CHAPTER I: DEPARTMENT OF PUBLIC HEALTH
SUBCHAPTER b: HOSPITALS AND AMBULATORY CARE FACILITIES
PART 250 HOSPITAL LICENSING REQUIREMENTS
SECTION 250.2440 GENERAL HOSPITAL STANDARDS
Section 250.2440 General Hospital Standards
Minimum Requirements in the General Hospital
a) Administration and Public Areas
1) Main Entrance: Designed to accommodate persons with physical disabilities;
2) Lobby: A reception and information counter or desk, waiting space, public toilet facilities, public telephones and drinking fountain;
3) Interview Space: Space for private interviews relating to social service, credit or admissions;
4) General or Individual Office: Office for business transactions, medical and financial records, and administrative and professional staffs.
5) Multipurpose Room: For conferences, meetings and education purposes including provision for the use of visual aids;
6) Medical Library Facilities; and
7) Storage Areas.
b) Medical Records Unit. Adequate space for the reviewing, dictating, sorting, recording and storage of medical records shall be provided.
c) Adjunct Diagnostic and Treatment
1) Laboratory Suite. Laboratory facilities shall be provided to meet the work load described in the program narrative. These may be provided within the hospital or through an effective contract arrangement with a nearby laboratory service. If laboratory services are provided by contractual arrangement, then at least the following minimum services shall be available within the hospital (for additional requirements, see Subpart E of this Part):
A) A laboratory work counter with appropriate services;
B) A lavatory or counter sink equipped for hand-washing;
C) A storage cabinet or closet;
D) Blood storage facilities; and
E) Specimen and sample collection facilities, urine collection rooms equipped with a water closet and lavatory, and blood collection facilities with space for a chair and work counter.
2) Morgue and Autopsy Suite
A) The morgue and autopsy suite shall be accessible to an outside entrance and shall be located to avoid movement of bodies through public areas.
B) The following shall be provided when autopsies are performed within the hospital:
i) Refrigerated facilities for body holding; and
ii) An autopsy room. This room shall contain a work counter with sink equipped for hand-washing; storage space for supplies, equipment and specimens; and an autopsy table.
C) If no autopsies are performed in the hospital, a well-ventilated body-holding room shall be provided.
3) Radiology Suite
A) Facilities shall be provided for radiology purposes as required by the program narrative. (For additional requirements see Subpart F of this Part.)
B) The suite shall contain the following elements:
i) A radiographic room;
ii) Film processing facilities, if necessary;
iii) A viewing and administration area;
iv) Film storage facilities, if necessary;
v) A toilet room with hand-washing facilities, directly accessible from each fluoroscopy room without entering the general corridor area;
vi) A dressing area with access to toilets and facilities for patients' belongings; and
vii) A waiting room or alcove.
C) Radiation protection requirements for X-ray and gamma ray installations shall conform with National Council on Radiation Protection and Measurements (NCRP), Report 49: Structural Shielding Design and Evaluation for Medical Use of X-rays and Gamma Rays of Energies up to 10 MeV and Report 102: Medical X-Ray, Electron Beam and Gamma-Ray Protection for Energies Up to 50 MeV (Equipment Design, Performance and Use). Provisions shall be made for testing the completed installation and correcting defects before use.
D) X-ray installations for fixed and mobile X-ray equipment: shall conform to Article 660, X-ray Equipment, of NFPA 70.
4) Pharmacy Suite. The size and type of services to be provided in the pharmacy will depend upon the type of drug distribution system to be used in the hospital and whether the hospital proposes to provide, purchase, or share pharmacy services with other hospitals or other medical facilities. This shall be explained in the program narrative. (For additional requirements see Subpart R.) Provisions shall be made for the following:
A) Administrative functions, including requisitioning, recording and reporting, receiving, storage (including refrigeration), and accounting;
B) A quality control area (if bulk compounding or packaging functions are performed);
C) Locked storage for drugs and biologicals;
D) A dispensing area; and
E) Hand-washing facilities. If required by the program, provisions shall be made for the following:
i) A drug information area for reference materials and personnel; and
ii) A sterile products area for compounding I.V. admixtures and other sterile dosage forms. A separate sink for hand-washing shall be provided in this area.
5) Physical Therapy Suite
A) Appropriate services may be planned and arranged for shared use by occupational therapy patients and staff.
B) If a physical therapy suite is required by the program narrative, the following shall be provided:
i) Office space;
ii) Waiting space;
iii) A treatment area for modalities such as thermotherapy, diathermy, ultrasonics and hydrotherapy. Cubicle curtains shall be provided around each individual treatment area. Hand-washing facilities shall be provided. One lavatory or sink may serve more than one cubicle;
iv) Facilities for the collection of wet and soiled linen and other material;
v) An exercise area;
vi) Storage space for clean linen, supplies and equipment;
vii) Patients' dressing areas and toilet rooms, for both men and women;
viii) Wheelchair and stretcher storage; and
ix) Showers, lockers and service sinks, as required by the program narrative.
6) Occupational Therapy Suite
A) Appropriate elements may be planned and arranged for shared use by physical therapy patients and staff.
