The provisions of this section shall apply to general acute-care hospitals, acute psychiatric hospitals and general acute-care hospitals providing only acute medical rehabilitation center services. The provisions of Section 1225 shall apply to distinct part skilled nursing and intermediate-care services on a general acute-care or acute psychiatric hospital license, provided either in a separate unit or a freestanding building.
New buildings and additions, alterations or repairs to existing buildings subject to licensure shall comply with applicable provisions of the California Electrical Code, California Mechanical Code, California Plumbing Code, California Energy Code, California Fire Code (Parts 3, 4, 5, 6 and 9 of Title 24) and this section.
- Facilities licensed and in operation prior to the effective date of this section shall not be required to institute corrective alterations or construction to comply with any new requirements imposed thereby or subsequently, except where specifically required or where the enforcing agency determines that a definite hazard to health and safety exists. Facilities for which preliminary drawings have been submitted to the enforcing agency prior to the effective date of this change shall not be required to comply with such new requirements, provided working drawings are submitted within one year of the effective date of such new requirements.
- A change in function shall require compliance with all the functional requirements for new construction in this code, including requirements in Sections 1224, 1225, 1226, and 1227.
- The provisions of this section do not prohibit the use of alternate space utilization, new concepts of design, treatment techniques, equipment and alternate finish materials provided the intent of this section is accommodated and written approval for such alternative is granted by the enforcing agency. Written substantiating evidence in support of the alternate and a written request for consideration shall be submitted to the enforcing agency.
- Nothing in this section shall prohibit the provisions of required services from a centralized service facility serving two or more licensed facilities when approved in writing by the licensing agency. Buildings and required spaces for services provided in a separate centralized services facility shall comply with all applicable provisions of these regulations and applicable local codes and ordinances for the services so provided.
- Acute psychiatric hospitals and general acute-care hospitals providing only acute medical rehabilitation center services may provide for surgical and anesthesia services to be provided by an outside licensed facility when approved by the licensing agency.
- When the Corrections Standards Authority, the Department of Corrections or the Department of Youth Authority determines that a particular requirement for hospitals located in a correctional facility may compromise the safety, security or protection of staff, inmates or property, the enforcement agency shall consider an alternate design.
Specific terms and definitions are provided to facilitate consistency in the interpretation and application of these requirements. Some of these terms may have a broader definition in other contexts, but the definitions provided here reflect the use of the terms for OSHPD requirements.
The process or system by which simultaneously the temperature, humidity, air motion and quality are maintained within required limits. .
A single-occupancy .patient room where environmental factors are controlled in an effort to minimize the transmission of those infectious agents usually spread from person to person by droplet nuclei associated with coughing and inhalation.
A defined health care encounter(s) of less than 24 hours in duration that requires direct professional health care support within a specific facility. .
Any surgical facility organized for the purpose of providing procedural, invasive surgical care to patients with the expectation that they will be recovered sufficiently to be discharged in less than a 24-hour period. .
The radiographic visualization of blood vessels following introduction of contrast material for purposes of diagnosis. .
Those essential services required for licensure as a .hospital, including medical, nursing, surgical, anesthesia, laboratory, radiology, pharmacy, dietary services and support services. See “SUPPLEMENTAL SERVICES.”
The use, or threat of use, of biological agents to intimidate a political entity or population group. .
A .change in function is a change in activity, service or licensed service provided, within the project limits, that does not necessarily change the use, specific use, and/or occupancy. Conversion of a space that results in a change in activity such that the space will be required to satisfy the functional space requirements under a different code sub-section than that of the prior use is considered a change in function.
An unobstructed .room dimension exclusive of built-in casework and equipment and available for functional use.
An open exterior .space bounded on three or more sides by the walls of a structure.
Those features in a built health care entity that are created, structured, and maintained to support quality health care. .
A .room with a bed, stretcher, or examination table and capability for periodic monitoring (e.g., measurement of blood pressure or pulse oximetry) in which procedures that do not require a specialized suite can be performed (e.g., pelvic examination, blood transfusion).
A .hospital, licensed by the California Department of Public Health, having a duly constituted governing body with overall administrative and professional responsibility and an organized medical staff which provides 24-hour inpatient care, including the basic services.
Services anywhere within a health care facility that include general cleaning and tidying and the provision and positioning of identified materials, e.g., soaps, towels, etc. (While routine disinfection protocols can be included in such a definition, the definition is not intended to include complex, nonroutine disinfection procedures nor the nonroutine disposition of .hazardous materials such as potentially toxic drugs or other chemicals and radioactive wastes.)
LDR. Labor, Delivery, Recovery (an unlicensed patient bed)
Labor, Delivery, Recovery, Postpartum (a licensed patient bed) .
The .Department of Public Health, Licensing and Certification.
(terms for relationship to an area or room)
Located next to but not necessarily connected to the identified area or .room.
IN. Located within the identified area or room.
Available on the same floor as the identified area or .room.
A surface free of fissures, cracks, perforations, and crevices. .
A ceiling constructed with a surface free of fissures, cracks, and crevices. Any penetrations such as lights, diffusers, and access panels shall be sealed or gasketed. Lay-in ceilings are not considered “ .monolithic.”
A designated patient care area of the .hospital which is planned, organized, operated and maintained to function as a unit. It includes patient rooms with adequate support facilities, services and personnel providing nursing care and necessary management of patients.
A .room specifically designed for the performance of surgical procedures. (In common understanding, this means most types of surgical procedures, especially those involving the administration of anesthesia, multiple personnel, recovery room access, and a fully controlled environment.)
A .room that meets the definition of an operating room and is also equipped to enable diagnostic imaging before, during, and after surgical procedures. Imaging equipment is permanently installed in the room and may include MRI, fixed single-plane and bi-plane tomographic imaging systems, and computed tomographic equipment.
An organizational unit of the .hospital, which provides nonemergency healthcare services to patients.
A .space intended for human occupancy that has at least one opening and no door and is enclosed on three sides with full-height or partial-height partitions.
A designated .space for a specific patient care function. This term does not imply any structural requirement (e.g., a Post-anesthesia Care Unit (PACU) can have 10 patient care stations of which three are rooms, three are cubicles, and four are bays).
Licensed patient bed .rooms.
Patient care and other related supportive activities before, during or after the operative event. .
A bedded unit or .patient room where severely immunosuppressed patients are cared for.
A designated .space with limited access eligibility. Such space has one or more of the following attributes: specific signage, physical barriers, security controls and protocols that delineate requirements for monitoring, maintenance, attire, and use. The term is often applied to specialized procedure suites, such as operating rooms and suites, interventional imaging, cardiac catheterization labs, angiography suites, etc.
A .space enclosed by hard walls and having a door. Where the word “room” or “office” is used, a separate, enclosed space for the one named function is intended. Otherwise, the described area may be a specific space in another room or common area.
