1224.28 Supplemental Surgery and Special Procedure Services
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.
A control room or area shall be provided. A view window permitting full view of the patient from the control console shall be provided.
Appropriate areas shall be provided for male and female staff working within the surgical service space. The areas shall contain lockers, showers, toilets, lavatories equipped for handwashing, and space for donning surgical attire. These areas shall be arranged to ensure a traffic pattern so that personnel entering from outside the service space can enter, change their clothing, and move directly into the cardiac catheterization service space. The staff change area may be combined with the surgical staff change area.
A clean utility room shall be provided. If the room is used for preparing patient care items, it shall contain a work counter and handwashing fixture. If the room is used only for storage and holding of clean and sterile supply materials, the work counter and handwashing fixtures shall be permitted to be omitted. The clean utility may be shared with an adjacent surgical unit.
A soiled utility room shall be provided which shall contain a handwashing fixture and a clinical sink (or equivalent flushing rim fixtures). When the room is used for temporary holding or soiled materials, the clinical sink and handwashing fixture shall be permitted to be omitted. The soiled utility may be shared with an adjacent surgical unit.
A general acute care hospital referenced in Health and Safety Code Section 1255 (d)(3)(E) may provide cardiac catheterization laboratory service in a freestanding nonhospital building in conformance with this section and Section 1226.2.2. In addition, the service space shall comply with Section 1224.28.2 and applicable requirements in Section 1224.15.3 that are not covered by this section.
Outpatient support areas shall include outpatient waiting rooms in compliance with Section 1224.4.5. A separate space shall be provided where outpatients change from street clothing and are prepared for a procedure. This space shall include provisions for clothing storage, toilet room(s), sink and an area for clothing change and gowning.
The freestanding cardiac catheterization laboratory service space shall be located in the nonhospital building such that the service space has a direct connection to the general acute care hospital providing cardiac surgery by a patient corridor link in compliance with Section 1224.4.7. The corridor link shall have a minimum width of 8 feet (2438 mm) as required under Section 1220.127.116.11. The corridor link shall connect to the hospital corridor system with access to all basic services as required under Section 118.104.22.168.
Cardiac catheterization laboratories shall meet the provisions for ambulatory surgical clinics required in the California Electrical Code including the requirements of Article 517.45 for an essential electrical system.
Services/ systems and utilities that support the catheterization laboratory space include, but are not limited to: normal power; emergency power; nurse call; communication and data systems; space heating systems; cooling systems; domestic hot and cold water systems; building drain and sewer systems; and medical gas systems. When these systems serve other portions of the building, any alteration to the system shall be subject to review by the Office of Statewide Health Planning and Development.
A control room or area shall be provided.
- The control room or area shall be sized to accommodate the image-recording and viewing equipment.
- A shielded view window permitting direct observation of the patient from the control console shall be provided.
- The shielded control room shall be configured to prevent radiation exposure into occupied areas of the control room when ionizing radiation modalities are used.
- Where the procedure room requires positive (or negative) pressure, a door shall be provided between the control room and the procedure room or between the combined control room/procedure room and other adjacent space.
- Where control functions for ionizing radiation exposures take place in the procedure room, storage for personal radiation protection devices shall be provided.
A medication station shall be provided in compliance with the requirements in Section 122.214.171.124.
A reading room for reviewing images shall be available for use by the interventional imaging suite.
A soiled workroom shall be provided in accordance with Section 1126.96.36.199.
Staff changing areas shall be provided and arranged to ensure a traffic pattern so that personnel can enter from outside the suite, change their clothing, and move directly into the semi-restricted corridor within the interventional imaging suite.
- A minimum clear floor area of 650 square feet (60.39 m2) is required for a hybrid operating room unless the imaging equipment requires a larger area.
- The minimum clear dimension shall be 24 feet (7315 mm) unless the requirements for the specific imaging equipment require a greater distance.
- If mobile storage units are used in lieu of fixed cabinets, the minimum clear dimension shall be available between such units when they are parked against a permanent partition.
If required, a control room shall be provided that accommodates the imaging system control equipment and the following requirements:
- The control room shall have a minimum clear floor area of 120 square feet (11.15 m2), which may include fixed work surfaces.
- The room shall be physically separated from the hybrid operating rooms with walls and a door.
- The room shall have viewing windows that provide for a full view of the patient and the surgical team.
- If the control room is adjacent to a restricted area, it must be physically separated from the restricted area with walls and a door.
If the imaging equipment emits ionizing radiation, protection shall be provided in accordance with Section 1188.8.131.52.
Hybrid operating rooms with intraoperative magnetic resonance imaging (iMRI) systems shall comply with the following:
- Space and configuration requirements in Section 1224.18.4, except the clearances shall meet the requirements of 1184.108.40.206.
- The control room shall comply with Section 1224.18.4, Item 1.
- The anteroom shall comply with Section 1220.127.116.11.
- Entry doors to iMRI hybrid rooms shall swing outward from inside the room.
If electroconvulsive therapy (ECT) is provided, the requirements of this section shall be met. Where a psychiatric unit is part of a general acute care hospital (Section 1224.31 Psychiatric Nursing Unit), all the requirements in this section shall be permitted to be accommodated in a procedure suite that complies with the requirements in this section or in an operating room in a surgical suite that meets the requirements in Section 1224.15.
- Space requirements. Each ECT procedure room shall have a minimum clear floor area of 200 square feet (18.6 m2) with a minimum clear dimension of 14 feet (4267 mm)
- Handwashing station. A handwashing station shall be provided.
- Documentation area. Accommodation for written or electronic documentation shall be provided.
A waiting area and changing area shall be provided for outpatient use in perioperative areas in support ECT suites that provide outpatient procedures. The waiting room shall comply with Section 1224.4.5. The changing area shall include space for changing or gowning, provisions for storing patients' belongings during the procedure, and access to patient toilet(s).