B) If an occupational therapy suite is required by the program narrative, the following elements shall be provided:
i) Office space;
ii) An activities area equipped with a sink or lavatory;
iii) Storage space for supplies and equipment; and
iv) Patients' toilet rooms.
d) Nursing Unit. The requirements in this subsection (d) do not apply to special care areas such as recovery rooms, intensive care areas and newborn care areas.
1) Patient Rooms
A) Each patient room shall be an outside room. Windows shall be provided for each patient room and shall be of a size not less than 7.5% of the square footage of the floor of the room.
B) Minimum room areas shall be 100 square feet clear in one-bed rooms and 80 square feet clear per bed in multi-bed rooms (no rooms shall have more than four beds). Clear is defined as the usable dimensions of the room, excluding the vestibule, toilet areas, and closets.
C) A minimum of 3 feet clear at the foot and sides of each bed shall be provided.
D) Each patient room shall have access to a toilet room without entering the corridor.
E) One toilet room shall serve not more than four beds and not more than two patient rooms.
F) The toilet room shall contain a water closet and a lavatory. The lavatory may be omitted from a toilet room that serves not more than two single bedrooms if each such single bedroom contains a lavatory.
G) Each patient shall have a wardrobe, locker, or closet that is suitable for hanging and storing personal effects.
H) Visual privacy shall be provided each patient bed in multi-bed rooms.
2) Nurses' Service Center. The requirements in this subsection (d)(2) shall be provided either as part of a centralized cluster serving more than one nursing unit or shall be used as supportive areas within a self-contained nursing unit.
A) A nurses' station with a work counter, storage areas, and communications equipment shall be provided.
B) A nurses' office shall be provided.
C) Hand-washing facilities convenient to both the nurses' station and the drug distribution station shall be provided.
D) Charting facilities shall be provided for nurses and doctors, including a work counter and charting racks.
E) A lounge and men's and women's toilet rooms for staff shall be provided.
F) Closets or compartments for the safekeeping of coats and personal effects of nursing personnel.
G) A multipurpose room shall be provided for conferences, demonstrations, and consultation. This room may be located outside the nursing unit, but within the hospital.
H) Accessibility to a room for the examination and treatment of patients shall be provided. This room may be omitted if all patient rooms are single bedrooms. This room shall have a minimum floor area of 100 square feet excluding spaces for vestibules, toilet rooms (if provided), and work counters. The room shall contain a lavatory, a work counter, storage facilities, and a writing space.
I) At least one tub or shower shall be provided for each 12 beds that do not have bathing facilities within the patients' rooms. Each tub or shower shall be in an individual room or enclosure that provides space for the private use of the bathing fixture and for drying and dressing.
J) A nourishment station with a sink equipped for hand-washing, equipment for serving nourishment between scheduled meals, a refrigerator, storage cabinets, and units to provide ice for patient's service and treatment shall be provided.
K) A drug distribution station shall be provided for convenient and prompt 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. A medicine dispensing unit may be located in an alcove under direct control of the nursing or pharmacy staff.
3) Service Area
A) A clean work room or a clean holding room shall be provided in each nursing unit. The clean work room shall contain a work counter, hand-washing facilities, a nurse signal, and storage facilities. The clean holding room shall be part of a system for storage and distribution of clean and sterile supplies and materials.
B) A separate designated area within the clean work room shall be provided for clean linen storage. If a cart system is used, the storage of the cart may be in an adjacent alcove.
C) Parking shall be provided for stretchers and wheelchairs out of the path of normal traffic.
D) A soiled work room or soiled holding room shall be provided. The soiled work room shall contain a clinical sink or equivalent flushing rim fixture, a nurse signal, a hand-washing sink, a waste receptacle, and a linen receptacle. The soiled holding room shall be part of a system for the collection and disposal of soiled materials. If bed pan flushing attachments are used on every patient room toilet, a clinical sink is not required in the soiled work room.
E) Room for the storage of equipment such as I.V. stands, inhalators, mattresses and walkers shall be provided.
F) Space shall be provided for the storage of required emergency equipment, such as a crash cart. This equipment shall be under the direct control of the nursing staff.
G) Sitz baths shall be provided when required by the program narrative.
4) Isolation Room. There shall be a room or rooms as required by the program narrative for the isolation of patients with known or suspected communicable diseases. Each isolation room shall have an individual toilet equipped with a bedpan flushing attachment and a lavatory. Isolation rooms shall be provided with an anteroom equipped with a hand-washing sink, trimmed with valves that can be operated without the use of hands, storage spaces for clean and soiled materials, and a space for gowning. There shall be only one patient per room. All isolation rooms shall be otherwise planned as required for a standard patient room.
5) Rooms for Disturbed Patients. Every hospital that does not have a psychiatric nursing unit shall provide facilities for the care of disturbed patients, usually for a duration of less than 24 hours. The design shall provide for close observation and shall minimize the dangers of patient escape, suicide or injury. This may be provided in a special care room used for multiple purposes. This room shall be located either in the emergency unit or in a private room in a medical nursing unit, or as otherwise provided by the program narrative.
e) Intensive Care Units
1) A means of controlling unnecessary noise shall be provided. A means of providing temporary privacy for each patient shall be provided. Windows shall be provided so that each patient may observe the outdoor environment. Beds may be arranged so that one window may serve more than one patient.
