Adopts Without Amendments:

FGI Hospital, 2018

Part 1 General

Part 2 Hospital Facility Types

ANSI/ASHRAE/ASHE Standard 170-2017 Ventilation of Health Care Facilities

Heads up: There are no amended sections in this chapter.
Appendix material, shown in shaded boxes at the bottom of the page, is advisory only.
A2.1-1 This chapter contains elements that are common to most types of hospitals.
Table 2.1-1
Electrical Receptacles for Patient Care Areas in Hospitals
Section Location Number of Single Receptacles1 Receptacle Locations
PATIENT BED LOCATIONS
2.1-2.4.2 All room2 12 2 at each side of the head of the bed
2 on all other walls
1 for a television, if used
1 for each motorized bed
2.2-2.2.2 Medical/surgical unit patient room2
2.2-2.2.4.4 Protective environment room2
2.2-2.5.2 Intermediate care unit patient room
2.2-2.9.2.2 Postpartum unit patient room2
2.2-2.11.2 Pediatric and adolescent unit patient room2
2.6-2.2.2 Rehabilitation unit patient room
2.2-2.6.2 Critical care unit (CCU) patient room 16 Convenient3 to head of bed with one on each wall
2.2-2.7.2 Pediatric critical care unit patient room
2.2-2.8.2 Neonatal intensive care unit (NICU) patient care station
2.2-2.9.3 LDR/LDRP room 16 8 convenient3 to head of mother's bed
4 convenient3 to each bassinet with one on each wall
2.2-2.10.3.1 Newborn nursery patient care station 4 Convenient3 to each bassinet
2.2-2.10.3.2 Continuing care nursery patient care station 5 Convenient3 to head of each bed, crib, or bassinet (At least 50% of these outlets shall be connected to emergency system power and be so labeled.)
2.5-2.2.2 Psychiatric nursing unit patient room No minimum
DIAGNOSTIC AND TREATMENT AREAS
2.1-3.2
Table 2.2-2
Examination room
Class 1 imaging room
8 4 convenient3 to head of gurney or bed or on each lateral side of the imaging gantry
2.2-2.9.11 Cesarean delivery room 304 16 convenient3 to table placement
2 on each wall
6 in the infant care area
2.2-3.1.2.6 Treatment room for basic emergency services 12 Convenient3 to head of gurney or bed
2.2-3.1.3.3 Triage room or area in the emergency department 6 Convenient3 to head of gurney or bed (At least 50% of these outlets shall be connected to emergency system power and be so labeled.)
2.2-3.1.3.6 (2) and (3) Emergency department treatment room 12 Convenient3 to head of gurney or bed
2.2-3.1.3.6 (4) Trauma/resuscitation emergency room 16 Convenient3 to head of gurney or bed
2.2-3.2.2 Observation unit patient care station 8 4 convenient3 to head of gurney or bed
2.2-3.3.2
Table 2.2-2
Procedure room (including endoscopy)
Class 2 imaging room
124 8 convenient3 to table placement with at least one on each wall
2.2-3.3.3
Table 2.2-2
Operating room
Class 3 imaging room
364 16 convenient3 to table placement
2 on each wall
2.2-3.10.2 Hemodialysis patient care stations 8 4 on each side of a patient bed or lounge chair. (Two on each side of the bed shall be connected to emergency power.)
POST-ANESTHESIA CARE LOCATIONS
2.1-3.4.4 Phase I post-anesthetic care (PACU) patient care station 8 Convenient3 to head of gurney or bed
2.1-3.4.5 Phase II recovery patient care station 4 Convenient3 to gurney, lounge chair, or bed
1Permanently installed single, duplex, or fourplex receptacles or a combination of these shall be permitted. Receptacles in relocatable power taps or mounted on portable equipment shall not be counted as part of the total minimum requirement.
2Omission of receptacles from exterior walls in patient rooms shall be permitted where construction or room configuration makes installation impractical.
3"Convenient" in this table means the cords from the equipment to be used in the room can reach the receptacles without causing a trip hazard.
4The number of receptacles for these spaces is intended to agree with the number required in the governing edition of NFPA 99: Health Care Facilities Code.
Notes
  1. Consideration shall be given to providing some outlets on emergency power and some on normal power at the head of patient beds and in operating rooms, cesarean delivery rooms, and trauma/resuscitation emergency rooms in case of transfer switch failure.
  2. Each patient bed location or procedure room shall be supplied by at least two branch circuits, one from the essential electrical system and one or more from the normal system. Critical care locations served from two separate transfer switches on the essential electrical system shall not be required to have separate circuits from the normal system.
  3. Branch circuits serving only special purpose receptacles or equipment in critical care areas shall be permitted to be served by other panelboards.
  4. An additional outlet shall be provided for a television if one is furnished in the room.
  5. A minimum of one dedicated circuit shall be provided to each critical care patient location.
  6. Open heart post-anesthesia recovery spaces require more receptacles than those specified in this table; the number should be determined during the planning phase.
Maximum Length of Hot Water System Pipe or Tube
Nominal Pipe Size (in.) Liquid Ounces per Foot of Length Maximum Pipe or Tube Length (ft.)
System without Circulation Loop or Heat Traced Line System with Circulation Loop or Heat Traced Line Public Hand-Washing Station Faucets (metering and non-metering)
1/4 0.33 25 16 6
5/16 0.5 25 16 4
3/8 0.75 25 16 3
1/2 1.5 25 16 2
5/8 2 25 12 1
3/4 3 21 8 0.5
7/8 4 16 6 0.5
1 5 13 5 0.5
11/4 8 8 3 0.5
The common elements in this chapter shall be required for a project when referenced from a specific hospital facility chapter listed in Section 2.1-1.1.2.
Additional specific requirements are located in the facility chapters listed below:
General hospitals (Chapter 2.2)
Freestanding emergency care facilities (Chapter 2.3)
Critical access hospitals (Chapter 2.4)
Psychiatric hospitals (Chapter 2.5)
Rehabilitation hospitals (Chapter 2.6)
Children's hospitals (Chapter 2.7)
Mobile/transportable medical units (Chapter 2.8)
Cross-references in this chapter and in the facility chapters include the section as identified by number and heading and all its subsections, unless otherwise noted.
Outpatient projects located in hospitals shall meet the requirements of the FGI Guidelines for Design and Construction of Outpatient Facilities.
See Section 1.2-2 (Functional Program) for requirements.
Size of spaces provided shall meet the clear floor area requirements and the clear dimensions required in the Guidelines for the specific space.
Combination or sharing of some functions shall be permitted when specified in the Guidelines and/or approved by the authority having jurisdiction (AHJ).
Parking provided shall comply with the general requirements in Section 1.3-3.4 (Parking) and the specific requirements in each chapter.
Table 2.1-2
Locations for Nurse Call Devices in Hospitals*
KEY:       Required      □ Optional
Section Location Patient Station Bath Station Staff Assistance Station Emergency Call Station Nurse Master Station Duty Station Notes
NURSING UNITS
2.1-2.2.6 Patient toilet room           2
2.2-2.2.2 Medical/surgical unit patient bed       1,2, 3, 4
2.2-2.6.2 Critical care unit patient bed       1, 2, 4, 5
2.2-2.8.2 NICU          
2.2-2.9.3 LDR/LDRP room       1, 2, 3, 4
2.2-2.10.3.1 Newborn nursery          
2.2-2.10.3.2 Continuing care nursery              
2.5-2.4.2 Alzheimer's and other dementia unit patient bedroom            
SUPPORT AREAS
2.1-2.8.2 Nurse/control station            
2.1-2.8.5 Multipurpose room            
2.1-2.8.8 Medication safety zone            
2.1-2.8.9 Nourishment area or room            
2.1-2.8.11.2 Clean workroom            
2.1-2.8.11.3 Clean supply room            
2.1-2.8.12.2 Soiled workroom            
2.1-2.8.12.3 Soiled holding room            
2.1-2.8.13.1 Clean linen storage              
2.1-2.8.13.2 Equipment storage room              
2.1-2.9.1 Staff lounge            
DIAGNOSTIC & TREATMENT AREAS
2.1-2.4.3 Seclusion room anteroom          
2.1-3.2
Table 2.2-2
Examination room
Class 1 imaging room
       
2.1-3.4.3 Pre-procedure patient care room or area     1,2
2.1-3.4.4 Phase I post-anesthetic (PACU) patient care station     2, 4
2.1-3.4.5 Phase II recovery patient care station     1,2
2.2-2.9.11 Cesarean delivery room         2
2.2-3.1.3.6 Emergency treatment room, triage area         1, 2, 4
2.2-3.2.2 Observation unit patient care station        
2.2-3.3.2
Table 2.2-2
Procedure room
(including endoscopy)
Class 2 imaging room
      2, 4
2.2-3.3.3
Table 2.2-2
Operating room
Class 3 imaging room
        2
2.2-3.4.10 Imaging waiting and changing area, including toilet room           2
2.5-3.4.2.2 Electroconvulsive therapy (ECT) treatment room         2
2.5-3.4.3.2 ECT pre-procedure patient care station
2.5-3.4.3.3 ECT recovery patient care station
*It is recognized that staff other than nurses may respond to these devices, but the term "nurse call" is used here as an industry-accepted term.
Notes
  1. One device shall be permitted to accommodate patient station, emergency call, and staff assistance station functionality.
  2. A visible signal shall be activated in the corridor at the patient's door, at the nurse/control station, and at all duty stations. In multi-corridor nursing units, additional visible signals shall be installed at corridor intersections.
  3. Two-way voice communication shall be provided with the nurse/control station.
  4. One device shall be permitted to accommodate both staff assistance and emergency station functionality.
  5. A patient station shall not be required in the NICU.
The patient care unit and other patient care area requirements included in this section are common to most hospitals. For requirements specific to a hospital type, see the applicable hospital facility chapter.
A2.1-2.1.1 Accommodations to encourage patient mobility. Patient care units should be designed to enhance opportunities for patient ambulation, including provision of ceiling track systems that support a harnessed patient walking with assistance (e.g., in patient unit corridors, a physical therapy clinic, and other patient rehabilitation service locations). See Section 1.2-4.7 (Patient Immobility Assessment) for more information about patient immobility prevention as a component of the safety risk assessment.
Provisions shall be made to address patient visual and speech privacy.
A2.1-2.1.2 Patient privacy
  1. Visual privacy. Visual privacy can be achieved using various means, including cubicle curtains, blinds, and electronically controlled vision panels. In single-patient rooms, the entry room door can be used to achieve visual privacy provided the door is solid or has non-transparent glass. Where doors with vision panels or transparent glass are used, provisions for visual privacy should be made.
  2. Speech privacy. Speech privacy should be addressed. Use of full-height partitions and/or sound-masking can enhance speech privacy.
A2.1-2.2 Equipment and architectural details for the patient room
  1. Standing assists. Aids to help patients stand from seated positions (e.g., bedrails, grab bars, and extended chair armrests) should be available.
  2. Orientation of TV. Space should allow for at least one television screen to be viewed from the patient chair, recliner, wheelchair, or other such device.
  3. Access to controls and communications. Patient control of the environment should be accessible to the patient in a bed, patient chair, recliner, wheelchair, or other such device.
  4. Trip hazards. Chair legs should not extend laterally or forward beyond the chair seat.
See facility chapters for specific requirements.
Where indicated by the safety risk assessment (SRA), fall-safe provisions such as handrails and grab bars shall be included in the patient room, patient toilet room, and patient care unit corridors. See sections 2.1-7.2.2.9 (Grab bars) and 2.1-7.2.2.10 (Handrails) for information.
A2.1-2.2.2 Space considerations for patient mobility. Patient rooms should be sized, arranged, and furnished to maximize safe patient mobility, mobilization, weight-bearing exercise, and ambulation potential while minimizing risk to caregivers. This should apply for patients of all sizes and conditions described in the functional program.
Clearances should be provided and maintained to accommodate safe patient mobility and mobilization of patients. Designated clearances should not be obstructed by any object that does not qualify as movable according to appendix section A1.4-2 (Equipment types). Particular attention should be given to the following:
  1. Provision of bed clearances to support patient safety
    • -Medical/surgical patient rooms: 36 inches on far side, 48 inches on transfer side, 36 inches at foot of bed
    • -Critical care patient rooms: 54 inches on far side, 66 inches on transfer side, 60 inches at foot of bed, 18 inches at head of bed
    • -Rooms for patients of size: 60 inches on far side, 72 inches on transfer side, 60 inches at foot of bed
  2. Furniture and equipment size. Furnishings and equipment (e.g., beds, exam tables, exam chairs, gurneys) impact clearance requirements. As furnishings and equipment vary based on clinical needs, patient size, manufacturer, and model, it is important that furnishings and equipment be selected for planning purposes by the operator of the facility.
  3. Sizing of patient rooms to accommodate clearances for patient chairs, etc. The size of patient rooms should allow unimpeded clearance on at least one side and at the front of any patient chair, recliner, wheelchair, or other such device. The clearances should equal, at minimum, those recommended just above for the far side and foot of the bed and may share bed clearance space.
Minor encroachments (including columns and corridor door swing) that do not interfere with functions as determined by the AHJ shall be permitted to be included when determining minimum clear floor area requirements for a patient room.
For other space requirements, see facility chapters.
See Section 2.1-7.2.2.5 (Windows in patient rooms) for requirements. For psychiatric hospital and psychiatric patient care unit requirements, see Section 2.5-7.2.2.5 (Windows).
For requirements, see Section 2.1-2.1.2 (Patient Privacy).
A hand-washing station shall be provided in the patient room in addition to that in the toilet room.
  1. This hand-washing 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.
  2. When multi-patient rooms are permitted, this station shall be located outside the patients' cubicle curtains.
See Section 2.1-2.8.7.2 (Hand-Washing Station-Design requirements).
In renovations of existing facilities, a hand-washing station shall be provided in the patient room unless it is technically infeasible or space does not permit the installation. In this situation, a hand-washing station shall be provided in the toilet room and a hand sanitation dispenser shall be provided in the patient room.
Where required by other sections of the Guidelines, each patient shall have access to a toilet room without having to enter a corridor.
In patient care units, the patient toilet room shall serve no more than one patient room.
The patient toilet room shall be equipped with the following:
  1. A toilet
  2. A hand-washing station. See Section 2.1-2.8.7 (Hand-Washing Station) for requirements.
  3. A bedpan-rinsing device. See Section 2.1-8.4.3.7 (Bedpan-rinsing devices) for requirements.
Each patient room shall have a separate wardrobe, locker, or closet suitable for garments and for storing personal effects.
During hospital project planning, health care organizations shall determine their need to provide spaces designed to enable safe care of patients of size as required in Section 1.2-6.4.1 (Projected Need for Accommodations for Care of Patients of Size).
  1. All patient care areas designated for care of patients of size shall meet the requirements in this section.
  2. A patient handling and movement assessment (Section 1.2-4.3) shall determine the need for expanded-capacity lifts and architectural details that support movement of patients of size in spaces where these patients may be seen. See sections 1.2-6.4.1.3 (Projected number of expanded-capacity lifts required) and 1.2-6.4.2 (Design Response for Accommodations for Patients of Size).
Spaces designated for care of or use by patients of size shall be provided where they are needed to accommodate the population expected to be served by the facility.
  1. Accommodations for patient handling, movement, and mobilization shall be provided by either an overhead lift system or a floor-based full-body sling lift and standing-assist lifts.
  2. Lifts chosen shall be capable of accommodating the threshold weight capacity of patients of size identified in the planning phase. See sections 1.2-4.3 (Patient Handling and Movement Assessment) and 1.2-6.4.1.1 (Projected weight capacities for patients of size in population to be served).
A2.1-2.3.1.3 Patient lift system. Overhead lift systems have some advantages over floor-based lifts. In addition to needing smaller room dimensions than floor-based lifts, overhead systems biomechanically impact the musculoskeletal system of health care providers less than floor-based models. As well, staff prefer and are more compliant in using overhead lifts, reducing the risk of musculoskeletal injury to staff and improving the quality of patient care.
The following shall apply to patient rooms designated for patients of size.
(1) Capacity. All rooms designated for patients of size shall be single-patient rooms.
*(2) Patient lift system. All patient rooms designated for care of patients who weigh 600 lbs. (272.16 kg) or more shall be provided with a lift system (e.g., a ceiling- or wall-mounted system) that can be used to transfer the patient from bed to toilet and is rated to accommodate the maximum patient weight defined in the planning phase.
A2.1-2.3.2.1 (2) Patient lifts. See Section 1.2-4.3 (Patient Handling and Movement Assessment) for information on the lifts appropriate for a project. If, in a renovation project, structural and building material constraints impede the installation of ceiling- and wall-mounted lifts, mobile lifts may be an option. Note that more floor space is needed for use of these floor-based lifts. As well, floor-based lifts are not as stable and result in increased risk of injury for both staff and patients.
*(1) Area. See Section 2.1-2.2.2.1 (Area) for information on minor encroachments.
(2) Clearances. The following clearances shall be provided by the room dimensions and arrangements:
(a) At the foot of the patient bed: 5 feet (1.52 meters)
(b) On the non-transfer side of the bed: 5 feet 6 inches (1.68 meters) from the edge of the expanded-capacity patient bed
(c) On the transfer side of the bed: A rectangular clear floor area parallel to the bed shall have these dimensions:
*(i) In rooms with ceiling- or wall-mounted lifts:
10 feet 6 inches (3.20 meters) long, measured beginning 2 feet (60.96 centimeters) from the headwall
5 feet 6 inches (1.68 meters) wide, measured from the edge of the expanded-capacity patient bed
*(ii) In rooms without ceiling- or wall-mounted lifts where mobile lifts will be used:
10 feet 6 inches (3.20 meters) long, measured beginning 2 feet (60.96 centimeters) from the headwall
7 feet (2.13 meters) wide, measured from the edge of the expanded-capacity patient bed
A2.1-2.3.2.2 (1) Furniture and equipment size. Furnishings and equipment (e.g., beds, chairs, gurneys) impact clearance requirements. As furnishings and equipment vary based on clinical needs, patient size, manufacturer, and model, it is important that furnishings and equipment be selected for planning purposes by the operator of the facility.
A2.1-2.3.2.2 (2)(c)(i) Rectangular clear floor area. This clear floor area is needed to provide space for the use of an overhead lift and an expanded-capacity wheelchair as well as space for staff to help a patient of size transfer from bed to wheelchair or gurney.
A2.1-2.3.2.2 (2)(c)(ii) Floor space for mobile lifts. Mobile lifts require more floor space than overhead lifts to accommodate the lift footprint and the staff needed to help a patient of size transfer from bed to wheelchair or gurney.
At least one airborne infection isolation (AII) room that meets the requirements in Section 2.1-2.3 (Accommodations for Care of Patients of Size) and the requirements in Section 2.1-2.4.2 (Airborne Infection Isolation Room) shall be provided in the facility.