A .sink used to wash and scrub the hands and arms during the aseptic preparation for surgery, and equipped with a supply spout and controls as required for a handwashing fixture. Refer to the California Plumbing Code Sections 210.0 and 221.0.
A segment within a continuum of levels of care determined by patient acuity, clinical stability, and resource needs. .
Note: See “BASIC SERVICES.”
See Section 3416A.
Spaces for dietary, laundry, morgue, ambulance entrance, receiving areas, power plants, mechanical equipment, incinerator, garbage can cleaning, automobile parking and storage areas for garbage, trash and medical gases shall be located and constructed to minimize noise, steam, odors, hazards and unsightliness in patient-care areas and bedrooms.
Radiology, laboratory, pharmacy, physical therapy and service spaces serving only outpatients and similar outpatient service departments shall not be located in nursing units, surgical units, peri-natal units, nursery areas, central sterilization rooms, food-service' areas, power plants, mechanical equipment rooms, maintenance shops, general storage, laundry, employees' dressing or housekeeping facilities.
Exception: Physical and occupational therapy spaces of a rehabilitation service may serve both outpatients and inpatients.
Identifiable spaces shall be provided for each function indicated in all Basic and applicable Supplemental Service Space sections with requirements for support areas. The following rooms and spaces are common to most types of health care facilities and the requirements associated with each, as listed below, shall be used unless modified under a specific Service Space section.
Unless specified elsewhere, if an exam room is provided, it shall have a minimum clear floor area of 80 square feet (7.4 m2), the least dimension of which shall be 8 feet (2438mm). The room shall contain a handwashing fixture and accommodations for written or electronic documentation shall be provided.
Unless specified elsewhere, if a treatment room is provided, it shall have a minimum clear floor area of 120 square feet (11.15 m2), the least dimension of which shall be 10 feet (3048 mm). A minimum of 3 feet (914 mm) is required between the sides and foot of the bed/gurney/table and any wall or other fixed obstruction. The room shall contain an examination light, a work counter for medical equipment, a handwashing fixture, cabinets, medication storage and counter space for writing or electronic documentation. Multi-bed treatment rooms shall have separate patient cubicles with a minimum clear floor area of 80 square feet (7.4 m2) per cubicle. Each cubicle shall contain an examination light, counter and storage facilities, In multi-bed treatment rooms, a hand-washing fixture shall be provided in the room for each three or fewer cubicles.
- Capacity. Each airborne infection isolation exam/treatment room shall contain only one examination table or recliner.
- Handwashing station. A handwashing station shall be located in each airborne infection isolation exam/treatment room.
- Gowning and storage area. An area for gowning and storage of clean and soiled materials shall be located directly outside or inside the entry door to the airborne infection isolation exam/treatment room.
- Doors. Room doors shall be self-closing and include latching devices.
- Sealed-tight room. Room perimeter walls, ceiling, floors, doors and penetration shall be sealed tightly to minimize air infiltration from the outside or from other spaces.
- Ventilation. The ventilation shall be provided as required by the California Mechanical Code for airborne infection isolation room.
An airborne infection isolation anteroom is not required; however, when an anteroom is provided, it shall meet the following requirements:
- The anteroom shall provide space for persons to don personal protective equipment before entering the patient room.
- All doors to the anteroom shall have self-closing devices.
- The anteroom shall provide storage of personal protective equipment (e.g. respirators, gowns, gloves) and clean equipment.
- Ventilation shall be provided in the anteroom as required by the California Mechanical Code for airborne infection isolation anteroom.
If provided, this room shall be directly accessible from the nursing station. When a medicine preparation room is to be used to store one or more self-contained medicine dispensing units, the room shall be designed with adequate space to prepare medicines with the self-contained medicine dispensing unit(s) present. Medicine preparation rooms shall include:
- Work counter.
- Handwashing station.
- Locked storage for controlled drugs.
Nourishment areas or rooms required in patient care areas shall include the following:
- Work counter
- Storage cabinets
- Equipment for hot and cold nourishment between scheduled meals.
- The nourishment shall include space for trays and dishes used for nonscheduled meal service.
- Provisions and space shall be included for separate temporary storage of unused and soiled dietary trays not picked up at mealtime.
- Handwashing fixtures separate from the nourishment sink shall be in or adjacent to the nourishment area.
The clean work-room or clean supply room shall be separate from and have no connection with the soiled workroom or soiled holding room. If the room is used for preparing patient care items, it shall contain the following:
- Work counter
- Handwashing station
- Storage facilities for clean and sterile supplies
Station outlets for oxygen, vacuum, and medical air shall comply with Table 1184.108.40.206.
STATION OUTLETS FOR OXYGEN, VACUUM (SUCTION), AND MEDICAL AIR1, 6
|1||Patient rooms (medical/surgical unit)||1/bed||1/bed||—|
|2||Examination or treatment (medical/surgical unit and postpartum care)||1/room||1/room||—|
|3||Airborne infection isolation or protective environment rooms (medical/surgical unit)||1/bed||1/bed||—|
|4||Seclusion room (medical/surgical unit and postpartum care)||1/bed||1/bed||—|
|5||Intensive care (general)||3/bed||3/bed||1/bed|
|6||Airborne infection isolation||3/bed||3/bed||1/bed|
|7||Coronary-care service space||3/bed||2/bed||1/bed|
|8||Pediatric intensive care||3/bed||3/bed||1/bed|
|9||Newborn intensive care||3/bassinet||3/bassinet||3/bassinet|
|10||Newborn nursery (full term)||1/4 bassinets2||1/4 bassinets2||1/4 bassinets2|
|11||Pediatric and adolescent||1/bed||1/bed||1/bed|
|13||Psychiatric patient room||—||—||—|
|14||Seclusion treatment room||—||—||—|
|15||General operating room||2/room||3/room||—|
|16||Cardio, ortho, neurological||2/room||3/room||—|
|18||Surgical cysto and endo||1/room||3/room||—|
|19||Post-anesthesia care unit||1/bed||3/bed||1/bed|
|20||Anesthesia workroom||1 per workstation||—||1 per workstation|
|21||Endoscopy procedure room||1/room||3/room||—|
|23||Cesarean operating/delivery room||2/room||3/room||1/room|
|24||Infant resuscitation space4||1/bassinet||1/bassinet||1/bassinet|
|26||OB recovery room||1/bed||3/bed||—|
|29||Initial emergency management||1/bed||1/bed||1/bed|
|30||Triage area (definitive emergency care)||1/station||1/station||—|
|31||Definitive emergency care examination or treatment rooms||1/bed||1/bed||1/bed|
|32||Definitive emergency care observation unit||1/bed||1/bed||—|
|34||Orthopedic and cast room||1/room||1/room||—|
|35||Cardiac catheterization lab||2/bed||2/bed||2/bed|
|36||Autopsy room||—||1 per workstation||—|
|38||Interventional imaging procedure room||2/room||2/room||1/room|
|39||Hyperbaric suite pre-procedure/patient holding area||2/station||2/station||—|
|40||Electroconvulsive therapy procedure room||1/room||1/room||—|
- For any area or room not described above, the facility clinical staff shall determine outlet requirements after consultation with the enforcing agency.