2) Intensive Care Units shall provide the following:
A) Patient Rooms. Cardiac intensive care, medical intensive care, and surgical intensive care patients may be housed in either single bedrooms or multi-bed rooms; however, at least one single bedroom shall be provided. All beds shall be arranged to permit visual observation by nursing staff. Patient rooms shall meet the following requirements:
i) Clearance between beds shall be not less than 6 feet. Single bedrooms shall have a minimum area of 120 square feet and a minimum dimension of 10 feet.
ii) Viewing panels shall be provided for nursing staff observation of patients. Curtains or other means shall be provided to cover the viewing panels when the patient requires visual privacy. Glazing in viewing panels shall be safety glass, wire glass, or clear plastic to reduce the hazard from accidental breakage, except that wire glass is required in glazed openings to corridors or passageways used as means of egress for fire safety purposes.
iii) An I.V. solution support shall be provided for each patient so that the solution is not suspended directly over the patient.
iv) A lavatory equipped for hand-washing shall be provided in each private patient room. In multi-bed rooms, no fewer than one lavatory for each six beds shall be provided.
v) A nurses' call system shall be provided. (See Section 250.2500(g).)
vi) Each cardiac intensive care patient shall be provided with a toilet facility that is directly accessible from the bed area. The water closet shall have sufficient clearance around it to facilitate its use by patients needing assistance. Portable water closet units are permitted within patient rooms. If portable units are used, facilities for servicing and storing them shall be conveniently located to the cardiac care unit.
B) Service Areas. The following service areas shall be located in or readily available to each Intensive Care Unit. One area may serve two or more adjacent Intensive Care Units. The size and location of each service area shall depend upon the number of beds to be served.
i) A nurses' station shall be located to permit monitoring or visual observation of each patient served.
ii) Hand-washing facilities shall be convenient to the nurses' station and drug distribution station.
iii) Charting facilities shall be furnished with work counters and charting racks.
iv) A staff toilet room shall contain a water closet and a lavatory equipped for hand-washing.
v) Closets or compartments for the safekeeping of coats and personal effects of nursing personnel shall be provided at or near the nurses' station.
vi) A clean work room (or a system for storage and distribution of clean and sterile supply materials) shall contain a work counter, a hand-washing facility, and storage facilities.
vii) The soiled work room or soiled holding room shall contain a clinical sink or equivalent flushing rim fixture, sink equipped for hand-washing, work counter, waste receptacle, and linen receptacle. A soiled holding room shall be part of a system for collection and disposal of soiled materials and shall be similar to the soiled work room except that the clinical sink and work counter may be omitted.
viii) Facilities for washing or flushing bedpans shall be provided within the unit.
ix) A drug distribution station shall be provided for convenient and prompt 24-hour distribution of medicine to patients either from a medicine preparation room or unit, a self-contained medicine dispensing unit, or by another approved system. If used, a medicine preparation room or unit shall be under the nursing staff's visual control and shall contain a work counter, a sink, refrigerator, and locked storage for biologicals and drugs. A medicine dispensing unit may be located at the nurses' station, in the clean work room, or in an alcove or other space under direct control of the nursing or pharmacy staff.
x) Clean Linen Storage. A storage closet or a designated area within the clean work room shall be provided. If a closed cart system is used, storage may be in an alcove.
xi) A nourishment station shall contain a sink equipped for hand-washing, equipment for serving nourishment between scheduled meals, refrigerator, storage cabinets, and units to provide ice for patients' service and treatment.
xii) Emergency Equipment Storage. Space shall be provided for a "crash cart" and similar emergency equipment.
xiii) Equipment Storage Room. Space for necessary equipment shall be provided.
xiv) Patients' storage facilities shall be provided for the storage of patients' personal effects. These may be located outside the intensive care unit.
C) A waiting room shall be provided for family members and others who may be permitted to visit the intensive care patients. A toilet room, public telephone, and seating accommodations for long waiting periods shall be provided.
f) Pediatric Nursing Unit. Young children and adolescents shall be housed in a nursing unit separate from adults unless special allowance has been made in the program narrative. This unit shall meet the following requirements:
1) General Unit Requirements Including Patient Rooms. The requirements noted in subsection (d) of this Section shall be applied to a pediatric and adolescent nursing unit containing hospital beds, youth beds or cribs.
2) Nursery as Specified in the Program Narrative. Each nursery serving pediatric patients shall contain no more than eight bassinets. The minimum clear floor area per bassinet shall be 40 square feet. Each room shall contain a lavatory equipped for hand-washing, a nurses' emergency calling system as provided in Section 250.2500(g), and glazed viewing windows for observing infants from public areas and the work room.
3) Nursery Work Rooms as Specified in the Program Narrative. Each nursery shall be served by a connecting work room. One work room may serve more than one nursery. It shall contain gowning facilities for staff and housekeeping personnel.
4) Examination and Treatment Room. 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 in the pediatric and adolescent nursing unit shall conform to the conditions listed in subsection (d)(3) and shall meet the following additional conditions:
A) Multipurpose or individual areas shall be provided for dining, educational, and play, or other patient care purposes.
B) Space for preparation or storage of infant formula shall be provided in the unit or in a convenient location nearby.
C) Patients' toilet rooms shall be provided convenient to multipurpose areas and central bathing facilities.
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 youth and adult beds to provide flexibility for interchange of patient accommodations.
6) Fixtures and Accessories
A) Attention shall be given to other details affecting small children as required by the program.