The number of additional AII rooms for patients of size shall be determined on the basis of an infection control risk assessment (ICRA).
Hand-washing stations in toilet rooms designated for use by patients of size shall meet the requirements in Section 2.1-2.8.7 (Hand-Washing Station) as amended in this section.
The downward static force required for hand-washing stations designated for patients of size shall be identified during the planning phase and shall accommodate the maximum patient weight of the patient population.
Toilet rooms designated for use by patients of size shall meet the requirements in Section 2.1-2.2.6 (Patient toilet room) as amended in this section.
Where an expanded-capacity toilet is used, it shall be mounted a minimum of 36 inches (91.44 centimeters) from the finished wall to the centerline of the toilet on both sides.
Where a regular toilet is used, the toilet shall be mounted a minimum of 44 inches (111.76 centimeters) from the finished wall to the centerline of the toilet on both sides to allow for positioning of an expanded-capacity commode over the toilet when the weight capacity of the existing toilet will not accommodate the patient weight.
A 46-inch-wide (1.17-meter wide) clear floor area shall extend 72 inches (1.83 meters) from the front of the toilet.
See Section 2.1-7.2.2.9 (Grab bars) for requirements.
Where bathing facilities are designated for use by patients of size, they shall meet the following requirements:
Shower stalls shall be a minimum of 4 feet by 6 feet (1.22 meters by 1.83 meters).
Showers shall be equipped with grab bars that are capable of supporting 800 lbs. (362.88 kilograms).
Showers shall be provided with handheld spray nozzles mounted on a side wall.
A single-patient examination or treatment room designated for care of patients of size shall meet the requirements in Section 2.1-3.2 (Examination Room or Emergency Department Treatment Room) as amended in this section.
(1) Clearances. Rooms shall be sized to permit the clearances in this section.
(a) At the foot of the expanded-capacity exam table: 5 feet (1.52 meters)
(b) On the non-transfer side of the expanded-capacity exam table: 5 feet (1.52 meters)
*(c) On the transfer side of the expanded-capacity exam table:
(i) Where a ceiling- or wall-mounted lift is provided: 5 feet (1.52 meters) from the edge of the expanded-capacity table
(ii) In rooms without a ceiling- or wall-mounted lift: 7 feet (2.13 meters) from the edge of the expanded-capacity table
(2) When not in use for a patient of size, this examination or treatment room shall be permitted to be subdivided with cubicle curtains or movable partitions to accommodate two patients if each resulting bay or cubicle:
(a) Meets the clearance requirements for patient care stations in Section 2.1-3.2.3 (Multiple-Patient Examination Room).
(b) Has direct access to a hand-washing station.
(c) Meets all electrical and medical gas requirements.
A2.1-2.3.7.2 (1)(c) Floor space for using patient lifts. The transfer side clearance in an exam/treatment room with a ceiling- or wall-mounted lift is smaller than that in a patient room because the patient is anticipated to be upright for transfer. In rooms where mobile lifts will be used, more floor space is required to accommodate the lift footprint and the staff needed to help a patient of size transfer from a wheelchair to an exam table.
When sizing equipment storage for areas where care will be provided for patients of size, space shall be provided to accommodate the size of the expanded-capacity equipment (e.g., floor-based lifts, lift slings and accessories, etc.) and supplies that will be used.
A2.1-2.3.8 Expanded-capacity floor-based lifts, slings, and accessories for patients of size are larger than standard equipment and require greater unit and in-room storage spaces than may be required in other patient care areas.
Waiting areas shall be sized to accommodate the expanded-capacity furniture required for patients and visitors of size.
A minimum of 5 percent of the seating shall be able to accommodate a person who weighs 600 pounds (272.16 kilograms).
All plumbing fixtures, handrails, grab bars, patient lift equipment, built-in furniture, and other furnishings and equipment shall be designed to accommodate the maximum patient weight established in the planning phase.
A2.1-2.3.10.1 Maneuvering of patients of size is an issue designers must consider. If a patient is able to walk, he or she likely will need to use a handrail for support or balance. Such handrails should be designed to support at least 800 lbs.
Door openings shall be provided in accordance with Section 2.1-7.2.2.3 (2) (Door openings for patient rooms and diagnostic and treatment areas) as amended in this section.
*(1) All door openings used for the path of travel to public areas and areas where care will be provided for patients of size shall have a minimum clear width of 44.5 inches (1130 millimeters) to provide access for expanded-capacity wheelchairs. Access for expanded-capacity gurneys or beds will require additional clear width.
(2) Door openings to patient rooms for patients of size shall have a minimum clear width of 57 inches (144.8 centimeters).
(3) Door openings to toilet rooms designated for patients of size shall have a minimum clear width of 44.5 inches (1130 millimeters).
A2.1-2.3.10.2 (1) Larger door openings may be required to allow for movement of expanded-capacity beds and equipment. When calculating clearances for expanded-capacity beds, an allowance should be made for two inches on each side of the bed for staff to maneuver through the door openings. For additional information, see appendix section A2.1-2.2.2 (Space considerations for patient mobility).
The special patient care room requirements in this section shall apply to all facilities that provide these rooms. See facility chapters for other specific requirements. Requirements for other types of special patient care rooms are located in the facility chapters.
A2.1-2.4.2 For additional information, refer to the Centers for Disease Control and Prevention (CDC) publication "Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings," December 2005, and "Guidelines for Environmental Infection Control in Health-Care Facilities," December 2003, both published in MMWR and available on the CDC website.
  1. The AII room requirements contained in the Guidelines for particular areas throughout a facility shall be:
    1. Predicated on an infection control risk assessment (ICRA).
    2. Based on the needs of specific community and patient populations served by an individual health care organization. See Section 1.2—4.2.3 (Infection Control Risk Mitigation).
    3. Used for patients who require an AII room but do not need a protective environment (PE) room.
    4. Permitted to be used for patients without airborne infectious diseases when not required for patients with airborne infectious diseases.
  2. Number. For specific requirements, see facility chapters.
  3. Location. AII rooms shall be permitted to be located in individual patient care units or grouped as a separate isolation patient care unit.
Each airborne infection isolation room shall comply with the requirements in sections 2.1-2.2 (Patient Room) and 2.2-2.2.2 (Medical/Surgical Patient Care Unit-Patient Room) as well as the following requirements:
  1. Capacity. Each AII room shall contain only one bed.
  2. Provision shall be made for personal protective equipment (PPE) storage at the entrance to the room.
  3. Hand-washing station. Section 2.1-2.2.5.3 (Hand-washing station in the patient room-Renovation) shall not apply to AII rooms.
  4. The patient toilet room shall serve only one AII room.
  5. The patient toilet room shall have a bathtub or shower.
  6. A door from the AII room directly to the corridor shall be permitted.
An anteroom is not required; however, where an anteroom is provided, it shall meet the following requirements:
  1. The anteroom shall provide space for persons to don personal protective equipment (PPE) before entering the patient room.
  2. All doors to the anteroom shall have self-closing devices or an audible alarm arrangement that can be activated when the AII room is in use as an isolation room.
  3. The anteroom shall be equipped with at least the following:
    1. Hand-washing station
    2. Storage for unused PPE
    3. Disposal/holding container for used PPE
These requirements are in addition to those in Section 2.1-7.2 (Architectural Details, Surfaces, and Furnishings) that apply to AII rooms.
(1) Architectural details
(a) AII room perimeter walls, ceiling, and floor, including penetrations, shall be constructed to prevent air exfiltration.
(b) Doors
(i) AII rooms shall have self-closing devices on all room exit doors. Omission of self-closing devices shall be permitted if the alarm required by Section 2.1-2.4.2.5 (Pressure alarm) has an arrangement that allows activation of the audible alarm when the AII room is in use as an isolation room.
(ii) Edge seals shall be provided along the sides and top of the doorframe for any door into the AII room.
*(iii) Use of bottom edge door sweeps to assist in maintaining negative pressure shall be permitted.
(2) Window treatments and privacy curtains
(a) Window treatments shall meet the requirements in Section 2.1-7.2.4.2 (Window treatments in patient rooms and other patient care areas), except that fabric drapes and curtains shall not be used.
(b) Privacy curtains shall be provided in accordance with Section 2.1-7.2.4.3 (Privacy curtains in patient rooms and other patient care areas).
A2.1-2.4.2.4 (1)(b)(iii) Door sweeps. To support maintenance of negative pressure, the opening under the door should be the minimum required for proper door operation. However, if the All room is not sealed well and the negative pressure of the room cannot be maintained at negative 0.01 inches of water column (negative 2.5 pascals) without a door sweep, provision of a sweep is necessary.
A visual or audible alarm that indicates if negative pressure is not maintained in the room shall be provided for the AII room.
A seclusion room for short-term occupancy shall be provided.
A2.1-2.4.3 Seclusion room design
  1. This space is intended for patients requiring security and protection.
  2. Guidelines for seclusion room design are available in the International Association for Healthcare Security & Safety Security Design Guidelines for Healthcare Facilities: 02.03 Behavioral/Mental Health Areas.
  1. Capacity
    1. Each room shall be for only one patient.
    2. There shall be at least one seclusion room for each 24 beds or fewer and for each major fraction thereof on each psychiatric unit.
    3. Where a facility has more than one psychiatric patient care unit, the number of seclusion rooms shall be a function of the total number of psychiatric beds in the facility.
  2. Location
    1. The room(s) shall be located to permit observation from the nurse station.
    2. Seclusion rooms shall be permitted to be grouped together.
  3. Seclusion rooms shall be accessed by an anteroom or vestibule that also provides access to a toilet room.
*(1) Seclusion rooms shall have a minimum clear floor area of 60 square feet (5.57 square meters) with a minimum wall length of 7 feet (2.13 meters) and a maximum wall length of 11 feet (3.35 meters).
(2) Where a room for restraining patients is provided, it shall have a minimum clear floor area of 80 square feet (7.43 square meters).
A2.1-2.4.3.2 (1) The limit on wall length is included to address two issues:
  1. To prevent a patient from being able to make a "running start" attack on a window, door, or staff member
  2. To limit the space in which a patient can try to avoid staff if a "take-down" becomes necessary
Seclusion rooms shall be designed and constructed to avoid features that enable patient hiding, escape, injury, or suicide.
(1) Architectural details
(a) The walls, ceiling, and floor of the seclusion room shall be designed to withstand direct and forceful impact.
(b) Minimum ceiling height shall be 9 feet (2.74 meters).
(c) Doors
(i) Door openings shall be provided in accordance with Section 2.1-7.2.2.3 (2)(a) (Door openings [for patient rooms and diagnostic and treatment areas]).
(ii) The entrance door to the seclusion room shall swing out.
*(iii) Doors shall permit staff observation of the patient through a view panel, while also maintaining provisions for patient privacy. The view panel shall be fixed glazing with polycarbonate or laminate on the inside of the glazing.
(d) Seclusion rooms shall not contain outside corners or edges.
(2) Building systems
(a) All items in the room, including but not limited to lighting fixtures, sprinkler heads, HVAC grilles, and surveillance cameras, shall be tamper-resistant and designed to prevent injury to the patient.
(b) Electrical switches and receptacles are prohibited in the seclusion room.
A2.1-2.4.3.9 (1)(c)(iii) Visual patient privacy may be obtained using elements such as exterior curtains, blinds, electronic shading of windows, and cameras.
Each support area shall be permitted to be arranged and located to serve more than one patient care unit. However, unless otherwise noted, at least one such support area shall be provided on each floor.
This area shall include the following:
  1. Space for counters
  2. Hand-washing station(s)
    1. At least one hand-washing station shall be located in, next to, or directly accessible to the administrative center or nurse station.
    2. A hand sanitation dispenser shall be permitted as a substitute for this requirement.
This area shall be permitted to be combined with or include centers for reception and communication.
Documentation areas shall have a work surface to support the documentation process for the number of staff who will use it at the same time.
A documentation area that also serves as a medication safety zone shall meet the requirements of Section 2.1-2.8.8 (Medication Safety Zones).
See facility chapters for requirements.
At least one multipurpose room for each facility shall be provided for staff, patients, and patients' families for patient conferences, reports, education, training sessions, and consultation.
A multipurpose room shall be permitted to serve several patient care units and/or departments.
At least one hand scrub position shall be located adjacent to the entrance to each cesarean delivery, operating, and Class 3 imaging room.
One hand scrub station consisting of two scrub positions shall be permitted to serve two cesarean delivery, Class 3 imaging, or operating rooms if located adjacent to the entrance of each room.
The placement of the scrub station(s) shall not restrict the minimum required corridor width.
A2.1-2.8.6.3 Scrub station(s) may be recessed into an alcove to reduce the likelihood of incidental splatter on adjacent personnel or equipment. The alcove depth and/or configuration should enable personnel in the scrub process to keep their hands and arms below the elbow over the sink compartment without interference from other staff and equipment/gurneys passing in adjacent circulation areas. Scrub sink dimensions (particularly depth), which vary between manufacturers, should be considered when determining the space needed to accommodate the sink and clearance necessary beyond the front lip for personnel in the scrub process to be clear of adjacent activity.
Hand-washing stations shall be provided in each room where hands-on patient care is provided. For location and number requirements, see other common element sections in this chapter and the facility chapters.
Hand-washing stations shall meet the requirements in the following sections:
  1. For hand-washing station design details, see Section 2.1-7.2.2.8 (Architectural Details-Hand-washing stations).
  2. For hand-washing station sink requirements, see Section 2.1-8.4.3.2 (Plumbing Fixtures-Hand-washing station sinks).
  3. For electrical requirements, see Section 2.1-8.3.5.1 (Electrical Equipment-Hand-washing station sinks and scrub sinks).
Additional requirements for hand-washing stations that serve multiple patient care stations
(1) At least one hand-washing station shall be provided for every four patient care stations or fewer and for each major fraction thereof.
*(2) Based on the arrangement of the patient care stations, hand-washing stations shall be evenly distributed.
A2.1-2.8.7.3 (2) Distribution of hand-washing stations. In a linear arrangement of patient care stations, the distance from the two stations farthest from the hand-washing station should be approximately equal. In a circular arrangement, the distance from all patient care stations should be approximately equal.
(1) Application. Medication safety zones shall be provided as defined in this section for preparing, dispensing, storing, and administering medications.
(a) The number and location of medication safety zones for patient care areas shall be as determined in the medication safety risk assessment. See Section 1.2-4.5 (Medication Safety).
(b) A medication preparation room, self-contained medication dispensing unit, automated medication-dispensing station, or other system approved by the authority having jurisdiction (AHJ) shall be permitted to serve as a medication safety zone.
*(2) Design requirements. Medication safety zones shall meet the following physical environment requirements that promote safe medication use:
*(a) Medication safety zones shall be located out of circulation paths.
*(b) Work space for medication safety zones shall be designed so that staff can access information and perform required tasks. See Section 1.2-4.5 (Medication Safety).
(c) Work counters shall provide space to perform tasks referenced in paragraph (b).
*(d) Lighting. Task-specific lighting levels for health care settings recommended in the U.S. Pharmacopeia-National Formulary shall be used to design lighting.
*(e) Sharps containers shall be placed at a height that allows users to see the top of the container.
(f) Noise and sound. Medication safety zones shall meet the acoustic design criteria found in Section 1.2-6.1 (Acoustic Design).
A2.1-2.8.8.1 (2) Medication safety zone design requirements
  1. The physical environment requirements listed in Section 2.1-2.8.8.1 (2) are found in General Chapter <1066> "Physical Environments that Promote Safe Medication Use" of the U.S. Pharmacopeia-National Formulary (USP-NF).
  2. The following surface and furnishing recommendations should be incorporated in the design of medication safety zones:
    • -Surface materials should be selected to reduce glare and reflectivity.
    • -Use of surface materials with sound-mitigating properties should be considered.
    • -Built-in furnishings (where present) should be configured to provide visual and acoustic privacy, minimize visual and sound distractions and interruptions, and reduce staff fatigue through ergonomic design.
A2.1-2.8.8.1 (2)(a) Locating medication safety zones out of circulation paths minimizes the potential for distractions and interruptions that interfere with staff concentration and attentiveness to medication therapy activities.
A2.1-2.8.8.1 (2)(b) Work space organization
  1. Work space elements should be described in the functional program to assure medication safety zones can support effective use of medication-related information and accurate performance of tasks. Elements to consider include:
    • -Number of staff working in the medication safety zone
    • -Key tasks being performed
    • -Amount of space needed to support tasks being performed
    • -Types of products that should be clearly visible, enabled by the use of adjustable fixtures, drawer and storage design, and counter height
    • -Designs to minimize work surface clutter
  2. Space, power, and data requirements for medication-associated equipment and safety technology should be detailed in the functional program so the facility design will be able to accommodate the equipment and technology to be used in the medication safety zone.
A2.1-2.8.8.1 (2)(d) Detailed lighting recommendations for medication safety zone work areas can be found in USP-NF General Chapter <1066> "Physical Environments that Promote Safe Medication Use." Areas where task-specific lighting levels should be provided include:
  1. Designated computer entry and handwritten order-processing locations
  2. Pharmacy medication filling and checking
  3. Pharmacy patient counseling
  4. Sterile compounding and preparation
  5. Storeroom for pharmacy medication
  6. Medication preparation areas
  7. Medication administration work areas, including the patient room
A2.1-2.8.8.1 (2)(e) Height of sharps containers. NIOSH provides an ergonomically ideal formula for determining the height of sharps containers by establishing the eye-level height and maximum thumb tip reach of the worker population and then adding a drop angle of 15 degrees. For a standing work station, the sharps container height should be 52 to 56 inches above the standing surface of the user. For a seated work station, the sharps container height should be 38 to 42 inches above the floor on which the chair rests. These height installation recommendations will comfortably accommodate 95 percent of adult female workers. This information can be found in DHHS (NIOSH) Publication No. 97-111, "Selecting, Evaluating, and Using Sharps Disposal Containers."
  1. Medication preparation room
    1. This room shall be under visual control of the nursing staff.
    2. This room shall contain the following:
      1. Work counter
      2. Hand-washing station
      3. Lockable refrigerator
      4. Locked storage for controlled drugs
      5. Sharps containers, where sharps are used
    3. Where a medication preparation room is used to store one or more self-contained medication-dispensing units, the room shall be designed with space to prepare medication when the self-contained medication dispensing unit(s) are present.
    4. Where a medication preparation room is used to compound sterile preparations, it shall meet the requirements in USP-NF General Chapter <797> "Pharmaceutical Compounding-Sterile Preparations."
