**

60

Recovery Rooms

75-80

60

 

Intensive Care Rooms

72-78*

30

60

Nurseries

75-80

60

 

Special Care Nursery

75-80*

30

60

*Variable temperature range required.

**Minimum relative humidity may be reduced to thirty (30) percent if the facility establishes a written policy prohibiting the use of flammable anesthetics.

 

      2. For other areas occupied by inpatients, the indoor winter design temperature shall be seventy-five (75) degrees Fahrenheit. For all other occupied areas, the indoor winter design temperature shall be seventy-two (72) degrees Fahrenheit.

      3. For all other occupied areas, the indoor summer design temperature shall be seventy-five (75) degrees Fahrenheit.

      (b) Ventilation system details. Air-supply and air-exhaust systems shall be mechanically operated. Fans serving exhaust systems shall be located at the discharge end of the system. The ventilation rates as shown on Table 2, Section 33(2) of this administrative regulation shall be considered as minimum acceptable rates and shall not be construed as precluding the use of higher ventilation rates.

      1. Outdoor air intakes shall be located as far as practical but not less than twenty-five (25) feet from exhaust outlets of ventilation systems, combustion equipment stacks, medical surgical vacuum systems, plumbing vent stacks, or from areas which may collect vehicular or other noxious fumes. The bottom of outside air intakes serving central air systems shall be located as high as practical but not less than six (6) feet above ground level or, if installed above the roof, three (3) feet above roof level.

      2. The ventilation systems shall be designed and balanced in accordance with the pressure relationship as shown in Table 2, Section 33(2) of this administrative regulation.

      3. Air supplied to operating rooms, delivery rooms, nurseries, and other sensitive areas shall be delivered at or near the ceiling of the area served and return/exhaust air shall be removed near floor level. At least two (2) return/exhaust outlets shall be provided in each operating room and delivery room.

      4. Room supply, return, and exhaust outlets shall be located not less than three (3) feet above finished floor.

      5. Isolation rooms and intensive care rooms may be ventilated by induction units if the induction units contain only a reheat coil and if only the primary air from a central system passes through the reheat coil.

      6. Central ventilation or air-conditioning systems shall be equipped with filters having minimum efficiencies as listed below:

Area Designation

Minimum No.of Filters

Filter

Efficiencies %

No 1.

No. 2

 

Sensitive Areas*

2

25

90

 

Patient Care, Treatment, Diagnostic and Related Areas

2

25

90**

Food Preparation and Laundry

1

80

--

Administrative, Storage, and Soiled Holding

1

25

--

*Includes operating rooms, delivery rooms, nurseries, recovery units, and intensive care units.

**May be reduced to eighty (80) percent for systems using all-outdoor air.

 

      7. If two (2) filter beds are required in central ventilation and air-conditioning equipment, Filter Bed No. 1 shall be located upstream of the air-conditioning equipment and Filter Bed No. 2 shall be located downstream of the supply fan, any recirculating spray water system, or water reservoir type humidifiers. If only one (1) filter bed is required, it shall be located upstream of the air-conditioning equipment unless an additional prefilter is employed. In this case, the prefilter shall be located upstream of the equipment and the main filter may be located further downstream.

      8. Filter efficiencies as listed above shall be average atmospheric dust spot efficiencies tested in accordance with the "American Society of Heating, Refrigerating, and Air-Conditioning Engineers" (ASHRAE) Standard in effect at the time the hospital is constructed.

      9. Filter frames shall be durable and carefully dimensioned, and shall provide an airtight fit with the enclosing ductwork. Joints between filter segments and the enclosing ductwork shall be gasketed or sealed to provide a positive seal against air leakage.

      10. A manometer or its equivalent shall be installed across each filter bed serving sensitive areas or central air systems.

      11. Ducts which penetrate construction intended for x-ray or other ray protection shall not impair the effectiveness of the protection.

      12. Laboratories shall be provided with outdoor air at a rate of two (2) air changes per hour. If this ventilation rate does not provide the air required to ventilate fume hoods and safety cabinets, additional outdoor air shall be provided. A filter with ninety (90) percent minimum efficiency shall be installed in the air supply system at its entrance to the media transfer room.

      13. Laboratory hoods for general use shall have a minimum average face velocity of seventy-five (75) feet per minute. Hoods in which infectious or highly radioactive materials are processed shall have a face velocity of 100 feet per minute and each hood shall have an independent exhaust system with the fan installed at the discharge point of the system. Hoods used for processing infectious materials shall be equipped with a means of disinfection.

