902 KAR 20:170. Facility specifications; psychiatric hospitals.

 

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

      STATUTORY AUTHORITY: KRS 216B.042, 216B.105

      NECESSITY, FUNCTION, AND CONFORMITY: KRS 216B.042 and 216B.105 mandate that the Kentucky Cabinet for Human Resources regulate health facilities and health services. This administrative regulation provides the licensure requirements for the structural specifications and physical plant requirements for new construction, alteration and maintenance of psychiatric hospital facilities. Psychiatric hospital facilities licensed prior to the effective date of this administrative regulation shall meet the facility specifications in force on the date of their most recent licensure inspection.

 

      Section 1. Definitions. (1) "Board" means the Commission for Health Economics Control in Kentucky.

      (2) "License" means an authorization issued by the board for the purpose of operating a psychiatric hospital facility.

      (3) "Licensure agency" means the Division for Licensing and Regulation in the office of the Inspector General, Cabinet for Human Resources.

 

      Section 2. Preparation and Approval of Plans and Specifications. After receiving a certificate of need from the board, plans and specifications shall be submitted to the licensure agency and required approvals shall be obtained pursuant to the requirements of 902 KAR 20:009, Sections 2 and 3.

 

      Section 3. Compliance with Building Codes, Ordinances and Regulations. (1) This section of this administrative regulation may be administered independently from other sections of this administrative regulation.

      (2) Nothing stated herein shall relieve the sponsor from compliance with building codes, ordinances, and regulations which are enforced by city, county, or state jurisdictions.

      (3) The following requirements shall apply where applicable and as adopted by the respective agency authority:

      (a) Requirements of the Kentucky Building Code pursuant to 815 KAR 7:010 through 815 KAR 7:060;

      (b) Requirements for safety pursuant to 815 KAR 10:020, as amended;

      (c) Requirements for plumbing pursuant to 815 KAR 20:010 through 20:191, as amended;

      (d) Requirements for air contaminants for incinerators pursuant to 401 KAR 59:020 and 401 KAR 61:010;

      (e) Requirements for elevators pursuant to 815 KAR 4:010;

      (f) Requirements for making buildings and facilities accessible to and usable by the physically handicapped pursuant to KRS 198B.260 and administrative regulations promulgated thereunder;

      (g) Review of x-ray installation, construction and modification plans pursuant to 902 KAR 100:160;

      (h) Food Service Establishment Act (KRS 219.011 to 219.081) and State Food Service Code (902 KAR 45:005), as amended; and

      (i) Requirements for boilers pursuant to 815 KAR 15:010 through 815 KAR 15:070.

      (4) Prior to occupancy the facility shall have final approval from appropriate agencies.

      (5) All facilities shall be currently approved by the Fire Marshal's Office before relicensure is granted by the licensing agency.

 

      Section 4. Facility Requirements and Special Conditions. (1) A copy of the narrative program as submitted in the certificate of need application for each project shall be provided to the licensure agency by the sponsor which describes the functional space requirements, staffing patterns, departmental relationships, and other basic information relating to the fulfillment of the objectives of the facility.

      (2) The extent (number and types of rooms) of the diagnostic, clinical, and administrative facilities to be provided shall be determined by the services to be provided and the estimated patient load as described in the narrative program.

 

      Section 5. Nursing Unit. (1) Patient room. Each patient room shall meet the following requirements:

      (a) Minimum floor area of 100 square feet in one (1) bed rooms and eighty (80) square feet per patient in multibed rooms with a maximum of two (2) patients per room.

      (b) 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.

      (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. Sill height shall not be higher than three (3) feet above the floor. Windows in psychiatric units shall be of security type or a type that can only be opened by keys or tools that are under the control of staff. Degree of security required shall be as determined by the program. Operation of the sash shall be restricted to inhibit possible tendency for escape or suicide. Where glass fragments may create a hazard, safety glazing and/or other appropriate security features shall be incorporated.

      (e) If a nurses' call system is included, provisions shall be made to permit removal of call buttons and/or use of blank plates as appropriate.

      (f) Visual privacy shall be provided to each patient as needed which isolates patients from one another but not from observation by staff.

      (g) No patient room shall be located more than 120 feet from the nurses' station.

      (h) No room shall be used as a patient room where the access is through another patient's room.

      (2) Service areas. Each nursing unit shall include:

      (a) A separate space for occupational therapy at the rate of fifteen (15) square feet per patient and a minimum area of 400 square feet. This space may be outside the nursing unit.