  2. Medication-dispensing units, stations, and carts
    1. Use of self-contained medication-dispensing units (e.g., robotic devices used in pharmacies), automated medication-dispensing stations, mobile medication-dispensing carts, or other systems approved by the AHJ shall be permitted at the following locations provided the unit, station, or cart can be locked to secure controlled drugs:
      1. At a nurse station
      2. In a clean workroom
      3. In an alcove
      4. In a patient room
    2. Where mobile medication-dispensing carts are used, space shall be provided to accommodate the cart.
    3. A hand-washing station shall be located next to stationary medication-dispensing units or stations.
A2.1-2.8.8.2 Drug and needle controls. The operational procedures associated with drug and needle controls should be described in the functional program. Such controls may require physical environment components such as electronic surveillance, password-controlled access, and view panels in doors.
Each patient care unit shall have facilities for patient nourishment. Other patient care areas shall have facilities for patient nourishment as required in the facility chapters.
Patient nourishment facilities shall be permitted to be located in either an area or a room.
The nourishment area or room shall have the following:
  1. Hand-washing station
  2. Work counter
  3. Refrigerator
  4. Microwave
  5. Storage cabinets
  6. Space for temporary storage of food service implements
Provisions and space shall be included for separate temporary storage of unused and soiled meal trays.
A2.1-2.8.10 Noise from ice-making equipment. The location of and space for ice-making equipment in a patient care unit should be designed to mitigate noise. This can be achieved through various means, including considering its placement in relation to patient rooms or locating it in an enclosed space. See Table 1.2-6 (Design Criteria for Minimum Sound Isolation Performance Between Enclosed Rooms) for information about sound for patient rooms.
In public areas, all ice-making equipment shall be of the self-dispensing type.
In areas restricted to staff only, use of storage bin-type equipment for making and dispensing ice shall be permitted.
The clean workroom or clean supply room shall be separate from and have no direct connection with the soiled workroom or soiled holding room.
Where the room is used for preparing patient care items, it shall contain the following:
  1. Work counter
  2. Hand-washing station
  3. Storage facilities for clean and sterile supplies
A room used only for storage and holding as part of a system for distribution of clean and sterile supplies does not require a work counter or a hand-washing station.
A2.1-2.8.12 Functions for soiled workroom and soiled holding room
Soiled workroom. Soiled items may be handled in a soiled workroom to prepare them for subsequent cleaning, disposal, or reuse (e.g., emptying and rinsing bedpans or emesis basins, emptying or solidifying suction canisters, rinsing and gross cleaning of medical instruments). As well, this room provides temporary storage for soiled items prior to their removal from the unit.
Soiled holding room. This location is used exclusively for temporary storage of soiled materials and/or supplies prior to their removal from the unit.
Soiled workrooms and soiled holding rooms shall be separate from and have no direct connection with either clean workrooms or clean supply rooms.
  1. This room shall contain the following:
    1. Hand-washing station
    2. Flushing-rim clinical service sink with a bedpan-rinsing device or equivalent flushing-rim fixture
    3. Work counter
    4. Space for separate covered containers for waste and soiled linen
  2. Where a fluid management system is used, the following shall be provided:
    1. Electrical and plumbing connections that meet manufacturer requirements
    2. Space for the docking station(s)
This room shall contain the following:
  1. Hand-washing station or hand sanitation station
  2. Space for separate covered containers for waste and soiled linen
This storage shall meet the following requirements:
  1. Clean linen shall be permitted to be stored in the clean workroom, in a separate closet, or using a covered cart distribution system on each floor.
  2. Where a covered cart distribution system is used, storage of clean linen carts in a corridor alcove shall be permitted.
A room(s) or alcove(s)-sized to provide a minimum of 10 square feet (0.93 square meter) per patient bed-shall be provided on the patient care unit floor for storage of equipment and supplies necessary for patient care.
Storage space for gurneys, stretchers, and wheelchairs shall be provided.
  1. Each patient care unit shall have at least one emergency equipment storage location.
  2. Emergency equipment storage shall be provided under visual observation of staff.
  3. Emergency equipment storage locations in corridors shall not encroach on the minimum required corridor width.
A2.1-2.8.13.4 Emergency equipment storage. Emergency equipment can be positioned in an alcove located in a corridor. Types of emergency equipment stored include cardiopulmonary resuscitation (CPR) cart(s), pumps, ventilators, patient monitoring equipment, and portable x-ray units.
  1. Emergency power outlets for battery charging should be provided at each emergency equipment location.
  2. Needed emergency equipment storage locations and types should be identified in the functional program.
(1) Application. One environmental services room shall be permitted to serve more than one patient care unit on a floor.
*(2) Location. An environmental services room shall be readily accessible to the unit or floor it serves.
A2.1-2.8.14.1 (2) Environmental services room. Some departments or areas may need individually assigned environmental services rooms. Examples include:
  • -Patient care units
  • -Clinical areas: Pre- and post-procedure patient care areas, examination rooms, blood draw areas, dialysis treatment areas, infusion areas, and other areas likely to come into contact with blood or body fluids
  • -Sterile areas: Operating rooms, corridors in the semi-restricted area of the surgery suite, sterile labs, and sterile storage
  • -Endoscopy services rooms: Endoscopy procedure room and endoscope processing room
  • -Public and administrative areas: Waiting areas, offices, and hallways
  • -Compounding pharmacy
Each environmental services room shall be provided with the following:
  1. Service sink or floor-mounted mop sink
  2. Provisions for storage of supplies and housekeeping equipment
  3. Hand-washing station or hand sanitation station
A2.1-2.8.14.2 Environmental services room features
  1. Environmental services rooms should be planned to accommodate carts used in the housekeeping process.
  2. A storage or bin space should be included for recyclable materials: white paper, mixed paper, cans, bottles, and cardboard.
A2.1-2.9 Support areas for staff
  1. Location. Support areas for staff should be restricted from public access as defined in section 02: Buildings and the Internal Environment in the IAHSS Security Design Guidelines for Healthcare Facilities. Wherever possible, staff lounge facilities should have access to day-light and views of the outdoors.
  2. Staff rest areas. Staff rest areas should be provided for every unit that has overnight patient care activities. These rest areas should be readily accessible to the work unit and independent from staff on-call rooms.
    As described in the Joint Commission Sentinel Event Alert, Issue 48, "Health Care Worker Fatigue and Patient Safety," a substantial number of studies show that worker fatigue "increases the risk of adverse events, compromises patient safety and increases risk to personal safety and well-being."
    The Veterans Health Administration (VA) has demonstrated that conveniently located "napping rooms" lead to less staff fatigue and better performance; see the profile "Conveniently Located 'Napping Rooms' Provide Opportunity for Night- and Extended-Shift Providers to Rest, Leading to Less Fatigue and Better Performance" on the AHRQ Health Care Innovations Exchange website.
    Some suggested nap room features used by the VA and others include:
    • -Carpeting for noise control
    • -A single residential bed
    • -Storage space for linens
    • -Window treatments to block exterior light where windows are provided
    • -Security with door lock for the sleeper
    • -Communication means to reach the sleeper
    • -Bright lighting with timer to facilitate wake-up
    • -Acoustic features, including sound-absorbing ceiling tiles and a sound-masking system to control background noise levels and cover noise
      For relevant information about acoustics, see the following tables in this document:
    • -Table 1.2-4 (Minimum Design Room-Average Sound Absorption Coefficients)
    • -Table 1.2-5 (Maximum Design Criteria for Noise in Interior Spaces Caused by Building Systems)
    • -Table 1.2-6 (Design Criteria for Minimum Sound Isolation Performance Between Enclosed Rooms)
Lounge facilities of no less than 100 square feet (9.29 square meters) shall be provided.
A staff toilet room shall be readily accessible to each patient care unit.
Each staff toilet room shall contain a toilet and a hand-washing station.
Staff toilet rooms shall be permitted to be unisex.
Securable closets or cabinet compartments for the personal articles of staff shall be located in or near the nurse station. At minimum, they shall be large enough for purses and billfolds.
If coat storage is provided, storage of coats in closets or cabinets on each floor or in a central staff locker area shall be permitted.
Each patient care unit shall provide access to a lounge for family and visitors.
  1. The size of this lounge shall be defined in the functional program, but shall accommodate, at minimum, three chairs and one wheelchair space.
  2. In the absence of a functional program, the lounge shall be sized to accommodate at least 1.5 persons for every adult critical care bed and one person for every four medical/surgical beds in the unit.
This lounge shall be immediately accessible to the patient care unit(s) served.
This lounge shall be permitted to serve more than one patient care unit.
This lounge shall be designed to minimize the impact of noise and activity on patient rooms and staff functions.
A waiting room that meets the criteria in sections 2.1-2.10.1.1 through 2.1-2.10.1.4 shall be permitted to serve as a visitor lounge.
Public communication services shall be provided in each family and visitor lounge.
A2.1-2.10.1.6 Public communications services. These may include services such as internet connections, distributed antenna systems to accommodate mobile phone use, and telephones.
Table 2.1-3
Station Outlets for Oxygen, Vacuum (Suction), Medical Air, and Instrument Air Systems in Hospitals1
Section Location Oxygen Vacuum Medical Air WAGD2 Instrument Air
PATIENT CARE UNITS
2.1-2.4.2 Airborne infection isolation room 1/bed 1/bed - - -
2.2-2.2.2 Patient room (medical/surgical) 1/bed 1/bed -3 - -
2.2-2.2.4.4 Protective environment room 1/bed 1/bed - - -
2.2-2.5.2 Intermediate care room 2/bed 2/bed 1/bed - -
2.2-2.6.2 Critical care patient room
2.2-2.6.4.2 Airborne infection isolation (critical care) 3/bed 3/bed 1/bed - -
2.2-2.7.2 Pediatric critical care room
2.2-2.8.2 Neonatal intensive care unit (NICU) infant care bed 3/infant care bed 3/infant care bed 3/infant care bed - -
2.2-2.9.2 Antepartum and postpartum unit
2.2-2.9.3 Labor/delivery/recovery (LDR) 1/bed 1/bed - - -
2.2-2.9.3 Labor/delivery/recovery/postpartum (LDRP)
2.2-2.9.3.9 Infant resuscitation space4 (LDR/LDRP) 3/bassinet 3/bassinet 3/bassinet - -
2.2-2.9.11 Cesarean delivery room 2/room 4/room 1/room - -
2.2-2.9.11.1 Infant resuscitation space4 (cesarean delivery) 3/bassinet 3/bassinet 3/bassinet - -
2.2-2.9.11.11 Recovery space for cesarean delivery 1/bed 3/bed 1/bed - -
2.2-2.10.3.1 Newborn nursery 1/bassinet5 1/bassinet5 1/bassinet5 - -
2.2-2.10.3.2 Continuing care nursery 1/bassinet 1/bassinet 1/bassinet - -
2.2-2.11.2 Pediatric and adolescent patient room 1/bed 1/bed 1/bed - -
2.2-2.12.2
2.2-2.12.4.3
Psychiatric patient room
Seclusion treatment room (psychiatric unit)
- - - - -
DIAGNOSTIC AND TREATMENT LOCATIONS
2.1-3.2 Examination room or emergency department treatment room 1/room 1/room - - -
2.1-3.4.4 Phase I post-anesthesia (PACU) patient care station 2/station 3/station 1/station - -
2.1-3.4.5 Phase II recovery patient care station 1/station 1/station6 - - -
2.2-3.1.2.6 Treatment room for basic emergency services 1/gurney 1/gurney - - -
2.2-3.1.3.3 Triage area (emergency department) 1/station 1/station - - -
2.2-3.1.3.6 Emergency department treatment room or area 1/gurney 1/gurney 1/gurney - -
2.2-3.1.3.6 (4) Trauma/resuscitation room 2/gurney 3/gurney 1/gurney - -
Plaster and cast room 1/room 1/room - - -
2.2-3.2.2 Observation unit patient care station 1/station 1/station - - -
Table 2.2-2 Class 1 imaging room 1/room 1/room - - -
2.2-3.3.2
Table 2.2-2
Procedure room
Class 2 imaging room
2/room 2/room 1/room - -
2.2-3.3.3
Table 2.2-2
Operating room
Class 3 imaging room
2/room 5/room 1/room 1/room -
2.2-3.11.2 Endoscopy procedure room 1 3 - - -
2.2-3.11.3 Endoscopy pre- and post-procedure patient care area 07 08 - - -
2.2-3.13.4 Hyperbaric suite pre-procedure patient care area 2 2 - - -8, 9, 11
2.5-3.4.2.2 Electroconvulsive therapy treatment room 19 19 - - -
GENERAL SUPPORT FACILITIES
2.1-5.1.2.2 (2) Two-room sterile processing: Decontamination room
2.1-5.1.2.2 (3) Two-room sterile processing: Clean workroom
2.1-5.1.2.3 (2) One-room sterile processing: Decontamination area - - - - -9, 10, 11
2.1-5.1.2.3 (3) One-room sterile processing: Clean work area
2.1-5.7.2.2 Autopsy room - 1 per workstation - - -
2.2-3.11.4.3 Endoscope processing room clean work area
2.2-3.11.4.2 Endoscope processing room decontamination area - - -8 - -8, 9, 11
1 For any area or room not included in this table, the facility clinical staff shall determine station outlet requirements after consultation with the authority having jurisdiction.
2 WAGD stands for "waste anesthesia gas disposal" system.
3 Medical air outlets may be required in patient rooms.
4 When infant resuscitation takes place in a room such as a cesarean delivery room or an LDRP room, infant resuscitation services must be provided in that room in addition to the minimum service required for the mother.
5 Four bassinets may share one outlet that is accessible to each bassinet.
6 If the Phase II recovery area is combined with the PACU, three vacuum outlets per bed or station shall be provided.
7 A portable source shall be available for the space.
8 Vacuum and/or instrument air shall be provided if needed for the cleaning methods used.
9 Use of portable equipment in lieu of a piped gas system shall be permitted.
10In the one-room sterile processing facility and the clean workroom of the two-room sterile processing facility, the instrument air outlet shall be provided as required by the equipment used. In the decontamination room of the two-room sterile processing facility, an instrument air station outlet is required.
11NFPA 99 permits the use of portable medical compressed air for single applications. Where cylinders are used for non-respiratory purposes, such as air for blowing down scopes and/or running decontamination equipment, NFPA 99 should be consulted for cylinder air quality, placement, and handling.
Where an examination room is required in facility chapters, it shall meet the requirements in this section.
For requirements, see Section 2.1-2.1.2 (Patient Privacy).
A2.1-3.2.1.2 Patient privacy. Consideration should be given to designing examination and treatment rooms so the foot of the exam/treatment table does not face the door, especially in rooms where obstetrics/gynecology services are provided.
See the following tables for exam room requirements:
  1. Table 2.1-1 (Electrical Receptacles for Patient Care Areas in Hospitals)
  2. Table 2.1-2 (Locations for Nurse Call Devices in Hospitals)
  3. Table 2.1-3 (Station Outlets for Oxygen, Vacuum, Medical Air, and Instrument Air Systems in Hospitals)
  1. Area. Each single-patient examination room shall have a minimum clear floor area of 120 square feet (11.15 square meters) with a minimum clear dimension of 10 feet (3.05 meters).
  2. Clearances
    1. Room size shall permit a room arrangement with a minimum clearance of 3 feet (91.44 centimeters) at each side and at the foot of the examination table.
    2. A room arrangement in which an examination table, recliner, or chair is placed at an angle, closer to one wall than another, or against a wall to accommodate the type of patient being served shall be permitted.
The examination room shall contain the following:
  1. Examination light. See Section 2.1-8.3.4.3 (3) (Lighting for exam/treatment/trauma rooms) for requirements.
  2. Storage for supplies
  3. Accommodations for written or electronic documentation
  4. Space for a visitor's chair
  5. Hand-washing station that complies with Section 2.1-2.8.7.2 (Hand-Washing Station-Design requirements)
  1. Area. Multiple-patient examination rooms shall have separate patient bays or cubicles with a minimum clear floor area of 80 square feet (7.43 square meters) per patient care station.
  2. Clearances. The following minimum clearances shall be provided:
    1. 5 feet (1.52 meters) between the sides of adjacent patient beds
    2. 4 feet (1.22 meters) between the sides of patient beds and adjacent walls or partitions
Each bay or cubicle shall contain the following:
  1. Examination light. See Section 2.1-8.3.4.3 (3) (Lighting for exam/treatment/trauma rooms) for requirements.
  2. Accommodations for written or electronic documentation
  3. Space for a visitor's chair
  1. At least one hand-washing station(s) shall be provided in each multiple-patient examination room.
  2. Hand-washing stations shall comply with Sections 2.1-2.8.7.2 (Hand-Washing Station-Design requirements) and 2.1-2.8.7.3 (Hand-Washing Station-Additional requirements for hand-washing stations that serve multiple patient care stations).
Storage for supplies shall be provided in the multiple-patient examination room.
Where a sexual assault forensic examination room is provided, it shall meet the requirements in Section 2.1-3.2.2 (Single-Patient Examination Room) and the following:
Each sexual assault forensic examination room shall contain:
  1. Pelvic examination bed/table
  2. Lockable storage areas for forensic collection kits, laboratory supplies, and equipment
  3. A private toilet and shower with storage space for clothing, shoes, linens, and bathing products that is directly accessible to the sexual assault forensic examination room
A room for consultation, family, support services, and law enforcement shall be readily accessible to the sexual assault forensic examination room.
A2.1-3.3 Patient experience. Remote communications via electronic equipment, although not a replacement for in-person care, may be offered as a supplement where in-person care is not available or medically necessary. To assist in the adoption of telemedicine and maximize its benefits for elderly patients, those unaccustomed to electronic communication, and those with vision, hearing, or cognitive impairments, care should be given to remove technological barriers and provide telemedicine endpoints that facilitate natural communication for the widest range of participants. Facilities and systems used for telemedicine communications should strive to maintain the level of safety, privacy, quality of care, and patient experience that would be expected for in-person communication.
Where clinical telemedicine services are provided in a health care facility, telemedicine spaces to accommodate those services shall meet the requirements in this section.
A2.1-3.3.1 Telemedicine service types
  1. Services may include one-on-one interactions, consultations with a patient and family members (e.g., pediatric or elderly patients), examinations supported by a telemedicine presenter located with the patient, or specialty services such as dermatology or orthopedics. Each type of service may have specific needs for lighting and space to support the clinical function; for example, evaluation of patient gait requires unobstructed space to walk from one end of the bay, cubicle, or room to the other. Therefore, to achieve a functional design, it is important to know what services will be provided.
  2. The requirements in this section are not intended to apply to virtual visits that do not require a physical examination of the patient or visits that originate from a physician's or patient's home.
A bay, cubicle, or room shall be provided for telemedicine services.
A2.1-3.3.2 Design considerations for telemedicine
  1. Equipment
    • -Camera placement should be set so recipients perceive the exchange as happening eye-to-eye. The discrepancy between gaze angle should be minimal.
    • -Temperature control should be considered based on the amount of electronic equipment that may generate significant amounts of heat.