      14. Duct systems serving hoods in which highly radioactive materials and strong oxidizing agents are used shall be constructed of stainless steel for a minimum distance of ten (10) feet from the hood and shall be equipped with washdown facilities.

      15. Boiler rooms shall be provided with sufficient outdoor air to maintain combustion rates of equipment and reasonable temperatures in the rooms and in adjoining areas.

      (6) Plumbing systems. Plumbing systems shall be designed and installed in accordance with the applicable state plumbing regulations.

      (a) Plumbing fixtures.

      1. The material used for plumbing fixtures shall be of nonabsorptive acid-resistant material.

      2. Lavatories and sinks required in patient care areas shall have the water supply spout mounted so that its discharge point is a minimum of five (5) inches above the rim of the fixture. Fixtures used by medical and nursing staff and lavatories used by patients and food handlers shall be equipped with valves which can be operated without the use of hands. If blade handles are used for this purpose, they shall not exceed four and one-half (4 1/2) inches in length, except that handles on scrub sinks and clinical sinks shall be not less than six (6) inches long.

      3. Clinical sinks shall have an integral trap in which the upper portion of a visible trap seal provides a water surface.

      (b) Water supply systems.

      1. Systems shall be designed to supply water at sufficient pressure to operate all fixtures and equipment during maximum demand periods.

      2. Each water service main, branch main, riser, and branch to a group of fixtures shall be valved. Stop valves shall be provided at each fixture.

      3. A backflow preventer or vacuum breaker shall be installed on hose bibbs, laboratory sinks, janitors' sinks, bedpan flushing attachments, autopsy tables, and other fixtures to which hoses or tubing can be attached.

      4. Flush valves installed on plumbing fixtures shall be of a quiet operating type.

      5. Bedpan flushing devices shall be provided in each patient toilet room and in the soiled workrooms located in the patient nursing units.

      6. An auxiliary water supply shall be available to provide potable water in case of emergencies.

      (c) Hot water heating systems.

      1. The hot water heating equipment shall have a sufficient capacity to supply water at the temperature and amounts indicated below:

 

Use

 Clinical

Dishwasher

 

Laundry

Gal/hr/bed

6 1/2

4

4 1/2

Temp. F.

125

180*

160**

*Temperature may be reduced to 160 degrees Fahrenheit if a chloritizer is used. Required temperature must be provided throughout the wash and rinse cycles.

**Required temperature of 160 degrees Fahrenheit is that measured in the washing machine and shall be supplied so that the temperature will be maintained over the entire wash and rinse cycles.

      2. Storage tanks shall be fabricated from corrosive-resistant metal or be lined with noncorrosive material.

      (d) Drainage systems.

      1. Drain lines from sinks in which acid wastes may be poured shall be fabricated from an acid-resistant material.

      2. Piping over operating and delivery rooms, nurseries, food preparation centers, food serving facilities, food storage areas, and other critical areas shall be kept to a minimum and shall not be exposed. Special precautions shall be taken to protect these areas from possible leakage or condensation from necessary overhead piping systems.

      3. Floor drains shall not be installed in operating and delivery rooms. Flushing rim type floor drains may be installed in cystoscopic operating rooms.

      4. Building sewers shall discharge into a community sewerage system. If a community sewerage system is not available, a facility providing sewage treatment shall be installed which conforms to applicable local and state administrative regulations.

      (7) Nonflammable medical gas systems. Installations shall be in accordance with the requirements of the National Fire Protection Association (NFPA) 99, Health Care Facilities and the NFPA 99C, Gas and Vacuum Systems incorporated by reference in 815 KAR 7:120 as part of the Kentucky Building Code. The number, type, and location of outlets shall be as follows:

STATION OUTLETS FOR OXYGEN

AND VACUUM (SUCTION) OUTLETS

Location

Oxygen

Vacuum

Patient room for adult medical, surgical, postpartum, or pediatric care

A

A

Examination and treatment room in nursing unit

B

B

Patient room for intensive care

C

C

Nursery and pediatric nursery

A

A

General operating room

F

F

Cystoscopy and special procedure room

D

D

Recovery room

E

E

Delivery room

F

G

Labor room

A

A

Emergency treatment room

D

D

Autopsy room

--

D

A - One (1) outlet accessible to each bed. One (1) outlet may serve two (2) beds.