B) Switches and plugs for critical equipment shall be designed to preclude shock and located for inaccessibility by small children.
C) Toilets and washbasins shall be suitable for use by small children as described in the program narrative.
g) Psychiatric Nursing Unit
1) Units intended for psychiatric or other types of disturbed patient nursing care shall provide a safe and secure facility for patients needing close supervision to minimize hiding, escape, injury, or suicide. The unit shall be designed to facilitate care of ambulatory inpatients, to permit flexibility in arranging various types of therapy, and to present as non-institutional an atmosphere as possible.
2) Each nursing unit shall provide the following:
A) Patient Rooms and Nurses' Service Center. The requirements noted in subsection (d) shall be applied to patient rooms and nurses' service center in psychiatric nursing units except as follows:
i) A nurses' calling system is not required. Other types of communications systems may be utilized.
ii) Provision for visual privacy is not required.
B) Service Areas. The service areas noted in subsection (d)(3) shall be provided or made available to each Psychiatric Nursing Unit except that space for stretchers and wheelchairs is not required and clinical sinks or equivalent may be installed but are not required. The following elements shall be provided within and for the exclusive use of the unit:
i) Consultation room.
ii) Space for dining, recreation, and occupational therapy. The total area for these purposes shall not be less than 40 square feet per patient.
iii) Storage closets or cabinets for recreational and occupational therapy equipment.
iv) Storage for patients' clothing.
C) Additional Services. Appropriate additional services shall be provided as determined by the program narrative.
h) Newborn Care Unit. Newborn infants shall be housed in nurseries that are conveniently located to the postpartum nursing unit and obstetrical facilities. The nurseries shall be located and arranged to preclude unrelated traffic. No nursery shall open directly into another nursery. Subpart O shall apply. Additionally:
1) Each nursery shall contain:
A) Lavatory trimmed with valves that are aseptically operated (for example, knee or foot controls) at the rate of one for each eight bassinets.
B) A nurses' emergency calling system.
C) Bassinets in a number at least equal to the number of postpartum beds.
D) Glazed observation windows to permit the viewing of infants from public areas and from work rooms.
2) Full-Term Nursery. The full-term nursery shall contain no more than 12 bassinets; however, this number may be increased to 16 if the extra bassinets are of the isolation type. The minimum floor area shall be 30 square feet for each regular bassinet and 40 square feet for each isolation type bassinet. When a "rooming-in" program is used, the total number of bassinets provided in these units may be reduced by no more than 50%, but the full-term nursery shall not be omitted.
3) Special Care and Observation Nursery
A) A hospital shall make available a nursery to provide special care for infants in distress if the hospital has 25 or more maternity beds, unless equivalent facilities for these infants are conveniently available elsewhere. The floor area per bassinet shall be as determined by the program narrative but shall not be not less than 40 square feet. Additional area shall be provided to accommodate work room functions if these are located within the nursery area.
B) When a separate special care nursery is provided, it shall have its own work room areas.
4) Work Room. Each nursery shall be served by a connecting work room. It shall contain gowning facilities at the entrance for staff and housekeeping personnel, work space with counter, refrigerator, and lavatory or sink equipped for hand-washing, and storage. One work room may serve more than one nursery. The work room that serves the special care nursery may be omitted if equivalent work area and facilities are provided within the nursery, in which case the gowning facilities shall be located near the entrance to the nursery and shall be separated from the work area.
5) Examination and Treatment Room or Space for Infants. The examination and treatment room or space for infants shall contain a work counter, storage, and lavatory equipped for hand-washing trimmed with valves that are aseptically operated (for example, knee or foot controls), and shall be located so that doctors need not enter nurseries. It may serve more than one nursery and may be located in the work room. If the examination and treatment of infants will take place in the individual bassinets, space for physicians' and nurses' gowning shall be provided as well as a conveniently accessible hand-washing sink trimmed with valves that are aseptically operated (for example, knee or foot controls).
6) Infant Formula Facilities. When the program narrative requires it, the hospital shall provide the following:
A) On-site Formula Preparation
i) Clean-up facilities for washing and sterilizing supplies. These shall consist of a lavatory or sink equipped for hand-washing, a bottle washer, work counter space, and an equipment sterilizer.
ii) A separate room for preparing infant formula. It shall contain a lavatory or sink equipped for hand-washing, refrigerator, work counter, formula sterilizer, and storage facilities. It may be located near the nurseries or at another appropriate place within the hospital. Direct access from the formula room to a nursery or to a nursery work room shall not be permitted.
B) Commercially Prepared Formula. If a commercial infant formula is used, the storage and handling may be done in the nursery work room or in another appropriate room that has a work counter, a sink equipped for hand-washing, and storage facilities.
7) Janitors' Closet. A closet for exclusive use of the housekeeping staff in maintaining the nursery unit shall be provided. It shall contain a floor receptor or service sink and storage space for housekeeping equipment and supplies.
8) Gowning and Scrubbing Areas. Gowning and scrub areas shall be equipped with lockers for doctors' and nurses' belongings, cabinets for clean gowning, receptacles for used gowns, and hand-washing sinks aseptically operated without the use of hands.
9) Clean Utility Area. Clean utility area with work counter and hand-washing sink shall be provided.