    • -Depending on the complexity of equipment used, multiple outlets may be required for equipment. Outlets should be located near the unit to avoid wires/cables on the floor.
  2. Architectural details
    • -Doors in view of the main camera should be able to be closed to assure maximum privacy during the telemedicine appointment.
    • -Placement of doors behind the patient should be avoided as this can make patients uncomfortable.
  1. A bay, cubicle, or room where clinical telemedicine services are provided shall meet the requirements of the section of the Guidelines that directly relates to the services provided and the patient population served.
  2. Where patient volume does not justify provision of a dedicated telemedicine room, the telemedicine room shall be permitted to serve other functions such as physician's office, exam room, or conference room.
Where used for examination purposes, the telemedicine bay, cubicle, or room shall be sized to accommodate the following:
  1. An examination table situated within view of the camera
  2. Telemedicine equipment (fixed or mobile)
  3. Peripheral devices
  4. An on-site caregiver or patient presenter
  5. A hand-washing station where hands-on patient examinations are provided
  6. A documentation area
A2.1-3.3.2.2 Sizing considerations
  1. Where a separate camera and microphone are used rather than a computer or other electronic device, the distance between walls will determine the proximity of the camera and microphone to the patient. Use of a small room may force the camera to be located too close to the patient, limiting the view of the clinician presenting the patient for consultation. Therefore, the camera and exam table should be positioned so a presenter using and manipulating telemedicine peripherals can see both the patient and the monitor of images being transmitted to the remote clinician's site.
  2. Stationary cameras should be placed on top of the monitor used for viewing and directed toward the patient to capture the most information possible (i.e., head plus full-body shots). This is easier with dedicated telemedicine carts than with desktop or mobile units.
  3. Where the microphone is not embedded in the device being used (e.g., desktop, laptop, smartphone, or similar device), space for microphones should be placed in front of and close to the individuals speaking in the videoconference, ideally at least 4 feet from the telemedicine workstation to prevent audio feedback.
  4. The bay, cubicle, or room should be large enough for the patient and the patient presenter, if one is present, to move around comfortably. The patient should be able to sit in a chair as well as use the examination table. Where necessary, a fax machine should be directly accessible. A second chair should be available for a family member.
  5. Where the examination includes gait evaluation, the bay, cubicle, or room should provide sufficient space for this activity to be captured by the camera.
  1. The telemedicine bay, cubicle, or room shall provide speech and visual privacy with adjacent spaces based on the bay, cubicle, or room's clinical function, as indicated in Table 1.2-7 (Design Criteria for Speech Privacy for Enclosed Rooms and Open-Plan Spaces).
  2. Space shall permit arrangement of monitors, screens, or other projections of images or data so they are not visible to casual observers outside the telemedicine bay, cubicle, or room.
(1) Speech intelligibility. Telemedicine rooms shall maintain the minimum sound absorption coefficient for the room's clinical requirement in Table 1.2-4 (Minimum Design Room-Average Sound Absorption Coefficients) or 0.10 (absolute), whichever is greater.
*(2) Sound isolation. Telemedicine rooms shall achieve the minimum STC rating for the room's clinical requirement in Table 1.2-6 (Design Criteria for Minimum Sound Isolation Performance Between Enclosed Rooms).
(3) Background noise. Telemedicine rooms shall maintain background noise levels for the room's clinical requirement in Table 1.2-5 (Maximum Design Criteria for Noise in Interior Spaces Caused by Building Systems).
A2.1-3.3.2.4 Acoustic considerations. The acoustic environment should be designed to facilitate speech intelligibility and communication. The telemedicine bay, cubicle, or room should be in a quiet location that minimizes exposure to noise that can be picked up by microphones. Noise sources may include, but are not limited to, open office areas, busy corridors, stairwells, parking lots, waiting rooms or areas, HVAC systems, and toilet rooms. Cooling fans for equipment should be controlled and limited for telemedicine bays, cubicles, or rooms.
A2.1-3.3.2.4 (2) In designing to achieve the minimum STC rating, all portions of the room's envelope should be considered, including walls, floor/ceiling assemblies, doors, glazing, and field conditions that may affect the performance of those elements.
*(1) The telemedicine bay, cubicle, or room shall provide the ability for direct frontal lighting.
*(2) Means for controlling glare from natural and artificial light sources shall be provided.
A2.1-3.3.2.5 (1) Lighting considerations
  1. Direct and indirect lighting should be provided to create images that have even lighting and accurately reproduced colors.
  2. Full spectrum or warm, white light (3200—4000 K) should be provided.
  3. A minimum light level of 150 fc should be provided.
A2.1-3.3.2.5 (2) Controlling glare
  1. Bays, cubicles, or rooms with windows should have shades or blinds to reduce light and glare, although this may not be enough to achieve acceptable images. In bays, cubicles, or rooms with windows, it should be possible for clinicians and/or patients to avoid sitting in front of a window unless the backlighting can be adequately addressed.
  2. A good source of diffused light is needed in front of the patient shining diagonally toward the patient to reduce shadows that occur on the face if only overhead lighting is used or if there is a light source behind the patient. Spotlights or harsh directional lighting can create unwanted shadows. "Egg-crate" diffusers are not recommended due to "hot spots."
*(1) Telemedicine bay, cubicle, or room finishes and colors shall be selected to maintain natural rendition of color and pattern.
*(2) Backdrop wall color shall have a light reflectance value of 30 to 40 percent.
A2.1-3.3.2.6 (1) Interior surfaces
Light to medium blue or light gray matte finishes are recommended for proper color rendition and to facilitate picture clarity. These shades are preferred because they offer the desired minimal light absorption and light reflectivity. (Although green is the color of choice for a surgical suite because it offers visual comfort when viewing pink and red tissues for a prolonged time, it is not appropriate here.)
Use of this color can be limited to the walls that will be the background for the camera views. This may include more than one wall depending on the configuration of the bay, cubicle, or room.
Screens or curtains may be used to provide the appropriate background color or to hide clutter (e.g., bookshelves, framed pictures with glass).
A2.1-3.3.2.6 (2) Avoiding glare and contrast
  1. A surface finish gloss rating level 1 or 2 (flat finish) should be used rather than gloss level 5 (semi-gloss) or gloss level 6 (gloss finish) to avoid glare and reflections. Reference the Master Painters Institute Gloss and Sheen Standards for latex versus alkyd paint gloss ratings.
  2. Glare and contrast problems in the visual environment may be avoided by specifying the following light reflectance values for surfaces in the telemedicine bay, cubicle, or room:
    • -Ceilings: 80-90 percent
    • -Furniture: 25-45 percent
    • -Flooring: 20-40 percent
Site identification. Facility identification shall be provided at the site so it appears in the transmitted image unless it is embedded in the telemedicine platform.
A2.1-3.3.2.7 Site identification. Facility identification may be provided through signage, such as a sign with the name of the site in the background, or site identification incorporated into the telemedicine technology platform. Identification can help keep everyone oriented and may be required for reimbursement.
Where portable equipment and peripheral devices are used (e.g., digital camera and task lighting, portable EKG devices, smartphones, roaming robots), secure storage shall be provided.
A2.1-3.3.3 Infection prevention considerations for telemedicine. Telemedicine equipment should be selected and installed to facilitate cleaning and infection prevention practices.
Patient care stations shall be provided to accommodate lounge chairs, gurneys, or beds for pre- and post-procedure (recovery) patient care as well as seating space for family/visitors.
The pre- and post-procedure patient care area(s) shall be an unrestricted area(s).
  1. Pre- and post-procedure patient care areas shall be designed to support how services are provided in the facility.
  2. The following arrangements shall be permitted as long as all patient care stations combined in the same area meet the most restrictive requirements of the areas to be combined:
    1. Combination of pre- and post-procedure patient care stations in one patient care area
    2. Separate pre-procedure patient care area and post-procedure recovery area
    3. Three areas: pre-procedure patient care area, Phase I post-anesthetic care unit (PACU), and Phase II recovery area
  1. Where pre- and post-procedure patient care stations are combined into one patient care area, at least two patient care stations shall be provided for each Class 2 and Class 3 imaging, procedure, and operating room.
  2. Where separate pre-procedure and recovery areas are provided, the number of patient care stations shall be as required in these sections:
    1. Section 2.1-3.4.3 (Pre-Procedure Patient Care Room or Area)
    2. Section 2.1-3.4.4 (Phase I Post-Anesthetic Care Unit)
    3. Section 2.1-3.4.5 (Phase II Recovery Room or Area)
A2.1-3.4.1.4 Determining the number of patient care stations. When designing the pre- and post-procedure patient care area(s) and determining the number of patient care stations required, at minimum consideration should be given to the types of surgery and procedures performed, volume of patients to be served, and anticipated staffing levels.
Bays, cubicles, or single-patient rooms that meet the requirements in this section shall be permitted to serve as patient care stations.
(1) Area. When determining the area for a patient care station, space needed for equipment shall be identified.
*(2) Clearances
(a) Where bays are used, the following minimum clearances shall be provided:
(i) 5 feet (1.52 meters) between the sides of patient beds/gurneys/lounge chairs
(ii) 3 feet (91.44 centimeters) between the sides of patient beds/gurneys/lounge chairs and adjacent walls or partitions
(iii) 2 feet (60.96 centimeters) between the foot of patient beds/gurneys/lounge chairs and the cubicle curtain
(b) Where cubicles are used, the following minimum clearances shall be provided:
(i) 3 feet (91.33 centimeters) between the sides of patient beds/gurneys/lounge chairs and adjacent walls or partitions
(ii) 2 feet (60.96 centimeters) between the foot of patient beds/gurneys/lounge chairs and the cubicle curtain
(iii) Where bays or cubicles face each other, an aisle with a minimum clearance of 8 feet (2.44 meters) independent of the foot clearance between patient stations or other fixed objects shall be provided.
(c) Where single-patient rooms are used, 3 feet (91.44 centimeters) shall be provided between the sides and foot of beds/gurneys/lounge chairs and adjacent walls or partitions.
A2.1-3.4.2.2 (2) Two bays may be used to accommodate non-standard equipment (e.g., an expanded-capacity patient bed), but clearances do not include any area that would have to be shared to meet the standard. Clearances noted around gurneys are between the normal use position of the gurney and any adjacent fixed surface or between adjacent gurneys.
Provisions shall be made for the isolation of infectious patients.
  1. An airborne infection isolation room is not required in pre- and post-procedure patient care areas.
  2. Provisions for the recovery of a potentially infectious patient with an airborne infection shall be determined by an infection control risk assessment (ICRA).
Patient privacy. Provisions shall be made for patient privacy in accordance with Section 2.1-2.1.2 (Patient Privacy).
Hand-washing stations. See Section 2.1-2.8.7 (Hand-Washing Station) for requirements.
Other design requirements
  1. For electrical receptacle requirements, see Table 2.1-1 (Electrical Receptacles for Patient Care Areas in Hospitals).
  2. For nurse call requirements, see Table 2.1-2 (Locations for Nurse Call Devices in Hospitals).
  3. For oxygen and vacuum requirements, see Table 2.1-3 (Station Outlets for Oxygen, Vacuum, Medical Air, and Instrument Air Systems in Hospitals).
Where a separate pre-procedure patient care room or area is provided, a minimum of one patient care station per imaging, procedure, or operating room shall be provided.
A minimum of one Phase I patient care station per Class 3 imaging or operating room shall be provided.
At least one route of patient transport shall provide direct access from the semi-restricted area of the surgical suite to the Phase I recovery area without crossing public corridors.
The design of the Phase I recovery area shall provide observation of all patient care stations from the nurse station.
A minimum of one Phase II patient care station per Class 2 or Class 3 imaging, procedure, or operating room shall be provided.
Table 2.1-4
Hot Water Use-General Hospital
Clinical Dietary Laundry
Liters per hour per bed1 11.9 7.2 7.6
Gallons per hour per bed1 3 2 2
Temperature (°C) 41—492 493 714
Temperature (°F) 105—1202 1203 1604
1 Quantities indicated for design demand of hot water are for general reference minimums and shall not substitute for accepted engineering design procedures using actual number and types of fixtures to be installed. Design will also be affected by temperatures of cold water used for mixing, length of run and insulation relative to heat loss, etc. As an example, the total quantity of hot water needed will be less when the temperature available at the outlet is very nearly that of the source tank and the cold water used for tempering is relatively warm.
2 The range represents the maximum and minimum allowable temperatures.
3 Provisions shall be made to provide 180°F (82°C) rinse water at warewasher (may be by separate booster) unless a chemical rinse is provided.
4 Provisions shall be made to provide 160°F (71 °C) hot water at the laundry equipment when needed. (This may be by steam jet or separate booster heater.) However, it is emphasized that this does not imply that all water used would be at this temperature. Water temperatures required for acceptable laundry results will vary according to type of cycle, time of operation, and formula of soap and bleach as well as type and degree of soil. Lower temperatures may be adequate for most procedures in many facilities, but the higher 160°F (71 °C) should be available when needed for special conditions.
  1. Space shall be provided to accommodate equipment and activities for testing performed on-site. Determination of specific testing to be done on-site with point-of-care and other laboratory instrumentation shall be reviewed with the medical staff of the hospital or freestanding emergency facility.
  2. Provisions shall be included for specimen collection and processing.
A2.1-4.1.1.1 Certain tests may be performed on-site or provided through a contractual arrangement with a laboratory service when approved by the authority having jurisdiction. When testing is performed on-site, space and facilities will be needed to accommodate these services. Testing may include hematology, clinical chemistry, urinalysis, coagulation, genetic testing, molecular diagnostics, toxicology, microbiology, anatomic pathology (including cytology and histology), and blood banking as well as tests for blood glucose, arterial blood gases, and electrolytes.
Laboratory equipment requiring permanent connections to power, water, ventilation, or other utility systems shall meet the requirements in Section 1.4-1.3.1.1 (Drawings or other project documentation).
The following laboratory work areas shall be provided:
  1. Space shall be provided to accommodate equipment used and, at minimum, shall include the following:
    1. Laboratory work counter
    2. Sink
  2. Access to the following shall be provided as required:
    1. Vacuum and gases
    2. Tele/data service
    3. Electrical service
    4. Computer/printer
  1. A hand-washing station shall be provided where staff handle specimens, test reagents, or blood products.
  2. If there is one workstation, a hand-washing station shall be provided at the workstation.
  3. If more than one workstation is provided, a hand-washing station shall be provided within 25 feet (7.62 meters) of all testing and specimen-handling areas.
  4. A hand-washing station shall be provided in each enclosed room where bio-hazardous specimens and/or hazardous chemicals are handled.
  1. A refrigerator shall be provided.
  2. Blood storage facilities shall meet the requirements of the Clinical Laboratory Improvement Amendments (CLIA) standards for blood banks.
Storage shall be provided for reagents, specimens, flammable materials, acids, bases, and other supplies used in the laboratory.
A2.1-4.1.2.4 Storage should meet the requirements of NFPA 400: Hazardous Materials Code and NFPA 30: Flammable and Combustible Liquids Code, where applicable.
All work counter(s) in areas used for specimen handling, preparation of specimens or reagents, and laboratory testing shall be constructed of non-porous materials.
A2.1-4.1.2.5 Reagent water systems. Deionized or reverse osmosis reagent water systems should be designed in accordance with ASTM D1193: Standard Specification for Reagent Water.
  1. Terminal sterilization provisions. Facilities and equipment shall be provided for terminal sterilization of bio-hazardous waste before transport (autoclave or electric oven).
    1. Terminal sterilization is not required for waste that is incinerated on-site.
    2. If the facility includes a biosafety Level III lab, autoclave requirements shall be in conformance with Section IV of the CDC Biosafety in Microbiological and Biomedical Laboratories (BMBL).
  2. Radioactive material-handling provisions. If radioactive materials are employed, facilities for long-term storage and disposal of these materials shall be provided in accordance with the requirements of authorities having jurisdiction.
A2.1-4.1.2.6 Safety and security provisions
  1. Additional security information can be found in Section 02.09 Biological, Chemical and Radiation Areas of Security Guidelines for Healthcare Facilities, published by the International Association for Healthcare Security & Safety (IAHSS).
  2. Eyewash and emergency showers. The number and location of eyewash and emergency showers that may be required will be based on requirements from different occupational safety organizations at local, state, and federal levels. The application of these requirements will depend on the types and volumes of chemicals used in a lab. Hospitals should consult with the local authority having jurisdiction to determine these requirements.
  1. Space shall be provided for specimen collection.
  2. Specimen collection facilities shall be permitted to be outside the laboratory work area.
At minimum, specimen collection facilities shall have the following:
  1. A blood collection area with:
    1. Work counter
    2. Space for patient seating
    3. Hand-washing station(s)
    4. Supply storage
  2. A urine and feces collection facility equipped with a toilet and a hand-washing station
  3. Storage spaces for specimen collection supplies
  4. Work counters for labeling and computerized data entry
  5. Storage for specimens awaiting pickup
Office(s) and space for clerical work, filing, and record maintenance and storage shall be provided.
Lounge, locker, and toilet facilities shall be readily accessible for laboratory staff.
Location of these areas outside the laboratory area and sharing of these areas with other departments shall be permitted.
  1. Facilities shall be provided to accommodate the pharmacy services and equipment described in the functional program.
  2. Pharmacy facilities shall be designed to address risks identified in the medication safety assessment and security risk assessment portions of the safety risk assessment.
  3. Satellite pharmacy facilities shall be permitted.
A2.1-4.2.1.1 Pharmacy services. The size and type of services to be accommodated in the pharmacy depend on the type of drug distribution system used, the number of patients to be served, and the extent of shared or purchased services.
(1) The pharmacy room or suite shall be located to be accessible to clinical areas of the hospital.
*(2) Access to the room or suite shall be controlled.
A2.1-4.2.1.2 (2) Controlled access to the pharmacy. Additional security information can be found in Security Design Guidelines for Healthcare Facilities, published by the International Association for Healthcare Security & Safety (IAHSS).
See Section 2.1-2.8.8 (Medication Safety Zones) for general requirements for design of medication safety zones.
The following shall be provided:
  1. A room or area for receiving, unpacking, and inventory control of materials used in the pharmacy
  2. Work counters and space for automated and manual dispensing activities
  3. An extemporaneous compounding area. This shall include a sink and counter space for drug preparation.
  4. An area for reviewing and recording
  5. An area for temporary storage, exchange, and restocking of carts
  6. Security provisions for drugs and personnel in the dispensing counter area
A2.1-4.2.2.1 Dispensing facilities. Dispensing facilities should meet all applicable requirements of:
  1. USP <795>: Pharmaceutical Compounding-Nonsterile Preparations
  2. USP <797>: Pharmaceutical Compounding-Sterile Preparations
  3. USP <800>: Hazardous Drugs-Handling in Healthcare Settings
The following shall be provided:
  1. A bulk compounding area
  2. Provisions for packaging and labeling
  3. A quality control area
Cabinets, shelves, and/or separate rooms or closets shall be provided for the following:
(1) Bulk storage
(2) Active storage
(3) Refrigerated storage
(4) Storage for volatile fluids and alcohol in accordance with applicable fire safety codes for the substances involved
*(5) Secured lockable storage for narcotics and controlled drugs
(6) Equipment and supply storage for general supplies and equipment not in use
A2.1-4.2.2.3 (5) Storage should be in accordance with Code of Federal Regulations, Title 21.