B - One (1) outlet. Portable equipment may be considered acceptable in lieu of fixed outlets.

C - Two (2) outlets for each bed or provide one (1) outlet with Y-fitting.

D - One (1) outlet.

E - One (1) outlet for each bed.

F - Two (2) outlets.

G - Three (3) outlets.

 

      Section 32. Electrical Requirements. (1) General.

      (a) Equipment, conductors, controls, and signaling devices shall be installed to provide a complete electrical system with the necessary characteristics and capacity to supply the electrical facilities shown in the specifications or indicated on the plans. Materials shall be listed as complying with applicable standards of Underwriters' Laboratories, Inc., or other similarly established standards.

      (b) Electrical installations and systems shall be tested to show that the equipment is installed and operates as planned or specified. A written record of performance tests on special electrical systems and equipment shall be supplied to the owner. These tests shall show compliance with the governing codes and shall include conductive floors, isolated power centers, grounding continuity, and alarm systems.

      (2) Switchboard and power panels. Circuit breakers or fusible switches that provide disconnecting means and overcurrent protection for conductors connected to switchboards and panel boards shall be enclosed or guarded to provide a dead front type of assembly. The main switchboard shall be located in a separate enclosure accessible only to authorized persons. The switchboard shall be convenient for use, readily accessible for maintenance, clear of traffic lanes, and in a dry ventilated space devoid of corrosive fumes or gases. Overload devices shall be suitable for operating properly in the ambient temperature conditions.

      (3) Panel boards. Lighting and appliance panel boards shall be located on the same floor as the circuits they serve.

      (4) Lighting.

      (a) Spaces occupied by people, machinery, or equipment within buildings, and the approaches thereto, and parking lots shall have lighting.

      (b) Patient bedrooms shall have general lighting and night lighting. A reading light shall be provided for each patient. Flexible light arms shall be mechanically operated to prevent the bulb from coming in contact with the bed linen. Patients' reading lights and other fixed lights not switched at the door shall have switch controls located convenient to the luminaire. A fixed type night light, mounted at approximately sixteen (16) inches above the floor, shall be provided in each patient room. Switches for control of lighting in patient areas shall be of the quiet operating type.

      (c) Operating and delivery rooms shall have general lighting in addition to local lighting provided by special lighting units at the surgical and obstetrical tables. Each fixed special lighting unit at the tables, except portable units, shall be connected to an independent circuit.

      (d) Nursing unit corridors shall have general illumination with provisions for reduction of light levels at night. Refer to Table 3, Section 33(3) of this administrative regulation.

      (5) Receptacles.

      (a) Anesthetizing locations. Each operating, delivery, and emergency room shall have at least three (3) receptacles. In locations where mobile x-ray is used, an additional outlet distinctively marked for x-ray use shall be provided.

      (b) Bedroom. Each patient bedroom shall have duplex receptacles as follows:

      1. One (1) on each side of the head of the bed;

      2. One (1) for the television, if used; and

      3. One (1) on another wall.

      (c) Receptacles in pediatric and psychiatric units shall be of the safety type or shall be protected by five (5) milliampere ground fault interrupters.

      (d) Nurseries. Each bassinet shall have a minimum of one (1) duplex receptacle. Additional receptacles shall be provided in special care nurseries, dependent on the types of equipment which will be used to provide medical care.

      (e) Corridors. Duplex receptacles for general use shall be installed approximately fifty (50) feet apart and within twenty-five (25) feet of ends of corridors. Receptacles in corridors of pediatric and psychiatric units shall be of the safety type or shall be protected by five (5) milliampere ground fault interrupters.

      (6) Equipment installation in special areas.

      (a) Installation in anesthetizing locations. Electrical equipment, devices, receptacles, and wiring shall be in accordance with NFPA 99, Health Care Facilities and the NFPA 99C, Gas and Vacuum Systems as adopted by the State Fire Marshal's Office for hospitals.

      (b) Facilities where sources of radiation are used or stored shall conform to applicable state regulations for radiation protection.

      (c) Equipment for displaying images. At least two (2) x-ray illuminators or a monitor for displaying at least two (2) films or images simultaneously shall be installed in each operating room, emergency treatment room, and viewing room in the radiology department.

      (7) Nurses' calling system.

      (a) General.