      (b) A minimum of two (2) separate social spaces, one (1) appropriate for noisy activities and the other for quiet activities shall be provided. The combined area shall not be less than thirty (30) square feet per patient or not less than 120 square feet for each of the two (2) spaces, whichever is greater. This space may be shared by dining activities and may be outside of the nursing unit.

      (c) Storage for patients' belongings.

      (d) Bathing facilities. Bathtubs or showers shall be provided 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 with an assisting attendant.

      (e) Nurses' station for charting, communications, and storage for supplies with a sink equipped for handwashing.

      (f) Clean workroom or clean holding area. There shall be a clean workroom with a work counter, handwashing and storage facilities or a clean holding room which is part of a central system for storage and distribution of clean and sterile supplies.

      (g) Soiled workroom or soiled holding room. There shall be a soiled workroom with a clinical sink or equivalent flushing rim fixture, sink equipped for handwashing, work counter, waste receptacle, and linen receptacle or a soiled holding room which is a part of a central system for collection and disposal of soiled materials.

      (h) Medicine area. Provision shall be made for 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. If a medicine preparation room or unit is used it shall be under the nursing staff's visual control and contain a work counter, refrigerator, and locked storage for biologicals and drugs. If a medicine dispensing unit is used it 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. The controlled substances locker must have a double lock.

      (i) Clean linen storage in an enclosed space (may be a designated area within the clean workroom). If a closed cart system is used, storage may be in an alcove.

      (3) Seclusion room(s). A seclusion room shall be provided for patients requiring security and protection from either himself or others. The room shall be located in a manner affording direct observation of the patient by the nursing staff. It shall be a single room and be constructed to minimize the patient's hiding, escape, injury or suicide. There shall be a minimum of one (1) seclusion room for every twenty-four (24) beds. The seclusion room(s) is intended for short term occupancies by patients who may have become violent or suicidal. Therefore, special fixtures, hardware, etc., including ground fault interrupters for electrical circuits and tamper proof screws, shall be used. Doors shall have provisions for staff observation while maintaining privacy from public and other patients.

 

      Section 6. Outpatient Services. Outpatient department. If outpatient services are provided 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 transverse areas being used by inpatients.

 

      Section 7. Laboratory Facilities. Facilities for laboratory services shall be provided directly within the psychiatric hospital or through a contract with a hospital or laboratory service for hematology, clinical chemistry, urinalysis, cytology, and bacteriology. If the psychiatric hospital has a full medical laboratory providing these services it shall comply with the applicable requirements of 902 KAR 20:009 concerning laboratories. If these services are provided through a contract, the following shall be provided in the psychiatric hospital:

      (1) Laboratory work counter(s) with sink, gas and electric service;

      (2) Lavatory(ies) with handwashing facility;

      (3) Storage cabinet(s) or closet(s); and

      (4) Specimen collection facilities. Urine collection rooms shall be equipped with a water closet and lavatory. Blood collection facilities shall have space for a chair and work counter.

 

      Section 8. Pharmacy or Drug Room. There shall be adequate facilities for the safe storage and handling of pharmaceuticals including double locking of controlled substances and refrigeration for biologicals and drugs which require refrigeration.

 

      Section 9. Other Medical Services. If the psychiatric hospital provides radiologic, physical therapy, surgical services or other medical services not addressed by this administrative regulation the facility shall comply with the applicable requirements of 902 KAR 20:009, Facility specifications, hospitals.

 

      Section 10. Dietary Department. Food service facilities shall be designed and equipped for sanitary storage, processing, and handling of food. The facilities shall include refrigerated storage and dry storage to accommodate a three (3) day minimum supply and dining space for ambulatory patients, staff and visitors.

 

      Section 11. Administrative and Public Areas. The facility shall have adequate administrative, public, and staff facilities (e.g., offices, lobby, toilet facilities) to accommodate the needs of the public, patients, and staff without interfering with the provision of medical care services.

 

      Section 12. Medical Records Unit. This unit shall include adequate space for record storage, record review and dictating, record sorting and recording.

 

      Section 13. Laundry. (1) The arrangement of facilities and equipment shall assure an orderly work flow with a minimum of cross traffic that might mix clean and soiled operations.