Where sterile work areas are provided, they shall meet the requirements in this section.
  1. Layout. The pharmacy shall be laid out to preclude unrelated traffic through the intravenous (IV) and hazardous drug IV preparation rooms.
  2. Where robotic systems are used in the preparation of IV solutions in either the positive pressure IV preparation room or the negative pressure hazardous drug IV prep room, the robotics shall be separate systems and shall not pass from one room to the other.
A2.1-4.2.3.1 General. Sterile work areas should meet the requirements of USP <797>: Pharmaceutical Compounding-Sterile Preparations and USP <800>: Hazardous Drugs-Handling in Healthcare Settings as applicable.
If IV solutions are prepared in the pharmacy, a sterile work area with a laminar-flow workstation designed for product protection shall be provided.
  1. The laminar-flow workstation shall include a nonhydroscopic filter rated at 99.97 percent (HEPA), as tested by dioctyl phthalate (DOP) tests.
  2. The laminar-flow workstation shall have a visible pressure gauge for detection of filter leaks or defects.
A separate room shall be provided for preparation of hazardous drug IV admixtures under a Class II (Type A2, B1, or B2) or Class III biological safety cabinet.
A2.1-4.2.3.3 Hazardous drug IV prep room
  1. Biological safety cabinets are classified according to biosafety levels established by the Centers for Disease Control and Prevention. See the CDC document "Primary Containment for Biohazards: Selection, Installation and Use of Biological Safety Cabinets."
  2. The hazardous drugs IV preparation room should meet the requirements of USP <800>: Hazardous Drugs-Handling in Healthcare Settings.
Access to the following types of information shall be provided:
  1. Patient information. Provision shall be made for cross-checking medication and drug profiles of individual patients.
  2. Pharmacological information. Provision shall be made for access to poison control, reaction data, and drug information.
A2.1-4.2.8.1 Access to information. Where access to patient and pharmacological information is via a computer, consideration should be given to providing backup access during a power failure or a failure of the health care organization's electronic data system.
A separate room or area shall be provided for office functions.
A2.1-4.2.8.2 Office. When sizing this room, consider the space needed to accommodate a desk, filing capabilities, communication equipment, and reference materials.
A multipurpose room shared with other departments shall be permitted to serve this purpose.
If medication is dispensed to outpatients from the hospital pharmacy, an area for consultation and patient education shall be provided.
A hand-washing station(s) shall be provided either in an anteroom or immediately outside the room where open medication(s) are prepared.
A2.1-4.2.8.7 A hand-washing station(s) should be in accordance with:
  1. USP <795>: Pharmaceutical Compounding-Nonsterile Preparations
  2. USP <797>: Pharmaceutical Compounding-Sterile Preparations
  3. USP <800>: Hazardous Drugs-Handling in Healthcare Settings
If a unit dose procedure is used, additional space and equipment shall be provided to accommodate supplies, packaging, labeling, and storage, including space for carts.
Lounge, locker, and toilet facilities shall be readily accessible to the pharmacy.
These areas shall be permitted to be outside the pharmacy area and shared with other departments.
Facilities and equipment shall be provided to support food services provided for staff, visitors, and patients.
A2.1-4.3.1.1 Food service in a hospital may be provided in special dining areas (e.g., a physicians' dining room, conference center, boardroom, training facilities) and in retail serving areas for staff, ambulatory patients, and visitors. In addition, snacks between scheduled meals may be provided.
The equipment and design layout shall provide a workflow that minimizes potential for cross-contamination of clean food and wares with contaminated trays from patients or retail customers.
A2.1-4.3.1.2 Layout of food and nutrition service facilities
  1. The design should keep food service storage, production, sanitation, tray assembly, and main retail areas contiguous to each other.
  2. Small retail options or minimal amounts of storage may be remote from the main food service area.
  3. If the food service department is split onto two levels, there should be a dedicated elevator and an internal service stair connecting the multi-level food service operations.
  4. The design should not split retail and patient food service in hospitals with fewer than 250 occupied beds.
  5. Nutrition service offices should be located near the functional work centers of the food and nutrition service facilities.
Construction, equipment, and installation of food and nutrition service facilities in a hospital shall comply with the requirements of:
  1. U.S. Food and Drug Administration (FDA)
  2. U.S. Department of Agriculture (USDA)
  3. Underwriters Laboratories, Inc. (UL)
  4. NSF International
The space shall be designed to prevent soiled trays or tray carts from passing through food preparation areas or areas with open food.
A sink(s) shall be provided as required by local codes.
Food preparation surface areas shall be provided. When combined, these shall have a length equal to or greater than the length of all commercial cooking equipment.
  1. Cooking equipment. Commercial-grade cooking equipment that meets NSF International, Underwriters Laboratories, and American Gas Association standards shall be provided.
  2. Refrigeration equipment. Commercial-grade refrigeration shall be provided to hold chilled and frozen food at temperatures in accordance with local, state, and federal requirements, including the FDA "Food Code."
  3. Hot food holding equipment. Commercial equipment shall be provided for maintaining food at hot temperatures in accordance with local, state, and federal requirements, including the FDA "Food Code."
A2.1-4.3.2.4 Cooking equipment should be mounted on casters with locking brakes for ease of cleaning requirements. Flexible quick-disconnects or plug connectors with restraining devices should be used to minimize damage to utility connection points during cleaning and/or service.
Hand-washing stations shall be provided within 20 feet (6.10 meters) of each food preparation or serving area.
A2.1-4.3.3 The patient meal service distribution process should be described in the functional program. This process may include a conventional patient tray line, room service, pantry service, or other methodology for serving patient meals.
Space shall be provided for patient food assembly in a non-public service area.
Where dinnerware and serving utensils are retained in patient care areas and not returned to a central wing/sanitation area, the patient care unit shall be provided with a NSF-listed automatic dishwashing unit.
Space shall be provided for the following functions to support food service cart distribution:
(1) Storing carts when not in use
(2) Loading carts for distribution
(3) Distributing meals
(4) Receiving soiled carts
*(5) Sanitizing carts. A designated area shall be provided with a grated or sloped floor with floor drain and a source of water and sanitizing agents.
A2.1-4.3.3.3 (5) Cart sanitizing
  1. A high-pressure water and chemical hose/spray system should be provided to facilitate cleaning.
  2. A cart-drying area with floor drain should be provided where carts can air-dry.
A NSF-listed automatic dishwashing unit shall be provided for dinnerware and utensil washing.
A2.1-4.3.4.1 Dishwashing unit. Use of a hot water sanitizing dish machine is recommended rather than a low temperature chemical washing unit.
Soak sinks shall be provided.
A three-compartment sink with an integral sloped drainboard on both the clean and soiled sides shall be provided.
A hand-washing station(s) shall be provided.
Dining space(s) shall be provided for ambulatory patients, staff, and visitors.
A minimum aisle spacing and chair clearance of 3 feet (91.5 centimeters) shall be provided.
The design of aisles, tables/chairs, and casework used for self-service shall accommodate wheelchair access. See Section 1.1-4.1 (Design Standards for Accessibility).
A2.1-4.3.6 Vending machine areas. Provision of space for vending equipment near staff support areas, high-traffic areas, and public waiting areas should be considered.
  1. Vending equipment may be coordinated with interior finish design concepts through use of custom or false fronts or enclosures that conceal commercial messages.
  2. Space should be provided for trash collection devices in each vending equipment complex.
  3. Environmental services facilities should be located near vending areas as they are high-use areas.
  4. Vending rooms may also contain a seating area, microwaves, and trash-holding containers.
(1) Location. A receiving area shall be provided at the receiving entrance to the department.
*(2) Space requirements. Space shall be provided for vendor storage, the breakdown of boxes, and the delivery and transport equipment used, such as receiving carts/jacks, transport carts, and returnables.
*(3) Door. The exterior door into the receiving area shall have a minimum clear width of 4 feet (1.22 meters) and a minimum clear height of 7 feet (2.14 meters).
A2.1-4.3.8.1 Design considerations for the receiving dock should include, at minimum, dock height, a dock depth of 10-12 feet, dock levelers, automatic doors, multiple truck bays, ramps from grade, and balers. Vestibules may be needed depending on climatic conditions.
A2.1-4.3.8.1 (2) In facilities with more than 250 beds, space should be allowed for a receiving desk or office at the receiving dock.
A2.1-4.3.8.1 (3) The 4-foot (1.22-meter) wide receiving door is sized to fit a pallet/transport nominally 3 feet 4 inches (1.02 meters) wide.
Office space shall be provided for food service management.
*(1) General
(a) Dry storage and refrigerator/freezer space shall be provided to support both patient and non-patient food service based on the number of deliveries available, the menu, and the method of preparation.
*(b) Aisles with a minimum width of 36 inches shall be provided between storage units.
*(2) Refrigeration equipment
(a) Refrigerators and freezers shall be thermostatically controlled to maintain temperature settings in increments of 2 degrees or less.
(b) Commercial-grade refrigeration shall be provided to hold chilled and frozen food at temperatures in accordance with local, state, and federal requirements, including "HACCP [Hazardous Analysis Critical Control Point] Principles & Application Guidelines" and the FDA "Food Code."
(c) Interior temperatures shall be indicated digitally on the exterior of the equipment in accordance with FDA Food Code safe food handling guidelines and verification standards.
(i) Controls shall include audible and visible high- and low-temperature alarms.
(ii) The time of the alarm shall be automatically recorded.
(d) A coved base shall be provided on the interior and exterior of walk-in refrigerator and low-temperature units.
(e) All walk-in refrigerator and low-temperature units shall have a view panel in the door and safety release mechanism for exit from the inside.
(f) Shelving in walk-in refrigerator and low-temperature units shall be non-corrosive and mobile.
(g) The interior of walk-in refrigerator and low-temperature units shall be lighted when occupied.
(h) The bottom shelf shall be located no less than 10 inches (25.40 centimeters) above the finished floor.
*(3) Chemical storage. Chemical storage shall be provided.
(4) Emergency storage. The following shall be provided as determined in the design phase:
(a) Storage for emergency or disaster food and water
(b) Emergency utility support for refrigerated storage and food preparation and serving areas
A2.1-4.3.8.13 (1) Storage in food and nutrition areas
  1. Room temperature should be maintained below 72°F (22°C) and 55 percent relative humidity to minimize food spoilage.
  2. Most shelving in storage areas should be 21—24 inches (53—61 cm) wide.
  3. Children's hospitals or hospitals with more than 25 pediatric/NICU beds should have a separate storage area for formula and human milk on the patient care unit near the patient beds.
A2.1-4.3.8.13 (1)(b) Aisles in food and supply storage areas. In facilities with pallet/transport traffic, aisles should be a minimum of 3 feet 6 inches (1.07 meters) wide.
A2.1-4.3.8.13 (2) Refrigeration equipment
  1. Walk-in refrigerator and low-temperature units should be constructed with a recessed insulated floor that is flush with the adjoining finished floor.
  2. Walk-in refrigerator and low-temperature units should have a minimum interior ceiling height of 7 feet 11 inches (2.4 meters).
  3. A quick-chill refrigeration capability should be provided to meet FDA "Food Code" requirements.
A2.1-4.3.8.13 (3) Chemicals should be stored on non-corrosive or stainless steel shelving.
An environmental services room shall be provided in the food and nutrition services department in accordance with Section 2.1-2.8.14 (Environmental Services Room), except as amended in this section.
  1. The environmental services room in the food and nutrition services department shall not be shared with patient care units or clinical departments.
  2. Space requirements
    1. The size of the environmental services room shall accommodate the following:
      1. A utility sink with check valves on hot and cold water supply lines
      2. Storage for warewashing and general cleaning chemicals
      3. A rack for air drying mops
      4. Mobile carts with water containers and related janitorial equipment
    2. Where hot water or steam is used for general cleaning, additional space shall be provided in the room for storage of hoses and nozzles.
  3. Environmental services rooms shall not be combined with locations for trash storage.
Space for holding covered trash containers prior to removal to dock waste-handling facilities shall be provided in food preparation, serving, and sanitation areas.
A2.1-4.3.8.16 Recycling and composting. Today's hospitals are increasingly using recycling and composting as a means of reducing waste. Providing space for these functions should be considered.
  1. Toilet rooms shall be provided in, adjacent to, or directly accessible to the food and nutrition services department.
  2. Toilet rooms in the food and nutrition services department shall not be permitted to open directly into food preparation or food storage areas.
  1. Lockers shall be provided for food and nutrition services staff.
  2. If staff lockers are not readily accessible to the department, space for lockable storage for staff personal items shall be provided in the department.
Each hospital shall have provisions for sterile processing.
(1) Application
(a) Where sterile processing is provided on-site, sterile processing facilities that meet the requirements in Section 2.1-5.1.2.2 (Two-room sterile processing facility) shall be provided with the following exception:
(b) Where sterilization equipment is limited to a table-top or similar-sized sterilizer(s), provision of a one-room sterile processing facility that complies with Section 2.1-5.1.2.3 (One-room sterile processing facility) shall be permitted.
(2) The sterile processing facility shall meet the requirements of a semi-restricted area.
*(3) Layout. Sterile processing facilities shall be designed to provide a one-way traffic pattern.
A2.1-5.1.2.1 (3) One-way traffic in sterile processing. The process for cleaning contaminated instruments and reprocessing items for patient use is: The contaminated item is transported from the point of use to the decontamination room or decontamination area, where it is cleaned. The clean item is then moved to the clean workroom or clean work area, where it is readied for sterilization, packaged, and sterilized.
(1) General
*(a) The two-room sterile processing facility shall consist of a decontamination room and a clean workroom that are physically separated by a wall containing a door or pass-through window that can be closed and secured or a built-in washer/disinfector with a pass-through door or window.
(b) A sterilizer access room for maintaining the equipment shall be provided if required by the sterilizer manufacturer.
(2) Decontamination room
*(a) The decontamination room shall be sized to meet the minimum equipment space and clearances needed for the equipment used.
(b) In addition to space for equipment, the decontamination room shall contain the following:
(i) Work counter(s)
(ii) Hand-washing station
(iii) Three-basin sink with counter
(iv) Flushing-rim clinical sink or equivalent fixture unless alternative methods for disposal of bio-waste are provided
(v) Space for waste and soiled linen receptacle(s)
(vi) Documentation area
(vii) Instrument air outlet or portable compressed air for drying instruments. See Table 2.1-3 (Station Outlets for Oxygen, Vacuum, Medical Air, and Instrument Air Systems in Hospitals).
(viii) Eyewash station if required by the safety risk assessment
(ix) Storage for decontamination supplies and personal protective equipment (PPE)
(3) Clean workroom
*(a) The clean workroom shall be sized to accommodate the space and clearances needed for the sterilization equipment used.
(b) In addition to space for equipment, the clean workroom shall contain the following:
*(i) Work counter(s)
(ii) Hand-washing station
(iii) Eyewash station if required by the safety risk assessment
(iv) Storage for sterilization supplies
(v) Documentation area
(vi) Instrument air outlet or portable compressed air as required by equipment used to dry instruments. See Table 2.1-3 (Station Outlets for Oxygen, Vacuum, Medical Air, and Instrument Air Systems in Hospitals).
(vii) Cooling area for sterilization cart where the sterilizer is loaded/unloaded using a rolling cart
(4) Sterile storage. A sterile storage space shall be provided for storage of sterile instruments and supplies.
(a) This space shall be permitted to be in the clean workroom or a separate storage room.
(b) Space for case cart storage shall be provided where case carts are used.
A2.1-5.1.2.2 (1)(a) The intent of this requirement is to support a work flow in which decontaminated items are transferred directly to the clean workroom for final assembly, packaging, and sterilization. This direct flow pattern reduces the risk of environmental contamination of adjoining corridors and other spaces.
A2.1-5.1.2.2 (2)(a) Decontamination room equipment. Equipment used in the decontamination room may include:
  1. Washer/sterilizer or washer/decontaminator
  2. Ultrasonic cleaner
  3. Case cart washer, where carts are used
  4. Case cart storage, where carts are used
A2.1-5.1.2.2 (3)(a) Clean workroom equipment. Equipment used in the clean workroom may include:
  1. Steam sterilizer (manual load, cart, or countertop)
  2. Low-temperature sterilizer (may be countertop)
A2.1-5.1.2.2 (3)(b)(i) The work counter space provided should be able to accommodate the volume of equipment assembly for the procedures performed in the facility and the expected staffing levels.
(1) General. The one-room sterile processing facility shall consist of a decontamination area and a clean work area.
(a) Location of the clean work area in an alcove or in a clean workroom as described in Section 2.1-2.8.11 (Clean Workroom or Clean Supply Room) shall be permitted provided decontamination takes place in a readily accessible soiled workroom as described in Section 2.1-2.8.12 (Soiled Workroom or Soiled Holding Room).
*(b) One-room sterile processing facilities shall be permitted to have one entrance provided it is located approximately equidistant from the clean and decontamination sides of the room and allows for a one-way traffic flow.
(2) Decontamination area
(a) The decontamination area shall be equipped with the following:
(i) Countertop
(ii) Two-basin sink for washing instruments
(iii) Hand-washing station separate from the instrument-washing sink
(iv) Storage for supplies
(v) Instrument air outlet or portable compressed air as required by equipment used to dry instruments. See Table 2.1-3 (Station Outlets for Oxygen, Vacuum, Medical Air, and Instrument Air Systems in Hospitals).
(b) To avoid splash, the instrument-washing sink shall be separated from the clean work area by either a 4-foot (1.22-meter) distance from the edge of the sink or a separating wall or screen. If a screen is used, it shall extend a minimum of 4 feet (1.22 meters) above the sink rim.
(3) Clean work area. The clean work area shall be equipped with the following:
(a) Countertop
(b) Sterilizer as required for the services provided
(c) Storage for supplies
(d) Instrument air outlet or portable compressed air as required by equipment used to dry instruments. See Table 2.1-3 (Station Outlets for Oxygen, Vacuum, Medical Air, and Instrument Air Systems in Hospitals) for requirements.
A2.1-5.1.2.3 (1)(b) A one-way traffic flow may also be created by placing a door at or near the ends of both the clean and decontamination areas.
(1) Instrument and supply storage. Storage shall be provided for sterile and clean instruments and supplies.
(a) This storage shall be permitted to be a separate room or a portion of the clean workroom.
