Section 264.2350  Environmental Management

a)         The birth center shall maintain birth rooms that meet the requirements for emergency procedures, pursuant to Section 264.2100.  All birth rooms shall allow, for the physical and emotional care of a client, their support person and the newborn during labor, birth, and the recovery period.

b)         The birth center shall be designed to provide for the following:

1)         Birth rooms shall be located to provide unimpeded, rapid access to an exit of the building that will accommodate emergency transportation vehicles;

2)         The birth center shall be located on the same level as ambulance delivery and pickup;

3)         Fixed and portable work surface areas shall be maintained for use in the birth room;

4)         A separate space for a clean area and a contaminated area shall be provided.  Sanitary waste containers, soiled linen containers, storage cabinets, and sterilizing equipment shall be available;

5)         Space shall be provided for prenatal and postpartum examinations, which will include privacy for the client, hand-washing facilities, and the appropriate equipment for staff;

6)         Space shall be provided for medical record storage; and

7)         Client interview, instruction and waiting rooms shall be provided.

c)         Toilet and Bathing Facilities

1)         A toilet and lavatory shall be maintained in or adjacent to the birth room.

2)         Hand-washing facilities shall be in or immediately adjacent to the birth room entry door.

3)         A bathtub or shower shall be available for client use and may include a large tub used for hydrotherapy for labor.

4)         All floor surfaces, wall surfaces, water closets, lavatories, tubs, and showers shall be kept clean, and all appurtenances of the structures shall be of sound construction, properly maintained, in good repair and free from safety hazards.

d)         The birth center shall provide facilities for secure storage of personal belongings and valuables of clients.

e)         Visual privacy shall be provided for each pregnant person and their support person.

f)         Hallways and doors providing access and entry into the birth center and birth room shall be able to accommodate maneuvering of ambulance stretchers and wheelchairs.

g)         All areas of the birth center shall be well-lighted and shall have light fixtures capable of providing at least 20-foot candles of illumination at 30 inches from the floor to permit observation, cleaning, and maintenance.  Light fixtures shall be maintained and kept clean.

h)         Heating and cooling systems shall be provided to maintain a minimum temperature of 68 degrees Fahrenheit and a maximum temperature of 78 degrees Fahrenheit.

i)          Laundry

1)         Clean clothing, bed linens, and towels shall be available to the clients.  Where laundry facilities are provided, space shall be provided, and areas shall be designated for separating clean and soiled clothing, linen, and towels.

2)         Written procedures shall be developed and maintained pertaining to the handling, storage, transportation, and process of linens in a manner that will prevent spread of infection and will assure the maintenance of clean linens.

3)         Laundry rooms (if provided) shall be well lighted and properly ventilated.  Clothes dryers shall be vented to the exterior.  Carts used for transporting dirty clothes, linen and towels shall not be used for transporting clean articles.

A)        All linens shall be cleaned and disinfected as follows:

1)         Mechanically wash and dry following the instructions for sanitizing from the washer/dryer manufacturer; and

2)         Use hot water (158-176 degrees Fahrenheit) and laundry detergent.

B)        If laundry facilities are not provided, soiled laundry items shall be cleaned per contractual agreement with a commercial laundry.

j)          Beds and bedding shall be kept in repair and shall be cleaned and sanitized whenever soiled.  Mattresses and pillows shall have cleanable covers, which shall be cleaned and sanitized between use by different clients.  Clean sheets shall be used for each client.  Blankets shall be washed or dry cleaned between clients and whenever soiled.  Sheets, blankets, and clean clothing shall be stored in a clean, dry place between laundering and use.

k)         The grounds and building shall be maintained in a safe and sanitary condition.

l)          The birth center shall be kept free of all insects and rodents.  All outside openings shall be effectively sealed or screened to prevent entry of insects or rodents.

m)        Poisonous or toxic compounds shall be labeled, locked, and stored apart from food and other areas where storage would constitute a hazard to the clients.

n)         Drinking water shall be available to all clients.

o)         Hot and cold running water under pressure and at a safe temperature, not to exceed 110 degrees Fahrenheit to prevent scalding, shall be provided to all restrooms, lavatories, and bathing areas.

p)         Refuse, biohazards, infectious waste and garbage shall be collected, transported, sorted, and disposed of by methods that will minimize nuisances or hazards in compliance with federal, State, and local laws.