Or. Admin. R. 333-535-0120 - Obstetrical Facilities

The maternity unit shall consist of, but not be limited to, facilities as follows for exclusive use of the maternity department, unless otherwise noted:

(1) General:

(a) The maternity unit shall be located in one area of the hospital and include delivery rooms, labor rooms, recovery rooms, postpartum rooms, labor, delivery, recovery (LDR) and/or labor, delivery, recovery, postpartum (LDRP) rooms, and the support features described in this section to support the estimated obstetrical workload;

(b) The obstetrical care unit shall be located and arranged to prohibit non-related traffic through the unit;

(c) When delivery and non-obstetrical operating rooms are part of the same suite, access and service arrangements shall be such that neither staff nor patients need to travel through one area to reach the other;

(d) At least one delivery room shall be provided within the obstetrical unit for performing Caesarean sections (C-sections) and complex deliveries except for hospital-based obstetrical centers limited to less than 300 low-risk deliveries per year. In such centers, mothers requiring emergency C-sections and complex deliveries may be transferred to surgery, provided a clean operating room can normally be made available, and infants can be transported back to the obstetrical unit in a controlled transport environment such as an isolette;

(e) When the program indicates wide usage of LDR and/or LDRP rooms in place of separate labor, delivery, recovery and postpartum rooms, the number of labor and postpartum rooms may be reduced or eliminated in accord with the hospital's obstetrical program and workload. Delivery rooms shall be provided per subsection (d) of this section; and

(f) Service areas may be arranged to serve LDR rooms, LDRP rooms and delivery rooms. However, gowning facilities, clean supply, soiled utility rooms, and anesthesia facilities must be arranged to conveniently serve delivery rooms used for C-sections and allow for a sterile operating suite environment. When such support areas are not immediately adjacent, the program and infection control policy must be submitted for Oregon Health Authority, Public Health Division approval and shall account for such arrangement.

(2) The following patient care facilities shall be provided in accord with section (1) of this rule for exclusive use of the maternity department, unless otherwise noted:

(a) Postpartum patient rooms must meet the same rules as medical and surgical patient rooms under OAR 333-535-0025(1);

(b) Each delivery room shall have a minimum clear area of 300 square feet exclusive of fixed cabinets and built-in shelves and shall be not less than 16 feet wide. Delivery rooms that are routinely used for C-sections shall have not less than 360 square feet of clear area. An emergency communications system that can be activated without use of hands shall be connected with the obstetrical suite control station. Resuscitation facilities (electrical outlets, oxygen, suction, and compressed air) shall be provided for newborn infants within each delivery room in addition to the facilities required for the mother;

(c) LDR and LDRP rooms, when provided, shall be entered from a corridor within the maternity department where public access is under direct control of maternity staff and include the following features:

(A) Each room shall be for single occupancy and provide for a minimum of 5 feet of clear space at the sides and foot of the bed during delivery procedures. Additional space shall be provided for relatives and significant others, a chair for mothers who are breastfeeding, and an infant cribbette;

(B) Mechanical and electrical services for LDR and LDRP rooms shall meet applicable requirements stated in OAR 333-535-0300 and 333-535-0310; and

(C) Each room shall contain or be closely served by each of the following:

(i) Enclosed storage cabinets or space for a covered cart for supplies used in normal spontaneous vaginal delivery and the immediate care of a normal newborn, unless the program indicates centralized storage and distribution from a nearby clean supply room;

(ii) Storage space for equipment utilized in medical emergencies for mother and infant;

(iii) A hand-washing station or scrub sink equipped with a wrist blade fitting or equivalent fitting allowing operation without use of the hands;

(iv) Toilet facility and shower;

(v) A window is required in each patient room as noted in OAR 333-535-0025;

(vi) Storage space for clothing, toilet articles, and other personal belongings of the patient;

(vii) An electrically operated nurses' calling system as specified under electrical requirements of this division; and

(viii) Examination lighting shall be provided but may be built-in or portable.

(d) Labor rooms. When provided, these rooms shall be single bed or two-bed rooms with a minimum clear area of 100 square feet per bed. In facilities having only one delivery room, two or more labor rooms or LDRP rooms shall also be provided. When two labor rooms only are utilized in connection with a single delivery room, one labor room shall be large enough to function as an emergency delivery room with a minimum of 160 square feet and have at least two oxygen and two suction outlets. Each labor room shall contain a hand-washing station and shall have direct access to a toilet room. One toilet room may serve two labor rooms. Labor rooms shall be closely served by facilities for medication, charting, and storage for supplies and equipment. At least one shower for use of labor room patients shall be provided. A water closet shall be accessible to shower facility. Windows, if provided, shall be located, draped or otherwise arranged, to preserve patient privacy from observation from outside.

(e) Recovery room. It shall contain not less than two beds, charting facilities located to permit staff to have visual control of all beds, facilities for medicine dispensing, hand-washing stations at a rate of one per four beds or a minimum of one, clinical sink with bedpan flushing device, and storage for supplies and equipment. The recovery room may be omitted in hospitals with fewer than 300 annual births.