(b) Space for case cart storage shall be provided where case carts are used.
(c) Storage for clean/sterile packs shall include provisions to maintain humidity and temperature levels specified by the manufacturer(s) of the materials being stored.
*(2) Clean/sterile medical/surgical supply receiving. A room shall be provided for receiving/unpacking clean/sterile supplies received from outside the department or facility.
A2.1-5.1.2.4 Space for instrument vendor (loaner set) receiving/pickup. If the facility uses an equipment consignment process, provision of space should be considered where instrument vendors can deliver, inventory, inspect, and prepare their consigned equipment for delivery into the sterile processing area. This space should be adjacent to the sterile processing area without providing direct access into it. Provision of space for vendor pickup of used equipment also should be considered; this could be a separate space or part of the vendor receiving/pickup space.
A2.1-5.1.2.4 (2) A receiving room is required because the exterior containers in which supplies are delivered are considered dirty and may harbor various infectious agents.
Staff changing areas shall be provided.
  1. General
    1. Separate changing areas shall be provided for male and female staff. Provision of a unisex changing area with one or more private changing rooms shall be permitted.
    2. Staff changing area(s) shall meet the requirements of an unrestricted area.
    3. Sharing of these areas with other departments or services shall be permitted.
  2. Staff changing areas shall contain the following:
    1. Lockers
    2. Toilet
    3. Hand-washing station
    4. Space for donning surgical attire
    5. Provision for separate storage of clean and soiled surgical attire
Where sterile processing services are provided off-site, the following on-site support spaces shall be provided:
See Section 2.1-5.1.2.4 (2) (Clean/sterile medical/surgical supply receiving) for requirements.
See Section 2.1-5.1.2.4 (1) (Instrument and supply storage) for requirements.
The soiled workroom described in Section 2.1-2.8.12 (Soiled Workroom or Soiled Holding Room) shall be permitted to serve this purpose.
A2.1-5.2 Linen services facilities provide for processing and storage of soiled and clean linen throughout the hospital.
Each hospital shall have provisions for storing and processing of clean and soiled linen used for patient care and support.
Linen processing shall be permitted to occur on-site or in an off-site laundry.
Where linen is processed in the hospital or in a separate building on the hospital campus, at minimum the following shall be provided:
  1. Soiled linen holding room. A separate room shall be provided for soiled linen receiving and holding that meets the requirements in Section 2.1-2.8.12.3 (Soiled holding room).
    1. A hand-washing station shall be provided in each room or area where soiled linen is processed or handled.
    2. Discharge from soiled linen chutes shall be received in a separate room adjacent to the soiled holding room.
  2. Clean linen inspection room or area
    1. If not provided as part of the clean linen storage room, a room or area shall be provided for inspection, removal of lint, mending, folding, assembling, and packaging of clean linen.
    2. Space for a table, shelving, and storage shall be provided.
  3. Clean linen storage room. A clean linen storage and issuing room(s) shall be provided in addition to the linen storage required at individual patient units.
  4. Cart storage area. Separate areas shall be provided for parking of clean and soiled linen carts out of traffic.
  5. Service entrance. Where linen processing facilities are located in a separate building on the hospital campus, a service entrance protected from inclement weather shall be provided for loading and unloading of linen.
  1. General
    1. Laundry facilities to accommodate the washing and drying of laundry shall include those listed in this section.
    2. Laundry facilities shall be designed to permit an orderly work flow and minimize cross-traffic that might mix clean and soiled operations.
  2. Laundry processing room. This room shall have space for commercial or industrial washing and drying equipment that can process at least a seven-day supply of laundry during the regularly scheduled work week.
  3. Hand-washing station. A hand-washing station shall be provided in the laundry processing room.
  4. Storage for laundry supplies. Storage shall be provided for all supplies necessary for laundry operations.
Where linen is processed off-site, the following support areas shall be provided at the hospital:
  1. A separate room shall be provided for soiled linen receiving and holding that meets the requirement in Section 2.1-2.8.12.3 (Soiled holding room).
  2. Discharge from soiled linen chutes shall be received in a separate room adjacent to the soiled holding room.
A clean linen storage and issuing room(s) shall be provided in addition to the linen storage required at individual patient units.
Separate areas shall be provided for parking of clean and soiled linen carts out of traffic.
A service entrance shall be provided for loading and unloading linen.
  1. A control station for pickup and receiving of soiled and clean linen shall be provided.
  2. This control station shall be permitted to be shared with other functions.
Toilets, lockers, and lounge facilities shall be readily accessible to the linen services area.
Location of these areas outside the linen services area and sharing of them with other departments or services shall be permitted.
A2.1-5.3 Materials management services include receiving, processing, and storing general supplies for the hospital.
The facilities provided to support a hospitals materials management services shall, at minimum, consist of the requirements in this section.
A2.1-5.3.1.1 The facilities needed to support materials management in a hospital will depend on the size and complexity of the materials management services provided.
Materials management facilities shall be separate from patient care areas.
A2.1-5.3.1.2 Acoustic considerations for materials management and other services. Activities such as loading and unloading of trucks, trash compacting and removal, and ambulance arrival and departure include potentially noisy vehicles, backup signals, and activities inside or adjacent to the building. Hours of operation are usually unlimited. Patient rooms and other sensitive rooms often overlook these areas, and limiting the transmission of sound from vehicles and associated activities into the building should be a high priority during design of the built environment. See Section 1.2-6.1 (Acoustic Design) for more information.
An area separated from public streets shall be provided for unloading materials for the hospital.
A receiving area shall be provided to accommodate delivery trucks and other vehicles.
*(1) Location
(a) The receiving area shall be separated from other occupied building areas and located so that noise and odors from operation will not adversely affect building occupants.
(b) The receiving area shall be segregated from waste staging and other outgoing materials-handling functions.
(2) Space requirements
(a) An area shall be provided for unpacking, sorting, and staging of incoming materials and supplies.
(b) If provided, balers and other devices shall be located to capture packaging for recycling or return to manufacturer or deliverer.
(c) In facilities with centralized warehousing, space shall be provided at receiving points to permit staging of reusable transport containers for supplies moving from central warehouses to individual receiving sites.
(d) A workstation area shall be provided.
A2.1-5.3.2.2 (1) The receiving area should be located to promote the safe, secure, and efficient movement of arriving materials without compromising patient areas. It should be immediately accessible to service elevators and other internal corridor systems.
  1. In addition to supply storage facilities located in individual departments, a central facility for general storage shall be provided.
  2. Location of central storage facilities in a separate building on-site shall be permitted as long as provisions are made for protection against inclement weather during transfer of supplies to the hospital.
A2.1-5.3.3.1 Supplies for emergencies. During planning for central storage facilities, consideration for storage of emergency preparedness supplies, linens, etc. should be included. Emergency preparation storage may be located off-site provided a transportation plan is in place for accessing the supplies.
Central storage facilities for general storage shall consist of one or more storage rooms.
  1. Location
    1. Location of the general storage room(s) in a separate, concentrated area(s) in the hospital, or in one or more individual storage buildings on the hospital campus, shall be permitted.
    2. Off-site location for a portion of this storage shall also be permitted.
  2. Space requirements. General storage room(s) with a total area of no less than 20 square feet (1.86 square meters) per inpatient bed shall be provided.
  1. Location. The location of additional storage areas for outpatient departments in the general storage room, in a central area in the outpatient department, or at an off-site location shall be permitted.
  2. Space requirements. Additional storage areas for outpatient departments shall have a total area of no less than 5 percent of the total floor area of the outpatient departments served.
A2.1-5.4 Nuclear waste disposal. For information about handling and disposal of nuclear materials in health care facilities, see Code of Federal Regulations, Title 10, Part 20 (Standards for Protection Against Radiation) and Part 35 (Medical Use of Byproduct Material).
A2.1-5.4.1 Waste collection and storage
  1. The underlying framework of waste management is composed of waste minimization and segregation. Facilities should seek both to separate different components of the total waste stream and to minimize all components of each waste stream. At minimum, considerations for regular trash, medical/infectious waste, hazardous waste, and low-level radioactive waste should be addressed during the project planning phase.
    The following should also be addressed during project planning:
    • -Development of effective collection, transport, pest control, and storage systems
    • -Waste management and contingency planning
    • -Protection of the health and safety of workers
    • -Proper siting of all on-site waste treatment technologies
  2. Optimizing waste management has programmatic and space impacts throughout the facility at points where waste is generated, collected, and staged for disposal. For facilities or municipalities with recycling programs in place, particular consideration should be given to sorting and staging areas. The following elements are examples that may be considered:
    • -The hospital should include adequate space to accommodate bins/carts for appropriate waste segregation such as recyclables, infectious waste, sharps, etc. Corridors and materials handling systems should be designed to minimize risk to personnel while achieving efficient movement of waste from points of generation to storage or treatment.
    • -Dedicated storage and flow space and cleaning/sanitation facilities should be designed to facilitate reuse of items such as medical products and food service items to eliminate disposables and reduce waste.
    • -Space should be included for autoclaves, shredders, compactors, and other technologies for processing waste prior to its removal to landfill. Secure storage should be provided for staging/storage of environmentally hazardous materials (e.g., fluorescent lamps) for recycling.
  1. Locations shall be provided for waste collection and storage as identified during project planning.
  2. Where the following are provided in a facility, their locations shall be indicated in the design documents:
    1. Compactor units (for municipal solid waste and recycling)
    2. Balers
    3. Sharps disposal containers
    4. Recycling containers
    5. Composting containers
  3. Waste collection and storage spaces for each of the following produced by the facility shall be indicated in the design documents:
    1. Municipal solid waste (MSW)
    2. Regulated medical waste (RMW)
    3. Pharmaceutical waste (RCRA and non-RCRA)
    4. Anatomical remains
    5. Hazardous wastes
    6. Chemotherapy wastes (bulk and trace)
    7. Universal wastes
    8. Radiologic wastes
A2.1-5.4.1.1 Where possible, the path of travel for waste streams should be separate from the path of travel for food and clean supplies.
Size of spaces provided for waste collection and storage shall be based on the following as identified during the project planning phase:
  1. Categories and projected volume of waste
  2. Methods for handling and disposing of waste
  3. Length of anticipated storage
  1. Secured space shall be provided for regulated medical waste and other regulated waste types.
    1. Where provided as interior spaces, regulated medical waste or infectious waste holding spaces shall have cleanable floor and wall surfaces.
    2. Where an exterior holding space is provided, it shall have the following:
      1. Cleanable floor (and wall, where provided) surfaces
      2. Protection from weather
      3. Protection from animals
      4. Protection from vermin infestation
  2. Such holding spaces shall provide:
    1. Illumination to a minimum of 50 foot-candles
    2. Protection from unauthorized entry
  3. Refrigeration requirements for such holding facilities shall comply with local and/or state regulations.
Refuse chutes shall meet the requirements of applicable codes and standards.
A2.1-5.4.1.4 The minimum cross-sectional dimension of gravity chutes should be as specified in NFPA 82: Standard on Incinerators and Waste and Linen Handling Systems and Equipment. For sprinkler protection information, refer to NFPA 13: Standard for the Installation of Sprinkler Systems.
  1. Where provided, on-site hospital incinerators shall comply with local, state, and federal regulatory and environmental requirements.
  2. The design and construction of incinerators shall comply with NFPA 82: Standard on Incinerators and Waste and Linen Handling Systems and Equipment.
A2.1-5.4.2.1 Incinerator design and construction. The EPA has identified medical waste incineration as a significant contributor to air pollution. Health care facilities should seek to minimize incineration of medical waste, consistent with local and state regulations and public health goals. Refer to the Code of Federal Regulations, 40 CFR part 60, Standards of Performance for New Stationary Sources, regarding emission guidelines and source performance criteria for hospital, medical, or infectious waste incinerators.
Where incinerators are used, consideration should be given to the recovery of waste heat from on-site incinerators used to dispose of large amounts of waste materials. Incinerators should be designed in a manner fully consistent with protection of public and environmental health, both on-site and off-site, and in compliance with federal, state, and local statutes and regulations. Toward this end, permit applications for incinerators and modifications thereof should be supported by environmental assessments and/or environmental impact statements (EISs) and/or health risk assessments (HRAs) as may be required by regulatory agencies. Except as noted below, such assessments should utilize standard U.S. EPA methods, specifically those set forth in U.S. EPA guidelines, and should be fully consistent with U.S. EPA guidelines for health risk assessment. Under some circumstances, however, regulatory agencies having jurisdiction over a particular project may require use of alternative methods.
Types of non-incineration technology(ies) used by the facility shall be determined by the governing body.
  1. Location
    1. The following shall be considered when locating non-incineration technology:
      1. Safe transportation routes
      2. Distances from waste generation sources
      3. Temporary storage spaces
      4. Spaces required for treatment equipment
    2. The location of the technology shall not cause traffic problems as waste is brought in and out.
    3. Odor, noise, and the visual impact of medical waste operations on patients, visitors, public access, and security shall be considered.
  2. Space requirements for such technologies shall be determined by equipment requirements, including associated area(s) for opening waste entry doors; access to control panels; and space for hydraulic lifts, conveyors, and operational clearances.
A2.1-5.4.2.2 Safe access and operation of equipment by equipment operators should be a primary consideration when designing spaces for non-incineration technology.
Each hospital shall provide environmental services rooms throughout the facility. See Section 2.1-2.8.14 (Environmental Services Room) for requirements.
A2.1-5.5.1 Environmental services rooms are provided as required in specific departments or units, with at least one environmental services room for each floor of the hospital.
Facilities shall be provided to clean and sanitize carts serving the central services department, food and nutrition facilities, and linen services.
Facilities for cleaning and sanitizing carts shall be permitted to be centralized or departmentalized.
A2.1-5.6 Engineering and maintenance services provide the entire hospital with the necessary engineering utilities to maintain a safe and secure building environment for patient care and support. The size and complexity of engineering and maintenance services provided vary depending on the hospital.
Sufficient space shall be included in all mechanical and electrical equipment rooms for proper maintenance of equipment.
A2.1-5.6.2.1 Provisions should be made to allow for removal and replacement of equipment.
Room(s) or building(s) shall be provided for boilers and mechanical and electrical equipment, except for the following:
  1. Rooftop air-conditioning and ventilation equipment installed in weatherproof housing
  2. Emergency generators where the engine and appropriate accessories (i.e., batteries) are properly heated and enclosed in a weatherproof housing
  3. Cooling towers and heat rejection equipment
  4. Electrical transformers and switchgear where required to serve the facility and where installed in a weatherproof housing
  5. Medical gas parks and equipment
  6. Air-cooled chillers where installed in a weatherproof housing
  7. Trash compactors
  8. Site lighting, post indicator valves, and other equipment normally installed on the exterior of the building
  9. Telecommunication signaling or tower equipment
Mechanical and electrical equipment rooms shall be secured with controlled access.
A2.1-5.6.2.3 Additional information can be found in Security Design Guidelines for Healthcare Facilities, Section 02.08: Utility, Mechanical and Infrastructure Areas, published by the International Association for Healthcare Security & Safety (IAHSS).
  1. A storage room shall be provided for building maintenance supplies.
  2. Storage for solvents and flammable liquids shall comply with local, state, and federal code requirements.
If yard equipment and supply storage areas are provided, they shall open directly to the exterior of the facility.
If required in the functional program, a general maintenance shop(s) shall be provided to accommodate repair and maintenance requirements.
If required in the functional program, a separate area or room shall be provided for storage, repair, and testing of electronic and other medical equipment.
The amount of space and type of utilities provided shall accommodate the type of equipment used in the hospital and the types of outside contracts used for equipment maintenance.
If required in the functional program, a facility manager's office shall be provided.
This office shall have file space and provisions for protected storage of facility drawings, records, manuals, etc.
A2.1-5.7 Morgue services provide facilities for the care and handling of deceased patients.
Morgue services shall be provided when required in the functional program.
Morgue service facilities shall be located to avoid the need for transporting a body through public areas.
Morgue service facilities shall be secured with controlled access.
If autopsies are performed in the hospital, the following elements shall be provided:
Body-holding refrigerators shall be equipped with temperature-monitoring and alarm signals that annunciate at a 24-hour staffed location.
This shall contain the following:
  1. Work counter with hand-washing station
  2. A storage space for supplies, equipment, and specimens
  3. An autopsy table
  4. A deep sink for washing specimens
  5. A combination emergency deluge shower and facewash where embalming fluid or fixatives containing formaldehyde are used
A service sink or receptor shall be provided for cleanup and housekeeping.
If autopsies are performed outside the facility, a well-ventilated, temperature-controlled body-holding room shall be provided.
See Part 3 (ANSI/ASHRAE/ASHE Standard 170) for ventilation requirements for autopsy and body-holding rooms.
A2.1-6.1 Public and administrative areas are those non-patient care areas where the public is received into the hospital and where administrative functions in support of hospital operations take place.
These areas should be designed with consideration for security principles involving zones of protection as defined in Section 02: Buildings and the Internal Environment in the IAHSS Security Design Guidelines for Healthcare Facilities.
Where required by the facility chapters, public and administrative areas shall be designed according to the requirements in Section 2.1-6 (Public and Administrative Areas).
Public areas shall be clearly identified and located to accommodate persons with disabilities.
The following shall be provided:
A minimum of one drop-off or entrance shall be reachable from grade level.
A2.1-6.2.1 Climate, patient acuity, and community standards may influence whether a covered or canopied entrance is desired.
This space shall include the following:
  1. Access to information
  2. Public waiting area(s)
  3. Public toilet room(s)
  4. Provisions for telephone access
  5. Provisions for drinking water
Shared lobbies shall be permitted in multi-occupancy buildings.
A toilet room shall be readily accessible to all public waiting rooms.
Where a wheelchair(s) owned by the health care organization is made available for patient use, a designated area located out of the required corridor width and directly accessible to the entrance shall be provided for at least one wheelchair.
If the facility provides services that require patients to transfer to a facility chair, wheelchair, recliner, examination table, or gurney, a designated area shall be provided for parking at least one patient-owned wheelchair in a non-public area located out of any required egress width or other required clearance.
A2.1-6.2.7.2 Wheelchair parking. Facilities that provide a significant quantity of services to aging and disabled populations that use wheelchairs (e.g., dialysis patients) should provide more than one wheelchair parking space. Other facilities may be able to address the issue with scheduling and transportation procedures. Check with the authority having jurisdiction to determine if this is an acceptable alternative.
An admissions area for initial admission of inpatients shall include:
A separate waiting area for patients and accompanying persons
A work counter or desk for staff
A storage area for wheelchairs located out of the path of egress
Space(s) for private interviews shall be separate from public and patient areas.
Shared use of an office or consultation room for this purpose shall be permitted.
Several services or departments shall be permitted to share one multipurpose room.
Shared use of an office or interview room for this purpose shall be permitted.
Provisions shall be made for securing medical records of all media types used by the facility.
