1224.32 Obstetrical Facilities (Perinatal Unit Space)

The obstetrical facility, including cesarean operating room(s) and delivery room(s), shall be located and designed to prohibit nonrelated traffic through the unit.

Antepartum and post-partum bedrooms shall comply with Section 1224.14.1.

Shall be provided in accordance with Section 1224.14.2 with the following additions:

1. Staff lounge.
2. Staff storage. Lockable closets or cabinets for personal articles of staff.
3. Consultation/conference room(s).

A minimum of one cesarean operating room shall be provided in the obstetrical unit, unless a surgical operating room is designated specifically for cesarean delivery procedures. The cesarean delivery suite shall include the following:

At least one delivery room shall be provided in the obstetrical unit. Delivery rooms shall have a minimum clear floor area of 300 square feet (27.87 m²). An emergency communication system shall be connected with the obstetrical facilities control station

Delivery rooms, which are used for no other purpose, shall be provided at the ratio of one per 12 postpartum beds and for each major fraction thereof.

Exceptions:

1. If LDR or LDRP beds are provided, each LDR or LDRP may be counted as a delivery room in the postpartum bed ratio.
2. When approved by the licensing agency, the operating room of small or rural hospitals with a licensed bed capacity of 50 or less may serve as the delivery room.

Shall be provided as follows:

1. A direct-wired or battery-operated clock with sweep second hand and lapsed time indicators in each cesarean operating and delivery room.
2. A direct-wired or battery-operated clock or other equivalent timing device, visible from the scrub-up sinks.

Provide a surgical light in each cesarean operating or delivery room.

Provide within cesarean operating rooms and delivery rooms a minimum clear floor area of 80 square feet (7.43 m²) in addition to the required area of each room or may be provided in a separate but immediately accessible room with a clear floor area of 150 square feet (13.94 m²). Six single or three duplex electrical outlets shall be provided for the infant in addition to the facilities required for the mother.

Where LDRs or LDRPs are not provided, a minimum of two labor beds shall be provided for each cesarean operating room. Each room shall be designed for either one or two beds with a minimum clear floor area of 120 square feet (11.15 m²) per bed. Each labor room shall contain a handwashing fixture and have access to a toilet room. One toilet room may serve two labor rooms, Labor rooms shall have controlled access with doors that are arranged for observation from a nursing station. At least one shower (which may be separate from the labor room if under staff control) for use of patients in labor shall be provided. Windows in labor rooms, if provided, shall be located, draped, or otherwise arranged, to preserve patient privacy from casual observation from outside the labor room.

Exception: Where renovation of labor rooms is undertaken in facilities built under the 2001 or prior California Building Code, existing labor rooms shall have a minimum clear floor area of 100 square feet (9.29 m²) per bed.

Each recovery room shall contain at least two beds and have a nurse station, with charting facilities, located to permit visual observation of all beds. Each room shall include a handwashing station and a medication station. A clinical sink with bedpan flushing device shall be directly accessible, as shall storage for supplies and equipment. Provide visual privacy of the new family.

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.

The following services shall be provided:

1. Control/nurse station. This shall be located to restrict unauthorized traffic into the service space.
2. Soiled workroom or soiled holding room. See Section 1224.4.4.7.
3. Fluid waste disposal.

The following services shall be provided and may be shared with the surgical facilities. Where shared, areas shall be arranged to avoid direct traffic between the delivery and operating rooms

Office or station shall be a minimum of 80 square feet (7.43 m²) and have a desk.

This room shall have toilet rooms, telephone(s) and drinking fountains that are immediately accessible. The toilet rooms shall contain a lavatory.

Shall have a handwashing fixture and provisions for controlled storage, preparation and distribution of medication.

Two positions shall be provided adjacent to entrance to the first cesarean operating room. Provide one additional scrub sink per cesarean or delivery operating room. Scrub facilities shall be arranged to minimize any splatter on nearby personnel or supply carts. In new construction, provide view windows at scrub stations to permit the observation of room interiors.

A clean utility room shall be provided if clean materials are assembled within the obstetrical service space prior to use. If a clean utility room is provided see Section 1224.4.4.6.

1. Clean sterile storage area readily accessible to the delivery room.
2. Equipment storage room(s) for equipment and supplies used in the obstetrical service space.

An anesthesia work-room for cleaning, testing and storing anesthesia equipment. It shall contain a work counter, sink, and provisions for separation of clean and soiled items.

The clothing change area shall be designed to encourage one-way traffic and eliminate cross-traffic between clean and contaminated personnel. The area shall contain lockers, showers, toilets, handwashing fixtures, and space for donning and disposing scrub suits and booties.

Lounge and toilet room facilities for obstetrical staff shall be readily accessible to cesarean operating rooms(s), delivery room(s), labor rooms(s) and recovery room(s). Each toilet room shall contain a hand-washing station.

An on-call room(s) for physician and/or staff shall be provided, but may be located elsewhere in the facility.

LDR room(s) may be located in a separate LDR service space or as part of the cesarean/delivery service space. The postpartum unit may contain LDRP rooms.

These rooms shall have a minimum of 250 square feet (23.23 m²) of clear floor area with a minimum dimension of 13 feet (3962 mm). There shall be space for crib and sleeping space for support person. An area within the room but distinct from the mother's area shall be provided for infant stabilization and resuscitation. The medical gas outlets shall be located in the room so that they are accessible to the mother's delivery area and infant resuscitation area.

Each LDR or LDRP room shall be for single occupancy.

Each LDR or LDRP room shall have direct access to a private toilet room with shower or tub.

Each LDR or LDRP room shall be equipped with handwashing fixtures.

Infants shall be housed in nurseries that comply with the standards below. All nurseries shall be immediately accessible to the postpartum unit and obstetrical facilities. The nurseries shall be located and arranged to preclude the need for unrelated pedestrian traffic. No nursery shall open directly onto another nursery. Each nursery shall contain the following:

At least one handwashing fixture for each six infant bassinets.

Storage for linens and infant supplies at each nursery room.

A consultation/demonstration/breast feeding or pump room shall be provided in a location that is readily accessible to the nursery. Provisions shall be made, either within the room or immediately accessible to the room, for a sink, counter, refrigeration and freezing, storage for pump and attachments, and educational materials. This area may be shared between units.

Each nursery shall be served by a connecting workroom. The workroom shall contain gowning facilities at the entrance for staff and housekeeping personnel, work counter, refrigerator, storage for supplies, and a handwashing fixture. One workroom may serve more than one nursery room provided that required services are convenient to each. Adequate provision shall be made for storage of emergency cart(s) and equipment out of traffic and for the sanitary storage and disposal of soiled waste.

A housekeeping room shall be provided for the exclusive use of the nursery unit. It shall be directly accessible from the unit.

Charting facilities shall have linear surface space to ensure that staff and physicians may chart and have simultaneous access to information and communication systems.

Each newborn nursery room shall contain no more than 16 infant stations. Nurseries shall provide a minimum of 25 square feet (2.32 m²) of floor area per bassinet, with at least 3 feet (914 mm) between bassinets and at least 6 inches (152 mm) from a wall.