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.