- Four bassinets may share one outlet that is accessible to each bassinet.
- Not used.
- When infant resuscitation takes place in a room such as cesarean section/delivery or LDRP, then the infant resuscitation services must be provided in that room in addition to the minimum service required for the mother.
- One outlet for mother and one for each bassinet.
- Renovation projects of existing spaces where the existing function is not changed, are not required to comply with the requirements of this table.
The design, installation and testing of medical gas and vacuum systems shall conform to Table 1220.127.116.11 and NFPA 99.
The design and construction of hyperbaric facilities shall conform to NFPA 99; Health Care Facilities and Section 1224.39.5.
[OSHPD 1, 2, 3 & 4] LOCATION OF NURSE CALL DEVICES KEY: ● Required
|AREA DESIGNATION||PATIENT STATION||BATH STATION||STAFF EMERGENCY STATION||CODE CALL STATION||NURSE MASTER STATION||DUTY STATION||NOTES|
|Nursing Unit bed location||●||1, 2, 3, 4|
|Patient showers and baths||●||2|
|Critical care bed locations, including NICU||●||●||●||1, 2, 4, 5|
|LDR/LDRP rooms||●||●||●||1, 2, 3, 4|
|Newborn and special care nurseries||●||●|
|Medication preparation room||●|
|Diagnostic and Treatment Areas|
|Psychiatric seclusion ante/exam rooms||●|
|Cesarean delivery rooms||●||2|
|Emergency exam, treatment, triage rooms||●||●||●||1, 2, 4|
|Observation unit patient station||●|
|Preoperative patient care area||●||●||1, 2|
|MRI, CT, stress testing areas||●||●||2, 4|
|Diagnostic radiology, fluoroscopy and ultrasound procedure rooms||●||2|
|Cardiac catheterization, interventional imaging, angiography||●||●|
|Nuclear medicine procedure room||●||2|
|Endoscopy procedure room||●||2|
|Electroconvulsive therapy procedure room||●|
- One device shall be permitted to accommodate both patient station and emergency staff assistance station functionality.
- A visible signal shall be activated in the corridor at the patient’s door, at the nurse/control station, and at all duty stations. In multicorridor nursing units, additional visible signals shall be installed at corridor intersections.
- Two-way voice communication shall be provided with the nurse/control station.
- One device shall be permitted to accommodate both emergency staff assistance and code call station functionality.
- A patient station shall not be required in the NICU.
The minimum width of corridors and hallways shall be 8 feet (2438 mm).
Exception: Patient-care corridors and hallways in hospitals for psychiatric care of patients who are not bedridden shall have a minimum clear and unobstructed width of 6 feet (1829 mm). For the purposes of this section, bedridden patients shall be defined as patients confined to beds who would be transported or evacuated in beds or litters.
Outpatient clinics or outpatient departments which contain facilities for out-patient use only, such as laboratory, x-ray, physical therapy or occupational therapy, shall have a minimum corridor or hallway width of 5 feet (1524 mm). Outpatient clinics and outpatient departments consisting only of waiting rooms, business offices, doctor's offices, and examining rooms, where there is no traffic through such area to other services or to exits from the building, shall have a minimum corridor or hallway width of 44 inches (1118 mm).
Pocket sliding doors are not permitted.
Exception: Administration and business areas.
Rooms approved for the housing of patients shall be provided with natural light by means of exterior glazed openings excluding clerestory windows, obscure glass and skylights, with an area not less than one tenth of the total floor area.
Patient room windows shall have sills not more than 36 inches (914 mm) above the floor. If operable windows are provided that require the use of tools or keys for operation, the tools or keys shall be located at the nurses’ station.
Exception: Window sills in intensive-care units may be 60 inches (1524 mm) above the floor.
Safety glass or plastic glazing materials shall be used in windows in psychiatric patient areas.
Windows which may be frequently left in an open position shall be provided with insect screens of 16 meshes to the inch.
All portions of a building used by patients, personnel or other persons shall be provided with artificial light and a mechanically operated ventilating system as specified in the California Electrical Code and the California Mechanical Code.
Operating rooms, emergency rooms, delivery rooms, radiographic rooms and other rooms containing ceiling-mounted, major fixed equipment or ceiling-mounted surgical light fixtures shall have ceiling heights to accommodate the equipment or fixtures and their normal movement. Suspended tracks, rails and pipes located in the traffic path for patients in beds and/or on stretchers, including those in inpatient service areas, shall be not less than 7 feet (2134 mm) above the floor.
Exception: Mobile suspended tracks such as traverse rails for overhead patient lifts that may be moved out of the traffic path shall provide a clearance of not less than 6 feet, 8 inches (2032mm) above the floor when in use.
ACCEPTABLE CEILING AND CARPET LOCATIONS
|AREAS/ROOMS3,4||GENERAL ACUTE CARE HOSPITAL CEILING/CARPET||ACUTE PSYCHIATRIC HOSPITAL CEILING/ CARPET||SKILLED NURSING AND INTERMEDIATE-CARE FACILITIES CEILING/CARPET||CLINIC CEILING/ CARPET|
|Airborne infection isolation rooms||2||N||2||N||2||N||2||N|
|Protective environment rooms||1||N||1||N||1||N||-||-|
|Nurses’ or administration station||3||Y||3||Y||3||Y||3||Y|
|Central sterile supply||2||N||2||N||2||N||2||N|
|Morgue and autopsy||3||N||—||—||—||—||—||—|
|General storage rooms||3||N||3||N||3||N||3||N|
|Dietary day storage||2||N||2||N||2||N||—||—|
|Labor rooms, LDRP and LDR||3||N||—||—||—||—||—||—|
|Speech pathology and audiology||3||Y||3||Y||3||Y||3||Y|
1 – Continuous monolithic surface equal in smoothness to enamel plaster.
2 – Smooth and easily cleanable without perforations or fissures.
3 – Pin perforated, fine fissured, or lightly textured.
4 – Any finish meeting code requirements.
Yes = Y
No = N
* Upon approval by the licensing agency with adequate maintenance procedure. However, should the carpet not be maintained adequately, the licensing agency has the right to have it removed and replaced with another acceptable material.
- Carpet permitted in mammography.
- Except those rooms specified otherwise.
- For rooms not listed, contact the Office of Statewide Health Planning and Development (OSHPD).
- Table applies to new construction, additions, remodels, and conversions. The patching and replacement of existing materials will be permitted.
- Lay-in ceiling meeting the requirements of Section 118.104.22.168.1.7 may be substituted in laundry and kitchens
Floor finishes shall be smooth, waterproof and durable. Flooring surfaces shall provide smooth transitions between different floor materials. Slip-resistant flooring products shall be used for flooring surfaces in wet areas (e.g., kitchens, shower and bath areas), ramps, stairways, entries from exterior to interior space, and other areas as determined by the functional program. Joints for floor openings for pipes, ducts and conduits shall be tightly sealed. Joints of structural elements shall be similarly sealed.