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

      (a) Soiled linen receiving, holding, and sorting room with handwashing facilities;

      (b) Laundry processing room with commercial-type equipment which can process seven (7) days of linen needs within a regularly scheduled work week. Handwashing facilities shall be provided;

      (c) Clean linen storage, inspection, and issuing room or area; and

      (d) Cart storage and cart sanitizing facilities.

      (3) If linen is to be processed off the hospital site there shall be a soiled linen holding room with a handwashing facility conveniently accessible and a room or rooms for receiving, inspection and storage of clean linen.

 

      Section 14. Waste Processing Services. 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.

 

      Section 15. Details and Finishes. All details and finishes shall meet the following requirements:

      (1) 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.

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

      (3) Grab bars provided at patients' toilets, showers, or tubs 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.

      (4) Recreation rooms, exercise rooms, and similar spaces where impact noises may be generated shall not be located directly over patient bed areas unless special provisions are made to minimize such noise.

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

      (6) Noise reduction criteria. Partition, floor, and ceiling construction in patient areas shall comply with Section 19, Table 1 of this administrative regulation.

      (7) Floors that are subject to traffic while wet, such as shower and bath areas shall have a nonslip finish.

 

      Section 16. Elevators. (1) Number of elevators. All hospitals having patients' facilities, such as patient rooms, dining rooms or recreation areas, or diagnostic or therapy areas, located other than on the main entrance floor shall have elevators.

      (a) At least one (1) hospital-type elevator shall be installed where 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 where sixty (60) to 200 patient beds are located on floors other than the main entrance floor, or where 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 where 201 to 350 patient beds are located on floors other than the main entrance floor, or where the inpatient services are located on a floor other than those containing patient beds.

      (d) For hospitals with 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 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 not less than three (3) feet and eight (8) inches.

 

      Section 17. Mechanical Requirements. (1) General. Prior to completion of the contract and final acceptance of the facility, the architect and/or engineer shall obtain from the contractor certification in writing that all mechanical systems have been tested and that the installation and performance of these systems conform with the final plans and specifications.

      (2) 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, based upon the published Steel Boiler Institute or Institute of Boiler and Radiation Manufacturer's net rating, must be able to supply 150 percent of the normal requirements for all 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.

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

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

      (b) Ventilation system details. All air-supply and air-exhaust systems shall be mechanically operated. All fans serving exhaust systems shall be located at the discharge end of the system. The ventilation rates as shown in Section 19, Table 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, 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 relationships as shown in Section 19, Table 2 of this administrative regulation.

      3. All room supply, return and exhaust outlets shall be located not less than three (3) inches above the finished floor.

      4. Corridors shall not be used to supply air to or exhaust air from any room, except that exhaust air from corridors may be used to ventilate rooms such as bathrooms, toilet rooms, or janitor's closets which open directly on corridors.

      (4) Plumbing systems.

      (a) 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. All fixtures in medical and nursing staff work areas and all lavatories used by food handlers shall be equipped with valves which can be operated without the use of hands. Where 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. These special fixtures are not required on lavatories in patient rooms or patient toilet rooms.

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

      (c) Hot water heating systems. The hot water heating equipment shall have a sufficient capacity to supply water at the temperature and amounts indicated below:

 

 

Hot Water Use

Clinical

Dishwasher

Laundry

Gal/hr/bed

61/2

4

41/2

Temp. F.

100-110

180*

140-180**

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

**If the temperature used is below 180 degrees Fahrenheit, the facility shall utilize detergents and other additives to insure that the linens will be adequately cleaned.

 

      Section 18. Electrical Requirements. (1) General. All material including 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. All materials shall be listed as complying with applicable standards of Underwriters' Laboratories, Inc., or other similarly established standards.

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

      (3) Lighting. Patients' bedrooms shall have general lighting and night lighting. A reading light shall be available for each patient. 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 shall be provided in each patient room.

      (4) Receptacles (convenience outlets).

      (a) Patient room. Each patient room shall have duplex receptacles as follows: one (1) on each side of the head of the bed; and one (1) on another wall. Receptacles shall be of the safety type or shall be protected by five (5) milliampere ground fault interrupters.

      (b) 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 shall be of the safety type or shall be protected by five (5) milliampere ground fault interrupters.

      (5) Nurses' emergency calling system. An emergency calling system, which may be used by nurses to summon assistance, shall be provided in each nursing unit.

      (6) Emergency electrical.

      (a) To provide electricity during interruption of the normal electric supply, an emergency source of electricity shall be provided and connected to certain circuits for lighting and power.

