Section 1224 [OSHPD 1] Hospitals

The provisions of this section shall apply to general acute-care 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 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.

Exceptions:

1. 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.
2. 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, 1227 and 1228.
3. 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.
4. 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.
5. 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.
6. 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.

AIR CONDITIONING. The process or system by which simultaneously the temperature, humidity, air motion and quality are maintained within required limits.

AIRBORNE INFECTION ISOLATION ROOM. 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.

AMBULATORY CARE. A defined health care encounter(s) of less than 24 hours in duration that requires direct professional health care support within a specific facility.

AMBULATORY SURGICAL 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.

ANGIOGRAPHY. The radiographic visualization of blood vessels following introduction of contrast material for purposes of diagnosis.

BASIC SERVICES. 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.”

BIOTERRORISM. The use, or threat of use, of biological agents to intimidate a political entity or population group.

CENTRAL AIR-HANDLING SYSTEMS. Any units requiring ductwork on the supply or inlet side and serving more than one room.

CHANGE IN FUNCTION. 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.

CLEAR DIMENSION. An unobstructed room dimension exclusive of built-in casework and equipment and available for functional use.

COURT. An open exterior space bounded on three or more sides by the walls of a structure.

ENVIRONMENT OF CARE. Those features in a built health care entity that are created, structured, and maintained to support quality health care.

EXAM ROOM. 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).

FLOOR AREA, CLEAR. The actual occupied area exclusive of fixed or wall-mounted cabinets, fixed beds and furnishings, built-in shelves, toilet rooms, closets, lockers, wardrobes, alcoves, anterooms or vestibules.

GENERAL ACUTE-CARE HOSPITAL. 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.

HANDWASHING STATION. An area that provides a hand-washing fixture, cleansing agents and means for drying hands. Refer to the California Plumbing Code, Section 210.0 for the definition of handwashing fixture.

HOSPITAL. A general acute-care hospital, including those providing only acute medical rehabilitation center services and acute psychiatric hospitals.

HOUSEKEEPING. 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)

LDRP. Labor, Delivery, Recovery, Postpartum (a licensed patient bed)

LICENSING AGENCY. The Department of Public Health, Licensing and Certification.

MONOLITHIC. A surface free of fissures, cracks, perforations, and crevices.

MONOLITHIC CEILING. 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.”

NURSING UNIT. 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.

OUTPATIENT SERVICE. An organizational unit of the hospital, which provides nonemergency healthcare services to patients.

PATIENT ROOM. Licensed patient bed rooms.

PERIOPERATIVE. Patient care and other related supportive activities before, during or after the operative event.

PROTECTIVE ENVIRONMENT. A bedded unit or patient room where severely immunosuppressed patients are cared for.

RESTRICTED AREA. 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.

ROOM. 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.

SCRUB SINK. 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.

SERVICE SINK. A sink located in a housekeeping room and designed for the purpose of cleaning mops and the disposal of waste water.

SUB-ACUTE CARE. A segment within a continuum of levels of care determined by patient acuity, clinical stability, and resource needs.

SURGICAL SERVICE SPACE. A space that includes the operating room(s) and service areas.

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.

When provided, the airborne infection isolation room shall be an exam/treatment room, shall be labeled with the words “Airborne Infection Room”, and provide the following:

1. Capacity. Each airborne infection isolation exam/treatment room shall contain only one examination table or recliner.
2. Handwashing station. A handwashing station shall be located in each airborne infection isolation exam/treatment room.
3. 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.
4. Doors. Room doors shall be self-closing and include latching devices.
5. 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.
6. 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:

1. The anteroom shall provide space for persons to don personal protective equipment before entering the patient room.
2. All doors to the anteroom shall have self-closing devices.
3. The anteroom shall provide storage of personal protective equipment (e.g. respirators, gowns, gloves) and clean equipment.
4. Ventilation shall be provided in the anteroom as required by the California Mechanical Code for airborne infection isolation anteroom.

This area shall have space for counters and storage and at least one hand-washing station shall be located in, adjacent to, or directly accessible to the administrative center or nurse station. It may be combined with or include centers for reception, charting and communication.

When provided, specimen collection facilities shall comply with the following requirements:

1. Urine collection rooms shall be equipped with a water closet and handwashing station.

   Exception: The handwashing station may be located immediately outside the collection room when the specimen is used for drug testing.

2. Use of the toilet room provided within the examination and treatment room shall be permitted for specimen collection.

When provided, blood collection facilities shall comply with the following requirements:

Provision shall be made for distribution of medications. This shall be done from a medication preparation room or from a self-contained dispensing unit.

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:

1. Work counter.
2. Handwashing station.
3. Refrigerator.
4. Locked storage for controlled drugs.

If provided, a self-contained medicine dispensing unit shall be located at the nurses’ station, in the clean utility room, or in an alcove.

Nourishment areas or rooms required in patient care areas shall include the following:

1. Sink
2. Work counter
3. Refrigerator
4. Storage cabinets
5. Equipment for hot and cold nourishment between scheduled meals.
6. The nourishment shall include space for trays and dishes used for nonscheduled meal service.
7. Provisions and space shall be included for separate temporary storage of unused and soiled dietary trays not picked up at mealtime.
8. 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:

1. Work counter
2. Handwashing station
3. 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 materials, the work counter or a handwashing station may be omitted.

The soiled work-room or soiled holding room shall be separate from and have no connection with either clean workrooms or clean supply rooms. The soiled utility/workroom shall contain:

1. Clinical sink (or equivalent flushing-rim fixture).
2. Handwashing station
3. Work counter
4. Space for separate covered containers for soiled linen and/or waste

Rooms used only for temporary holding 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.

Waiting rooms for outpatients shall provide a seating area and space for wheelchairs and have public corridor access. Public toilets, drinking fountains and telephones shall be readily accessible.

Note: One waiting area may serve more than one department or service.

If x-ray examinations are to be performed on outpatients, outpatient access to the radiological spaces shall not traverse a nursing unit.

Exception: Satellite radiology, laboratory, pharmacy, and physical and occupational therapy space serving inpatients may be located in nursing units and inpatient treatment areas.

The design, installation and testing of medical gas and vacuum systems shall conform to Table 1224.4.6.1 and NFPA 99.

The design and construction of hyperbaric facilities shall conform to NFPA 99; Health Care Facilities and Section 1224.39.5.

The design and construction of hospital laboratories shall conform to NFPA 99.

The location of nurse call devices shall comply with Table 1224.4.6.5. The design of call systems shall comply with the California Electrical Code, Part 3 of Title 24.

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.

Service corridors and hallways with anticipated light traffic volume for nonpatient use may be reduced to a width of 5 feet (1524 mm) if approved by the enforcing agency.

Exception: Corridors and hallways in administrative and business areas may be reduced to a width of 44 inches (1118 mm).

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).

Corridors for patient traffic in areas providing skilled nursing, intermediate care or rehabilitation services shall be furnished with a handrail on both sides at a height not less than 30 inches (762 mm) or greater than 36 inches (914 mm).

Corridor systems shall connect all patient rooms and basic services.

Exception: Covered pedestrian walkways connecting separate buildings are permitted for ambulatory, psychiatric or chemical dependency patients.

Department/service space areas shall be contiguous and include internal circulation to access each of the rooms/spaces associated with it, as identified under the specific Service Space requirements.

Doors to toilet rooms shall have an opening of not less than 32 inches (813 mm) clear in width and shall be equipped with hardware which will permit the door to swing outward or in a manner to negate the need to push against a patient who may have collapsed within the toilet room.

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.

If operable windows are provided in airborne infection isolation or protective environment rooms, they shall only be operable by the use of tools or keys which shall be located at the nurses’ station.

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.

The minimum height of ceilings shall be 8 feet (2438 mm).

Exception: Closet, toilet room and bathroom minimum ceiling heights shall not be less than 7 feet (2134 mm).

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.

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.

Exception: Upon written appropriate documented requests, the licensing agency may grant approval of the installation of carpets. See Table 1224.4.11.

Resilient flooring, if used in toilet and bathing rooms, shall be continuous and extend upward onto the wall at least 5 inches (127 mm) to minimize moisture infiltration. Wood bases are prohibited except in waiting areas and administration departments.

Floors in areas used for food preparation and assembly shall be water-resistant. Floor surfaces, including tile joints, shall be resistant to food acids. Floor construction in dietary and food preparation areas shall be free of spaces that can harbor pests.

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.