In all areas subject to frequent wet-cleaning methods, flooring materials shall not be physically affected by germicidal or other types of cleaning solutions.
These rooms and anterooms shall have seamless flooring with integral coved base.
The material and textures of bases and the installation thereof shall be such as to minimize dust-catching surfaces, moisture, infiltration and the harboring of vermin.
Exception: In locations where carpet is permitted as a floor finish material, the use of carpeted base (coved or strip base) up to a maximum height of 5 inches (127 mm) is also permissible.
Floors and wall bases in operating rooms, delivery rooms, emergency operating rooms, cast rooms, interventional rooms and special procedure rooms shall be monolithic and constructed without joints. The floors and wall bases of kitchens, soiled and clean utility rooms, housekeeping rooms with mop sinks, patient, public and staff sanitary facilities and other areas subject to frequent wet cleaning, shall also be homogeneous, but may have tightly sealed joints and shall be constructed without voids at the intersection of floor and wall surfaces.
Wall finishes shall comply with the following requirements:
- Wall finishes shall be washable. In the vicinity of plumbing fixtures, wall finishes shall be smooth, scrubbable and water-resistant.
- Wall finishes in areas such as operating rooms, delivery rooms and trauma rooms shall be monolithic, scrubbable and able to withstand cleaning with chemicals.
- Wall finishes in operating rooms, cesarean delivery rooms, isolation rooms and sterile processing rooms shall be free of fissures, open joints or crevices that may retain or permit passage of dirt particles.
- Wall finishes in areas such as clean corridors, central sterile supply spaces, specialized radiographic rooms and minor surgical procedure rooms shall be washable, smooth and able to withstand cleaning with chemicals.
- Wall areas penetrated by pipes, ducts and conduits shall be tightly sealed to minimize entry of rodents and insects. Joints of structural elements shall be similarly sealed.
- Wall finish requirements of Section 122.214.171.124 do not apply to boiler rooms, mechanical equipment rooms, administration departments, other offices, enclosed stairways, maintenance shops and similar spaces.
Dietary and food preparation areas shall comply with the following requirements:
- In dietary and food preparation areas, wall construction, finish, and trim, including the joints between the walls and the floors, shall be free of spaces that can harbor insects and rodents.
- Wall surfaces in wet areas (e.g., kitchens, environmental services closets) shall be monolithic and all seams shall be covered and/or sealed.
Ceilings in areas occupied by patients and the public shall be cleanable with the use of routine housekeeping equipment. Acoustic and lay-in ceiling, where used, shall not create ledges or crevices.
- Ceiling finishes in semirestricted areas such as airborne infection isolation exam/treatment rooms, surgical corridors, central sterile supply spaces and minor surgical procedure rooms, shall be nonabsorptive, nonperforated, capable of withstanding cleaning with chemicals, and without crevices that can harbor mold and bacterial growth.
- If a lay-in ceiling is provided in semi-restricted areas, it shall be gasketed or each ceiling tile shall weigh at least one pound per square foot to prevent the passage of particles from the cavity above the ceiling plane into the semirestricted environment. Perforated, tegular, serrated cut or highly textured tiles are not acceptable.
- 3. Ceilings in restricted areas shall be monolithic with no cracks or perforations.
- 4. Ceilings in restricted areas shall be scrubbable and able to withstand cleaning and/ or disinfecting chemicals.
- 5. All access openings in restricted area ceilings shall be gasketed.
Dietary and laundry areas:
- 6. Provide either a sealed monolithic and scrubbable gypsum board ceiling or a layin ceiling.
- A rust-free grid.
- Ceiling tiles that weigh at least one pound per square foot and are smooth, scrubbable, nonabsorptive, nonperforated and able to withstand cleaning with chemicals.
- 8. Ceiling finish requirements of Section 1126.96.36.199.1 do not apply to boiler rooms, mechanical equipment rooms, administration departments, other offices, enclosed stairways, maintenance shops and similar spaces.
Rooms or screening enclosures shall be provided for the washing and cleaning of garbage containers and for the storage of garbage, trash and other solid wastes. Such rooms or screening enclosures shall include the following:
- A concrete floor with a curb and with a drain connected to the sewer.
- Steam or hot-water and cold-water supply.
- A minimum floor area of 1/2 square foot (0.046 m2) per bed, but not less than 25 square feet (2.3 m2), the least dimension of which shall be 4 feet (1219 mm).
- A method of limiting access to the material except by authorized persons.
Gravity-type laundry and trash chutes shall have a minimum diameter of 2 feet (610 mm) and shall be designed to prevent distribution of airborne contaminating elements to all floors served.
Each floor accommodating patients shall have a telephone installed for patient use. Such telephones shall be readily accessible to patients who are limited to wheel chairs and stretchers. This may not be required in separate buildings having six or fewer beds which are restricted to occupancy by ambulatory patients.
SOUND TRANSMISSION LIMITATIONS IN HOSPITALS
|NEW CONSTRUCTION||AIRBORNE SOUND TRANSMISSION CLASS (STC)1|
|Patient room to patient room||45||40|
|Public space to patient room3||55||40|
|Service areas to patient room4||65||45|
|Patient room access corridor5||45||45|
|Exam room to exam room||45|
|Exam room to public space||45|
|Toilet room to public space||45|
|Consultation rooms/conference rooms to public space||45|
|Consultation rooms/conference rooms to patient rooms||45|
|Staff lounges to patient rooms||45|
- Sound Transmission Class (STC) shall be determined by tests in accordance with methods set forth in ASTM 90 and ASTM 413. Where partitions do not extend to the structure above, sound transmission through ceilings and composite STC performance shall be considered.
- Treatment rooms shall be treated the same as patient rooms.
- Public space includes corridors (except patient room access corridors), lobbies, dining rooms, recreation rooms, and similar space.
- Service areas for the purposes of this table include kitchens, elevators, elevator machine rooms, laundries, garages, maintenance rooms, boiler and mechanical equipment rooms, and similar spaces of high noise. Mechanical equipment located on the same floor or above patient rooms, offices, nurses stations, and similar occupied space shall be effectively isolated from the floor.
- Patient room access corridors contain composite walls with doors/ windows and have direct access to patient rooms.
- Renovation projects of existing spaces where the existing function is not changed, are not required to comply with the requirements of Table 1224.5.
The noise reduction criteria shown in Table 1224.4.19 shall apply to partitions, floors, and ceiling construction in patient areas.
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
- Where renovation of existing patient rooms is undertaken in facilities built under the 2001 or prior California Building Code, patient rooms shall have no less than 80 square feet (7.43 m2) of clear floor area per bed in multiple-bed rooms and 110 square feet. (10.22 m2) of clear floor area in single-bed rooms.