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

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

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

      (c) Emergency generating set. 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. Generator sets shall be self-sufficient insofar as possible without dependency on public utilities that may be subject to cutoff or outages. Exception: A system of prime movers which are ordinarily used to operate other equipment and alternately used to operate the emergency generator(s) will be permitted provided that the number and arrangement of the prime movers are such that when one (1) of them is out of service (due to breakdown or for routine maintenance), the remaining prime mover(s) can operate the required emergency generator(s) and provided that the connection time requirements as listed in Section 19 of this administrative regulation are met. The emergency generator set shall be of sufficient kilowatt capacity to supply all lighting and power load demands of the emergency electrical system. 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. Exitways and all necessary ways of approach thereto including exterior of exits, exit doorways, stairways, and corridors.

      b. Nursing station and medication preparation areas.

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

      d. Elevator cabs.

      e. Night light in patient rooms.

      f. Dining and recreational areas, occupational therapy and physical therapy.

      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.

      c. Fire pump and jockey pump, if installed.

      d. Sewerage or sump lift pump, if installed.

      e. Selected receptacles at the nurses' stations; medicine dispensing area; and basic laboratory functions, if provided.

      f. Duplex receptacles in patient corridors.

      g. Equipment necessary for maintaining telephone service.

      3. Heating. Equipment for heating patient rooms; except that service for heating of patient rooms will not be required if:

      a. 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;

      b. The hospital has an alternate emergency heating system for the heating of corridors; or

      c. The hospital has a written plan approved by the licensure agency for the transfer of patients within a reasonable time to other facilities.

      (e) Details. The emergency electrical system shall be so controlled that after interruption of the normal electric power supply, the generator is brought to full voltage and frequency and it must be connected within ten (10) seconds through one (1) or more primary automatic transfer switches to all emergency lighting systems; alarms systems; nurses' calling systems; equipment necessary for maintaining telephone service; and task illumination and receptacles in patient corridors. All 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. Receptacles connected to the emergency system shall be distinctively marked for identification. 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. Where stored fuel is required for emergency generator operation, the storage capacity shall be sufficient for not less than twenty-four (24) hours of continuous operation.

 

      Section 19. Table 1 - Sound Transmission Limitations in Psychiatric Hospitals. Table 2 - Pressure Relationships and Ventilation of Certain Psychiatric Hospital Areas.

 

Table 1.

Sound Transmission Limitations in Psychiatric Hospitals

Location

Airborne Sound Transmission Class (STC)a*

Impact

Insulation Class (IIC)b*

Partitions

Floors

Floors

Patients' room to patients' room

45

45

45

Corridor to patients' room

40

45

45c*

Public space to patients' room d*

50

50

50c*

Service areas to patients' room e*

55

55

55c*

 

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

b* - Impact insulation class (IIC) shall be determined in accordance with criteria set forth in 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 patients' 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 patients' 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.


 

TABLE 2.

PRESSURE RELATIONSHIPS AND VENTILATION OF CERTAIN PSYCHIATRIC HOSPITAL AREAS

Area Designation

Pressure

Relationship

to Adjacent

Areas

All Supply

Air From

Outdoors

Minimum Air

Changes of

Outdoor Air

per Hour

Minimum total Air Changes Per Hour

All Air Exhausted Directly to Outdoors

Patient room

O

--

1

4

--

Patient area corridor

O

--

2

4

--

Treatment room

O

--

2

6

--

Physical therapy and hydrotherapy if applicable

N

--

2

6

--

Dining and recreation areas

O

--

2

4

--

Soiled workroom

N

--

2

4

Yes

Clean workroom

P

Yes

2

4

--

Toilet room

N

--

--

10

Yes

Bedpan room if applicable

N

--

--

10

Yes

Bathroom

N

--

--

10

Yes

Janitor's closet

N

--

--

10

Yes

Linen and trash chute rooms

N

--

--

10

Yes

Food preparation center

O

Yes

2

10

Yes

Dishwashing area

N

--

--

10

Yes

Dietary day storage

O

--

--

2

--

Laundry, general

O

Yes

2

10

Yes

Soiled linen sorting and storage

N

--

2

10

Yes

Clean linen storage

P

--

1

4

--

P=Positive N=Negative O=Equal --= Optional


      (9 Ky.R. 1350; eff. 7-6-83; Am. 16 Ky.R. 1018; eff. 1-12-90.)