Section 1226 [OSHPD 3] Clinics

The provisions of this section shall apply to outpatient clinical services of a hospital when provided in a freestanding building, primary care clinics, specialty clinics, and psychology clinics. Primary care clinics include free clinics, community clinics, employee clinics and optometric clinics. Specialty clinics include surgical clinics, chronic dialysis clinics, rehabilitation clinics and alternative birth centers (ABC).

All new buildings and additions, alterations or repairs to existing buildings, and conversion of space to a clinic use within existing buildings, subject to licensure by Licensing and Certification, California Department of Public Health, shall comply with applicable provisions of the California Electrical Code, California Mechanical Code, California Plumbing Code, California Fire Code, (Parts 3, 4, 5, and 9 of Title 24) and this section. OSHPD requirements apply to all facilities described above and are not dependent upon Occupancy Group designations.

Exception: See Section 1224.2.

Hospitals providing outpatient clinical services and clinics licensed under Health and Safety Code Section 1200 providing services that are not covered by this section shall meet the applicable requirements in Section 1224.

A general acute care hospital referenced in Health and Safety Code Section 1255 (d) (3) (E), that provides special services in conformance with Health and Safety Code Section 1255, shall meet all the provisions of Section 1224.28.3 in addition to Section 1226.2. The Office of Statewide Health Planning and Development (OSHPD) shall review any proposed construction or alteration for OSHPD compliance.

Refer to Section 1224.3.

Clinics and outpatient clinical services under a hospital license shall comply with the following provisions wherever applicable.

Refer to Section 1224.4.2.

Refer to Section 1224.4.3.

Refer to Section 1224.4.4.1.

Refer to Section 1224.4.4.1.3.

When provided, refer to Section 1224.4.6.1.

When provided refer to Section 1224.4.6.2.

When provided, refer to Section 1224.4.6.3.

Refer to Section 1224.4.6.4.

Refer to Section 1224.4.6.5.

Refer to Section 1224.4.7.3

For clinics with bed/gurney patient(s) refer to Section 1224.4.7.1.

Refer Section 1224.4.7.2.

For rehabilitation services space, refer to Section 1224.4.7.4.

Refer to Section 1224.4.7.5.

Refer to Section 1224.4.8.1.

Refer to Section 1224.4.8.2.

Refer to Section 1224.4.9.4.

Refer to Section 1224.4.9.5.

For minimum ceiling height requirements, refer to Section 1224.4.10.1.

Refer to Section 1224.4.10.2.

Refer to Section 1224.4.11.1 and Table 1224.4.11.

Refer to Section 1224.4.11.1.1.

Refer to Section 1224.4.11.1.3.

Refer to Section 1224.11.1.4.

Refer to Section 1224.4.11.2.1.

Refer to Section 1224.4.11.2.2.

Refer to Section 1224.4.11.3.

Ceiling finishes shall comply with Section 1224.4.11.4 and Table 1224.4.11.

Buildings over one story in height with accommodations or services for patients on floors without grade-level entrance shall provide at least one elevator in compliance with Section 3002.4.

Elevators used for the routine transport of wheeled stretchers shall have minimum inside platform dimensions of 5 feet by 8 feet (1524 mm by 2438 mm) and a minimum clear door opening of 3 feet 8 inches (1118 mm).

These facilities shall comply with the appropriate local health and environmental authorities' requirements, California Department of Public Health requirements for medical waste management, and comply with the following minimum requirements:

A location shall be provided for waste collection and storage with sufficient space based upon the volume of projected waste and length of anticipated storage. The location of compactors, balers, sharps containers, and recycling container staging at docks or other waste removal areas shall comply with Section 1224.4.2.

A lockable room or screened enclosure of at least 25 square feet (2.32 m²) shall be provided for the washing and cleaning of garbage containers and for the storage of garbage, trash and other solid wastes.

Exception: This amount of space may not be required by the enforcing agency if there is a proposed method of handling and storage which requires a lesser amount of space. Additional space may be required by the enforcing agency when special operations or collection and disposal methods result in greater than usual accumulation of solid wastes.

The room or screened enclosure shall include the following:

1. Floor and curb. A concrete floor with a curb and with a drain connected to the sewer.
2. Water. Steam or hot water and cold water supplies in accordance with the California Plumbing Code.
3. Size. A minimum floor area of not less than 25 square feet (2.32 m²), the least dimension of which shall be 4 feet (1219 mm). This amount of space may not be required by the enforcing agency if there is proposed a method of handling, storage, or cleaning of containers which requires a lesser amount of space. Additional space may be required by the enforcing agency when special operations or collection and disposal methods result in greater than usual accumulation of solid wastes.

As an alternative to the requirements in Section 1226.4.9.2, a holding room for medical waste and garbage may be provided.

Exception: This amount of space may not be required by the enforcing agency if there is a proposed method of handling and storage which requires a lesser amount of space. Additional space may be required by the enforcing agency when special operations or collection and disposal methods result in greater than usual accumulation of solid wastes.

The waste holding room shall comply with the following:

1. The waste holding room shall be a minimum of 25 square feet, with the least dimension of which is 4 feet.
2. The waste holding room shall have 100 percent exhaust ventilation.
3. All finishes in the waste holding room shall comply with the requirements in Section 1224.4.11.
4. The waste holding room shall be immediately accessible to an exterior door.

Trash compactor systems shall meet the drainage and wash-down requirements under Section 1226.4.9.2, Items 1 and 2.

Exception: If a dumpster system is proposed, operational procedures for handling and storage must be specifically approved by the local health officials.

