1224.14 Nursing Service Space
In new construction, patient rooms shall have a minimum of 100 square feet (9.29 m2) of clear floor area per bed in multiple-bed rooms and 120 square feet (11.15 m2) of clear floor area for single-bed rooms. The dimensions and arrangement of rooms shall be such that there is a minimum of 3 feet (914 mm) between the sides and foot of the bed and any wall or any other fixed obstruction. In multiple-bed rooms, a minimum clearance of 3 feet (914 mm) shall be provided between beds and a clearance of 4 feet (1219 mm) shall be available at the foot of each bed to permit the passage of equipment and beds
Each patient room shall have a window in accordance with Section 1224.4.9.
Patient rooms shall not be designed to permit the placement of beds more than three deep from the exterior window, but shall be of such shape and dimensions to allow for the performance of routine functions, including the easy transfer of patients to and from bed to wheelchair or wheeled gurney.
All patient bedrooms shall have an outside exposure and shall not be below ground level.
A handwashing station shall be provided in the patient room. This handwashing station shall be located at or adjacent to the entrance to the patient room with unobstructed access for use by health care personnel and others entering and leaving the room. Water spouts used shall have clearances adequate to avoid contaminating utensils and the contents of carafes, etc. In multiple-bed rooms the handwashing station shall be located outside of the patient's cubicle curtain so that it is immediately accessible to staff. Where renovation of patient rooms is undertaken a handwashing station shall be located in the patient toilet room or patient room.
Each patient shall have access to a toilet room without having to enter the general corridor area. One toilet room shall serve no more than four beds and no more than two patient rooms. The toilet room shall contain a water closet and a lavatory and the door shall swing outward or be double acting. Unless located in a toilet room, bedpan-washing fixtures shall be installed in dedicated rooms, separate from patient care areas.
Each patient shall have within his or her room a separate wardrobe, locker, or closet suitable for hanging full-length garments and for storing personal effects.
A method of assuring visual privacy for each patient shall be maintained in patient rooms and in tub, shower and toilet rooms. Windows or doors within a normal sightline that would permit observation into the room shall be arranged or curtained as necessary for patient privacy. In multiple-bed rooms, visual privacy from casual observation by other patients and visitors shall be provided for each patient. The design for privacy shall not restrict patient access to the entrance, lavatory, or toilet room.
Grab bars shall be installed in accordance with Section 1224.4.18.
Each patient room shall be labeled with an identification number, letter or combination of the two.
Unless otherwise indicated, provision for the services listed below shall be in or immediately accessible to each nursing unit. The size and location of each service area will depend upon the numbers and types of beds served. Identifiable spaces are required for each of the indicated functions. Each service area may be arranged and located to serve more than one nursing unit but, unless noted otherwise, at least one such service area shall be provided on each nursing floor. Where the words "room" or "offices" are used, a separate, enclosed space for the one named function is intended; otherwise, the described area may be specific space in another room or common area.
Administrative center(s) or nurse station shall be provided in accordance with Section 1224.4.4.2.
Multipurpose rooms shall be provided for staff, patients, patients' families for patient conferences, reports, education, training sessions, and consultation. These rooms must be readily accessible to each nursing unit. One such room may serve several nursing units and/or departments.
Clean utility/ workroom shall be provided in accordance with to Section 1224.4.4.6.
Soiled workroom or soiled holding room shall be provided in accordance with Section 1224.4.4.7.
Medication station shall be provided in accordance with Section 1224.4.4.4.
Each nursing unit shall contain a designated area for clean linen storage. This may be within the clean utility room or a separate closet.
A nourishment area or room shall be provided in accordance with Section 1224.4.4.5.
Each nursing unit shall have equipment to provide ice for treatments and nourishment. Ice making equipment may be in the clean utility room/holding 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 equipment necessary for patient care. Each unit shall provide not less than 10 square feet (0.93 m2) per patient bed.
Provide a storage room or alcove for gurneys and wheelchairs which shall be a minimum of 15 square feet (1.39 m2).
When individual bathing facilities are not provided in patient rooms, there shall be at least one shower and/or bathtub for each 12 beds without such facilities. Each bathtub or shower shall be in an individual room or enclosure that provides privacy for bathing, drying, and dressing.