10) Soiled Utility Area. Soiled utility area with work counter, hand-washing sink, clinical service sink or equivalent flushing rim fixture, and space for storage hamper (one for diapers and one for soiled linen provided at a ratio of one for each four bassinets or fraction thereof) shall be provided.
11) Storage Areas. Storage space for replacement bassinets, phototherapy units, and other large items shall be provided. These storage areas may be located either within the unit or in the central supplies storage.
i) Surgical Suite. The number of operating rooms and recovery beds and the sizes of the service areas shall be based on the expected surgical work load. The surgical suite shall be located and arranged to preclude unrelated traffic through the suite. The requirements of Section 250.1300 shall be used for the surgical suite wherever applicable. The suite shall provide the following elements:
1) General Operating Rooms. Each room shall have a minimum clear area of 360 square feet exclusive of fixed cabinets and shelves. The minimum dimension shall be 18 feet. A communications system shall be provided connecting with the surgical suite control station. At least two x-ray film illuminators shall be provided in each room.
2) Rooms for Surgical Cystoscopic and Other Endoscopic Procedures. These rooms shall have a minimum clear area of 250 square feet exclusive of fixed cabinets and shelves. If necessary to accommodate special functions in one or more of these rooms, additional clear space shall be required by the program narrative. A communications system connecting with the surgical suite control station shall be provided. Facilities for the disposal of liquid wastes shall be provided.
3) Fracture Rooms. Fracture rooms shall be provided with an adjacent splint room. The fracture room may be located in the emergency department, the surgical suite, or as indicated in the program narrative.
4) Recovery Room. The recovery room may be part of an approved combined surgical/obstetrical program as provided in Section 250.1300.
A) The postoperative recovery room shall be located within or adjacent to the surgical suite. A separate entrance and exit doors remote from each other shall be provided to facilitate a one-way traffic flow within the recovery room.
B) A minimum of one recovery room bed shall be provided for each operating room.
C) A minimum of 70 square feet per bed shall be provided in open units. This area shall exclude the nursing station, work space, and storage area. In addition, a minimum of 4 feet shall be maintained between the sides of the beds, at least 3 feet between the side of any bed and any wall or other fixed device, and at least six feet between the foot end of any bed and any other equipment or fixed device.
D) The recovery room shall have adequate lighting to allow accurate observation of the patients.
E) A lavatory trimmed with valves operated without the use of hands, and a clinical sink, shall be provided.
F) A soiled holding area shall be provided.
G) A nursing station shall be provided within the postoperative recovery room. Facilities for medical storage and preparation shall be provided.
H) Adequate storage and work space within or adjacent to the recovery room shall be available for necessary supplies and equipment.
I) Each bed site shall be adequately equipped with oxygen, suction and at least two duplex electrical outlets.
5) Stage II Recovery Room. If outpatient surgery services are provided in the surgical suite, a Stage II recovery room shall be provided for outpatient observation prior to discharge. The Stage II recovery area may be combined with an outpatient receiving and preparation area and may be located at a site remote from the recovery room. Additionally, it shall contain the following elements:
A) A minimum of four recovery stations per operating room;
B) Lounge chairs at each recovery station with a minimum clear area of 50 square feet and a minimum clearance around three sides of the chairs of 4 feet;
C) A nurses' station with a work counter and space for communications equipment and charting;
D) A drug distribution station with a work counter, locked storage for narcotics, refrigerator, and hand-washing sink;
E) A toilet space for the exclusive use of the Stage II recovery area. The toilet shall be equipped with a gray diverter valve; and
F) Clean and soiled utility rooms.
6) Service Areas. Individual rooms shall be provided, or alcoves or other open spaces that will not interfere with traffic may be used. Services may be shared with, and organized as part of, the obstetrical facilities, if the approved program narrative reflects this sharing concept. Cross-circulation between the surgical and delivery suites when using shared service areas shall not be permitted. The following services shall be provided:
A) A control station located to permit direct visual surveillance of all traffic that enters the operating suite;
B) A supervisor's office or station;
C) Sterilizing facilities with high speed autoclaves conveniently located to serve all operating rooms. When the program narrative indicates that adequate provisions have been made for replacement of sterile instruments during surgery, sterilizing facilities in the surgical suite will not be required;
D) A drug distribution station. An area shall be provided for preparation of medication to be administered to patients;
E) Two scrub stations, conveniently located near each operating room. Scrub facilities shall be arranged to minimize any incidental splatter on nearby personnel or supply carts. A scrub sink or sinks shall be provided that shall be aseptically operated without the use of hands (wrist blades are not acceptable);
F) A soiled work room for the exclusive use of the surgical suite staff (or a soiled holding room that is part of a system for the collection and disposal of soiled materials). The soiled work room shall contain a clinical sink or equivalent flushing type fixture, work counter, sink equipped for hand-washing, waste receptacle, and linen receptacle. A soiled holding room shall be similar to the soiled work room except that the clinical sink and work counter may be omitted;
G) Fluid waste disposal facilities. These shall be conveniently located with respect to the general operating rooms. A clinical sink or equivalent equipment in a soiled work room or in a soiled holding room meets this requirement;