- For shelled spaces built under the 2001 or prior California Building Code, patient rooms shall have no less than 80 square feet (7.43 m2) of clear floor area per bed in multiple-bed rooms and 110 square feet (10.22 m2) of clear floor area in single-bed rooms.
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.
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 1188.8.131.52.
Clean utility/ workroom shall be provided in accordance with to Section 1184.108.40.206.
Medication station shall be provided in accordance with Section 1220.127.116.11.
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.
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, or 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.
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 118.104.22.168 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.
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.
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.
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.
A minimum of one operating room is required. The surgical service space shall be divided into two designated areas: 1) semi-restricted areas (e.g. storage areas for clean and sterile supplies, sterile processing rooms, scrub stations, and corridors leading to restricted areas of the surgical suite, etc.); and 2) restricted areas (e.g. operating rooms, hybrid operating rooms, sterile procedure rooms, cardiac catheterization labs, etc.) that can be reached only through a semi-restricted area. The surgical service space shall be located and arranged to provide direct support from the anesthesia/recovery service space with a common door to prevent nonrelated traffic through the surgical service space.
An operating room suite design with a sterile core shall provide for no cross traffic of staff and supplies from the decontaminated/soiled areas to the sterile/clean areas. The use of facilities outside the operating room for soiled/decontaminated processing and clean assembly and sterile processing shall be designed to move the flow of goods and personnel from dirty to clean/sterile without compromising universal precautions or aseptic techniques in either departments.
Exception: Surgical service space is not required in a rural general acute care hospital, if the hospital maintains written transfer agreements with one or more general acute care hospitals that provide surgical and anesthesia services. Written transfer agreements shall be approved by the Department of Public Health, Licensing and Certification.
Each room shall have a minimum clear floor area of 400 square feet (37.16 m2) with a minimum of 20 feet (6096 mm) clear dimension between fixed cabinets and built-in shelves; and a system for emergency communication with the surgical service space control station. X-ray or imaging viewing capabilities shall be provided.
Exception: Where renovation of existing operating rooms is undertaken in facilities built under the 2001 or prior California Building Code, each operating room shall have a minimum clear floor area of 324 square feet (30.10 m2) with a minimum of 18 feet (5486 mm) clear dimension between fixed cabinets and built-in shelves.
Each room shall have a minimum clear floor area of 250 square feet (23.23 m2) with a minimum of 15 feet (4572 mm) clear dimension between fixed cabinets and built-in shelves. X-ray viewing and/or other imaging modality capabilities shall be provided
Exception: Where renovation of operating rooms is undertaken in facilities built under the 2001 or prior California Building Code rooms for surgical cystos-copy shall have a minimum clear floor area of 180 square feet (16.72 m2). Cast rooms for open reductions, if provided, shall have a minimum clear floor area of 180 square feet (16.72 m2), no dimension of which shall be less than 11 feet (3353 mm).
Services, except for the enclosed soiled workroom referenced in Section 122.214.171.124 and the housekeeping room referenced in Section 1126.96.36.199, may be shared with the obstetrical facilities. Service areas, when shared with delivery rooms, shall be designed to avoid the passing of patients or staff between the operating room and the delivery room areas. The following shall be provided in support of the surgical service space:
Control stations shall be located to permit visual observation of all traffic into the surgical service space.
If provided within the surgery suite, a sub-sterile area(s) shall be equipped with a flash sterilizer, warming cabinet, countertop, and handwashing station. If a sterilizing facility(ies) with high-speed sterilizer(s) or other sterilizing equipment for immediate or emergency use are provided, they shall be directly accessible from the operating room(s) it serves or shall be located inside the clean core if the clean core is directly accessible from the operating room(s). This room shall be accessible without traveling through any operating room. Other facilities for processing and sterilizing reusable instruments, etc., may be located in another hospital department such as central sterile supply.
A medication station shall be provided in accordance with Section 1188.8.131.52.
Scrub sinks shall be located outside of sterile areas. A minimum of two scrub sinks shall be provided in a surgical unit containing one operating room. Four scrub sinks shall be provided in surgical units containing two operating rooms. One additional scrub sink shall be provided for each additional operating room. Scrub sinks shall have water supply controls not requiring direct contact of the hands for operation.
A direct-wired or battery-operated clock or other equivalent timing device shall be visible from the scrub-up sinks.
An enclosed soiled workroom (or soiled holding room that is part of a system for the collection and disposal of soiled material) for the exclusive use of the surgical service space shall be provided. The soiled workroom shall contain a flushing-rim clinical sink or equivalent flushing-rim fixture, a handwashing fixture, a work counter, and space for waste receptacles and soiled linen receptacles. Rooms used only for temporary holding of soiled material may omit the flushing-rim clinical sink and work counters. However, if the flushing-rim clinical sink is omitted, other provisions for disposal of liquid waste shall be provided. The room shall not have direct connection with operating rooms. Soiled and clean utility room or holding rooms shall be separated. The soiled workroom shall provide 24 square feet (2.23 m2) per operating room up to eight operating rooms and shall have a minimum area of 48 square feet (4.46 m2), with no dimension less than 6 feet (1829 mm).
This room shall not be used for food preparation.
A clean utility room is required when clean materials are assembled within the surgical service space prior to use or following the decontamination cycle. It shall contain a work counter, a handwashing fixture, storage facilities for clean supplies, and a space to package reusable items. The storage for sterile supplies must be separated from this space. If the room is used only for storage and holding as part of a system for distribution of clean supply materials, the work counter and hand-washing fixture may be omitted. Soiled and clean utility rooms or holding rooms shall be separated.
for equipment and supplies used in surgical service space. Each surgical service space shall provide sufficient storage area to keep its required corridor width free of equipment and supplies, but not less than 150 square feet (13.94 m2) or 50 square feet (4.65 m2) per operating room, whichever is greater.
Appropriate areas shall be provided for male and female personnel (orderlies, technicians, nurses and doctors) working within the surgical service space. The areas shall contain lockers, showers, toilets, lavatories equipped for handwashing, and space for donning surgical attire. These areas shall be arranged to encourage a one-way traffic pattern so that personnel entering from outside the surgical service space can change and move directly into the surgical service space.
The anesthesia/recovery service space shall provide perioperative support services to the surgical service space as required under this section. Perioperative services shall include preoperative patient care and post-operative recovery with a Post-Anesthesia Care Unit (PACU). The anesthesia/recovery service space shall be located adjacent to the surgical service space with direct access to the surgical suite’s semi-restricted corridor.
Exception: In a rural general acute care hospital, when the surgical service space is not provided, the anesthesia service space is not required. The hospital must maintain written transfer agreements with one or more general acute care hospitals that provide surgical and anesthesia services. Written transfer agreements shall be approved by the Department of Public Health, Licensing and Certification.