Special bathing facilities, including space for attendant, shall be provided for patients on gurneys, carts, and wheelchairs at the ratio of one per 100 beds or a fraction thereof. The special bathing facility may be located in a nursing unit on a separate floor.
Common patient toilet room(s), in addition to those serving bed areas, shall be located adjacent to multipurpose room(s) and within, or directly accessible to each central bathing facility.
Space shall be provided for emergency equipment that is under direct control of the nursing staff, such as a cardiopulmonary resuscitation (CPR) cart. This space shall be directly accessible from the nursing station, but out of normal traffic.
Grab bars shall be installed in accordance with Section 1224.4.18.
Single rooms shall be provided for the isolation of patients with airborne communicable disease at a ratio of one room for each 35 licensed beds, and for each major fraction thereof. At least one airborne infection isolation room shall be provided. Airborne infection isolation rooms shall be labeled with the words "Airborne Infection Room" on or adjacent to the anteroom side of the door between the isolation room and the anteroom.
Exceptions:
- Acute psychiatric hospitals shall provide airborne infection isolation rooms at the ratio of one room for each 50 beds, or major fraction thereof.
- Airborne infection isolation rooms are not required for chemical dependency recovery services.
Airborne infection isolation room(s) shall have self-closing and latching devices on all anteroom doors.
A separate anteroom shall be provided between the airborne infection isolation room and the corridor, which shall constitute the primary entrance to the airborne infection isolation room. This anteroom shall have a handwashing fixture, work counter at least 3 feet (914 mm) long, cabinets and space to gown and to store clean and soiled materials. There shall be a view window from the anteroom to the isolation room and means to allow for airflow from the anteroom into the airborne infection isolation room. Doors shall be aligned to allow large equipment to be wheeled into the airborne infection isolation room unless a secondary door complying with Section 1224.14.3.2 is provided. One anteroom may serve no more than two airborne infection isolation rooms.
When a secondary entry is provided, the secondary doors shall be provided with locking devices which are readily operable from the room side and which are readily operable by the facility staff on the other side. When key locks are used on isolation rooms, keys shall be located at the nurses' station in a prominent readily accessible location.
Airborne infection isolation room perimeter walls, ceilings, floors, doors, and penetrations shall be sealed tightly to minimize air infiltration from the outside or from other spaces.
Each isolation room shall have its own directly accessible toilet room with an emergency nurse call system, a lavatory, a shower providing a seat or a space for a shower chair and a toilet equipped with a bedpan flushing attachment with a vacuum breaker.
Protective environment rooms for the protection of certain immunosuppressed patients may be provided by the facility. Protective environment rooms shall be labeled "Protective Environment Room" on or adjacent to the anteroom side of the door between the isolation room and the anteroom. Protective environment rooms shall contain only one bed.
Protective environment room (s) shall have self-closing and latching devices on all anteroom doors.
A separate anteroom shall be provided between the protective environment room and the corridor, hallway or adjoining space which shall constitute the only entrance to the protective environment room. This anteroom shall have a handwashing fixture, work counter at least 3 feet (914 mm) long, cabinets and space to gown and to store clean and soiled materials. There shall be a view window from the anteroom to the protective environment room. There shall be means to allow for airflow from the protective environment room into the anteroom. Anteroom doors shall be aligned so that large equipment can be wheeled into the protective environment room. One anteroom may serve no more than one protective environment room.
Exception: Alternate designs for protective environment rooms, without individual anterooms, may be approved by the enforcement agency when it can be demonstrated that the alternate design meets the requirements of the California Mechanical Code and does not compromise or alter any health or fire protection component, assembly or system.
Room shall meet the requirements of Section 1224.14.3.6.
Protective environment room perimeter walls, ceiling, floors, doors, and penetrations shall be sealed tightly to minimize air infiltration from the outside or from other spaces.
If provided, the hospital shall provide one or more single bedrooms for patients needing close supervision for medical and/or psychiatric care. This may be part of the psychiatric unit described in Section 1224.31. If the single bedroom(s) is part of the acute-care nursing unit, the provisions of Section 1224.14.1 shall apply, with the following exceptions: each room shall be for single occupancy; each shall be located to permit staff observation of the entrance, preferably adjacent to the nurses' station; and each shall be designed to minimize the potential for escape, hiding, injury or suicide. If vision panels are used for observation of patients, the arrangement shall insure patient privacy and prevent casual observation by visitors and other patients.