      1. In general patient areas, each room shall be served by at least one (1) calling station and each bed shall be provided with a call button.

      2. Two (2) call buttons serving adjacent beds may be served by one (1) calling station.

      3. Calls shall register at an annunciator panel at the nurses' station and shall actuate a visible signal in the corridor at the patient room door, in the clean workroom, soiled workroom, the nourishment station, and the nurses' lounge of the nursing unit.

      4. In multicorridor nursing units, additional visible signals shall be installed at corridor intersections.

      5. In rooms containing two (2) or more calling stations, indicating lights shall be provided at each station.

      6. Nurses' calling systems that provide two (2) way voice communication shall be equipped with an indicating light at each calling station which lights and remains lighted as long as the voice circuit is operating.

      (b) Patient emergency.

      1. A nurses' call emergency button shall be provided for patient use at each patient's toilet, bath, sitz bath, and shower room on the nursing unit floors.

      2. Call buttons shall be usable by a patient lying on the floor, and the inclusion of a pull cord shall satisfy this requirement.

      (c) Intensive care. In areas where patients are under constant surveillance, the nurses' calling system may be limited to a bedside station that will actuate a signal that can be readily seen by the nurse.

      (d) Staff emergency. An emergency calling station, which may be used by staff to summon assistance, shall be provided in each operating, delivery, recovery, emergency treatment, and intensive care room, in nurseries, and in supervised nursing units for psychiatric patients.

      (8) Fire alarm and fire detection systems. The design and installation of fire alarm and fire detection systems shall be approved by the State Fire Marshal's Office.

      (9) Emergency electrical.

      (a) General. To provide electricity during interruption of the normal electric supply, an emergency source of electricity shall be provided and connected to circuits for lighting and power as set forth in paragraph (d) below.

      (b) Sources. The source of this emergency electric service shall be as follows:

      1. An emergency generating set if the normal service is supplied by one (1) or more central station transmission lines; or

      2. An emergency generating set or a central station transmission line if the normal electric supply is generated on the premises.

      (c) Emergency generating set.

      1. The required emergency generating set, including the prime mover and generator, shall be located on the premises and shall be reserved exclusively for supplying the emergency electrical system.

      2. Generator sets shall be self-sufficient insofar as possible, without dependency on public utilities that may be subject to cutoff or outages.

      3. A system of prime movers which is ordinarily used to operate other equipment and alternately used to operate the emergency generators shall be permitted provided that the:

      a. Number and arrangement of the prime movers are such that when one (1) is out of service, due to breakdown or for routine maintenance, the remaining prime movers can operate the required emergency generators; and

      b. Connection time requirements as listed in paragraph (e) of this subsection are met.

      4. The emergency generator set shall be of sufficient kilowatt capacity to supply the lighting and power load demands of the emergency electrical system.

      5. The power factor rating of the generator shall be not less than eighty (80) percent.

      (d) Emergency electrical connections. Emergency electric service shall be provided to circuits as follows:

      1. Lighting:

      a. Exits and necessary ways of approach thereto, including exterior of exits, exit doorways, stairways, and corridors;

      b. Surgical, obstetrical, and emergency room operating lights;

      c. Nursery, laboratory, recovery room, intensive care areas, nursing station, medication preparation area, and labor rooms;

      d. Generator set location, switch-gear location, mechanical room, and boiler room;

      e. Elevator cabs; and

      f. Night light in patient rooms.

      2. Equipment essential to life safety and for protection of important equipment or vital materials:

      a. Nurses' calling system;

      b. Paging or speaker systems, if intended for issuing instructions during emergency conditions with alarms required for medical gas systems;

      c. Fire pump and jockey pump, if installed;

      d. Pump for central suction system;

      e. Sewerage or sump lift pump, if installed;

      f. Blood bank refrigerator; and

      g. Selected receptacles in:

      (i) Infant nurseries;

      (ii) Medicine dispensing areas;

      (iii) Cardiac catheterization laboratories;

      (iv) Angiographic laboratories;

      (v) Labor, operating, delivery, and recovery rooms;

      (vi) Dialysis units;

      (vii) Intensive care units;

      (viii) Emergency treatment rooms;

      (ix) Basic laboratory functions; and

      (x) Nurses' stations.

      h. Duplex receptacles in patient corridors and at least one (1) duplex receptacle located on the patient headwall in each patient room.

      i. Elevator service that will reach every patient floor. Manual throw over facilities shall be provided to allow temporary operation of any elevator for the release of persons who may be trapped between floors.

      j. Ventilation of operating and delivery rooms.

      k. Equipment necessary for maintaining telephone service.