Wall finishes shall comply with the following requirements:

1. Wall finishes shall be washable. In the vicinity of plumbing fixtures, wall finishes shall be smooth, scrubbable and water-resistant.
2. Wall finishes in areas such as operating rooms, delivery rooms and trauma rooms shall be monolithic, scrubbable and able to withstand cleaning with chemicals.
3. 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.
4. 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.
5. 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.
6. Wall finish requirements of Section 1224.4.11.3 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:

1. 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.
2. 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 shall comply with Table 1224.4.11 and the following requirements:

Semirestricted areas:

1. 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.
2. 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.

Restricted areas:

1. 3. Ceilings in restricted areas shall be monolithic with no cracks or perforations.
2. 4. Ceilings in restricted areas shall be scrubbable and able to withstand cleaning and/ or disinfecting chemicals.
3. 5. All access openings in restricted area ceilings shall be gasketed.

Dietary and laundry areas:

1. 6. Provide either a sealed monolithic and scrubbable gypsum board ceiling or a layin ceiling.

2. 7. If a lay-in ceiling is provided, it shall include the following:

   • 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.
3. 8. Ceiling finish requirements of Section 1224.4.11.4.1 do not apply to boiler rooms, mechanical equipment rooms, administration departments, other offices, enclosed stairways, maintenance shops and similar spaces.

Where one or more walls of a court contain a door or window of one or more patients’ bedrooms, the least dimension of the court shall be 20 feet (6096 mm) between facing structures.

Patient elevators shall have minimum inside platform dimensions of 5 feet by 8 feet (1524 mm by 2438 mm), and a minimum clear door opening of 4 feet 0 inches (1219 mm).

Passenger elevators shall have minimum inside platform dimensions of 4 feet 8 inches by 7 feet 4 inches (1422 mm by 2236 mm).

Buildings over one story in height with accommodations or services for patients on floors without grade-level entrance shall provide at least one patient elevator.

If bed patients are accommodated on one or more floors, other than the main entrance floor or where operating rooms or delivery rooms are above or below the main entrance floor, at least one patient elevator shall be provided.

At least one patient elevator and one service elevator shall be provided in hospitals with a capacity of from 60 to 149 beds on floors other than the main entrance floor.

At least one patient elevator, one passenger elevator and one service elevator shall be provided in hospitals with a capacity of 150 or more beds on floors other than the main entrance floor.

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:

1. A concrete floor with a curb and with a drain connected to the sewer.
2. Steam or hot-water and cold-water supply.
3. 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).
4. A method of limiting access to the material except by authorized persons.

This room shall be a minimum floor area of 15 square feet (1.4 m²). It shall contain a service sink or floor receptor and provisions for storage of supplies and housekeeping equipment.

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.

Each toilet, bathtub and shower serving patients shall have conveniently placed grab bars that shall comply with Chapter 11B.

Exception: Excluding facilities designed for use by persons with disabilities, grab bars may be deleted from those facilities serving chemical dependency recovery and psychiatric patients.

Recreation rooms, exercise rooms, equipment rooms and similar spaces where impact noises may be generated, shall not be located directly over patient bed areas or delivery and operating suites, unless special provisions are made to minimize such noise.

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

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:

1. Acute psychiatric hospitals shall provide airborne infection isolation rooms at the ratio of one room for each 50 beds, or major fraction thereof.
2. 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.

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 department.

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 1224.15.3.7 and the housekeeping room referenced in Section 1224.15.3.12, 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 1224.4.4.4.

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.

Provide an anesthesia workroom for cleaning, testing and storing anesthesia equipment. This room shall contain work counter(s) and sink(s) and racks for cylinders.

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.

Shall be provided for the exclusive use of the surgical service space. It shall be directly accessible from the 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.

Each station shall have a minimum clear floor area of 80 square feet (7.43 m²) and a minimum clearance of 3 feet (914 mm) shall be provided between the sides and foot of patient lounge chairs/gurneys and adjacent walls, partitions or fixed elements.

Provisions for patient privacy such as cubicle curtains shall be made.

Handwashing station(s) shall be provided in the preoperative service area at a ratio of one for each 4 stations, and for each major fraction thereof, in open bay areas. A handwashing station shall be provided in each single care station room.

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.

Provisions for patient privacy such as cubicle curtains shall be made.

Handwashing stations shall be provided in the post-anesthesia care unit with at least one for every four patient positions, and for each major fraction thereof, uniformly distributed to provide equal access from each patient station. A handwashing station shall be provided in each single care station room.

A nurse station shall be provided in postoperative patient care areas, and shall allow direct observation of the patients and charting facilities. The nurse station shall comply with the requirements of Section 1224.4.4.2.

A clinical sink shall be provided in postoperative patient care areas with provisions for bedpan cleaning.

Each Post-Anesthesia Care Unit shall contain a medication station. The medication station shall comply with the requirements of Section 1224.4.4.4.

Ice-making equipment shall be provided in the perioperative service space. Ice-making equipment is permitted to be located in preoperative or postoperative patient care areas, however, it shall not be located in semi-restricted areas.

Storage shall be provided for gurneys, supplies and equipment.

Staff toilet rooms shall be immediately accessible to the postoperative patient care area(s) to maintain staff availability to patients.

A waiting area, in compliance with Section 1224.4.5, shall be provided.

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:

1. Laboratory work space.
2. Refrigerated blood storage facilities for transfusions shall be provided. Blood storage refrigerator shall be equipped with temperature-monitoring and alarm signals that are monitored continuously.
3. Handwashing fixture.

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:

1. One fluoroscopy room, which can also provide x-ray examination services.
2. Space for processing images.
3. 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.
4. An office or other suitable area for viewing and reporting radiographic examination.
5. Storage spaces for all image equipment, supplies and copies of reports.
6. Handwashing stations located within the unit.
7. 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.

If provided, diagnostic angiography space shall accommodate the following:

1. A control room with a view window to permit full view of the patient.
2. A scrub sink located outside the staff entry to the procedure room.
3. Patient holding area shall accommodate at least one patient gurney with a minimum of 3-foot (914 mm) clearance on the long side.
4. Storage for portable equipment and catheters shall be provided.

If interventional angiography procedures are to be performed in the angiography room, the suite shall comply with interventional imaging requirements in Section 1224.28.4. If cardiac catheterization procedures are performed refer to Section 1224.28.2.

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:

1. A control room shall be provided that is designed to accommodate the computer and other controls for the equipment. A view window shall be provided to permit view of the patient.
2. A patient toilet room convenient to the procedure room.

If provided, intraoperative CT scanning spaces shall comply with Section 1224.28.5.

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:

1. 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.
2. 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.
3. A computer room shall be provided.

Handwashing station(s) shall be immediately accessible to the MRI scanner room.

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.

MRI rooms shall be clearly marked with a red light and lighted sign stating, “The Magnet Is On”. This light and sign are to be lighted at all times and have a backup energy source to remain illuminated for at least 24 hours in the event of a loss of power.

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.

If provided, the intraoperative magnetic resonance imaging (iMRI) suite shall comply with Section 1224.28.5.

When provided, the ultrasound room shall comply with the following:

1. Area. Rooms used for ultrasound examination/ treatment shall have a minimum clear floor area of 120 square feet (11.15 m²).
2. Clearances. A minimum clear dimension of 3 feet (914 mm) shall be provided on three sides of the table/stretcher.

A handwashing fixture shall be provided within the procedure room.

A patient toilet shall be directly accessible to the ultrasound procedure room.

The patient toilet may be permitted to serve more than one ultrasound procedure room.

When provided, the mammography room shall comply with the following:

1. Area. Mammography rooms shall be a minimum of 100 square feet (9.3 m²).
2. Shielded alcove. Each x-ray room shall include a shielded control alcove. For mammography machines with built-in shielding for the operator, omission of the alcove shall be permitted when approved by the certified physicist.

A handwashing fixture shall be provided within the procedure room.

The following spaces are common to the imaging service area and are minimum requirements unless stated otherwise:

In service spaces with procedure rooms that do not have dedicated patient toilets, provide a minimum of one patient toilet room within the service space.

Dressing areas shall be provided adjacent to the imaging rooms.

In service space of three or more procedure rooms, staff toilet room(s) internal to the service space shall be provided.

If film systems are used, provide the following:

1. A room with cabinet or shelves for filing patient film for immediate retrieval shall be provided.
2. 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.

Provide for immediate accessibility to staff toilet rooms and lockers.

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.