To maintain confidentiality of records, the medical records area shall be restricted to staff access.
  1. Space shall be provided for medical records management.
  2. Physical space requirements for electronic storage of forms or documents shall be coordinated with electronic medical records personnel from the facility.
Lockers, lounges, and toilets shall be provided for employees and volunteers.
Lockers, lounges, and toilets for staff shall be separate from those provided for the public.
Corridor widths shall meet applicable life safety and building code requirements.
A2.1-7.2.2.1 Corridor width. In areas where patient ambulation is encouraged or necessary for recovery, rest areas should be provided.
The minimum ceiling height shall be 7 feet 10 inches (2.39 meters), with the following exceptions:
*(1) The minimum ceiling height in corridors and in normally unoccupied spaces shall be 7 feet 6 inches (2.29 meters).
(2) Seclusion rooms shall have a minimum ceiling height of 9 feet (2.74 meters).
(3) The minimum height above the floor of suspended tracks, rails, and pipes located in the traffic path for patients in beds and/or on gurneys, including those in patient care areas, shall be 7 feet 6 inches (2.29 meters).
A2.1-7.2.2.2 Ceiling height for food service areas. The ceiling height in food service areas should be a minimum of 10 feet (3.05 meters).
A2.1-7.2.2.2 (1) Examples of normally unoccupied rooms/spaces are toilet, storage, changing, soiled holding, clean holding, environmental services, electrical, and information technology rooms and alcoves.
Door and door hardware finishes shall be selected to withstand impact damage and cleaning with EPA-registered hospital disinfectants.
(1) Door type
(a) All doors between corridors, rooms, or spaces subject to occupancy shall be of the swing type or shall be sliding doors.
*(b) Sliding doors
(i) Use of manual or automatic sliding doors shall be permitted where fire and other emergency exiting requirements are not compromised.
(ii) Sliding doors with emergency breakaway features in the full open position shall be permitted to temporarily restrict the minimum corridor width required by applicable building codes.
*(iii) Sliding doors shall not have floor tracks.
*(2) Door openings
*(a) The minimum clear door opening for patient rooms and diagnostic and treatment areas such as x-ray, surgery, or physical therapy shall have these dimensions:
(i) 44.5 inches (1130 millimeters) in width
(ii) 83.25 inches (2115 millimeters) in height
(b) Where sliding doors are used and a swinging door is provided for personnel use, the minimum clear width for the swinging door shall be 32 inches (813 millimeters).
(3) Door swing
*(a) Doors shall not be permitted to swing into corridors except doors in behavioral health units and doors to non-occupiable spaces (e.g., environmental services rooms, electrical closets) and doors with emergency breakaway hardware.
(b) Doors shall be permitted to swing outward into an alcove that is deeper than the width of the door.
(c) A 180-degree door swing is not exempt from this requirement.
*(4) Door hardware. Lever hardware or push/pull latch hardware shall be provided.
(5) Doors for patient bathing/toilet facilities
(a) Door type. Rooms that contain bathtubs, sitz baths, showers, or toilets for patient use shall have one of the following:
*(i) Two separate doors
(ii) A door that swings outward
*(iii) A door equipped with emergency rescue hardware
*(iv) A sliding door other than a pocket door
(b) Door opening. Where the bathing area or toilet room opens onto a public area or corridor, visual privacy shall be maintained.
(c) Door hardware. Doors to patient toilet rooms in psychiatric patient care units shall be permitted to have hardware that allows staff to control access.
A2.1-7.2.2.3 (1)(b) Sliding doors. Use of sliding doors rather than swing doors is highly recommended for airborne infection isolation rooms, protective environment rooms, and other spaces for which an ICRA has identified infection control as an issue. Research has shown that swinging door motion induces up to six times more possible contaminates than sliding door motion and can significantly affect contaminant control.
A2.1-7.2.2.3 (1)(b)(iii) Eliminating floor tracks and using breakaway door hardware minimizes the possibility of jamming.
A2.1-7.2.2.3 (2) Door openings-general
  1. The door opening sizes given are the minimum clear width and height.
  2. The clear width needed to accommodate access by patients and patient equipment has been taken into consideration in calculating the door opening dimensions given.
  3. Door openings through which patient mobility, mobilization, and handling and movement equipment and accompanying staff will pass should be sized for the equipment used and the number of staff required to support patient safety.
A2.1-7.2.2.3 (2)(a) Door openings for patient rooms and diagnostic and treatment areas. The intent for the clear dimensions given in Section 2.1-7.2.2.3 (2) (Door openings) is to accommodate door slabs that are 48 inches (1219 millimeters) wide and 84 inches (2134 millimeters) tall.
A2.1-7.2.2.3 (3)(a) The intent of this requirement is to avoid injury caused by outward swinging doors.
A2.1-7.2.2.3 (4) Door protection should be provided where a door is subject to impact.
A2.1-7.2.2.3 (5)(a)(i) The two doors should be located so that a collapsed patient will not block both doors.
A2.1-7.2.2.3 (5)(a)(iii) Emergency rescue hardware. Emergency rescue hardware for toilet room doors permits quick access from outside the room to prevent blockage of the door and ensure quick access from outside the room.
A2.1-7.2.2.3 (5)(a)(iv) Use of sliding doors. Sliding doors are permitted for toilet rooms if they do not conflict with other requirements, such as handicapped accessibility, and cannot be blocked from the inside. A pocket type of sliding door would not meet this requirement because weight pushed up against this type of door prevents the door from opening for access from outside the room.
*(1) Each patient room shall be provided with natural light by means of a window to the outside.
*(2) Where operable windows are provided in patient rooms or suites, their operation shall be limited-with either stop limit/restrictor hardware or an open guard/screen-to prevent passage of a 4-inch (102-mm) diameter sphere through the opening.
(3) Window size in patient rooms
(a) The minimum net glazed area shall be no less than 8 percent of the required minimum clear floor area of the room served.
(b) In new construction, windowsill height in a patient room shall be a maximum of 36 inches above the finished floor.
(c) Where renovation work is undertaken and it is not possible to meet the above minimum standards, the authority having jurisdiction shall be permitted to grant approval to deviate from these requirements.
A2.1-7.2.2.5 (1) A window in each patient room, the view from it, and the diurnal cycle of natural light afforded by it are important for the psychological well-being of all patients.
A2.1-7.2.2.5 (2) When designed to open, a window in the patient room may be important for continued use of the area in the event of mechanical ventilation system failure. The window opening is limited to reduce the possibility of accidental falls, escape, or suicide.
Operable exterior windows that may be left open shall have insect screens.
In renovation projects, only glazing within 1 foot 6 inches (45.72 centimeters) of the floor must be changed to safety glass, wire glass, or plastic, break-resistant material.
(1) General
(a) Hand sanitation dispensers and hand-washing stations shall be provided.
(b) The number and placement of both hand-washing stations and hand sanitation dispensers shall be determined by the ICRA.
(i) See Section 2.1-2.2.5 (Hand-Washing Station in the Patient Room) and the facility chapters for information about locations where hand-washing stations are required.
(ii) See Section 2.1-2.8.7.3 (Additional requirements for hand-washing stations that serve multiple patient care stations) for information on the number of hand-washing stations required in certain locations.
*(c) Hand-washing stations in patient care areas shall be located so they are visible and unobstructed.
(2) Sinks. For basin, fitting, and anchoring requirements, see Section 2.1-8.4.3.2 (Hand-washing station sinks).
(3) Hand-washing station countertops
(a) Hand-washing station countertops shall be made of porcelain, stainless steel, solid-surface materials, or impervious plastic laminate assembly.
*(b) For countertops that require a substrate, marine-grade plywood (or an equivalent material) with an impervious seal shall be required.
(4) Where a hand-washing station includes casework, it shall be designed to prevent storage beneath the sink.
(5) Provisions for drying hands. Provisions for hand drying shall be required at all hand-washing stations (except hand scrub facilities).
(a) Hand-washing stations shall include a hand-drying device that does not require hands to contact the dispenser.
(b) These provisions shall be enclosed to protect against dust or soil and to ensure single-unit dispensing.
(c) Hot air dryers shall be permitted.
(d) Where provided, single-use towels shall be directly accessible to sinks.
(6) Cleansing agent. Hand-washing stations shall include liquid or foam soap dispensers.
(7) Mirror. Mirrors shall not be installed at hand scrub stations or at hand-washing stations in food preparation areas, nurseries, clean and sterile supply areas, or other areas where asepsis control would be lessened by hair combing.
A2.1-7.2.2.8 Consideration should be given to placement of electrical devices (space needed for work flow and placement away from the sink).
A2.1-7.2.2.8 (1)(c) Hand-washing stations hidden behind stowed cubicle curtains; located in an area enclosed by curtains, columns, or doors; or located in an area used for equipment/material storage may be considered not visible and/or obstructed.
A2.1-7.2.2.8 (3)(b) Hand-washing station countertops
  1. The presence of water around hand-washing station sinks has consistently been proven to encourage the presence of mold and bacteria in the substrate materials if the countertops are not properly sealed and maintained. Integral backsplashes eliminate intersections that need to be caulked.
  2. Under-mount basins are difficult to clean, and their use is discouraged.
  1. Grab bars shall be anchored to sustain a concentrated load of 250 pounds (113.50 kilograms).
  2. Grab bars in toilet rooms used by patients of size shall be anchored to sustain a concentrated load of 800 pounds (362.87 kilograms).
  3. Ends of grab bars shall be constructed to prevent snagging the clothes of patients, staff, and visitors.
A2.1-7.2.2.9 Grab bars
  1. Grab bars should have a finish that contrasts with the adjacent wall surface and provides slip resistance.
  2. Grab bars in patient toilet rooms and bathing facilities should allow patients to be as safe and independent as possible. This includes using dropdown grab bars when needed, with or without integral toilet paper holder.
    Grab bars should be provided on both sides of the toilet to enable staff-assisted transfers. Wall-mounted bars that fold up are the preferred solution because they leave space to facilitate cleaning and patient transfer. Clearance on both sides of the toilet is needed for a double transfer. Floor-mounted grab bars can be used but are not preferred because of increased difficulty in cleaning and patient transfer. Seat-mounted grab bars are not recommended. Use of additional grab bars to facilitate patient mobility in the toilet room should be considered.
    When the toilet room entrance is located on the same wall as the headwall of the bed in a patient room, fewer steps are needed for the patient to reach the toilet. If this arrangement is provided, continuous handrails should also be installed to assist with mobility and safety.
  1. Handrails shall be installed on both sides of patient use corridors.
  2. Handrails shall comply with local, state, and federal requirements referenced in Section 1.1-4.1 (Design Standards for Accessibility) as amended in this section.
  3. Rail ends shall return to the wall or floor.
  4. Handrail gripping surfaces and fasteners shall be smooth (free of sharp or abrasive elements) with a 1/8-in. minimum (3.18-millimeter) radius.
  5. Handrails shall have eased edges and corners.
  6. Handrail finishes shall be cleanable.
A2.1-7.2.2.10 Handrails should be provided to assist mobility-impaired persons.
Radiation protection requirements for x-ray and gamma-ray installations shall conform with the following National Council on Radiation Protection & Measurements (NCRP) reports and local, state, and federal codes and standards.
  1. Report No. 102: Medical X-Ray, Electron Beam and Gamma-Ray Protection for Energies Up to 50 MeV (Equipment Design, Performance and Use)
  2. Report No. 147: Structural Shielding Design for Medical X-Ray Imaging Facilities
  3. Report No. 151: Structural Shielding Design and Evaluation for Megavoltage X- and Gamma-Ray Radiotherapy Facilities
  1. 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.
  2. The noise reduction criteria shown in Table 1.2-6 (Design Criteria for Minimum Sound Isolation Performance Between Enclosed Rooms) shall apply to partitions, floors, and ceiling construction in patient areas.
A2.1-7.2.2.12 Acoustic design. For additional information on acoustic design, see Section 1.2-6.1 (Acoustic Design).
Rooms containing heat-producing equipment (e.g., boilers, heaters, or laundry equipment) shall be insulated to prevent the floor surface above, ceiling below, and adjacent walls of occupied areas from exceeding a temperature of 10°F (6°C) above ambient room temperature.
  1. Installation of indoor, unsealed (open) water features shall not be permitted.
  2. Covered fish tanks shall be permitted in public areas.
A2.1-7.2.2.14 Fountains and other open decorative water features can represent a reservoir for opportunistic human pathogens.
A2.1-7.2.3 Characteristics and criteria for selecting surface and furnishing materials and products. The effect of surface materials, colors, textures, and patterns on patient, staff, and visitor safety and on maintenance and life cycle performance should be considered in the overall planning and design of the facility.
  1. Surface and furnishing materials and products selected for hospital design and construction projects should meet local, state, and federal regulations and industry standards for infection control and assembly or construction. National testing standards should be used to verify whether a product or material provides specific characteristics.
    A specified surface or furnishing material or product should be evaluated for (1) suitability for a particular application, (2) the intended life cycle use, and (3) quality assurance regarding patient and staff safety. Proposed life cycle use should be based on occupancy classification and function of the space.
    Materials and products selected for use in patient care settings that operate 24 hours a day, seven days a week should meet local, state, and federal regulations and industry standards for heavy-duty commercial use. However, in certain non-patient care and non-clinical areas of the hospital, use of products that meet all of the performance characteristics described in this section is not required (although it is still preferred).
    The effects of repair and demolition and replacement should be considered when selecting surface and furnishing materials and products for use in occupied 24/7 hospital environments. Selected materials and products should comply with use requirements and support the findings of patient safety risk assessments and the requirements of the model of care as described in the functional program.
  2. The following characteristics and criteria should be used in selecting and specifying surface and furnishing materials and products for hospital design and construction projects. (The characteristics included in this text are supported by quantifiable industry test methods. See the Facility Guidelines Institute website at www.fgiguidelines.org/resources for more information.)
    • -Inflammable. Surface and furnishing materials and products should meet NFPA 101 fire and smoke toxicity requirements.
    • -Durable. Surface and furnishing materials and products should be resistant to breakage, punctures/tears, stains, and damage and wear from abrasion as appropriate to the function of the material and product type being selected.
    • -Resilient and impact-resistant. Surface and furnishing materials and products should be able to remain intact, safe, and functional in heavy weight-bearing, high-traffic, and impact-susceptible areas. The materials and products should:
      • Meet "pounds per square inch" (PSI) weight tolerances for loads.
      • Meet tensile strength, flexibility, impact, and abrasion testing standards for the required use.
      • Self-repair from compressions caused by repeated use.
      • Resist shattering or fragmentation under abrasion or impact.
    • -Reduces user fatigue and musculoskeletal injury. Surface and furnishing materials and products should meet specific safety, assembly, and construction industry criteria for flexibility to address foot compression and heel strike absorption.
    • -Uses compatible substrate and materials in surface and furnishing assemblies
      • All assembled materials used in the product should meet the characteristics listed in appendix section A2.1-7.2.3 (Characteristics and criteria for selecting surface and furnishings materials and products).
      • Surface and furnishing assembly seams and joints should be smooth and fully sealed to reduce wear and degradation and should be able to remain intact, safe, and functional during the proposed service life of the assembly.
      • Water-resistant materials, sealed-seam construction methods, and moisture-impervious surface selections should be used for assemblies where water or moisture is continuously present (e.g., clinical use work surfaces with inset or integral sinks and seamed integral wall, flooring, and/or cove base assemblies) to reduce or eliminate the possibility of seepage within or under the assembly. Seepage under assemblies where water is continually present has been proven to produce and encourage layer delamination and growth of mold, mildew, and bacteria, contributing to the possibility of material, staff, and patient contamination.
    • -Safe and efficient for use in occupied patient care settings. Throughout their life cycle, surface and furnishing materials and products should minimize and/or prevent the incidence and effects of noise, odors, gas, particulates, dust, and debris that reduce air quality during product assembly, installation, and operation as well as during maintenance, repair, or demolition in an occupied hospital setting.
    • -Supports the facility's clinical needs and is appropriate for the emotional and cultural well-being of patients, staff, and visitors. Design, layout, size, color, and pattern of surface and furnishing materials and products should create patient environments that support the model of care and functional program requirements.
    • -Has acoustic properties that support clinical function and patient safety and well-being. Surface and furnishing materials and products must meet the noise reduction requirements for patient care areas in sections 1.2-6.1.3 (Design Criteria for Acoustic Surfaces) and 1.2-6.1.6 (Design Guidelines for Speech Privacy) where applicable to the function of the specific material or product.
    • -Made of non-toxic, non-allergenic materials. A review of potential product-based allergens should be performed during the material selection process to identify products inappropriate for use with the facility's patient acuity populations.
    • -Can control and minimize reflectivity and glare. Surface and furnishing materials and products and light fixtures and lamps that are specified should combine to meet ANSI/IES RP-29: Lighting for Hospital and Healthcare Facilities and/or USP-NF (U.S. Pharmacopeia-National Formulary) light level and glare control standards.
  3. Patient safety risk assessment issues addressed by surfaces and furnishings performance characteristics and criteria
    • -Reduction of surface contamination linked to health care-associated infections (HAIs). Surfaces and furnishings selected should have clear, written manufacturer-provided cleaning protocols that will ensure the product remains durable and can meet CDC cleaning standards for health care facilities.
      • Surfaces should be easy to clean, with no surface crevices, rough textures, joints, or seams.
      • Surfaces should be non-absorptive, nonporous, and smooth.
      • Manufacturer-recommended cleaning and disinfection methodologies should be easy to use and effective for meeting CDC and other clinical bacterial elimination requirements.
    • -Reduction of patient falls and associated injuries. Surfaces and furnishings should be selected in accordance with the safety risk assessment (see Section 1.2-4) and sections 2.1-7.2.3.1 (Flooring and wall bases) and 2.1-7.2.4.1 (Built-in furnishings).
    • -Reduction in medication errors. See appendix section A2.1-2.8.8.1(2) (Medication safety zone design requirements) for surface recommendations for medication safety zones.
    • -Reduction of stress and fatigue and improvement in communication and social support for patients and family members.
      • The sound-mitigating properties of surfaces and furnishings should be used to reduce noise.
      • Surface materials should provide options for color, pattern, and texture that are clinically and emotionally appropriate and culturally supportive to patient, staff, and visitor well-being.
      • Built-in seating should meet industry resting standards for safe use by all users, including persons of size.
      • Built-in furnishing layouts should support acoustic and visual privacy for staff, patients, and visitors.
    • -Improvement in staff safety, effectiveness, efficiency, and communication. The sound-mitigating properties of surface and furnishing materials should be used to reduce noise in patient and staff communication areas. Built-in furnishings should be planned to facilitate the individual worker's visibility, privacy, and ergonomic needs. Built-in furnishing layouts should enable care coordination, communication, and information-sharing.