In facilities with two or more operating rooms, area(s) with patient care stations shall be provided to accommodate gurney patients or sitting space for ambulatory patients not requiring gurneys. The preoperative area is an unrestricted area and shall be under the direct visual control of the nursing staff and may be part of the recovery space. If the preoperative patient care area will serve other purposes, such as overflow PACU or holding area, applicable requirements in Section 1224.16.3 PACU shall be met.
The recovery area and Post-Anesthesia Care Unit is an unrestricted area and located such that at least one door to the recovery room shall provide access directly from the surgical service space without crossing unrestricted corridors. A minimum of 1.5, or major fraction thereof, post-anesthesia care stations per operating room shall be provided. If pediatric surgery is provided, pediatric recovery stations shall be provided. They shall be separate from adult stations, and shall include space for family or visitors and be visible from the nurse station.
A minimum of 4 feet (1218 mm) clearance shall be provided between the sides and the foot of patient gurneys, or beds, and adjacent walls or other fixed elements. A minimum clear floor area of 80 square feet (7.43 m2) shall be provided for each station in an open-bay plan. A minimum clearance of 5 feet (1524 mm) shall be provided between patient gurneys or beds, and a minimum of 3 feet (914 mm) clearance shall be provided between the foot of the gurney or bed, to a closed cubicle curtain.
A clinical sink shall be provided in postoperative patient care areas with provisions for bedpan cleaning.
Storage shall be provided for gurneys, supplies and equipment.
A changing area shall be provided for outpatient use in perioperative areas in support of surgical suites that provide outpatient procedures. The changing area shall include space for changing or gowning, provisions for storing patients’ belongings during the procedure, and access to patient toilet(s).
All hospitals shall provide space and equipment to perform urinalysis, complete blood counts, hemoglobin blood typing and cross matching. If laboratory facilities for bacteriological, serological, pathological and additional hematological procedures are not available in the community, then space, equipment and supplies for such procedures shall be provided. The following physical facilities shall be provided:
Space and equipment shall be provided to accommodate all required elements, and any additional imaging modalities included in the service space, as required in this section. If interventional or image-guided procedures are performed in the imaging services area, additional provisions shall be as described in Section 1224.28 Supplemental Surgery and other Special Procedure Services. If nuclear medicine is provided in the imaging services area, spaces shall also comply with the requirements described in Section 1224.34 Nuclear Medicine.
Hospital shall provide a minimum of:
- One fluoroscopy room, which can also provide x-ray examination services.
- Space for processing images.
- A toilet room shall adjoin and be directly accessible to each fluoroscopy room. In addition to the fluoroscopy toilet rooms, common patient toilet room facilities shall be located in the radiological/diagnostic imaging service space.
- An office or other suitable area for viewing and reporting radiographic examination.
- Storage spaces for all image equipment, supplies and copies of reports.
- Handwashing stations located within the unit.
- Dressing room facilities.
A certified physicist or other qualified expert shall specify the type, location, and amount of radiation protection to be installed in accordance with the final approved department layout and equipment selections. Where protected alcoves with view windows are required, a minimum of 1'-6″(0.45 meter) between the view window and the outside partition edge shall be provided. Radiation protection requirements shall be incorporated into the construction documents and comply with Chapter 31C and the requirements of California Radiation Control Regulations, California Code of Regulations, Title 17, Division 1, Chapter 5, and Subchapter 4.
- A control room with a view window to permit full view of the patient.
- A scrub sink located outside the staff entry to the procedure room.
- Patient holding area shall accommodate at least one patient gurney with a minimum of 3-foot (914 mm) clearance on the long side.
- Storage for portable equipment and catheters shall be provided.
If provided, CT space shall accommodate the following:
If provided, CT scan spaces shall accommodate the equipment with a minimum of 3 feet (914 mm) on all sides of the equipment, together with the following:
If provided, the MRI room shall accommodate the equipment with a minimum of 3 feet (914 mm) on all sides of the equipment, together with the following:
- A control room shall be provided with full view of the patient in the MRI scanner. The control console shall be positioned so the operator has a full view of the approach and entrance to the MRI scanner room.
- An anteroom or area visible from the control room shall be located outside the MRI scanner room so that patients, health care personnel, and other employees must pass through it before entering the scanning area and control room. The room or area shall be outside the restricted areas of the MRI’s magnetic field.
- A computer room shall be provided.
Wall, floor, and ceiling assemblies shall accommodate the installation of required radio frequency (RF)-shielded assemblies. All doors, windows, and penetrations into the RF-shielded enclosure shall be RF-shielded. As well as RF shielding, individual sites may also require magnetic shielding on some or all surfaces to contain portions of the magnetic field not contained by the RF shield.
Facilities shall use finishes or markings to identify the critical values of the magnetic field surrounding the MRI scanner, including the 5-gauss exclusion zone or other magnetic field strength values that may impair the operation of equipment.
Where superconducting MRI scanners are installed, an insulated cryogen quench exhaust pipe as well as room exhaust and pressure equalization shall be provided to protect occupants in the event of a cryogen breach.
The following spaces are common to the imaging service area and are minimum requirements unless stated otherwise:
If film systems are used, provide the following:
- A room with cabinet or shelves for filing patient film for immediate retrieval shall be provided.
- Storage facilities for unexposed film which shall include protection of film against exposure or damage.
Provision shall be made for locked storage of medications and drugs.
All hospitals having a licensed capacity of 100 or more beds shall have a pharmacy on the premises licensed by the California Board of Pharmacy.
Note: See General Acute Care Hospitals §70263(a), Article 3, Chapter 1, Division 5, Title 22, California Code of Regulations, for requirements concerning hospitals with fewer than 100 beds. The pharmacy room or service space shall conform to the requirements of § 1751, Article 7, Division 17, Title 16, California Code of Regulations as enforced by the California Board of Pharmacy.
Handwashing fixture(s) shall be provided within each separate room where open medication is handled, or in an anteroom, or immediately outside the room where open medication is handled, still within the pharmaceutical service space.
Exception: ISO Class 5 sterile preparation areas (e.g., chemotherapy and intravenous solutions) and their ISO Class 7 buffer area(s) shall not contain sources of water (sinks) or floor drains. However the anteroom to the buffer area shall have a hand-washing fixture regardless of its intended ISO Classification (i.e. Class 7 or Class 8). Reference: U.S. Pharmacopeia (USP) 797 Pharmaceutical Compounding – Sterile Preparations.
Food service facilities and equipment shall conform to these standards, the standards of the National Sanitation Foundation and the requirements of the local public health agency.
On-site conventional food service preparation shall be provided as follows in the size and number appropriate for the type of food service selected:
Patient food preparation areas shall be directly accessible to the entry for food supply deliveries and for the removal of kitchen wastes, interior transportation, storage, etc., without traversing patient or public circulation. Food preparation, service and storage shall be inaccessible to nondietetic service staff.
Provide an area for the receiving and control of incoming dietary supplies.