1. Food storage space shall be readily accessible to the receiving area and shall be located to exclude traffic through the food preparation area to reach them. Storage spaces for bulk, refrigerated, and frozen foods shall be provided. At least one week’s (7 days) supply of staple foods and at least two (2) days’ supply of frozen, and two (2) days’ supply of perishable foods shall be maintained on the premises. Food storage components shall be grouped for convenient access from receiving and to the food preparation areas. All food shall be stored clear of the floor. Lowest shelf shall be not less than 12 inches (305 mm) above the floor or shall be closed in and sealed tight for ease of cleaning.

   As a minimum, dietary storage space shall be provided in accordance with the following schedule:

   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

   Space to allow refrigeration for the storage of frozen and chilled foods shall be provided at a minimum of 2 cubic feet (0.057 m³) of usable space per bed.

2. Additional storage space for dietetic service supplies, such as paper products, equipment, tray delivery carts, etc., shall be provided.
3. Storage areas and sanitizing facilities for cans, carts and mobile-tray conveyors shall be provided.
4. 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.

The patient tray assembly area shall be immediately accessible to the food preparation and distribution areas.

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.

Provide dining space(s) for ambulatory patients, staff, and visitors. These spaces shall be separate from the food preparation and distribution 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.

1. Commercial-type ware-washing equipment shall be provided.
2. Space shall be provided for receiving, scraping, sorting and stacking soiled tableware separate from food preparation areas.
3. Handwashing stations shall be provided in the ware-washing space.

Pot washing shall include multi-compartmented sinks.

A food waste storage room shall be readily accessible to the food preparation and ware washing areas but not within the food preparation area. It shall have direct access to the hospital’s waste collection and disposal facilities.

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.

Toilet rooms shall be provided for the exclusive use of the dietary staff. They shall not open directly into the food preparation areas, but shall be readily accessible to them. An enclosed, separate locker area shall be provided for dietetic service employee’s clothing and personal belongings.

A housekeeping room, meeting the requirements of Section 1224.4.15, shall be provided within the dietary department for the exclusive use of the dietary department.

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.

An administration area shall be provided which shall provide for the following functions:

1. A lobby with reception and information counter or desk, waiting space, men’s and women’s public toilet room facilities, telephones and drinking fountain.
2. Offices for administrator and admitting.

Hospitals shall provide a health record service which shall accommodate the following functions:

1. Work area for sorting and recording records for either paper or electronic media.
2. Storage area for records for either paper or electronic media.

A central supply and sterilizing area shall be provided. Rooms and spaces shall accommodate the following services and equipment:

1. 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.
2. Clean work area. A clean work area which shall contain work space and equipment for sterilizing medical and surgical equipment and supplies.
3. Sterilizing space.

4. Storage. Provide storage space for sterile supplies and unsterile supplies.

   Exception:Section 1224.22.1 does not apply to hospitals which serve psychiatric or alcoholism patients exclusively.

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.

Hospitals shall provide general storage space of at least 20 square feet (1.86 m²) per bed in addition to specialized storage spaces. All storage spaces shall be located within the hospital building and readily accessible to the connecting corridor required under Section 1224.4.7.5.

Specialized storage spaces shall include the following:

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.

One supply storage space having a minimum area of 15 square feet (1.39 m²) shall be provided in each nursing unit. Supply storage may be within the clean utility room used only as part of a system for distributing clean and sterile supplies.

A room or space shall be provided in each nursing unit for wheelchairs and gurneys. The wheelchair and gurney space shall have a minimum area of 15 square feet (1.39 m²).

Sterile and unsterile supplies shall be stored separately.

Food storage shall be as described in Section 1224.20.

General acute-care hospitals with a licensed bed capacity of 50 or more beds shall provide a morgue with autopsy facilities.

Exception: This may not be required if it can be demonstrated to the licensing agency that morgue and autopsy facilities are available locally.

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:

1. Handwashing fixture.
2. Space for refrigerated compartments if human remains are held unembalmed. Refrigerated rooms and prefabricated body refrigerator temperatures shall not be higher than 45°F (25°C).

Hospitals shall provide the following:

1. Separate dressing rooms for male and female personnel with lockers, lavatory and toilet.
2. Additional dressing rooms for the surgical service and as required within any of the supplemental services.

Shall be provided to serve each department and nursing unit, and may be shared by compatible departments, except when specifically required by other sections.

If a laundry is to be provided, the following is required in addition to the laundry room:

1. A separate soiled linen receiving, holding and sorting room with handwashing fixture.
2. A separate clean linen storage, issuing and holding room.
3. Storage for laundry supplies.

If linen is processed off site, the following shall be provided within the hospital:

1. Soiled linen holding room.
2. Clean linen receiving room.
3. Clean linen storage room.

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.

Exception: 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).

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.

Where electrophysiology studies are performed, dedicated space and equipment for emergency resuscitation and stabilization shall be immediately accessible to the procedure 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.

Scrub facilities with hands-free operable controls shall be provided adjacent to the entrance of procedure rooms.

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 patient preparation, holding, and recovery area or room shall be provided and arranged to provide visual observation before and after the procedure. This may occur in a unit outside of the catheterization service space.

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.

Shall be a minimum floor area of 15 square feet (1.4 m²). It shall contain a service sink or floor receptor and provisions for storage of supplies and housekeeping equipment. This 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 1224.4.7.1. The corridor link shall connect to the hospital corridor system with access to all basic services as required under Section 1224.4.7.5.

Control station(s) shall be located to permit visual observation of all traffic into the semi-restricted service space from unrestricted corridors and/or passageways.

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.

Image-guided interventional procedures shall be performed in procedure rooms in compliance with this section. Cardiac catheterization operating rooms shall be in compliance with Section 1224.28.2, and hybrid operating rooms shall be in compliance with Section 1224.28.5.

The procedure room shall meet the space, clearance, and storage requirements for the imaging equipment contained in the room and the following:

1. A minimum clear dimension of 18 feet (5486 mm).
2. The procedure room shall also be sized to allow a minimum clearance of 4 feet (1219 mm) on all sides of the procedure table.

Pre-procedure and recovery areas shall be immediately accessible to procedure rooms and separate from corridors. The pre-procedure and recovery areas shall comply with the requirements of Section 1224.16 Anesthesia/ recovery Service Space.

Interventional and intraoperative magnetic resonance imaging (I-MRI) procedure rooms shall comply with Section 1224.28.5 Hybrid Operating Rooms.

A control room or area shall be provided.

1. The control room or area shall be sized to accommodate the image-recording and viewing equipment.
2. A shielded view window permitting direct observation of the patient from the control console shall be provided.
3. The shielded control room shall be configured to prevent radiation exposure into occupied areas of the control room when ionizing radiation modalities are used.
4. 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.
5. Where control functions for ionizing radiation exposures take place in the procedure room, storage for personal radiation protection devices shall be provided.

Scrub sinks shall be located outside of sterile areas. A minimum of one scrub sink station shall be provided for each interventional imaging procedure room. Scrub sinks shall have water supply controls not requiring direct contact of the hands for operation.

A medication station shall be provided in compliance with the requirements in Section 1224.4.4.4.

A reading room for reviewing images shall be available for use by the interventional imaging suite.

Electronic equipment or enclosures large enough to contain x-ray transformers, power modules, and associated electronics and electrical gear shall be provided. Sharing of electronics equipment rooms by multiple procedure rooms is permitted.

A clean utility room shall be provided in accordance with the requirements in Section 1224.4.4.6.

A soiled workroom shall be provided in accordance with Section 1224.4.4.7.

A housekeeping room shall be provided in accordance with the requirements of Section 1224.4.15.

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.

Hybrid operating rooms shall comply with the requirements of Section 1224.15 and comply with the requirements in this section.

Each hybrid operating room shall meet the space, clearance, and storage requirements for the imaging equipment contained in the room and the following:

1. 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.
2. The minimum clear dimension shall be 24 feet (7315 mm) unless the requirements for the specific imaging equipment require a greater distance.
3. 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:

1. The control room shall have a minimum clear floor area of 120 square feet (11.15 m²), which may include fixed work surfaces.
2. The room shall be physically separated from the hybrid operating rooms with walls and a door.
3. The room shall have viewing windows that provide for a full view of the patient and the surgical team.
4. If the control room is adjacent to a restricted area, it must be physically separated from the restricted area with walls and a door.

An imaging equipment room shall be provided for each hybrid operating room.

If the imaging equipment emits ionizing radiation, protection shall be provided in accordance with Section 1224.18.1.1.

