1224.29 Intensive Care Units
The following shall apply to all types of intensive care service spaces, acute respiratory-care service spaces, burn center spaces, critical-care units, coronary-care service spaces, pediatric intensive-care service spaces unless otherwise noted. Each unit shall comply with the following provisions:
Each intensive-care unit shall contain not less than four or more than 12 beds.
Exception: When approved by the licensing agency a small or rural hospital intensive care unit may consist of less than four but not less than two patient beds.
In new construction, each patient space (whether separate rooms, cubicles, or multiple bed space) shall have a minimum of 200 square feet (18.58 m2) of clear floor area with a minimum headwall width of 13 feet (3962 mm) per bed. There shall be a minimum clear dimension of 1 foot (305 mm) clear space from the head of the bed to the wall, a minimum of 5 feet (1524 mm) clear space from the foot of the bed to the wall, a minimum of 5 feet (1524 mm) clear space on one side of each bed for patient transfer, a minimum of 4 feet (1218 mm) clear width on the non-transfer side, and a minimum of 8 feet (2438 mm) clear space between beds.
Exception: Where renovation of existing intensive care units is undertaken, in facilities approved under the 2001 or prior California Building Code, existing patient space (whether separate rooms, cubicles, or multiple bed space) may be renovated or replaced in kind one for one in the renovated space. Such patient space shall have no less than 132 square feet (12.26 m2) with no dimension less than 11 feet (3353 mm), and with 4 feet (1219 mm) of clearance at each side and the foot of the bed, and with a minimum of 8 feet (2438 mm) between beds. The space shall be designed so that all beds shall be placed in relation to the nurse's station or work area to permit, enable or allow maximum observance of patients.
When private rooms or cubicles are provided, view panels to the corridor shall be required with a means to provide visual privacy. Where only one door is provided to a bed space, it shall be at least 4 feet (1219 mm) wide and arranged to minimize interference with movement of beds and large equipment. Sliding doors shall not have floor tracks. Where sliding doors are used for access to cubicles within a service space, a 3-foot-wide (914 mm) swinging door may also be provided for personnel communication.
Modular toilet/sink combination units located within a privacy curtain may be used within each patient space or private room. The toilet fixture shall be completely contained within cabinetry when not in use. This fixture shall not be equipped with a bedpan washing attachment. Exhaust ventilation requirements shall comply with the California Mechanical Code.
Each patient bed area shall have space at each bedside for visitors, and provisions for visual privacy from casual observation by other patients and visitors. For both adult and pediatric units, there shall be a minimum of 8 feet (2438 mm) between beds.
Each patient bed shall have visual access, other than clerestory windows and skylights, to the outside environment with not less than one outside window in each patient bed area.
Handwashing stations shall be directly accessible to nurse stations and patient bed areas. There shall be at least one handwashing station for every three beds in open plan areas, and one in each patient room. The handwashing station shall be located near the entrance to the patient cubicle or room.
This area shall have space for counters and storage. It may be combined with or include centers for reception and communication.
There shall be direct visual observation between either a centralized or distributed nurse station or work station and the heads of all patient beds in the intensive care unit.
Each unit shall contain equipment for continuous monitoring. Monitors shall be located to permit easy viewing but not interfere with access to the patient.
Space that is easily accessible to the staff shall be provided for emergency equipment such as a CPR cart.
A medication station shall be provided in accordance with Section 1126.96.36.199.
At least one airborne infection isolation room shall be provided per unit. The room shall comply with the requirements of Section 1224.14.3; however, the adjoining toilet room is not required. Modular toilet units located within a privacy curtain may be used within the airborne infection isolation room. The modular toilet fixture shall comply with Section 1188.8.131.52.
Exception: When approved by the licensing agency an airborne infection isolation room is not required for small or rural hospitals.
Clean utility/workroom shall be provided in accordance with Section 1184.108.40.206.
There shall be a designated area for clean linen storage. This may be within the clean utility room or a separate closet.
Soiled workroom or soiled holding room shall be provided in accordance with Section 1220.127.116.11.
A nourishment area or room shall be provided in accordance with Section 118.104.22.168.
Each unit shall have equipment to provide ice for treatments and nourishment. Ice-making equipment may be in the clean utility room or at the nourishment station. Ice intended for human consumption shall be from self-dispensing icemakers.
Appropriate room(s) shall be provided for storage of large items of equipment necessary for patient care. Each intensive care unit shall provide not less than 20 square feet (1.86 m2) per patient bed.
The following shall be provided and shall be located immediately accessible to the unit:
- Visitors' waiting room.
- Office space.
- Staff lounge(s) and toilet room(s).
- Multipurpose room(s). Provide for staff, patients, and patients' families for patient conferences, reports, education, training sessions, and consultation.
- Housekeeping room. Provide within or immediately adjacent to the intensive care unit. It shall not be shared with other nursing units or departments.
- Gurney and wheelchair storage. Provide a minimum 15 square feet (1.39 mm) per each nursing unit.
The NICU shall comply with all the requirements of Section 1224.29.1. Additionally each NICU shall include or comply with the following:
Provide one handwashing fixture for each four infants and for each major fraction thereof. In a multiple-bed room, every bed position shall be within 20 feet (6096 mm) of a handwashing fixture. Where an individual room concept is used, a handwashing fixture shall be provided within each infant care room.
At least one door to each patient room shall be a minimum of 44 inches (1118 mm) wide.
Ceilings shall have a noise reduction coefficient (NRC) of at least 0.90.
Space shall be provided for lactation support and consultation in or immediately adjacent to the NICU.
- Where infant formula is prepared on site, direct access from the formula preparation room to any infant care room is prohibited.
- The formula preparation room shall be located in or adjacent to the NICU. The formula preparation room may be located at another location as approved by the Licensing Agency.
The formula preparation room shall include the following:
- A separate cleanup area for washing and sanitizing. This area shall include a handwashing station, facilities for bottle washing and a work counter.
- A separate room for preparing infant formula. This room shall contain a refrigerator, work counter, formula sterilizer, storage facilities and a handwashing station.
Shall be accessible for use by NICU personnel at all times.
Where a commercial infant formula is used, omission of the separate cleanup and preparation rooms shall be permitted, and storage and handling in the NICU workroom or another appropriate room that is readily accessible at all hours shall be permitted. The preparation area shall have the following:
- A work counter
- A hand-washing station
- Storage facilities
Space shall be provided for emergency equipment that is under direct control of the nursing staff, such as a CPR cart.
Shall be directly accessible from the unit and be dedicated for the exclusive use of the neonatal intensive care unit.
- External windows in infant care rooms shall be glazed with insulating glass to minimize heat gain or loss.
- External windows in infant care rooms shall be situated at least 2 feet (610 mm) away from any part of a baby's bed to minimize radiant heat loss from the baby.
- All external windows shall be equipped with easily cleaned shading devices that are neutral color or opaque to minimize color distortion from transmitted light.