Licensed Bed Capacity Storage Space 1 to 99 beds 2 square feet (0.19 m2) per bed 100 to 199 beds 200 square feet (18.58 m2) plus 1 square foot 0.0929 m2) per bed in excess of 100 beds 200 beds and over 300 square feet (27.99 m2), plus 1/2 square foot (0.0465 m2) per bed in excess of 200 beds
- Additional storage space for dietetic service supplies, such as paper products, equipment, tray delivery carts, etc., shall be provided.
- Storage areas and sanitizing facilities for cans, carts and mobile-tray conveyors shall be provided.
- Waste storage and recycling facilities (per local requirements) shall be located in a separate room immediately accessible to the outside for direct pickup or disposal.
Provide a separate storage room for the storage of nonfood items such as cleaning supplies that might contaminate edibles.
Provide workspaces for food preparation, cooking, and baking. These areas shall be as close as possible to the user (i.e. tray assembly and dining). Provide additional spaces for thawing and portioning.
A cart distribution system shall be provided with spaces for storage, loading, distribution, receiving, and sanitizing of the food service carts. The cart traffic shall be designed to eliminate any danger of cross-circulation between outgoing food carts and incoming soiled carts, and the cleaning and sanitizing process. Cart circulation shall not be through food preparation areas.
If vending devices are used for unscheduled meals, provide a separate room that can be accessed without having to enter the main dining area.
Ware-washing space shall be provided in a room separate from food preparation and serving areas. It shall be designed to prevent contamination of clean wares with soiled wares through cross-traffic. The clean wares shall be transferred for storage or use in the dining room area without having to pass through food preparation areas.
Handwashing fixtures shall be located conveniently accessible at locations throughout the unit.
Office or other space shall be provided for the dietician or dietetic service supervisor.
On approval of the Licensing Agency, when food is provided by an outside food service, all applicable licensing and certification requirements shall be met. The facility shall maintain adequate space, equipment and food supplies to accommodate required functional elements listed in Section 1224.20.2, as required to provide patient food service in the event that outside food service is interrupted.
Hospitals shall provide a health record service which shall accommodate the following functions:
- Work area for sorting and recording records for either paper or electronic media.
- Storage area for records for either paper or electronic media.
- Soiled work area. A receiving and gross cleaning area which shall contain work space and equipment for cleaning medical and surgical equipment and for disposal of or processing of soiled material.
- Clean work area. A clean work area which shall contain work space and equipment for sterilizing medical and surgical equipment and supplies.
- Sterilizing space.
All sterilizers and autoclaves which emit steam exhaust shall be vented to the outside of the building. Such vents shall be independent from the plumbing vent system.
Exception: Small instrument sterilizers.
Provide separate and enclosed facilities for clean and soiled linen in each nursing unit. The clean linen storage space shall have a minimum area of 10 square feet (0.93 m2) and may be within the clean utility room. The soiled linen collection space shall have an area of no less than 10 square feet (0.93 m2), except where linen chutes are provided, and may be within the soiled utility room.
Sterile and unsterile supplies shall be stored separately.
The morgue and autopsy space shall have a minimum of 250 square feet (23.23 m2) of floor area, no dimension of which shall be less than 10 feet (3048 mm), and provide for:
When provided, the following supplemental surgery and special procedure services shall meet the requirements below:
When provided, the cardiovascular room shall have a minimum clear floor area of 650 square feet (60.39 m2), with a minimum of 20 feet (6096 mm) clear dimension. Orthopedic surgical and other special procedure rooms shall have a minimum clear floor area of 600 square feet (55.74 m2), with a minimum of 20 feet (6096 mm) clear dimension. When open-heart surgery is performed, an additional room in the restricted area of the surgical service space, that is directly accessible to this operating room, shall be designated as a pump room where extra corporeal pump(s), supplies and accessories are stored and serviced. Appropriate plumbing and electrical connections shall be provided in the cardiovascular, pump, and storage rooms.
Shall be provided in accordance with Section 1224.15.3.
- Where renovation work is undertaken in facilities built under the 2001 or prior California Building Code, existing rooms for cardiovascular, and other special procedures may have a minimum clear floor area of 500 square feet (46.45 m2). Orthopedic surgical rooms shall have a minimum clear floor area of 360 square feet (33.44 m2) and a minimum dimension of 18 feet (5486 mm).
- For shelled spaces built under the 2001 or prior California Building Code Rooms for cardiovascular, and other special procedures may have a minimum clear floor area of 500 square feet (46.45 m2). Orthopedic surgical rooms shall have a minimum clear floor area of 360 square feet (33.44 m2) and a minimum dimension of 18 feet (5486 mm).
A procedure room with a minimum clear floor area of 400 square feet (37.16 m2) for the procedure room in addition to spaces for control, monitoring and recording equipment, and x-ray power and controls, and a minimum of one scrub sink for each catheterization laboratory. This space does not include the control room.
A control room or area shall be provided. A view window permitting full view of the patient from the control console shall be provided.
An equipment space or enclosure large enough to contain x-ray transformers, power modules, and associated electronics and electrical gear shall be provided.
Appropriate areas shall be provided for male and female staff working within the surgical service space. The areas shall contain lockers, showers, toilets, lavatories equipped for handwashing, and space for donning surgical attire. These areas shall be arranged to ensure a traffic pattern so that personnel entering from outside the service space can enter, change their clothing, and move directly into the cardiac catheterization service space. The staff change area may be combined with the surgical staff change area.
A clean utility room shall be provided. If the room is used for preparing patient care items, it shall contain a work counter and handwashing fixture. If the room is used only for storage and holding of clean and sterile supply materials, the work counter and handwashing fixtures shall be permitted to be omitted. The clean utility may be shared with an adjacent surgical unit.
A soiled utility room shall be provided which shall contain a handwashing fixture and a clinical sink (or equivalent flushing rim fixtures). When the room is used for temporary holding or soiled materials, the clinical sink and handwashing fixture shall be permitted to be omitted. The soiled utility may be shared with an adjacent surgical unit.
A general acute care hospital referenced in Health and Safety Code Section 1255 (d)(3)(E) may provide cardiac catheterization laboratory service in a freestanding nonhospital building in conformance with this section and Section 1226.2.2. In addition, the service space shall comply with Section 1224.28.2 and applicable requirements in Section 1224.15.3 that are not covered by this section.
Outpatient support areas shall include outpatient waiting rooms in compliance with Section 1224.4.5. A separate space shall be provided where outpatients change from street clothing and are prepared for a procedure. This space shall include provisions for clothing storage, toilet room(s), sink and an area for clothing change and gowning.
The freestanding cardiac catheterization laboratory service space shall be located in the nonhospital building such that the service space has a direct connection to the general acute care hospital providing cardiac surgery by a patient corridor link in compliance with Section 1224.4.7. The corridor link shall have a minimum width of 8 feet (2438 mm) as required under Section 1184.108.40.206. The corridor link shall connect to the hospital corridor system with access to all basic services as required under Section 1220.127.116.11.