Hybrid operating rooms with intraoperative computerized tomography (CT) systems shall have control rooms that comply with Section 1224.18.3.1.

Hybrid operating rooms with intraoperative magnetic resonance imaging (iMRI) systems shall comply with the following:

1. Space and configuration requirements in Section 1224.18.4, except the clearances shall meet the requirements of 1224.28.5.1.
2. The control room shall comply with Section 1224.18.4, Item 1.
3. The anteroom shall comply with Section 1224.18.4.2.
4. Entry doors to iMRI hybrid rooms shall swing outward from inside the room.

Hybrid operating rooms with vascular imaging systems shall comply with Section 1224.28.4.4.

Pre-procedure and recovery areas shall be immediately accessible to procedure rooms and separate from corridors.

The pre-procedure and recovery areas shall comply with the requirements of Section 1224.16 (Anesthesia/ recovery Service Space).

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.

The ECT procedure area may be a single procedure room or a suite of procedure rooms.

1. 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)
2. Handwashing station. A handwashing station shall be provided.
3. Documentation area. Accommodation for written or electronic documentation shall be provided.

When ECT services have a low-volume of procedures, the ECT procedure room may be used for pre-procedure patient care and recovery. If a pre-procedure and recovery areas are provided they shall comply with the requirements of Section 1224.16.

Space shall be provided in the procedure room(s) for storage of emergency equipment such as a CPR cart. A separate emergency equipment storage is permitted to serve more than one ECT procedure room.

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:

Each intensive-care unit shall contain not less than four or more than 12 beds.

Exception: When approved by the licensing agency a small or rural hospital intensive care unit may consist of less than four but not less than two patient beds.

In new construction, each patient space (whether separate rooms, cubicles, or multiple bed space) shall have a minimum of 200 square feet (18.58 m²) of clear floor area with a minimum headwall width of 13 feet (3962 mm) per bed. There shall be a minimum clear dimension of 1 foot (305 mm) clear space from the head of the bed to the wall, a minimum of 5 feet (1524 mm) clear space from the foot of the bed to the wall, a minimum of 5 feet (1524 mm) clear space on one side of each bed for patient transfer, a minimum of 4 feet (1218 mm) clear width on the non-transfer side, and a minimum of 8 feet (2438 mm) clear space between beds.

Exception: Where renovation of existing intensive care units is undertaken, in facilities approved under the 2001 or prior California Building Code, existing patient space (whether separate rooms, cubicles, or multiple bed space) may be renovated or replaced in kind one for one in the renovated space. Such patient space shall have no less than 132 square feet (12.26 m²) with no dimension less than 11 feet (3353 mm), and with 4 feet (1219 mm) of clearance at each side and the foot of the bed, and with a minimum of 8 feet (2438 mm) between beds. The space shall be designed so that all beds shall be placed in relation to the nurse’s station or work area to permit, enable or allow maximum observance of patients.

When private rooms or cubicles are provided, view panels to the corridor shall be required with a means to provide visual privacy. Where only one door is provided to a bed space, it shall be at least 4 feet (1219 mm) wide and arranged to minimize interference with movement of beds and large equipment. Sliding doors shall not have floor tracks. Where sliding doors are used for access to cubicles within a service space, a 3-foot-wide (914 mm) swinging door may also be provided for personnel communication.

Modular toilet/sink combination units located within a privacy curtain may be used within each patient space or private room. The toilet fixture shall be completely contained within cabinetry when not in use. This fixture shall not be equipped with a bedpan washing attachment. Exhaust ventilation requirements shall comply with the California Mechanical Code.

Each patient bed area shall have space at each bedside for visitors, and provisions for visual privacy from casual observation by other patients and visitors. For both adult and pediatric units, there shall be a minimum of 8 feet (2438 mm) between beds.

Each patient bed shall have visual access, other than clerestory windows and skylights, to the outside environment with not less than one outside window in each patient bed area.

The distance from the patient bed to the outside window shall not exceed 50 feet (15 240 mm). When partitioned cubicles are used, patients’ view to outside windows may be through no more than two separate clear vision panels.

Handwashing stations shall be directly accessible to nurse stations and patient bed areas. There shall be at least one handwashing station for every three beds in open plan areas, and one in each patient room. The handwashing station shall be located near the entrance to the patient cubicle or room.

This area shall have space for counters and storage. It may be combined with or include centers for reception and communication.

There shall be direct visual observation between either a centralized or distributed nurse station or work station and the heads of all patient beds in the intensive care unit.

Each unit shall contain equipment for continuous monitoring. Monitors shall be located to permit easy viewing but not interfere with access to the patient.

Space that is easily accessible to the staff shall be provided for emergency equipment such as a CPR cart.

A medication station shall be provided in accordance with Section 1224.4.4.4.

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 1224.29.1.4.

Exception: When approved by the licensing agency an airborne infection isolation room is not required for small or rural hospitals.

The following additional service spaces shall be immediately accessible within each intensive care service space. These may be shared by more than one intensive care unit provided that direct access is available from each.

Clean utility/workroom shall be provided in accordance with Section 1224.4.4.6.

There shall be a designated area for clean linen storage. This may be within the clean utility room or a separate closet.

Soiled workroom or soiled holding room shall be provided in accordance with Section 1224.4.4.7.

A nourishment area or room shall be provided in accordance with Section 1224.4.4.5.

Each unit shall have equipment to provide ice for treatments and nourishment. Ice-making equipment may be in the clean utility room or at the nourishment station. Ice intended for human consumption shall be from self-dispensing icemakers.

Appropriate room(s) shall be provided for storage of large items of equipment necessary for patient care. Each intensive care unit shall provide not less than 20 square feet (1.86 m²) per patient bed.

The following shall be provided and shall be located immediately accessible to the unit:

1. Visitors’ waiting room.
2. Office space.
3. Staff lounge(s) and toilet room(s).
4. Multipurpose room(s). Provide for staff, patients, and patients’ families for patient conferences, reports, education, training sessions, and consultation.
5. Housekeeping room. Provide within or immediately adjacent to the intensive care unit. It shall not be shared with other nursing units or departments.
6. Gurney and wheelchair storage. Provide a minimum 15 square feet (1.39 mm) per each nursing unit.

The NICU shall comply with all the requirements of Section 1224.29.1. Additionally each NICU shall include or comply with the following:

The NICU shall have a clearly identified entrance and reception area for families. The area shall permit visual observation and contact with all traffic entering the unit.

Provide one handwashing fixture for each four infants and for each major fraction thereof. In a multiple-bed room, every bed position shall be within 20 feet (6096 mm) of a handwashing fixture. Where an individual room concept is used, a handwashing fixture shall be provided within each infant care room.

At least one door to each patient room shall be a minimum of 44 inches (1118 mm) wide.

When viewing windows are provided, provision shall be made to control casual viewing of infants. Controls shall be provided to enable lighting to be adjusted over individual patient care spaces. Darkening sufficient for transillumination shall be available when necessary.

A central area shall serve as a control station, and shall have space for counters and storage, and direct access to a handwashing station. It may be combined with or include centers for reception, communication and patient monitoring.

Ceilings shall have a noise reduction coefficient (NRC) of at least 0.90.

Shall comply with the requirements of Section 1224.29.1.13 except for separate toilet, bathtubs or shower. The room shall be enclosed and separated from the nursery unit with provisions for observation of the infant from adjacent nurseries or control area(s).

Space shall be provided for lactation support and consultation in or immediately adjacent to the NICU.

1. Where infant formula is prepared on site, direct access from the formula preparation room to any infant care room is prohibited.
2. 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:

1. A separate cleanup area for washing and sanitizing. This area shall include a handwashing station, facilities for bottle washing and a work counter.
2. 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:

1. A work counter
2. A hand-washing station
3. 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.

A pediatric nursing unit shall be provided if the hospital has eight or more licensed pediatric beds. The unit shall meet the following standards:

Each patient room shall meet the following standards:

The space requirements for pediatric patient beds shall be the same as required by Section 1224.14.1.2.

Each patient room shall have a window in accordance with Section 1224.4.9.

This room shall be provided for pediatric and adolescent patients. A separate area for infant examination and treatment may be provided within the pediatric nursery workroom.

The service areas in the pediatric and adolescent nursing units shall conform to Section 1224.14.2 and shall also provide the following:

A play area shall be provided.

Space for preparation and storage of infant formula shall be provided immediately accessible to the unit.