H) A clean work room or a clean supply room. A clean work room is required when clean materials are assembled within the surgical suite prior to use. A clean work room shall contain a work counter, a sink equipped for hand-washing, and space for clean and sterile supplies. A clean supply room shall be provided when the program narrative defines a system for the storage and distribution of clean and sterile supplies that would not require the use of a clean work room;
I) Anesthesia storage facilities. The use and storage of anesthetic gases shall be in accordance with NFPA 99. Areas for cleaning, testing and storing anesthesia equipment shall be provided;
J) An anesthesia work room for cleaning, testing and storing anesthesia equipment. It shall contain a work counter and sink;
K) Medical gas storage. Space for reserve storage of nitrous oxide and oxygen cylinders shall be provided;
L) Storage space for splints and traction equipment for operating rooms equipped for orthopedic surgery;
M) Equipment storage rooms for equipment and supplies used in the surgical suite;
N) Staff clothing change areas, including appropriate areas for male and female personnel (orderlies, technicians, nurses and doctors) working within the surgical suite. The areas shall contain lockers, showers, toilets, lavatories and space for donning scrub suits and boots. These areas shall be arranged to provide a one-way traffic pattern so that personnel entering from outside the surgical suite can change, shower, gown and move directly into the surgical suite. Space for removal of scrub suits and boots shall be designed so that personnel using it will avoid physical contact with clean personnel;
O) Outpatient surgery change areas. If the program requires outpatient surgery, a separate area shall be provided where outpatients change from street clothing into hospital gowns and are prepared for surgery. This shall include a waiting room, lockers, toilets, and clothing change or gowning area with a traffic pattern similar to that of the staff clothing change area;
P) Patients' holding area. In facilities with two or more operating rooms, a room or alcove shall be provided to accommodate stretcher patients waiting for surgery. This waiting area shall be under control of the surgical suite control station;
Q) Stretcher storage area. This area shall be out of the direct line of traffic;
R) Lounge and toilet facilities for surgical staff. These facilities shall be provided in hospitals having three or more operating rooms and shall be located to permit use without leaving the surgical suite. A nurses' toilet room shall be provided near the recovery room; and
S) Janitors' closet. A closet containing a floor receptor or service sink and storage space for housekeeping supplies and equipment shall be provided exclusively for the surgical suite.
7) Central Sterilizing and Supply Room. The central sterile supplies shall be located either within the surgical suite or provided as a separate department within the hospital. The following shall be provided:
A) A receiving and clean-up room containing work space and equipment for cleaning medical and surgical equipment, and for disposal or processing of unclean material. Hand-washing facilities operated without the use of hands shall be provided;
B) A clean work room containing work space and equipment for sterilizing medical and surgical equipment and supplies;
C) Storage areas for clean supplies and for sterile supplies (these may be in the clean work room);
D) Unsterile supplies storage room (this may be located in another department);
E) Separate storage area for soiled or contaminated supplies and equipment, separate from the clean or sterilized supplies and equipment; and
F) Cart storage areas. Cart storage areas and facilities for cleaning and sanitizing carts may be centralized or departmentalized.
j) Obstetrics and Neonatal Suite. The number of delivery rooms, labor rooms and recovery beds, and the sizes of the service areas shall depend upon the estimated obstetrical work load and the program narrative. The obstetrical and neonatal suite shall be located and arranged to preclude unrelated traffic through the suite. The requirements of Subpart O shall apply.
1) Delivery Rooms. Each delivery room shall have a minimum clear area of 300 square feet exclusive of fixed and movable cabinets and shelves. The minimum dimension shall be 16 feet clear. The communications system shall be connected with the obstetrical suite control station. Separate resuscitation facilities (electrical outlets, oxygen, suction, and compressed air) shall be provided for newborn infants.
2) Labor Rooms. These rooms shall be single or two-bed rooms with a minimum clear area of 80 square feet per bed. Labor beds shall be provided at the rate of two for each delivery room. In facilities having only one delivery room, two labor rooms shall be provided, one of which shall be large enough to function as an emergency delivery room. Each labor room shall contain a lavatory equipped for hand-washing. Labor rooms shall be arranged so that they are accessible from a nurses' work station and shall also be accessible to facilities for medication, hand-washing, charting, and storage for supplies and equipment.
3) Recovery Room. The recovery room may be part of an approved combined surgical/obstetrical program as provided in Section 250.1820(g).
A) The postpartum recovery room shall be located within or adjacent to the obstetrics and neonatal suite. A separate entrance and exit doors remote from each other shall be provided to facilitate a one-way traffic flow within the recovery room.
B) A minimum of 70 square feet per bed shall be provided. This area shall exclude the nurses' station, work space and storage area. In addition, a minimum of 4 feet shall be maintained between the sides of the beds, at least 3 feet between the side of any bed and any wall or other fixed device, and at least 6 feet between the foot end of any bed and any other equipment or fixed device.
C) The recovery room shall have adequate lighting of the type to allow accurate observation of the patients.
D) A lavatory operable without the use of hands, and a clinical sink shall be provided.
E) A soiled holding area shall be provided.
F) A nurses' station shall be provided within the postoperative recovery room. Facilities for medical storage and preparation shall be provided.
G) Adequate storage and work space within or adjacent to the recovery room shall be available for necessary supplies and equipment.
H) Each bed site shall be adequately equipped with oxygen, suction and at least two duplex electrical outlets.