(3) Service Areas. Individual rooms shall be provided as indicated in the following standards. Otherwise, alcoves or other open spaces that do not interfere with traffic may be used. Services, except the father's waiting room mentioned in subsection (c) of this section, soiled workroom in subsection (g) of this section, and the housekeeping closet in subsection (p) of this section, may be shared with the surgical facilities if the Functional Program reflects this concept. Where shared, areas shall be arranged to avoid direct traffic between the delivery and operating rooms. The following services shall be provided:

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

(b) Supervisor's office or station.

(c) Fathers' waiting room located convenient to the labor room area with provisions for personal communication between fathers and staff. Toilets, telephones, and drinking fountains shall be convenient to the waiting room. In hospitals with less than 300 deliveries per year, a separate fathers' waiting room is not required when a general purpose waiting area can be made available.

(d) Sterilizing facility(ies) with high speed autoclave(s) conveniently located to serve all delivery rooms. When a written program indicates that adequate provisions have been made for replacement of sterile instruments during a delivery, sterilizing facilities in the obstetrical suite will not be required.

(e) Drug distribution station. Provision shall be made for storage, preparation, and dispensing of medication.

(f) Scrub facilities. Two scrub stations shall be provided near the entrance to each delivery room; however, two scrub stations may serve two delivery rooms if the scrub stations are located adjacent to the entrance of each delivery room. Scrub facilities shall be arranged to minimize any incidental splatter on nearby personnel or supply carts.

(g) An enclosed soiled utility room for the exclusive use of the obstetrical suite staff or a soiled holding room that is part of a system for the collection and disposal of soiled materials. The soiled utility room shall contain a clinical sink or equivalent flushing type fixture, work counter, a hand-washing station, waste receptacle, and linen receptacle. If a soiled holding room is used, the hand-washing station and work counter may be omitted. Soiled utility and/or holding areas shall not have a direct connection with delivery rooms or other sterile activities.

(h) Fluid waste disposal facilities shall be provided in a location convenient to but not connected with the delivery rooms. (The clinical sink or equivalent equipment in a soiled utility room or soiled holding room would meet this standard.) See OAR 333-535-0260(5) for sanitary references.

(i) Clean utility room(s) or clean supply room(s). A clean utility room is required when clean materials are assembled within the obstetrical suite prior to use. A clean utility room shall contain a work counter, a hand-washing station, and space for clean and sterile supplies. A clean supply room shall be provided when the program defines a system for the storage and distribution of clean and sterile supplies that would not require the use of a clean utility room. When clean supplies and equipment used in LDR and LDRP rooms are kept in a central location, the room shall be sized to reflect this concept. (A clean utility room or supply room may be shared with surgery department when provisions for joint use are included in the hospital's infection control policy and arrangement allows direct access to both delivery and surgery suites.).

(j) Anesthesia storage facilities. Unless the narrative program and official hospital board action in writing prohibit use of flammable anesthetics, a separate room shall be provided for storage of flammable gases in accordance with the requirements detailed under the mechanical section of these rules (OAR 333-535-0300). (Anesthesia storage facilities may also serve the surgery suite when provision is made for direct access from both surgery and delivery suites.).

(k) Anesthesia utility room or space for cleaning, testing, and storing anesthesia equipment. It shall contain a work counter, sink, and provisions for separation of clean and soiled items. This may occur at a location outside the suite, provided that sufficient clean equipment and supplies are available at all times. The anesthesia utility room may be omitted when a narrative statement and hospital board policy are submitted stating that no anesthetics are utilized.

(l) Equipment storage room(s) for equipment and supplies used in obstetrical suite.

(m) Staff's clothing change areas. Appropriate areas shall be provided for male and female personnel (technicians, nurses, aides, and doctors) working within the obstetrical suite. The areas shall contain lockers, showers, toilets, hand-washing stations, and space for donning scrub apparel. A receptacle for discarding soiled surgical gowns and boots shall be located to minimize contact with clean personnel. (The same clothes change areas may serve the surgery suite when provision for joint use is included in the hospital's infection control policy and arrangement allows for direct access from both surgery and delivery suites.).

(n) Lounge and toilet facilities for obstetrical staff convenient to delivery, labor, recovery, LDR and LDRP rooms. A separate lounge may be omitted, however, in hospitals with less than 300 deliveries per year.

(o) Facilities for physician waiting, charting, and sleeping are recommended where the obstetrical staffing program and workload indicate need for such, but are not required.

(p) Housekeeping closet. A dedicated closet containing a floor receptor or service sink, in accordance with OAR 333-535-0260(7), and storage space for housekeeping supplies and equipment shall be provided exclusively for the obstetrical suite.

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

Notes

Or. Admin. R. 333-535-0120

HB 183, f. & ef. 5-26-66; HB 209, f. 12-18-68; HD 7-1979, f. & ef. 7-17-79; HD 11-1980, f. & ef. 9-10-80; Renumbered from 333-023-0200(12); HD 21-1987, f. & ef. 11-13-87; HD 29-1988, f. 12-29-88, cert. ef. 1-1-89; Renumbered from 333-074-0260; HD 21-1993, f. & cert. ef. 10-28-93; OHD 1-2002, f. & cert. ef. 2-28-02; PH 14-2005, f. 8-10-05, cert. ef. 8-15-05; PH 10-2009, f. & cert. ef. 10-1-09; PH 18-2019, repeal filed 10/01/2019, effective 1/1/2020

Statutory/Other Authority: ORS 441.060

Statutes/Other Implemented: ORS 441.060