Patient toilet room(s) with a lavatory in each room, in addition to those serving bed areas, shall be located adjacent to play area(s) and in or directly accessible to each central bathing facility.

Closets or cabinets for toys, educational, and recreational equipment shall be provided.

At least one airborne infection isolation room shall be provided within each pediatric unit; minimum of one per 15 beds. Airborne infection isolation room(s) shall comply with the requirements of Section 1224.14.3.

Separate clean and soiled workrooms or holding rooms shall be provided as described in Sections 1224.14.2.6 and 1224.14.2.7.

A psychiatric unit shall be housed in a separate and distinct nursing unit and shall provide the following:

A psychiatric nursing unit shall meet the requirements of Section 1224.14 or 1228.14, in addition to the requirements of Section 1228.4, based on the functional program. Specific application shall respond to the patient injury and suicide prevention component of the Patient Safety Risk Assessment prepared under California Administrative Code (Part 1 of Title 24) Section 7-119. If a unit provides acute medical care, the unit shall comply with Section 1224.14 and be located in a building rated SPC 3 or higher.

Windows modified to prevent patients from leaving the unit.

Entrances and exits which may be locked if necessary.

Seclusion rooms shall be provided and comply with Section 1224.4.4.1.4.

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.

A room for physical examinations and medical treatment.

Indoor and outdoor space for therapeutic activities.

Facilities for occupational therapy shall comply with Section 1224.35.3.

A recreation room with a minimum of 100 square feet (9.3 m²) in each building, and on each floor of a building accommodating six or more psychiatric patients.

Refer to Section 1224.4.6.5.

Visual privacy in multibed rooms (e.g., cubicle curtains) is not required.

The ceiling and the air distribution devices, lighting fixtures, sprinkler heads, and other appurtenances shall be of a tamper-resistant type.

Each patient room shall be provided with a private toilet room that meets the following requirements:

1. The door shall not be lockable from within.
2. The door shall be capable of swinging outward.
3. The ceiling shall be of tamper-resistant construction and the air distribution devices, lighting fix tures, sprinkler heads, and other appurtenances shall be of the tamper-resistant type.

Handwashing fixtures located in patient rooms and patient toilet rooms may include anti-ligature features that do not compromise compliance with the hot and cold water supply controls, laminar flow, and sink requirements of Section 210.0 and Table 4-2 of the California Plumbing Code. Handwashing fixtures within patient rooms and patient toilet rooms in psychiatric nursing units are not required to be equipped with gooseneck spouts and the discharge point may be less than 5 inches (127 mm) above the fixture rim.

If a unit treats children of school age over a period of one month or more, it shall provide physical facilities for an educational program, such as classrooms and an office for the teacher.

The standards noted in Section 1224.14.2 shall apply to service areas for psychiatric nursing units.

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.

Levels of emergency care range from initial emergency management as Standby Emergency Medical Service, with a Physician on call; to definitive emergency care as Basic Emergency Medical Service, with a Physician on duty; to a Comprehensive Emergency Medical Service as an Emergency Department.

If provided, initial emergency management shall be provided in a specifically designated area of the hospital which shall include the following elements:

A well-marked, illuminated and covered entrance, at grade level. The emergency vehicle entry cover shall provide shelter for both the patient and the emergency medical crew during transfer from an emergency vehicle into the building. This exterior entrance shall not be substituted for the required accessible entrance to the hospital, protected from the weather by canopy or roof overhang assigned for passengers loading zone. Ambulance entrances shall provide a minimum of 6 feet (183 mm) in clear width to accommodate bariatric stretchers, mobile patient lift devices, and accompanying attendants. Reception shall be located to permit staff observation and control of access to treatment area, pedestrian and ambulance entrances, and public waiting area.

Standby emergency service shall include at least one treatment room with the following elements:

1. The area shall not be less than 120 square feet (11.15 m²) of clear floor area, exclusive of toilet room(s), waiting area and storage.
2. Each treatment room shall contain an examination light, work counter, and handwashing station.
3. Medical equipment, cabinets, medication storage and counter space for writing.
4. The dimensions and arrangement of treatment rooms shall be such that there is a minimum of 3 feet (914 mm) between the sides and foot of the bed/gurney and any wall or any other fixed obstruction. The treatment room may have additional space and provisions for several patients with cubicle curtains for privacy.
5. Multiple-station treatment rooms shall provide a minimum of 80 square feet (7.43 m²) per patient gurney, with a minimum 8 foot width (2,438 mm) and 3 feet (914 mm) at the foot of the bed/gurney, with a minimum of 3 feet to any wall or fixed obstruction, and a minimum of 5 feet (1524 mm) between patient gurneys. Patient gurneys shall be separated from adjoining cubicles by curtains. Handwashing fixtures shall be provided for each four treatment stations and for each major fraction thereof in multiple-station areas. These shall be uniformly distributed to provide equal access from each patient station.

Exception: Where renovation of existing treatment rooms is undertaken in facilities approved under the 2001 or prior California Building Code, existing treatment rooms may be renovated, or replaced in kind one for one in the renovated space. Such treatment rooms shall have no less than 80 square feet (7.43 m²) of clear floor area, the least dimension of which shall be 8 feet (2438 mm).

Equipment and supply storage shall be provided and be sized for general medical/surgical emergency supplies, medications and equipment such as ventilator, defibrillator, splints, etc. This storage shall be located in an alcove or room, out of corridor or hallway traffic, and under staff control.

Provisions for reception, control, and public waiting, including a public toilet room(s) with handwashing fixture(s), and public telephone.

Patient toilet room(s) with handwashing fixture(s) shall be immediately accessible to the treatment room(s).

Communication connections to the Poison Control Center and local EMS system shall be provided.

A patient cubicle with a minimum clear floor area of 100 square feet (9.29 m²) shall be provided under the visual control of an emergency service staff work area. The patient station shall have space at bedside for visitors and shall have provision for visual privacy from casual observation by other patients and visitors. A handwashing station shall be located in each room, and at least one handwashing station shall be provided for every four patient stations, and for each major fraction thereof, in open-bay areas. These shall be uniformly distributed to provide equal access from each patient station.

Exception: For small and rural hospitals, the observation area need not be dedicated solely for that purpose.

If provided, the airborne infection isolation exam/treatment room shall comply with the requirements of Section 1224.4.4.1.3.

When 24-hour basic emergency service is to be provided, at a minimum, all the provisions of Standby Emergency Service under Section 1224.33.2 and the following shall be provided:

In addition to the requirements of Section 1224.33.2.1 the emergency entrance shall have direct access from public roads for ambulance and vehicle traffic conforming with the requirements of the local authorities having jurisdiction. Entrance and driveway shall be clearly marked. If a raised platform is used for ambulance discharge, provide a ramp for pedestrian and wheelchair access.

Paved emergency access shall be provided to permit discharge of patients from automobiles and ambulances, and temporary parking convenient to the entrance.

This area shall be located to permit staff observation and control of access to treatment areas, pedestrian and ambulance entrances, and public waiting area.

Storage for wheelchairs and gurneys for arriving patients shall be located out of circulation paths with access to emergency entrances.

A public waiting area shall be provided in compliance with Section 1224.4.5 and include provision of public toilet room(s), drinking fountains, and telephone adjacent to the waiting area, dedicated to, and within, the Emergency Service Space.

Examination and treatment rooms shall meet the requirements under Section 1224.33.2.2.

These rooms are for emergency procedures, including emergency surgery, and shall have at least 250 square feet (23.23 m²) of clear floor space. A minimum clearance of 5 feet (152 mm) shall be provided around all sides of the procedure table or gurney. Each room shall have cabinets and emergency supply shelves, image viewing capability, examination lights, and counter space for writing. Additional space with cubicle curtains for privacy may be provided to accommodate more than one patient at a time in the trauma room with a minimum clear floor area of 200 square feet (18.58 m²) for each patient bay defined by the privacy curtains. There shall be storage provided for immediate access to attire used for universal precautions. Doors leading from the ambulance entrance to the cardiac trauma room shall have an opening with a minimum width of 5 feet (1524 mm). At least one scrub sink shall be located outside the entrance to each trauma room. One scrub station consisting of two scrub positions is permitted to serve two trauma rooms if located adjacent to the entrance of each procedure room. The placement of scrub sinks shall not restrict the minimum required corridor width.