Cardiac catheterization laboratories shall meet the provisions for ambulatory surgical clinics required in the California Electrical Code including the requirements of Article 517.45 for an essential electrical system.
Services/ systems and utilities that support the catheterization laboratory space include, but are not limited to: normal power; emergency power; nurse call; communication and data systems; space heating systems; cooling systems; domestic hot and cold water systems; building drain and sewer systems; and medical gas systems. When these systems serve other portions of the building, any alteration to the system shall be subject to review by the Office of Statewide Health Planning and Development.
A control room or area shall be provided.
- The control room or area shall be sized to accommodate the image-recording and viewing equipment.
- A shielded view window permitting direct observation of the patient from the control console shall be provided.
- The shielded control room shall be configured to prevent radiation exposure into occupied areas of the control room when ionizing radiation modalities are used.
- Where the procedure room requires positive (or negative) pressure, a door shall be provided between the control room and the procedure room or between the combined control room/procedure room and other adjacent space.
- Where control functions for ionizing radiation exposures take place in the procedure room, storage for personal radiation protection devices shall be provided.
A medication station shall be provided in compliance with the requirements in Section 118.104.22.168.
A reading room for reviewing images shall be available for use by the interventional imaging suite.
A soiled workroom shall be provided in accordance with Section 122.214.171.124.
Staff changing areas shall be provided and arranged to ensure a traffic pattern so that personnel can enter from outside the suite, change their clothing, and move directly into the semi-restricted corridor within the interventional imaging suite.
- A minimum clear floor area of 650 square feet (60.39 m2) is required for a hybrid operating room unless the imaging equipment requires a larger area.
- The minimum clear dimension shall be 24 feet (7315 mm) unless the requirements for the specific imaging equipment require a greater distance.
- If mobile storage units are used in lieu of fixed cabinets, the minimum clear dimension shall be available between such units when they are parked against a permanent partition.
If required, a control room shall be provided that accommodates the imaging system control equipment and the following requirements:
- The control room shall have a minimum clear floor area of 120 square feet (11.15 m2), which may include fixed work surfaces.
- The room shall be physically separated from the hybrid operating rooms with walls and a door.
- The room shall have viewing windows that provide for a full view of the patient and the surgical team.
- If the control room is adjacent to a restricted area, it must be physically separated from the restricted area with walls and a door.
If the imaging equipment emits ionizing radiation, protection shall be provided in accordance with Section 1126.96.36.199.
- Space and configuration requirements in Section 1224.18.4, except the clearances shall meet the requirements of 1188.8.131.52.
- The control room shall comply with Section 1224.18.4, Item 1.
- The anteroom shall comply with Section 1184.108.40.206.
- Entry doors to iMRI hybrid rooms shall swing outward from inside the room.
If electroconvulsive therapy (ECT) is provided, the requirements of this section shall be met. Where a psychiatric unit is part of a general acute care hospital (Section 1224.31 Psychiatric Nursing Unit), all the requirements in this section shall be permitted to be accommodated in a procedure suite that complies with the requirements in this section or in an operating room in a surgical suite that meets the requirements in Section 1224.15.
- Space requirements. Each ECT procedure room shall have a minimum clear floor area of 200 square feet (18.6 m2) with a minimum clear dimension of 14 feet (4267 mm)
- Handwashing station. A handwashing station shall be provided.
- Documentation area. Accommodation for written or electronic documentation shall be provided.
A waiting area and changing area shall be provided for outpatient use in perioperative areas in support ECT suites that provide outpatient procedures. The waiting room shall comply with Section 1224.4.5. The changing area shall include space for changing or gowning, provisions for storing patients’ belongings during the procedure, and access to patient toilet(s).
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:
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.
- 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.
- For shelled space approved under the 2001 or prior California Building Code as an intensive-care unit, 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 separate rooms or cubicles for single patient use 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 (2428 mm) between beds. The space shall be designed so that all beds shall be placed in relation to the nurses’ station or work area to permit, enable or allow maximum observation 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 hand-washing 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 1220.127.116.11.
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 118.104.22.168.
If the room is used for preparing patient care items, it shall contain a work counter, a handwashing fixture, and storage facilities for clean and sterile supplies. If the room is used only for storage and holding as part of a system for distribution of clean and sterile supply materials, the work counter and handwashing fixture may be omitted. Soiled and clean utility rooms or holding rooms shall be separated and have no direct connection.
There shall be a designated area for clean linen storage. This may be within the clean utility room or a separate closet.
Size shall be a minimum 50 square feet (4.65 m2); if shared between units, it shall be a minimum of 75 square feet (6.97 m2). The soiled workroom shall contain a clinical sink (or equivalent flushing-rim fixture). The room shall contain a handwashing fixture. The above fixtures shall both have a hot and cold mixing faucet. The room shall have a work counter and space for separate covered containers for soiled linen and a variety of waste types. Rooms used only for temporary holding of soiled material may omit the clinical sink and work counter. If the flushing-rim clinical sink is eliminated, facilities for cleaning bedpans shall be provided elsewhere.
There shall be a nourishment area with sink, work counter, refrigerator, storage cabinets, and equipment for hot and cold nourishments between scheduled meals. The nourishment station shall include space for trays and dishes used for nonscheduled meal service. Provisions and space shall be included for separate temporary storage of unused and soiled dietary trays not picked up at mealtime. Handwashing fixtures shall be in or immediately accessible from the nourishment area.
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.
At least one door to each patient room shall be a minimum of 44 inches (1118 mm) wide.
Each patient care space shall contain a minimum of 120 square feet (11.15 m2) of clear floor area per bassinet excluding handwashing fixtures and aisles. There shall be an aisle for circulation adjacent to each patient care space with a minimum width of 4 feet (1219 mm).
- Where renovation of existing NICUs is undertaken in facilities built under the 2001 or prior California Building Code, patient care areas shall have no less than 80 square feet (7.43 m2) of clear floor area per bassinet exclusive of space for nurse control, scrubbing and gowning, and reception area.
- For shelled spaces built under the 2001 or prior California Building Code, NICUs shall have no less than 80 square feet (7.43 m2) of clear floor area per bassinet, exclusive of space for nurse control, scrubbing and gowning, and reception area.
Ceilings shall have a noise reduction coefficient (NRC) of at least 0.90.
- 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.
At least one source of daylight shall be visible from newborn care areas.
- 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 (60.96 centimeters) 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.
Closets or cabinets for toys, educational, and recreational equipment shall be provided.
A psychiatric unit shall be housed in a separate and distinct nursing unit and shall provide the following:
Windows modified to prevent patients from leaving the unit.
Used for interviewing patients.
Provide spaces for dining and recreation. The total area for these purposes shall be not less than 30 square feet (2.8 m2) per patient.
Storage closets or cabinets for recreational and occupation therapy equipment.