      3. Heating. Equipment for heating operating, delivery, labor, recovery, intensive care, and general patient rooms, except that service for heating of general patient rooms will not be required under either of the following conditions:

      a. The design temperature is higher than twenty (20) degrees Fahrenheit, based on the Median of Extremes as shown in the current edition of the "ASHRAE Handbook- Fundamentals".

      b. The hospital is supplied by two (2) or more electrical services supplied from separate generating sources, or a utility distribution network having multiple power input sources and arranged to provide mechanical and electrical separation, so that a fault between the hospital and generating sources will not likely cause an interruption of the hospital service feeders.

      (e) Details.

      1. The emergency electrical system shall be controlled so that, after interruption of the normal electric power supply, the generator shall be brought to full voltage and frequency and shall be connected within ten (10) seconds through one (1) or more primary automatic transfer switches to

      a. Emergency lighting systems;

      b. Alarm systems;

      c. Blood banks;

      d. Nurses' calling systems;

      e. Equipment necessary for maintaining telephone service;

      f. Pump for central suction system; and

      g. Task illumination and receptacles in:

      (i) Operating areas;

      (ii) Delivery areas;

      (iii) Emergency areas;

      (iv) Intensive care nursing areas;

      (v) Nurseries;

      (vi) Patient rooms; and

      (vii) Patient corridors.

      2. Other lighting and equipment required to be connected to the emergency system shall either be connected through the above described primary automatic transfer switching or shall be subsequently connected through other automatic or manual transfer switching.

      3. Receptacles connected to the emergency system shall be distinctively marked for identification.

      4. Storage-battery-powered lights, provided to augment the emergency lighting or for continuity of lighting during the interim of transfer switching immediately following an interruption of the normal service supply, shall not be used as a substitute for the requirement of a generator.

      5. If stored fuel is required for emergency generator operation, the storage capacity shall be sufficient to supply for at least twenty-four (24) hours of continuous operation.

 

      Section 33. (1) Table 1 - Sound Transmission Limitations in General Hospitals.

TABLE 1.

Sound Transmission Limitations in General Hospitals.

Location

Airborne Sound

Transmission Class (STC) a*

Impact

Insulation Class (IIC) b*

 

Partitions

Floors

Floors

Patient room to patient room

45

45

45

Corridor to patient room

40

45

45 c*

Public space to patient room d*

50

50

50 c*

Service areas to patient room e*

55

55

55 c*

a* - Sound transmission class (STC) shall be determined by tests in accordance with the methods set forth in ASTM International Standard E-90 and ASTM Standard E-413.

b* - Impact insulation class (IIC) shall be determined in accordance with criteria set forth in U.S. Department of Housing and Urban Development (HUD) FT/TS-24, "A Guide to Airborne, Impact and Structure Borne Noise - Control in Multifamily Dwellings."

c* - Impact noise limitation applicable only when corridor, public space, or service area is over a patient room.

d* - Public space includes lobbies, dining rooms, recreation rooms, treatment rooms, and similar spaces.

e* - Service areas include kitchens, elevators, elevator machine rooms, laundries, garages, maintenance rooms, boiler and mechanical equipment rooms, and similar spaces of high noise. Mechanical equipment located on the same floor or above patient rooms, offices, nurses' stations and similar occupied spaces shall be effectively isolated relating to noise transmission.

Note: The requirements set forth in this table assume installation methods which will not appreciably reduce the efficiency of the assembly as tested.

      (2) Table 2 - Pressure Relationships and Ventilation of Certain Hospital Areas.


TABLE 2.

PRESSURE RELATIONSHIPS AND VENTILATION OF CERTAIN HOSPITAL AREAS.