4) Service Areas. Individual rooms shall be provided, or alcoves or other open spaces that will not interfere with traffic may be used. Services may be shared with and organized as part of the surgical facilities if the approved program narrative reflects this sharing concept. Service areas shall be arranged to avoid direct traffic between the operating and the delivery rooms. The following services shall be provided:
A) Control station, located to permit direct visual surveillance of all traffic that enters the obstetrics suite;
B) Supervisor's office or station;
C) Sterilizing facilities with high speed autoclaves conveniently located to serve all delivery rooms. When the program narrative indicates that adequate provisions have been made for replacement of sterile instruments during delivery, sterilizing facilities in the delivery suite will not be required;
D) Drug distribution station. An area shall be provided for preparation of medication to be administered to patients;
E) Two scrub stations, which shall be conveniently located near each delivery room. Scrub facilities shall be arranged to minimize any incidental splatter on nearby personnel or supply carts. Scrub sinks, aseptically operated without the use of hands, shall be provided (wrist blades are not acceptable);
F) Soiled work room for the exclusive use of the obstetrical suite staff (or a soiled room that is part of a system for the collection and disposal of soiled materials). The soiled work room shall contain a clinical sink or equivalent flushing rim fixture, work counter, sink equipped for hand-washing, waste receptacle and linen receptacle. A soiled holding room shall be similar to the soiled work room except that the clinical sink and work counter may be omitted;
G) Fluid waste disposal facilities. These shall be conveniently located with respect to the delivery rooms. A clinical sink or equivalent flushing rim equipment in a soiled work room or in a soiled holding room would meet this requirement;
H) Clean work room or a clean supply room. A clean work room is required when clean materials are assembled within the obstetrical suite prior to use. A clean work room shall contain a work counter, a sink equipped for hand-washing, and space for clean and sterile supplies. A clean supply room shall be provided when the program narrative defines a system for the storage and distribution of clean and sterile supplies that would not require the use of a clean work room;
I) Anesthesia storage facilities. The use and storage of anesthetic gases shall be in accordance with NFPA 99. Areas for cleaning, testing and storing anesthesia equipment shall be provided;
J) Anesthesia work room for cleaning, testing and storing anesthesia equipment, containing a work counter and sink;
K) Medical gas storage. Space for reserve storage of nitrous oxide and oxygen cylinders shall be provided;
L) Equipment storage rooms for equipment and supplies used in the obstetrical suite;
M) Staff clothing change areas. Appropriate areas shall be provided for male and female personnel (orderlies, technicians, nurses, and doctors) working within the obstetrical suite. The areas shall contain lockers, showers, toilets, lavatories equipped for hand-washing and space for donning scrub suits and boots. These areas shall be arranged to provide a one-way traffic pattern so that personnel entering from outside the obstetrical suite can change, shower, gown, and move directly into the obstetrical suite. Space for removal of scrub suits and boots shall be designed so that personnel will avoid physical contact with clean personnel;
N) Stretcher storage area. This area shall be out of the direct line of traffic;
O) Lounge and toilet facilities for obstetrics staff. These facilities shall be provided in hospitals having three or more delivery rooms and shall be located to permit use without leaving the obstetrics suite. A nurses' toilet room shall be provided near the recovery rooms; and
P) Janitors' 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.
k) Emergency Suite. Facilities for emergency care shall be provided in each hospital. The extent of the emergency services to be provided in the hospital will depend upon community needs and availability of other organized programs for emergency services within the community. Hospitals having a program narrative calling for a minimum level of emergency services shall provide at least the facilities indicated in subsections (k)(1), (k)(4) and (k)(10) with back-up facilities within the hospital capable of furnishing the necessary support for facilities not provided in the emergency suite. Other hospitals shall provide all of the following to the degree called for in the program narrative:
1) An entrance at grade level, sheltered from the weather with provision for ambulance and pedestrian access;
2) A reception and control area conveniently located near the entrance, waiting area and treatment rooms;
3) Public waiting space with men's and women's toilet facilities, public telephone and drinking fountain;
4) Treatment area. The treatment area shall contain hand-washing facilities trimmed with valves that are aseptically operated (for example, knee or foot controls), general storage cabinets, medication cabinets, work counters, medical suction outlets, x-ray film illuminators as necessary, and space for storage of emergency equipment such as defibrillators, cardiac monitors and resuscitators;
5) A holding area adjacent to the treatment rooms, as required by the program narrative;
6) A storage area, out of the line of traffic, for stretchers and wheelchairs;
7) Staff work and charting areas. This may be combined with the reception and control area or located within the treatment area;
8) Clean supply storage, which may be separate or located within the treatment area;
9) Soiled work room or area containing a clinical sink, work counter and sink equipped for hand-washing, waste receptacle and linen receptacle; and
10) Toilet facilities convenient to the treatment area.
l) Outpatient Department
1) The outpatient department, if provided, should be located on an easily accessible floor convenient to the radiology, pharmacy and laboratory departments.
2) Size will vary in different locations with the availability of other examination and diagnostic facilities, and is not necessarily proportionate to the size of the hospital. The estimated patient load shall determine the number, size and scope of individual facilities in the outpatient department.