At least one orthopedic or cast room shall be provided within the emergency service space. Provisions shall include storage for splints and other orthopedic supplies, traction hooks, image viewing capability, and examination lights. If a sink is used for the disposal of plaster of paris, a plaster trap shall be provided. The clear floor space for this area shall be a minimum of 180 square feet (16.7 m²)

Communication connections shall be provided as required under Section 1224.33.2.6. The communications center may be a part of the staff work and charting area.

Equipment and supply storage shall be provided as required under Section 1224.33.2.3.

A patient toilet room with a lavatory shall be immediately accessible to the treatment room(s). Where there are more than eight treatment stations, a minimum of two toilet rooms, with a lavatory in each toilet room, shall be required.

Provide rooms for clean, soiled or used supplies.

See Section 1224.4.4.7. This room is for the exclusive use of the emergency service space.

See Section 1224.4.4.6.

These areas shall have space for counters, cabinets, and medication storage, and shall be provided with handwashing stations. They may be combined with or include centers for reception and communication.

A staff lounge shall be located within the Emergency Department and include staff clothing change areas with lockers, showers, toilets and handwashing stations for male and female staff.

A housekeeping room, compliant with Section 1224.4.15, shall be located within the unit and dedicated to the emergency service space.

If provided shall comply with the requirements of Section 1224.4.4.1.3.

When a secure holding room is provided, it shall meet the following requirements. The location of the secure holding room(s) shall facilitate staff observation and monitoring of patients in these areas. The secure holding room shall have a minimum clear floor area of 60 square feet (5.57 square meters) with a minimum wall length of 7 feet (2.13 meters) and a maximum wall length of 11 feet (3.35 meters). This room shall be designed to prevent injury to patients:

1. All finishes, light fixtures, vents, diffusers, and fire protection/alarm components shall be tamper resistant and ligature resistant.
2. There shall not be any electrical outlets, medical gas outlets, or similar devices.
3. There shall be no sharp corners, edges, or protrusions, and the walls shall be free of objects or accessories of any kind.
4. Patient room doors shall swing out and shall have hardware on the exterior side of the door only. The minimum width shall be 44 inches (1120 mm).
5. A small impact-resistant view panel or window shall be provided in the door for discreet staff observation of the patient.

When 24-hour comprehensive emergency service is to be provided, an Emergency Department shall be provided. At a minimum, all the provisions of Stand-by Emergency Service under Section 1224.33.2, the provisions of Basic Emergency Service under Section 1224.33.3, and all of the following shall be provided:

In addition to the requirements of Section 1224.33.3.3, the triage area shall include triage station(s) with the following minimum requirements:

1. 100 square feet (9.29 m²) minimum clear floor area for each private triage room and 80 square feet (7.4 m²) minimum clear floor area for each station in open-bay triage areas.
2. Provisions for patient privacy.
3. Handwashing station in each triage room. In open-bay triage areas, one handwashing station shall be provided for every four triage stations.
4. Immediate access to emergency call and code call stations.
5. Medical gas outlets for triage areas in compliance with Table 1224.4.6.1.

A fast-track area may be used for treating patients presenting simple and less serious conditions. If a fast-track area is provided, it shall meet the following requirements:

1. Space requirements – each fast-track station shall have a minimum 100 square feet (9.29 m²) of clear floor area.
2. Each station shall include a handwashing station, work/documentation counter, examination table light.
3. Storage areas for supplies and medication.
4. A separate procedure room may be provided. It shall have a minimum clear floor area of 120 square feet (11.15 m²).

A pre-screening area may be used prior to admission to the Emergency Department. If pre-screening is provided, each station must have a minimum of 80 square feet (7.4 m²) of clear floor area, a handwashing station, documentation counter, and a storage cabinet. Pre-screening stations, whether private rooms or open bays, are considered a part of the waiting area and must meet the same ventilation requirements.

Radiological/ Imaging services shall be readily accessible. The Emergency Department shall be supported by Clinical Laboratory services. A STAT lab may be provided within the emergency medical service space in addition to more comprehensive support provided by the Clinical Lab.

Provisions shall be made to accommodate on-call sleeping room(s) for physicians and/or medical staff within the Emergency Department.

Provisions shall be made to accommodate police briefing/debriefing and press releases. This may be located outside the Emergency Department.

Observation rooms for the monitoring of patients up to 24 hours may be provided as a distinct unit within, the emergency department. If provided the unit shall have the following:

1. Handwashing stations shall be provided in each patient room and for each four treatment stations, and for each major fraction thereof. These shall be uniformly distributed to provide equal access from each patient station. Handwashing stations shall be directly accessible to nurse stations and patient care areas.
2. Each patient station shall have a minimum of 120 square feet (11.15 m²) of clear floor area including space at each bedside for visitors and provision for visual privacy from casual observation by other patients and visitors.
3. One toilet room shall be provided for each six treatment stations and for each major fraction thereof.
4. An administrative center/nurse station, in compliance with Section 1224.4.4.2, positioned to allow staff to observe each patient care station or room.
5. A nourishment area in compliance with Section 1224.4.4.5.

If nuclear medicine is provided, the following shall be provided:

A certified physicist shall specify the type, location and amount of radiation protection to be installed in accordance with final approved department layout and equipment selection. 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.

Shall be sized to accommodate the equipment and a gurney.

When provided, the following facilities shall meet the requirements below:

Shall include the following:

1. Scanner room. The scanner room shall provide a minimum clearance of 4 feet (1218 mm).at each side and the foot of the table.
2. Handwashing stations shall be provided throughout the gamma camera suite at locations of patient contact and at locations where radiopharmaceutical materials are handled, prepared, or disposed of.

Shall include the following:

1. Scanner room shall provide a minimum clearance of 4 feet (1218 mm) at each side and the foot of the table. Additional space shall be provided when PET is combined with CT, and include compliance with Section 1224.18.3 and shielding requirements in Section 1224.34.1.1.
2. Cyclotron room. Where radiopharmaceuticals are prepared on-site, a cyclotron shall be provided. Cyclotron facilities shall be located in access-restricted areas. Shielding requirements for cyclotron facilities shall comply with Section 1224.34.1.1.
3. Control room. A control room shall be provided with a full direct view of the patient in the PET scanner.
4. Patient uptake/cool-down room. A shielded room with access to a dedicated patient toilet, to accommodate radioactive waste, and lavatory shall be provided.
5. Handwashing stations shall be provided throughout the PET suite at locations of patient contact and at locations where radiopharmaceutical materials are handled, prepared, or disposed of.
6. Pre-procedure patient care and recovery area shall be provided to accommodate at least two stretchers. This area shall comply with Section 1224.34.2.6.
7. Computer equipment room shall be provided in support of the equipment provided.
8. Contaminated (hot) soiled holding shall be provided and operationally integrated to minimize incidental exposure to ionizing radiation.

When provided shall include the following:

1. Scanner room. Scanner room shall provide a minimum clearance of 4 feet (1218 mm) at each side and the foot of the table.
2. Control room. A control room shall be provided with a full direct view of the patient in the SPECT scanner.
3. Computer equipment room shall be provided in support of the equipment provided.
4. Handwashing stations shall be provided throughout the SPECT suite at locations of patient contact and at locations where radiopharmaceutical materials are handled, prepared, or disposed.

If radiopharmaceutical preparation is performed, an area adequate to house a radiopharmacy shall be provided with appropriate shielding. This area shall include adequate space for storage of radionuclides, chemicals for preparation, dose calibrators, and record keeping. If preprepared materials are used, storage and calculation area may be considerably smaller than that for on-site preparation. Space shall provide adequately for dose calibration, quality assurance, and record keeping. The area may still require shielding from other portions of the facilities.

Nuclear medicine area when operated separately from the imaging department shall provide the following:

Space shall be adequate to permit entry of gurneys, beds, and able to accommodate imaging equipment, electronic consoles, and if present, computer terminals.

Provisions for cleanup shall be located within the service space and be readily accessible. They shall include a service sink or floor receptacle as well as storage space for equipment and supplies.

A consultation area may be provided.

Waiting areas shall be provided out of traffic, under staff control. If the department is routinely used for outpatients and inpatients at the same time, separate waiting areas shall be provided with screening or visual privacy between the waiting areas.

Provide a dose administration area that is immediately accessible to the preparation area. Since as much as several hours may elapse for the dose to take effect, the area shall provide for visual privacy from other areas.

A pre-procedure/holding area for patients on gurneys or beds shall be provided out of traffic and under control of staff and may be combined with the dose administration area with visual privacy between the areas.

