Ill. Admin. Code tit. 77, § 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.
Notes
Amended at 25 Ill. Reg. 3241, effective February 15, 2001
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No prior version found.