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Section 451 Ambulatory Surgical Centers
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All newly licensed or newly constructed ambulatory surgical centers, including conversions of existing buildings, all ambulatory surgical center outpatient facilities and ambulatory surgical center mobile and transportable units, unless exempted by Chapter 395.0163, Florida Statutes and all additions, alterations or renovations to an existing licensed ambulatory surgical center shall comply with all applicable requirements of this code and the minimum standards of design, construction and specified minimum essential utilities and facilities of this section and shall have plans reviewed and construction surveyed by the state agency authorized to do so by Chapter 553.80(1)(c), Florida Statutes to assure compliance with all applicable requirements of this code.
The following are exempt from review under this part:
Change of ownership of an existing licensed ambulatory surgical center.
Change to an existing ambulatory surgical center's license type that has no additional physical plant requirements.
Change of the functional use of a space, room, or area when no physical plant revisions are made or are required to be made by this code.
The Florida Building Code, Existing Building, Section 101.2, Scope exempts state licensed facilities such as ambulatory surgical centers from compliance with that code. Any repair, alteration, change of occupancy, addition or relocation of an existing state licensed ambulatory surgical center shall comply with the applicable requirements of this code and this section.
For project submission and fee requirements, and other administrative, licensure, and programmatic provisions for ambulatory surgical centers, see Agency for Health Care Administration (AHCA) Chapter 59A-5 Florida Administrative Code (F.A.C.) and Chapter 395, Florida Statutes.
For state licensure purposes, these codes and standards shall be applicable to the project on the effective date of this code at the time of Stage II preliminary plan approval by the Agency for Health Care Administration (the Agency) as described in Chapter 59A-5 Florida Administrative Code or at the first Stage III construction document review if there has been no previous Stage II preliminary plan approval for that project.
Additional codes and standards for the design and construction of ambulatory surgical centers and, unless exempted by Chapter 395.0163, Florida Statutes, all ambulatory surgical center outpatient facilities and ambulatory surgical center owned or leased mobile and transportable units. In addition to the minimum standards required by Section 451 of this code, Chapter 59A-5, Florida Administrative Code or by Chapter 395, Florida Statutes, all new ambulatory surgical centers and all additions, alterations or renovations to existing ambulatory surgical centers shall also be in compliance with the following codes and standards on the effective date of this code as described in Section 451.1.5 of this code:
The Florida Fire Prevention Code as described in Chapter 633.208 Florida Statutes, Minimum fire safety standards.
The Guidelines for Design and Construction of Outpatient Facilities (The Guidelines), including Part 1 General, and Part 2 Outpatient Facility Types, Chapter 2.7 Specific Requirements for Outpatient Surgery Facilities as referenced in Chapter 35 of this code.
In addition to the codes and standards referenced in Section 451.2 of this code, the minimum standards of construction and specified minimum essential facilities described in Section 451.3 of this code shall apply to all ambulatory surgical centers as described in Section 451.1 of this code and to all new additions, alterations or renovations to existing ambulatory surgical centers on the effective date of the code.
All ambulatory surgical centers shall have at least one operating room that has a minimum clear floor area of 270 square feet (25.08 m2) as described in The Guidelines. Only this size or larger operating room(s) shall be listed as an operating room(s) for purposes of licensure.
If provided, smaller operating rooms, and all procedure, examination or treatment rooms shall meet the requirements for these rooms as described in The Guidelines.
In lieu of audible alarm signals, visible alarm-indicating appliances shall be permitted to be used in critical care areas such as the operating room suite and the phase I recovery suite.
Reference The Guidelines for other requirements.
Only the phase I post-anesthesia recovery positions, as described in The Guidelines, will be listed as recovery positions for purposes of licensure.
Reference The Guidelines for other requirements.
No doors shall swing into the corridor except those to small closets or small mechanical or electrical rooms that cannot be usefully occupied with the doors in the closed position.
The use of sliding pocket doors to patient use toilets shall not be permitted.
All fire walls, fire barriers, smoke barriers, horizontal exits and exit passageway partitions shall be constructed prior to the construction of all intervening walls. Where rated walls, barriers or partitions intersect, the continuity of the higher priority wall, barrier, or partition shall be maintained through the intersection.
Smoke barriers shall be constructed so as to provide a continuous smoke-tight membrane from exterior wall to exterior wall and from the floor to the underside of the floor or roof deck above. This includes interstitial space and the area above monolithic fire-rated ceiling membranes. Roof trusses shall be permitted to penetrate portions of the smoke barrier located above the fire-rated ceiling membrane where the annular space between the penetrating truss member and the smoke barrier is sealed to limit the transfer of smoke.
Where it is not possible to inspect a fire-rated partition, fire wall or a smoke barrier that extends through the attic or interstitial space to the roof or floor deck above because of the location of a monolithic ceiling membrane, ceiling access panel(s) shall be installed adjacent to each side of the partition, wall or barrier at intervals not exceeding 30 feet (9.00 m) and in such locations as necessary to view all surfaces of the partition, wall or barrier. Other ceiling access panels shall only be installed as required by other sections of the code. Partitions, walls and barriers requiring protected openings or penetrations shall be identified in accordance with Section 703 of this code.
Reference The Guidelines for other requirements.
All new ambulatory surgical centers located in multistory buildings where patient treatment areas are located on other than the exit floor shall have at least one 2,500 pound (933 kg) capacity elevator that shall be in compliance with the requirements of Section 451.3.13.5 of this code and the requirements of Chapter 30 of the code.