Patient dressing rooms shall be immediately accessible to the waiting area and procedure rooms. Each dressing room shall include a seat or bench, a mirror, and provisions for hanging patients’ clothing and for securing valuables.

Patient toilet rooms shall be reserved for nuclear medicine patients and shall be immediately accessible to waiting and procedure rooms.

Staff toilet rooms shall be readily accessible to the nuclear medicine laboratory.

Shall be located within each procedure room.

Provisions with handwashing fixtures shall be made for holding soiled material. Separate provisions shall be made for holding contaminated material.

A securable area or room shall be provided in which radiopharmaceuticals can be safely stored and doses can be calculated and prepared.

1. A single hot lab shall be permitted to serve multiple scanners and nuclear medicine modalities.
2. The hot lab shall be shielded in compliance with Section 1224.34.1.1.
3. A source storage area, a dose area, and a storage area for syringe shields shall be provided.

If radiation therapy is provided, the following shall be accommodated:

1. Patient reception and waiting areas.
2. Space for medical and physics staff functions.
3. Space for equipment and supplies.
4. Housekeeping room.

5. Direct access to space provided for radiation measurement and calibration equipment, including a calibration constancy instrument and access to a secondary standard dose meter.

   1. 5.1. A megavoltage treatment unit capable of delivering x-rays or gamma rays of effective energy 500 KeV or more and conforming to the requirements of Chapter 31C and the California Radiation Control Regulations, California Code of Regulations, Title 17, Division 1, Chapter 5, Subchapter 4.
   2. 5.2. Access to a medium voltage or superficial treatment unit delivering 500 KeV or less, but otherwise having the same functional characteristics as the above mega-voltage units and conforming to the requirements of Chapter 31C and the California Radiation Control Regulations, California Code of Regulations, Title 17, Division 1, Chapter 5, Subchapter 4.
   3. 5.3. Direct access to space provided for brachytherapy equipment which shall meet the requirements of Chapter 31C and the California Radiation Control Regulations, California Code of Regulations, Title 17, Division 1, Chapter 5, Subchapter 4.
   4. 5.4. Shielding of the rooms shall meet the requirements of Chapter 31C and the California Radiation Control Regulations. California Code of Regulations, Title 17, Division 1, Chapter 5, Subchapter 4.

Cobalt, linear accelerators, hot lab and high dose rate brachytherapy rooms and simulation rooms require radiation protection. All rooms that provide radiation treatment shall be appropriately shielded. A certified physicist shall specify the type, location, and amount of protection to be installed in accordance with final approved department layout and equipment selection. 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.

Rooms shall be sized as follows:

1. Cobalt rooms and linear accelerators shall be sized in accordance with equipment requirements and shall accommodate a gurney for litter borne patients. Layouts shall provide for preventing the escape of radioactive particles. Openings into the room, including doors, ductwork, vents and electrical raceways and conduits, shall be baffled to prevent direct exposure to other areas of the facility.
2. Simulator, accelerator and cobalt rooms shall be sized to accommodate the equipment with patient access on a gurney, medical staff access to the equipment and patient, and service access.
3. Where a table is used, the room shall be sized to provide a minimum clearance of 4 feet (1218 mm) on three sides of the table to facilitate bed transfer and provide access to the patient. The door swing shall not encroach on the equipment space, patient circulation space, or transfer space.
4. Minimum room size shall be 260 square feet (24.15 m²) for the simulator room; 680 square feet (63.17 m²), including the maze, for accelerator rooms; 200 square feet (18.58 m²) for brachytherapy rooms; and 450 square feet (41.81 m²) for cobalt rooms.

The following areas shall be provided:

1. A gurney hold area adjacent to the treatment rooms, screened for privacy, and combined with a seating area for outpatients.

2. Exam or treatment room shall be provided with a minimum of 100 square feet (9.29 m²) with a minimum dimension of 8 feet (2438 mm). Each exam room shall be equipped with a handwashing fixture.

   Exceptions:

   1. Where renovation of existing treatment rooms is undertaken in facilities built under the 2001 or prior California Building Code, treatment rooms shall have no less than 80 square feet (7.43 m²) of clear floor area.
   2. Darkroom is optional. If provided, shall be readily accessible to the treatment room(s)
   3. Patient gowning area with provision for safe storage of valuables and clothing and with direct access to toilet room(s). At least one space shall be large enough for staffassisted dressing.
   4. Film files area is optional. If provided shall have storage for unprocessed film.

Mold room with exhaust hood and hand-washing fixture.

Block room with storage. The block room may be combined with the mold room.

A hot lab shall be provided in accordance with Section1224.34.2.14.

If radiosurgery (gamma knife/cyber knife) is provided, the following shall be provided:

The radiosurgery suite shall be located near the imaging services suite to facilitate image acquisition prior to radiosurgery treatment. Location of gamma knife or cyber knife treatment rooms in a radiation therapy suite shall be permitted.

Radiosurgery (gamma knife/cyber knife) treatment rooms shall provide a minimum clearance of 4 feet (1218 mm) shall be provided on all sides of the treatment table/chair. The door shall not encroach on the equipment or on patient circulation or transfer space. A handwashing station shall be provided in each radiosurgery treatment room.

If provided, pre-procedure/recovery patient care stations shall meet the following requirements:

1. Pre-procedure and recovery area(s) shall be immediately accessible to procedure rooms and separate from corridors. The pre-procedure and recovery patient area or room shall be arranged to permit visual observation of the patient by staff before and after the procedure. Bays, cubicles, or single-bed rooms shall be permitted to serve as patient care stations.
2. Area. Where open bays are used, each patient care station shall have a minimum clear floor area of 80 square feet (7.43 m²).
3. Clearances. Each bay or cubicle shall have a minimum clearance of 3 feet (914 mm) between walls or partitions and the sides and foot of gurneys or patient beds. Each bay shall have a minimum clearance of 4 feet (1218 mm) between sides of gurneys or patient beds.
4. Patient privacy. Provisions such as cubicle curtains shall be provided for patient privacy.
5. Handwashing station. A handwashing station shall be provided within the pre-procedure/ recovery area.

The following shall be provided:

1. Space for sterilization of head-frames.
2. Area for target planning.
3. Medication station.
4. Nourishment area.
5. Head-frame storage.
6. Toilet room(s) for patients, staff and the public.
7. Area for sedation of pediatric patients.

If provided, a rehabilitation center space shall be designed to meet the requirements of Section 1224.14, except as follows:

1. Patient bedrooms shall contain a minimum of 110 square feet (10.22 m²) of clear floor area per bed, exclusive of toilet room(s), closets, lockers, wardrobes, alcoves or vestibules, with greater space provided for special needs such as circ-o-electric beds.
2. Space for group dining shall be provided at the minimum rate of 20 square feet (1.86 m²) per bed.
3. Space for group recreation or patient’s lounge shall be provided at the minimum rate of 20 square feet (1.86 m²) per bed.
4. Space for staff conferences, patient evaluation, and progress reports.
5. A classroom space.
6. An examination and treatment room, adjacent or directly accessible to an office for the physician in charge of the outpatient service.
7. A patient waiting area with access to telephone, drinking fountain, and men’s and women’s toilet room facilities in or adjacent to the rehabilitation outpatient service area.
8. Access to an outside area to be used for therapeutic procedures for patients.
9. At least one training toilet room in each patient unit with minimum dimensions of 5 feet by 6 feet (1524 mm by 1829 mm).
10. Patient bathtubs, where provided, of standard height and located to provide access to both sides and one end of the tub.
11. Patient showers, where provided in centralized bathing facilities, shall comply with Section 11B-608.2.2, no dimension of which shall be less than 4 feet (1219 mm), be equipped with handrails, privacy curtains, and designed for ease of accessibility. The floor shall be sloped to provide drainage.

If physical therapy is part of the service, the following shall be included:

1. The minimum floor area for a physical therapy space shall be 300 square feet (27.87 m²) with no dimensions less than 12 feet (3658 mm). Each individual patient care station shall have a minimum clear floor area of 60 square feet (5.57 m²), except individual patient care stations formed with permanent partitions shall have a minimum clear floor area of 80 square feet (7.43 m²). Each individual patient care station shall have privacy screens or curtains.
2. Handwashing fixtures for staff either within or at each treatment space. (One handwashing fixture may serve several treatment stations.)
3. Exercise area and facilities.
4. Clean linen and towel storage.
5. Storage for equipment and supplies.
6. Separate storage for soiled linen, towels, and supplies.