Area Designation

Pressure Relationship to Adjacent Areas

All Supply Air From

Outdoors

Minimum Air Changes Outdoor Air per Hour

Minimum Total Air Changes Per Hour

All Air

Exhausted Directly to Outdoors

Recirculated Within Room Units

Operating room

P

--

5

12

--

No

Emergency operating room

P

--

5

12

--

No

Delivery room

P

--

5

12

--

No

Nursery

P

--

5

12

--

No

Recovery

O

--

2

6

--

No

Intensive Care

P

--

2

6

--

No

Patient room

O

--

1

4

--

--

Patient corridor

O

--

1

4

--

No

Isolation room

O

--

2

8

Yes

No

Isolation anteroom

N

--

2

8

Yes

No

Treatment room

O

--

2

8

--

No

X-ray, fluoroscopy room

N

--

2

8

yes

No

X-ray, treatment room

O

--

2

8

--

No

Physical therapy & hydrotherapy

N

--

2

8

Yes

No

Soiled workroom

N

--

2

8

Yes

No

Clean workroom

P

--

1

8

--

No

Autopsy and darkroom

N

--

3

12

Yes

No

Toilet room

N

--

--

10

Yes

No

Bedpan washing

N

--

2 room

8

Yes

No

Bathroom

N

--

2

10

Yes

No

Janitor's closet

N

--

--

10

Yes

No

Sterilizer equipment room

N

--

--

10

Yes

No

Linen and trash chute rooms

N

--

--

10

Yes

No

Laboratory, general

O

--

2

8

--

No

Laboratory, media transfer

P

--

2

8

--

No

Food preparation

O

--

2 centers

10

--

No

Dishwashing room

N

--

2

10

Yes

No

Dietary dry storage

O

--

--

2

--

No

Laundry, general

O

--

2

10

--

No

Soiled linen sorting & storage

N

--

2

10

Yes

No

Clean linen storage

P

--

1

4

--

No

Central medical & surgical supply:

 

Soiled or decontamination room

N

--

2

10

Yes

No

Clean workroom & supply storage

P

--

2

8

--

No

  (a) P = Positive

  (b) N = Negative

  (c) O = Equal

  (d) -- = Optional

      (3) Table 3 - Lighting Levels for Hospitals.


TABLE 3.

LIGHTING LEVELS FOR HOSPITALS

Area

Foot-candles*

Administrative and lobby areas, day

100

Administrative and lobby areas, night

20

Chapel or quiet area

30

Corridors and interior ramps

30

Corridor night lighting

10

Dining area and kitchen

50

Doorways

10

Examination and treatment room:

 

 General

50

 Examining table

100

Exit stairways and landings

30

Janitor's closet

20

Nurses' station, general, day

50

Nurses' station, general, night

20

Nurses' desk or counter, for charts & records

150

Nurses' medicine area, preparations & storage

100

Occupational therapy

30

Patient care unit or room, general

10

Patient care room, reading

50

Patient care room, night light (variable)

.5 to 1.5

Physical therapy

30

Stairways other than exits

50

Toilet and bathing facilities

30

Clean workroom

100

Soiled workroom

100

Nurses' lounge

30

Laundry, general

50

*Minimum on task at anytime.

 

      Section 34. New Construction and Renovation Facility Requirements. (1) Unless otherwise required by this section, effective June 1, 2008, hospital plans submitted for approval to the licensing agency:

      (a) Shall be compliant with the standards established in chapters 1.6 and 2.1 of the "Guidelines for Design and Construction of Health Care Facilities", 2006 edition; and

      (b) Shall not be required to comply with requirements established in other chapters of the "Guidelines for Design and Construction of Health Care Facilities", 2006 edition, as referenced in Chapter 2.1.

      (2) Hospital plans submitted for approval to the licensing agency after the effective date of this regulation and prior to June 1, 2008 may meet either the requirements established in this section or in Sections 6 through33 of this administrative regulation.

      (3) An endoscopy suite shall comply with requirements established in Chapter 3.9, Sections 2.3 through 3.5 of the "Guidelines for Design and Construction of Health Care Facilities", 2006 edition including requirements established in other chapters of the "Guidelines for Design and Construction of Health Care Facilities", 2006 edition, as referenced in Chapter 3.9, Sections 2.3 through 3.5.

      (4) A psychiatric nursing unit patient room shall comply with the requirements established in Chapter 2.3, Sections 2.1 through 2.1.1.6 of the "Guidelines for Design and Construction of Health Care Facilities", 2006 edition, as referenced in Chapter 2.1, Section 3.8.2 Health Care Facilities", 2006 edition.

      (5) Psychiatric nursing unit support areas shall comply with requirements established in Chapter 2.3, Sections 2.6.1 through 2.9.4 of the "Guidelines for Design and Construction of Health Care Facilities", 2006 edition.