Refer to Section 1224.4.15.

Gravity-type laundry and trash chutes shall comply with Section 1224.4.16.

This area shall have space for counters and storage and shall have direct access to a handwashing stations (refer to Section 1224.3 for definition of handwashing station). It may be combined with or include centers for reception, charting and communication.

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

When provided, the entry of the medicine preparation room or area shall be under the visual control of the staff. This may be a part of the administrative center or nurse station and shall include all of the following:

1. Work counter
2. Sink
3. Lockable refrigerator
4. Immediate access to handwashing station
5. Locked storage for biologicals and drugs

When a medicine preparation room or area is to be used to store self-contained medicine dispensing units, the room shall be designed with adequate space to prepare medicines with the self-contained medicine-dispensing units present.

When provided, the location of a self-contained medicine-dispensing unit shall be permitted in the clean workroom or at the administrative center or nurses' station, provided there is adequate security for medications and adequate lighting to easily identify drugs. Immediate access to a handwashing station shall be provided.

A clean utility room shall be provided. If the room is used for preparing patient care items, it shall contain:

1. Work counter
2. Handwashing fixture
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 and handwashing fixture may be omitted. Soiled and clean utility rooms or holding rooms shall be separated and have no direct connection.

Soiled workroom or soiled holding room shall be provided and contain:

1. Clinic sink

   Exception: For primary care clinics, a utility sink or patient toilet room equipped with a bedpan flushing device may be provided in lieu of a clinic sink. A utility sink may be used for soaking or rinsing and shall be provided as appropriate to the method of decontamination used.

2. Handwashing fixture
3. Work counter
4. Storage cabinets
5. A designated area for waste receptacle(s)
6. A designated area for soiled linen receptacle(s)

If the clinic includes a central sterile supply that complies with Section 1224.22 and the soiled holding room is used only for temporary holding of soiled materials, the clinic sink and work counter may be omitted. Where rooms are used for temporary holding of materials, provisions shall be made for separate collection, storage, and disposal of soiled materials. Soiled and clean utility rooms or holding rooms shall be separated and have no direct connection.

Separate storage for sterile supplies and pharmaceutical supplies shall be provided.

When provided, a sterilization facility shall meet the following applicable requirements:

Each facility shall provide space for the storage of disposable sterile supplies or provide space for sterilization and disinfection equipment.

Exception: Facilities with contractual arrangements for outside autoclaving and sterilizing services.

When provided, rooms and spaces of the central supply and sterilizing area shall comply with the following:

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 materials.
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 and equipment disinfection space.
4. Storage. Space for sterile supplies and unsterile supplies.

When provided, all sterilizers and autoclaves which emit system 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.

When provided, the nourishment room or area shall have all of the following:

1. Sink
2. Work counter
3. Refrigerator
4. Storage cabinets
5. Equipment for serving nourishment
6. A handwashing fixture, as defined in Section 1224.3, shall be located in the nourishment room or adjacent to the nourishment area.

Toilet room(s) with a lavatory shall be provided separate from public use toilet(s) and shall be located to permit access from patient care areas without passing through publicly accessible areas.

Exception: For primary care clinics where the facility contains no more than three examination and/or treatment rooms, the patient toilet room shall be permitted to serve outpatient waiting room(s).

When provided, refer to Section 1224.4.4.2. Use of patient toilet room(s) shall be permitted for specimen collection.

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

1. Soiled linen holding area or designated and dedicated area for soiled laundry cart.
2. Clean linen storage area that protects linen from soil or damage.

A reception and information counter or desk shall be provided.

Refer to Section 1224.4.5.

Outpatient clinics shall provide a health record service which shall comply with the following:

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.

General storage facilities for office supplies and equipment shall be provided.

Provide staff toilet(s) in addition to and separate from, public and patient facilities. The areas shall contain toilet(s) and handwashing fixtures pursuant to the California Plumbing Code, Table 4-2.

Provide storage for staff personal effects with locking drawers or cabinets (may be individual desks or cabinets). Such storage shall be readily accessible to individual workstations and shall be staff controlled.

When provided, the lounge shall have adequate space to accommodate staff.

A licensed hospital may elect to locate certain outpatient services in a freestanding outpatient clinical services building(s). To be considered a freestanding outpatient clinical services building the building must not be physically attached to a building in which inpatient services are provided. No more than 25 percent of the services provided in an outpatient clinical services building may be rendered to inpatients. Services that duplicate the basic services may be provided in freestanding building(s). These services, defined in Subsection (a) of the Health and Safety Code Section 1250, must be in excess of the basic services, necessary for hospital licensure, required to be located in a hospital building under OSHPD jurisdiction.

Outpatient clinical services of a hospital in a freestanding outpatient clinical services building shall comply with Sections 1226.4.2 through 1226.4.8 and the provisions of this section. Outpatient clinical services of a hospital that are not addressed in the provisions of Section 1226 shall comply with applicable provisions of Section 1224.

GENERAL SUPPORT AREAS FOR OUTPATIENT CLINICAL SERVICES - Requirements for all service types.

Refer to Section 1226.4.14.1.

When provided, refer to Section 1224.4.4.2.

Refer to Section 1226.4.9.

Refer to Section 1224.4.15.

Refer to Section 1226.4.16.1.1.

Refer to Section 1224.4.5.

Refer to Section 1224.4.5.

Refer to Section 1224.4.5.

Refer to Section 1224.4.5.

Refer to Section 1226.4.16.2.1.

Refer to Section 1226.4.16.2.2.

Refer to Section 1226.4.17.1.

Refer to Section 1226.4.17.2.