3) Required facilities include:
A) Waiting room with men's and women's public toilets;
B) Information, appointments and records;
C) Medical social services;
D) Examination rooms;
E) Dressing booths;
F) Utility rooms;
G) Storage room; and
H) Janitors' closet.
m) Service Departments
1) Dietary Facilities
A) General. Construction, equipment and installation shall comply with the standards specified in the Department's Food Service Sanitation Code and the Food Service Sanitation Manual, P.H.S. 93. Food service facilities shall be designed and equipped to meet the requirements of the program narrative. These may consist of an on-site conventional food preparing system, a convenience food service system, or an appropriate combination of the two.
B) Functional Elements. The following facilities shall be provided as required to implement the type of food service selected:
i) Control Station. For receiving food supplies;
ii) Storage Space. Adequate to provide normal and emergency supply needs, including food requiring cold storage and day storage;
iii) Food Preparation Facilities. Conventional food preparation systems require space and equipment for preparing, cooking and baking. Convenience food service systems, such as frozen prepared meals, bulk packaged entrees, and individual packaged portions, or systems using contractual commissary service, require space and equipment for thawing, portioning, heating, cooking and baking;
iv) Hand-washing Facilities. Located in the food preparation area;
v) Patients' Meal Service Facilities. Examples are those required for tray assembly and distribution;
vi) Dining Space. For ambulatory patients, staff and visitors;
vii) Ware-Washing Space. Located in a room or an alcove separate from food preparation and serving areas. Commercial-type dishwashing equipment shall be provided. Space shall also be provided for receiving, scraping, sorting, and stacking soiled tableware and for transferring clean tableware to the using areas. A hand-washing lavatory shall be conveniently available;
viii) Pot-Washing Facilities;
ix) Storage Areas. For cans, carts and mobile tray conveyors;
x) Waste Storage Facilities. Located in a separate room easily accessible to the outside for direct pickup or disposal;
xi) Offices or Desk Spaces. For dieticians and the dietary service manager;
xii) Men's and Women's Toilets Accessible to the Dietary Staff. Hand-washing facilities shall be immediately available;
xiii) Janitors' Closet. Located within the dietary department. It shall contain a floor receptor or service sink and storage space for housekeeping equipment and supplies;
xiv) Self-dispensing Ice-making Facilities; and
xv) Adequate Can, Cart and Mobile Tray Washing Facilities.
2) Central Stores. The following shall be provided:
A) Off-street unloading facilities;
B) Receiving area;
C) General storage rooms. These facilities shall have storage spaces adequate to meet the needs of the hospital. They shall be concentrated in one area, but in a multiple building complex, they may be in separate concentrated areas in more than one individual building; and
D) Office space.
3) Linen Services
A) On-site Processing. If linen is to be processed at the hospital site, the following shall be provided:
i) Soiled linen receiving, holding and sorting room with hand-washing facilities;
ii) A laundry processing room, including hand-washing facilities, with commercial-type equipment that can process seven days' needs within a regularly scheduled work week;
iii) A separate clean linen storage and issuing room or area;
iv) A clean linen inspection and mending room or area;
v) Storage for laundry supplies;
vi) A janitors' closet containing a floor receptor or service sink and storage space for housekeeping equipment and supplies;
vii) Cart storage; and
viii) Office space.
B) Off-site Processing. If linen is processed off the hospital site, the following shall be provided:
i) A soiled linen holding room with facilities for hand-washing;
ii) Clean linen, receiving, inspection and storage rooms;
iii) Cart storage; and
iv) Office space.
4) Facilities for Cleaning and Sanitizing Carts. Facilities shall be provided to clean and sanitize carts serving the central medical and surgical supply department, dietary facilities, and linen services. These may be centralized or departmentalized.
5) Employees' Facilities. In addition to the employees' facilities such as locker rooms, lounges, toilets, or shower facilities called for in certain departments, a sufficient number of these facilities as required to accommodate the needs of all personnel and volunteers shall be provided.
6) Janitors' Closets. In addition to the janitors' closets called for in certain departments, sufficient janitors' closets shall be provided throughout the facility as required to maintain a clean and sanitary environment. Each shall contain a floor receptor or service sink and storage space for housekeeping equipment and supplies. Space for large housekeeping equipment and for back-up supplies may be located in other areas.
7) Engineering Service and Equipment Areas. The following shall be provided:
A) Rooms or separate buildings for boilers, mechanical equipment, and electrical equipment;
B) Engineer's space;
C) A maintenance shop;
D) A storage room or rooms for building maintenance supplies; and
E) Yard equipment storage. Yard maintenance equipment and supplies may be stored in a separate room or building.
8) Waste Processing Services
A) Storage and Disposal. 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. Proper handling and disposal of radioactive waste substances shall be provided.
B) Incineration. A gas, electric or oil-fired incinerator shall be provided for the complete destruction of pathological and infectious waste. Infectious waste shall include, but shall not be limited to, dressings and material from open wounds, laboratory specimens, and all waste material from isolation rooms.
i) The incinerator shall be in a separate room or placed outdoors.
ii) Design and construction of incinerators and trash chutes shall be in accordance with NFPA 82, Standard on Incinerators and Waste and Linen Handling Systems and Equipment.
iii) Incinerators shall be designed and equipped to conform to requirements prescribed by air pollution regulations in the area.
9) Storage. In addition to the storage areas called for in certain departments of the hospital, suitable additional storage shall be provided.
(Source: Amended at 41 Ill. Reg. 7154, effective June 12, 2017)