      (6) A seclusion treatment room in a psychiatric nursing unit shall comply with requirements established in Chapter 2.3, Sections 2.2.1 through 2.2.1.5 of the "Guidelines for Design and Construction of Health Care Facilities", 2006 edition, as referenced in Chapter 2.1, Section 3.8.3 of the "Guidelines for Design and Construction of Health Care Facilities", 2006 edition.

      (7) A child psychiatric unit shall comply with requirements established in Chapter 2.3, Sections 2.3 through 2.3.3 of the "Guidelines for Design and Construction of Health Care Facilities", 2006 edition.

      (8) A geriatric, Alzheimer’s, or other dementia unit shall comply with requirements established in Chapter 2.3, Sections 2.4 through 2.4.2.3 of the "Guidelines for Design and Construction of Health Care Facilities", 2006 edition.

      (9) Outpatient surgery and post-anesthetic care provided in the surgical suite of the hospital, in a separate unit of the hospital, or in a separate facility licensed as part of the hospital, shall comply with the requirements established in Chapter 3.7, Sections 1.1 through 2.3.1 and Sections 2.3.1.2 through 6.4.1 of the "Guidelines for Design and Construction of Health Care Facilities", 2006 edition. Class A operating rooms shall not be allowed.

      (10) When directed by the "Guidelines for Design and Construction of Health Care Facilities", 2006 edition, to "see" another section of the Guidelines, a hospital shall comply with the language of the section to which it has been referred by the word "see" if the section is incorporated by reference in Section 35 of this administrative regulation.

      (11) Notwithstanding the version of a referenced code or standard in the "Guidelines for Design and Construction of Health Care Facilities", 2006 edition, a hospital shall meet the version of the code or standard adopted by the state authority having jurisdiction.

      (12) Outpatient services licensed as part of the hospital shall comply with requirements established in this administrative regulation and shall be provided in the main hospital building or in buildings on the premises or contiguous to the premises of the hospital.

      (13) A patient room shall have a window with a sill that is not more than three (3) feet above the floor and not less in area than eight (8) percent of the total floor area of the room.

      (14) Transportable or relocatable units utilized by the applicant or licensee shall:

      (a) Comply with requirements established in this section; and

      (b) Be accessible to the facility by a covered walkway that:

      1. Ensures a patient is protected from the outside elements; and

      2. Provides access to a patient in a wheelchair or on a stretcher.

      (15) Prior to completion of construction or renovation, the licensee or applicant shall obtain a letter from the engineer of record or contractor certifying that new or modified mechanical and electrical systems have been tested and that the installation and performance of these systems conform with the final plans and specifications.

 

      Section 35. Incorporation by Reference. (1) The following sections of "Guidelines for Design and Construction of Health Care Facilities", 2006 edition, are incorporated by reference:

      (a) Chapter 1.2, Sections 2.1 through 2.3.2;

      (b) Chapter 1.5, Sections 1.1 through 2.3.3.2;

      (c) Chapter 1.6;

      (d) Chapter 2.1;

      (e) Chapter 2.3, Sections 2.1 through 2.1.1.6;

      (f) Chapter 2.3, Sections 2.2.1 through 2.2.1.5;

      (g) Chapter 2.3, Sections 2.3 through 2.3.3;

      (h) Chapter 2.3, Sections 2.4 through 2.4.2.3;

      (i) Chapter 2.3, Sections 2.6.1 through 2.9.4;

      (j) Chapter 3.7, Sections 1.1 through 2.3.1;

      (k) Chapter 3.7, Sections 2.3.1.2 through 6.4.1; and

      (l) Chapter 3.9, Sections 2.3 through 3.5.

      (2) This material may be inspected, copied, or obtained subject to applicable copyright law, at the Office of Inspector General, 275 East Main Street, Fifth Floor East, Frankfort, Kentucky 40621, Monday through Friday, 8:00 a.m. to 4:30 p.m. (24 Ky.R. 1433; Am. 1714; eff. 4-13-98; 26 Ky.R. 484; 1017; 1161; eff. 10-20-99; 27 Ky.R. 606; 1319; 1492; eff. 12-21-2000; 29 Ky.R. 2377; eff. 6-16-03; Recodified from 902 KAR 17:041, 5-26-04. Am. 31 Ky.R. 236; 782; eff. 11-17-04; 32 Ky.R. 1785; 2295; eff. 7-24-06; 34 Ky.R. 410; 1005; 1439; eff. 12-12-2007.)