This required elevator shall be sized to accommodate an ambulance stretcher 76 inches (1931 mm) long and 24 inches (610 mm) wide in the horizontal position. This elevator shall be identified with a sign indicating it as the ambulance stretcher elevator.
Reference The Guidelines for other requirements.
Air-handling equipment shall be located either on the roof of the building it serves or in mechanical equipment rooms unless it serves only one room and is located in that room. In buildings with multiple uses, tenants or occupancies, the licensed health care areas required by this code to maintain filter efficiencies and relative air pressure relationships shall be served by separate ducted mechanical air supply, return and exhaust systems. This equipment may be located in other areas of the building or in the same room as the building air-handling equipment if access during normal business hours is available.
Variable volume systems shall not be permitted in surgical procedures rooms and recovery rooms.
Friable duct linings exposed to air movement shall not be used in ducts, terminal boxes or other systems supplying operating rooms and recovery rooms, unless terminal filters of at least 90-percent efficiency are installed downstream of linings. Flexible duct work shall have a continuous metal inner liner encased by insulating material with an outer vapor jacket conforming to UL 181 unless the flexible duct meets the following criteria:
The duct conforms to UL Class 1 Air Duct, Standard 181 with minimum rated air velocity of 4,000 feet per minute, and is pressure rated for a minimum of 4-inches water gage positive pressure and 1-inch water gage negative pressure.
The inner core of the duct is constructed of Chlorinated Polyethylene (CPE) material encircling a steel helix bonded to the CPE.
The duct has passed an impact test similar to the UL 181 standard, conducted by a nationally recognized testing laboratory (NRTL) except it shall use a 25-pound weight dropped from a height of 10 feet. As a result of the test, the inner and outer surfaces of the sample shall not have ruptured, broken, torn, ripped, collapsed or separated in order for the duct to pass the test. In addition, the helix shall rebound to a cross-sectional elliptical area not less than 80 percent of the original test sample diameter. The use of flexible duct shall be limited to flexible air connector applications.
Filter housing frame blank-off panels shall be permanently attached to the frame, constructed of rigid materials and have sealing surfaces equal to or greater than the filter media installed in the filter frame. All joints between the blank-off panels, filter housing frames and filter support structure shall be caulked air tight.
Air ducts and exhaust systems shall not be constructed of fiberglass duct board.
Roof top mounted mechanical equipment including air handler units, condensers, vents, exhaust fans, and other such equipment are not required to meet the impact requirements of the code.
All new ambulatory surgical centers shall have completely ducted air-supply, return, outside air, and exhaust systems.
During an automatic fire alarm activation, fan systems and fan equipment serving more than one room shall be stopped to prevent the movement of smoke by mechanical means from the zone in alarm to adjacent smoke zones or to adjacent areas within the smoke zone if there is only one zone in the facility.
Fan control shall be designed so as to minimize the interruption of heating, ventilating and air conditioning in compartments remote from the compartment in alarm.
Fan control shall not interfere with the continuous operation of exhaust systems conveying ethylene oxide or other hazardous chemicals and fumes or systems required to operate continuously for the health and safety of occupants. Air-handling systems shall be designed to allow for continuous operation of all such systems and to minimize movement of smoke by mechanical means from the zone in alarm.
Reference The Guidelines for other requirements.
Plumbing shall comply with the Florida Building Code, Plumbing.
Where required by another section of this code, a new fire pump, except for a replacement fire pump, that is electric motor-driven shall be connected to the emergency power supply system (EPSS) of the ambulatory surgical center. A fire pump(s) that is not electric motor-driven shall meet the requirements of NFPA 20, Standard for the Installation of Stationary Pumps for Fire Protection alternative power.
Reference The Guidelines for other requirements.
All material, including equipment, conductors, controls, and signaling devices, shall be installed to provide a complete electrical system with the necessary characteristics and capacity to supply the electrical facilities shown in the specifications or indicated on the plans.
All materials and equipment shall be factory listed as complying with applicable standards of Underwriter's Laboratories, Inc., or other similarly established standards of a nationally recognized testing laboratory (NRTL) that has been certified by the Occupational Safety and Health Administration (OSHA) for that referenced standard.
Field labeling of equipment and materials shall be permitted only when provided by a nationally recognized testing laboratory that has been certified by the Occupational Safety and Health Administration (OSHA) for that referenced standard.
There shall be documentation for equipotential grounding in all patient care areas, building service ground electrode systems, and special systems such as fire alarm, nurse call, paging, generator, emergency power and breaker coordination.
All spaces occupied by people, machinery and equipment within buildings, and the approaches thereto, and parking lots, shall have electric lighting.
Patients' recovery rooms shall have general lighting. Fixed lights not switched at the door shall have switch controls convenient for use at the luminaires. All switches for control of lighting in recovery areas shall be of the quiet operating type.
Operating rooms shall have general lighting for the room in addition to localized specialized lighting provided by a special lighting unit required at the surgical table. The type of special lighting unit shall be as specified by the functional program of the facility. Each special lighting unit for localized lighting at the surgical table shall be permanently installed and permanently connected to an independent circuit that shall be powered from the critical branch. In addition, a minimum of one general purpose lighting fixture shall be powered from a normal circuit in all operating rooms.
The number and circuitry of all duplex receptacles in operating rooms, cardiac catheterization laboratories, and post-operative recovery rooms, shall be provided as follows:
A minimum of four duplex receptacles shall be connected to the critical branch of the essential electrical system.
A minimum of two duplex receptacles shall be connected to a normal power circuit or to a critical branch circuit from a different transfer switch.
There shall be no more than two duplex receptacles per circuit for all receptacles for the areas as listed.
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