Exception: When approved by the licensing agency small or rural hospitals are exempt from Sections 1224.35.2.1 through 1224.35.2.6.

If this service is provided, the following shall be included:

1. Work areas and counters suitable for wheelchair access.
2. Handwashing fixture(s).
3. Storage for supplies and equipment.
4. An area for teaching daily living activities shall be provided. It shall contain an area for a bed, kitchen counter with appliances and sink, bathroom, and a table/chair.

If a speech pathology service is provided, space shall be provided for:

1. Tables and chairs to conduct interviews, consultations and treatment, and to accommodate patients in wheelchairs and stretchers.
2. A waiting area with access to public toilet room(s) if outpatients are being served.
3. Handwashing fixture.
4. Testing unit. If an audiology service is provided, there shall be, in addition to Items 1, 2 and 3 above, a minimum of one two-room testing unit that meets the American National Standards Institute, ANSI/ASA S-3.1, 1999, (2008) Maximum Permissible Ambient Noise Levels for Audiometric Test Rooms.

If provided, renal dialysis service shall comply with the following:

The treatment area may be an open area and shall be separate from administrative and waiting areas.

Shall be located within the dialysis treatment area and designed to provide visual observation of all patient stations.

Shall contain at least 80 square feet (7.44 m²). There shall be at least a 4-foot (1219 mm) space around and between beds and/or lounge chairs.

Handwashing stations shall be directly accessible to the nurses’ station and to patient treatment areas. Handwashing stations shall be provided for each four treatment stations, and for each major fraction thereof. These shall be uniformly distributed to provide equal access from each patient station.

The open unit shall be designed to provide privacy for each patient.

A minimum of one bloodborne infection isolation room of at least 120 square feet (11.15 m²) of clear floor space shall be provided for patients. This room shall contain a counter and handwashing fixture.

If provided, there shall be a medication dispensing station for the dialysis center. A work counter and handwashing fixtures shall be included in this area. Provisions shall be made for the controlled storage, preparation, distribution and refrigeration of medications.

If provided in the unit, a private treatment area of at least 120 square feet (11.15 m²) shall be provided for patients who are being trained to use dialysis equipment at home. This room shall contain counter, handwashing fixtures, and a separate drain for fluid disposal.

An examination room with a handwashing fixture shall be provided with at least 100 square feet (9.29 m²).

A clean utility room shall be provided. 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 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.

A soiled workroom shall be provided and contain a sink, handwashing fixture, work counter, storage cabinets, waste receptacles and a soiled linen receptacle.

If dialyzers are reused, a reprocessing room is required and sized to perform the functions required and include one-way flow of materials from soiled to clean with provisions for a refrigerator (temporary storage or dialyzer), decontamination/cleaning areas, sinks, processors, computer processors and label printers, packaging area and dialyzer storage and disinfectants cabinets.

If a nourishment station for the dialysis service is provided, the nourishment station shall contain a sink, a work counter, a refrigerator, storage cabinets and equipment for serving nourishments as required.

Provide a housekeeping room that is immediately accessible to, and for the exclusive use of the unit

If required, an equipment repair and breakdown room shall be equipped with a handwashing fixture, deep service sink, work counter and storage cabinet. Needs water supply and drain connection for testing machines.

Supply areas or supply carts shall be provided.

Storage space shall be available for wheelchairs and gurneys, if gurneys are provided, out of direct line of traffic.

A clean linen storage area shall be provided. This may be within the clean utility room, a separate closet, or an approved distribution system. If a closed cart system is used, storage may be in an alcove. It must be out of the path of normal traffic and under staff control.

Each facility using a central batch delivery system shall provide, either on the premises or through written arrangements, individual delivery systems for the treatment of any patient requiring special dialysis solutions. The mixing room shall also include a sink, storage space and holding tanks.

The water treatment equipment shall be located in an enclosed room.

A patient toilet room with a lavatory shall be provided.

Space shall be available for male and female personnel for staff clothing change area and lounge. The areas shall contain lockers, shower, toilet(s), and handwashing fixtures.

Storage for patients’ belongings shall be provided.

A waiting room, toilet room(s) with handwashing fixtures, drinking fountain, public telephone, and seating accommodations for waiting periods shall be available or accessible to the dialysis unit.

Provide office and clinical work space.

If respiratory service is provided, the following elements shall be included:

1. Storage for equipment and supplies.
2. Space and utilities for cleaning and disinfecting equipment. Provide physical separation of the space for receiving and cleaning soiled materials from the space for storage of clean equipment and supplies. Appropriate local exhaust ventilation shall be provided if gluteraldehyde or other noxious disinfectants are used in the cleaning process. This space may be co-located with other reprocessing functions within the hospital.

3. Additional facilities. If respiratory services such as testing and demonstration for outpatients are part of the program, additional facilities and equipment shall be provided including but not limited to:

   1. 3.1. Patient waiting.
   2. 3.2. A reception and control station.

An intermediate-care service unit shall be housed in a separate and distinct nursing unit and shall comply with the applicable requirements of Section 1225.

Provide with access to public toilet room facilities, a public telephone and a drinking fountain. These facilities may be shared with other services.

If outpatient surgery is performed in the out patient service area, the following shall be provided:

1. An operating room(s) with a minimum clear floor area of 270 square feet (25.08 m²), no dimension of which shall be less than 15 feet (4572 mm).
2. Preoperative patient holding shall be provided in accordance with Section 1224.16.2.
3. A postanesthesia recovery area which meets the requirements of Section 1224.16.
4. Each surgical unit shall provide a separate cleanup room separated from any surgical sterilizing facilities. The cleanup room shall provide 24 square feet (2.2 m²) per operating room up to eight operating rooms and shall have the minimum area of 48 square feet (4.5 m²), with no dimension less than 6 feet (1829 mm).
5. Scrub sinks which meet the requirements of Section 1224.15.3.5.
6. Service areas which meet the requirements of Section 1224.15.3.
7. A housekeeping room shall be provided for the exclusive use of outpatient surgery. It shall be directly accessible from the service area.

If gastrointestinal endoscopy is performed in the outpatient service area, the endoscopy suite shall be divided into a minimum of three major functional areas: the procedure room(s), instrument processing room(s), and patient holding/preparation and recovery room or area and the following shall be provided:

Procedure room shall have a minimum clear floor area of 200 square feet (18.6 m²). Room arrangement shall permit a minimum clearance of 3 feet, 6 inches (1067 mm) at each side, head, and foot of the gurney/table.

A separate dedicated handwashing station with hands-free controls shall be provided in the procedure room.

Dedicated processing room(s) for cleaning and decontaminating instruments shall be provided. The cleaning area shall allow for flow of instruments from the contaminated area to the clean assembly area and then to storage.

The decontamination area shall be equipped with the following:

1. Utility sink(s) shall be provided as appropriate to the method of decontamination used.
2. One freestanding handwashing station.
3. Work counter space(s).

A pre-operative patient holding area shall be provided in accordance with Section 1224.16.2.

A post-anesthesia recovery area shall meet the requirements of Section 1224.16.3.

A system for emergency communication shall be provided.

If provided, cancer treatment/ infusion therapy service shall comply with the following:

The treatment area may be an open area and shall be separated from administrative and waiting areas.

Shall be located within the cancer treatment/infusion therapy area and designed to provide visual observation of all patient stations.

Shall contain at least 80 square feet (7.4 m2).

There shall be at least a 4-foot (1219 mm) space around and between beds and/or lounge chairs used for chemotherapy treatment/infusion.

Handwashing stations shall be directly accessible to the nurses’ station and patient treatment areas. Handwashing stations shall be provided for each four patient stations, and for each major fraction thereof. These shall be uniformly distributed to provide equal access from each patient station.

The open unit shall be designed to provide privacy for each patient.

If provided, there shall be a medication dispensing station for the cancer treatment/infusion therapy area. A work counter and handwashing fixture(s) shall be included in the area. Provisions shall be made for the controlled storage, preparation, distribution and refrigeration of medications.

An examination room with a handwashing fixture shall be provided with at least 100 square feet (9.29 m²).

A clean utility room shall be provided. 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 for storage and holding as part of a system for distribution of clean and sterile 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.

A soiled work-room shall be provided and contain a sink, hand-washing fixture, work counter, storage cabinets, waste receptacles and a soiled linen receptacle.

If nourishment station for the cancer treatment/infusion therapy service is provided, the nourishment station shall contain a sink, a work counter, a refrigerator, storage cabinets and equipment for serving nourishment as required.