    • -Improvement in facility investments (reduction in life cycle cost and increase in funds available for patient care). The following characteristics and criteria represent optimal choices for longterm health care facility investments (life cycle cost):
      • Surface and furnishing materials and products that support the organizational commitment to quality care, the facility's mission, strategic goals, and service brand
      • Surfaces and furnishings that can easily be reconfigured to support a changing facility mission
      • Design without projections (protuberances) that may damage walls
      • Surface and furnishing materials and products from manufacturers (1) that meet appropriate industry standard safety and durability testing, (2) design products based on research into safety and patient outcome improvement in health care facilities, (3) provide a warranty that meets required standards and planned life cycle use, (4) effectively provide replacement parts to meet required standards and life cycle use, and (5) have representatives or local dealers who can assist with replacement, repair, and refurbishing
      • Surface and furnishing materials and products that can be safely repaired in an occupied health care facility
      • Surface and furnishing materials and products that environmental services staff can easily maintain using CDC cleaning standards for health care facilities
      • Surface and furnishing materials and products with durability that have been proven and tested to meet required life cycle and standards of use
(1) Flooring surfaces shall be cleanable and wear-resistant for the location.
(2) The use of carpeting in patient care areas and clinical support areas (e.g., labs and pharmacies) shall be permitted when approved as part of the ICRA process.
*(3) Smooth transitions shall be provided between different flooring materials.
(4) Flooring surfaces, including those on stairways, shall be stable, firm, and slip-resistant.
*(a) The slip-resistance ratings of flooring surfaces shall be appropriate for the area of use-for dry or wet conditions and for use on ramps and slopes.
(b) Carpet with or without padding shall be installed so it provides a stable and firm surface.
(5) The floors and wall bases of kitchens, soiled workrooms, toilet rooms, and other areas subject to frequent wet cleaning shall be constructed of materials that are not physically affected by germicidal or other types of cleaning solutions.
(6) Food and nutrition areas. Surfaces in preparation, sanitation/warewashing, and serving areas shall be non-absorbent, smooth, and easily cleaned.
(7) Floor and wall base assemblies
(a) The room types listed in this section shall have floor and wall base assemblies that are monolithic and have an integral coved wall base that is carried up the wall a minimum of 6 inches (150 mm) and is tightly sealed to the wall.
(i) Operating room
(ii) Class 2 and Class 3 imaging rooms
(iii) Cesarean delivery room
(iv) Procedure rooms where cystoscopy, urology, and endoscopy procedures are performed
(v) Endoscope processing room
(vi) IV and chemotherapy preparation room
(vii) Airborne infection isolation (AII) room
(viii) Protective environment (PE) room
(ix) Anteroom to AII and PE rooms, where provided
(x) Sterile processing facility
*(b) Equipment shall be permitted to penetrate these monolithic floors provided joints are sealed and do not represent a tripping hazard.
(8) Floor openings for pipes, ducts, and conduits as well as joints at structural elements shall be tightly sealed.
A2.1-7.2.3.1 Characteristics and criteria for selecting flooring materials and products
  1. The fall prevention portion of the safety risk assessment should be consulted when choosing flooring materials; see Section 1.2-4 (Fall Prevention Assessment).
    • -Balancing the softness (non-rigid properties) and firmness of a flooring material is a key consideration for supporting maintenance of gait, postural stability, and balance; reducing fatigue and falls; and facilitating movement of wheelchairs and other wheeled traffic.
    • -The subfloor, the composition of a flooring material, and the material's ability to yield to pressure should be considered when selecting flooring that can contribute to force attenuation when a fall does occur.
  2. The evidence associated with identification of single environmental variables and their importance in preventing, attenuating, or exacerbating patient falls is still emerging. A number of studies in which multiple variables were studied have suggested an association between falls and the following flooring materials and characteristics:
    • -Flooring. Some flooring types (e.g., carpet, resilient flooring such as rubber, VCT, sheet vinyl) can be a trip hazard.
    • -Floor pattern. Some studies suggest that flooring with a medium-sized pattern (1—6 inches wide) were associated with more falls than floors with no pattern, a small pattern (less than 1 inch wide), or a large pattern (wider than 6 inches).
    • -Floor contrast. High-contrast patterns on floor surfaces may be associated with more patient falls.
    • -Floor reflectivity. Finished floors with a high gloss value cause glare that may compromise patient vision, disrupting balance. The selection of non-wax flooring eliminates finish glare. Where a finish coat is required, smooth flooring surfaces should be sealed with a matte finish to reduce surface glare.
    • -Wall and floor color contrast. Color contrast between walls and floors and minimized transitions between different types of flooring may reduce fall risk.
    • -Floor acoustic properties. Floors should be selected with consideration to acoustic properties to help preserve sleep and to protect privacy and accuracy of communication in support of HIPAA compliance and medical error reduction. See sections 1.2-6.1.3 (Design Criteria for Acoustic Surfaces) and 1.2-6.1.6 (Design Guidelines for Speech Privacy).
  3. Floor resistance. Floor surfaces should allow easy movement of all wheeled equipment to be used in the facility. Portable lifting equipment without powered wheels may require more exertion by staff than ceiling-mounted equipment to move an elevated patient around and through a space. The exertion required by staff may increase with the use of carpet; however, different types and brands of carpet may have significantly different levels of resistance to wheeled devices. Installation of a mock-up to test flooring materials in relationship to wheeled equipment and devices used in a facility is recommended. Carpet should not be automatically discounted as inappropriate due to this challenge, as it has major advantages over hard-surface flooring in terms of noise reduction and acoustics.
A2.1-7.2.3.1 (3) Flush thresholds should be used to reduce tripping hazards.
A2.1-7.2.3.1 (4)(a) Wet conditions are common in areas such as kitchens and bathing areas, entries from exterior to interior space, and areas where water is used for patient services. Slip resistance is also an important consideration for ramps and stairways. In dry areas, soft flooring (e.g., carpet, cushioned flooring, etc.) can be used to reduce the risk of falls and the impact of associated injuries.
A2.1-7.2.3.1 (7)(b) Equipment that is fastened to the monolithic floor requires sealed joints at the fastening points to prevent fluids from penetrating the subfloor. Where infrastructure items such as floor ducts to accommodate electrical cabling are installed, the duct cover needs to be sealed to prevent fluids from entering the floor duct.
(1) Wall finishes
(a) Wall finishes shall be washable.
(b) Wall finishes near plumbing fixtures shall be:
(i) Smooth
(ii) Scrubbable
(iii) Water-resistant
(c) Wall finishes in the room types listed shall be free of fissures, open joints, or crevices that may retain or permit passage of dirt particles:
(i) Operating and procedure rooms
(ii) Class 2 and Class 3 imaging rooms
(iii) Cesarean delivery room
(iv) Endoscopy procedure room
(v) Endoscope processing room
(vi) IV and chemotherapy preparation room
(vii) Airborne infection isolation (AII) room
(viii) Protective environment (PE) room
(ix) Anteroom to AII and PE rooms, where provided
(x) Sterile processing facility
(2) Wall surfaces in areas routinely subjected to wet spray or splatter (e.g., kitchens, environmental services rooms) shall be monolithic or have sealed seams that are tight and smooth.
*(3) Food and nutrition areas. In these areas, wall construction, finish, and trim, including joints between the walls and the floors, shall be free of insect- and rodent-harboring spaces.
(a) Walls in food preparation, sanitation/warewashing, and serving areas
(i) Walls shall be non-absorbent, smooth, easily cleaned, and light in color.
(ii) Walls adjacent to cooking equipment shall have sealed surfaces that are cleanable and made of non-combustible materials.
(b) Walls behind cooking equipment
(i) Fire-rated, non-combustible materials with a surface that facilitates cleaning shall be used.
(ii) Walls of these materials shall match or exceed the width of the exhaust hood.
(c) Walls in non-food preparation or sanitation areas (e.g., storage rooms, corridors, offices, and dining or vending areas) shall have a surface finish that facilitates cleaning.
(4) Wall openings for pipes, ducts, and conduits as well as joints at structural elements shall be tightly sealed.
(5) Wall protection devices and corner guards shall be durable and scrubbable.
A2.1-7.2.3.2 Sharp, protruding corners should be avoided.
A2.1-7.2.3.2 (3) Walls in food and nutrition areas
  1. Sound-absorbing materials should be considered in accordance with infection prevention practices in food preparation and sanitation areas.
  2. Fiber-reinforced panels (FRP) may be used for walls in food preparation, sanitation/warewashing, or other wet areas.
  3. Painted surfaces should not be used in wet areas.
  4. In food preparation areas, wall surfaces should not be painted below 4 feet (1.22 meters) above the finished floor.
  5. Painted walls should only be considered for offices, storage areas, and corridors.
(1) Ceilings shall be provided in all areas except as noted in Section 2.1-7.2.3.3 (5).
(a) Ceilings shall be cleanable with routine housekeeping equipment.
(b) Acoustic and lay-in ceilings, where used, shall not create ledges or crevices.
*(2) Semi-restricted areas
(a) Ceiling finishes in semi-restricted areas shall be:
(i) Smooth and without crevices
(ii) Scrubbable
(iii) Non-absorptive
(iv) Non-perforated
(v) Capable of withstanding cleaning with chemicals
(b) Where a lay-in ceiling is provided, it shall be gasketed or each ceiling tile shall weigh at least one pound per square foot.
(c) Use of perforated, tegular, serrated, or highly textured tiles shall not be permitted in semi-restricted areas.
*(3) Restricted areas
(a) Ceilings in restricted areas shall be of monolithic construction.
(i) Cracks or perforations in these ceilings shall not be permitted.
*(ii) The central diffuser array shall not be considered part of a monolithic ceiling.
(b) Ceiling finishes shall be scrubbable and capable of withstanding cleaning and/or disinfecting chemicals.
(c) All access openings in these ceilings shall be gasketed.
(4) Food and nutrition service and laundry areas
(a) Either a sealed monolithic and scrubbable gypsum board ceiling or a lay-in ceiling shall be provided.
*(b) Where a lay-in ceiling is provided, it shall include the following:
(i) A non-corrosive grid
(ii) Ceiling tiles that weigh at least one pound per square foot and are smooth, scrubbable, nonabsorptive, nonperforated, and capable of withstanding cleaning with chemicals
(5) Mechanical, electrical, and communications equipment rooms. Omission of suspended ceilings in these rooms or spaces shall be permitted unless required for fire safety purposes.
A2.1-7.2.3.3 (2) Semi-restricted areas. These include areas such as procedure rooms, Class 2 imaging rooms, endoscope processing rooms, decontamination rooms, clean corridors, and central sterile supply.
A2.1-7.2.3.3 (3) Restricted areas. These include areas such as operating rooms, Class 3 imaging rooms, and sterile compounding and hazardous drug compounding pharmacies.
A2.1-7.2.3.3 (3)(a)(ii) Central diffuser array. A central diffuser array consisting of unidirectional flow diffusers and/or architectural fill-in panels should form a single assembly in the ceiling. The array should be gasketed between the diffuser array system and the ceiling and also between the system framing and the individual diffusers. Where booms and other equipment are located in the central diffuser array, the array should be provided with fill-in panels cut to accommodate the booms or other equipment. Fill-in panels are to be gasketed at the framing and at the perimeter of any cuts made to accommodate the equipment.
A2.1-7.2.3.3 (4)(b) Ceilings in food service areas. Ceiling tile with a noise reduction coefficient (NRC) of 0.80 or higher is recommended.
To minimize entry of rodents and insects, joints where floors and walls are penetrated by pipes, ducts, and conduits shall be tightly sealed. Joints of structural elements shall be similarly sealed.
A2.1-7.2.4 Furnishings
  1. Characteristics and criteria for selecting furnishing materials and products. The effect of furnishing material colors, textures, and patterns on patient, staff, and visitor safety and on maintenance and life cycle performance should be considered in the overall planning and design of the facility. See appendix section A2.1-7.2.3 (Characteristics and criteria for selecting surface and furnishing materials and products) for general information about surface characteristics and criteria and appendix section A2.1-7.2.4.1 (Built-in furnishing safety features) for information about selecting surfaces and materials for built-in furnishings.
  2. Work areas. Where a work space, work area, work counter, or work surface is provided, it should have a minimum of 4 square feet (.37 square meter) of contiguous clear surface for each person programmed to work in the space at the same time.
In patient treatment areas with risks of exposure and contamination from bodily fluids and/or other fluids, built-in furnishings shall be upholstered with impervious materials where required by an infection control risk assessment (ICRA).
A2.1-7.2.4.1 Built-in furnishing safety features. Following are furniture safety characteristics that should be considered in designing built-in furnishings for hospitals.
  1. General furnishing characteristics
    • -Built-in furnishings should have eased or rounded edges and corners of no less than 3/8-inch (9.5-mm) radius to avoid patient injuries.
    • -Built-in furnishings should have non-abrasive surfaces to minimize patient injuries, such as abrasions and skin shear.
  2. Seating. Evidence identifying single environmental variables and their importance in patient falls is still emerging. A number of studies have suggested an association between falls and the design of chairs, whether built-in or freestanding.
    • -Built-in seating used by patients should be appropriate or adaptable to the height, weight, and physical limitations of the patient population.
    • -Seated patients should be able to place their feet flat on the floor with level thighs to facilitate successful sit-to-stand movements.
    • -Space beneath a seat front should allow a user to pull back his or her heels far enough under the seat to assist with rising.
    • -The seat front edge should not compromise blood flow to the legs.
    • -Built-in furnishings used by patients and visitors should have armrests of a length and height appropriate to facilitate standing from a seated position for the patient population.
    • -The angle of the seat and seat back should not hinder rising nor cause shoulder-forward or hip-forward slumping or sliding out of the seat.
    • -Chair legs should not extend laterally or forward beyond the chair seat to avoid creating a trip hazard.
  1. Blinds, sheers, or other patient-controlled window treatments shall be provided to allow for patient privacy and to control light levels and glare.
  2. Window treatments shall not compromise patient safety and shall be easy for patients, visitors, and staff to operate.
  3. Window treatments shall be selected for ease of cleaning, disinfection, or sanitization.
  4. Use of fabric drapes and curtains for window treatments shall be permitted if the fabric is washable.
A2.1-7.2.4.2 Window shades should be a neutral color to maintain true rendition of patient skin.
Use of fabric privacy curtains shall be permitted if the fabric is washable.
A2.1-7.2.4.3 Use of a wipeable fabric with a smooth surface is preferable.
In psychiatric patient rooms, toilet rooms, and seclusion rooms, ceiling and air distribution devices, lighting fixtures, sprinkler heads, and other appurtenances shall be of a tamper- and ligature-resistant type.
HVAC system requirements are defined in Part 3 (ANSI/ASHRAE/ASHE Standard 170: Ventilation of Health Care Facilities).
  1. All electrical material and equipment, including conductors, controls, and signaling devices, shall be installed in compliance with applicable sections of:
    1. NFPA 70: National Electrical Code®
    2. NFPA 99: Health Care Facilities Code
  2. All electrical material and equipment shall be listed as complying with available standards of listing agencies or other similar established standards where such standards are required.
  1. Electrical installations, including alarm, nurse call, staff emergency signal, and communications systems, shall be tested to demonstrate that equipment installation and operation is appropriate and functional.
  2. A written record of performance tests on special electrical systems and equipment shall show compliance with applicable codes and standards.
  1. Location. Switchboards, switchgear, and automatic transfer switches shall be:
    1. Located in a room that meets the requirements of NFPA 70: National Electrical Code
    2. Accessible to authorized persons only
    3. Located in a dry, ventilated space free of corrosive or explosive fumes, gases, or any flammable material
  2. Overload protective devices shall be listed for the ambient room temperature for the space in which they are installed.
  1. Panelboards serving life safety branch circuits shall be permitted to serve the floors on which they are located and the floors immediately above and below the level where the panel is located.
  2. Panelboard critical branch circuits shall serve the floors on which they are located.
  3. New panelboards shall not be located in exit enclosures or exit passageways.
  1. Ground-fault circuit interrupters (GFCIs) shall comply with NFPA 70: National Electrical Code.
  2. Where GFCIs are used in critical care areas, each receptacle shall be individually protected by a single GFCI device.
(1) Essential power shall be provided for in accordance with the following:
(a) NFPA 70: National Electrical Code
(b) NFPA 99: Health Care Facilities Code
(c) NFPA 101: Life Safety Code
(d) NFPA 110: Standard for Emergency and Standby Power Systems
(e) NFPA 111: Standard on Stored Electrical Energy Emergency and Standby Power Systems
*(2) Where stored fuel is required, storage capacity shall permit continuous operation for at least 24 hours.
(3) Acoustic considerations for generators
*(a) Generator system designs shall assure the maximum noise levels in Table 1.2-5 (Maximum Design Criteria for Noise in Interior Spaces Caused by Building Systems) are not exceeded.
(b) An engine exhaust muffler shall be provided for the generator.
A2.1-8.3.3.1 (2) Storage of fuel for at least 96 hours should be considered for facilities in locations likely to experience an extended power outage.
A2.1-8.3.3.1 (3)(a) Meeting the applicable community noise code often translates into an emergency generator enclosure rated to provide a 30 to 35 dBA noise reduction.
Many procedures are available to satisfy lighting requirements, but the design should consider light quality as well as quantity for effectiveness and efficiency. While light levels in the IES publications are referenced herein, those publications include other useful guidance and recommendations which the designer is encouraged to follow.
A2.1-8.3.4 Required levels for artificial illumination in health care facilities should comply with Illuminating Engineering Society (IES) publication ANSI/IES RP-29: Recommended Practices for Lighting for Hospitals and Healthcare Facilities. Light intensity for staff and patient needs should generally comply with these IES guidelines. Consideration should be given to controlling intensity and/or wavelength to prevent harm to the patient's eyes (i.e., retina damage to premature infants and cataracts due to ultraviolet light).
Where special lighting needs for the elderly are required, they shall be incorporated into the lighting design.
A2.1-8.3.4.1 Refer to IES publication ANSI/IES RP-28: Recommended Practices for Lighting and the Visual Environment for Seniors and the Low Vision Population.
Luminaires in wet areas (e.g., kitchens, showers) shall have smooth, cleanable, shatter-resistant lenses and no exposed lamps.
(1) Patient rooms. Patient rooms shall have general lighting and night lighting.
(a) Lighting for reading shall be provided for each patient bed.
(i) Reading light controls shall be accessible to the patient(s) without the patient having to get out of bed.
(ii) Incandescent and halogen light sources that produce heat shall be placed or shielded to protect the patient from injury.
(iii) Unless the light source is specifically designed to protect the space below, the light source shall be covered by a diffuser or lens.
(iv) Flexible light arms, if used, shall be mechanically controlled to prevent the lamp from contacting the bed linen.
*(b) At least one night-light fixture shall be located in each patient room. This requirement does not apply to critical care patient rooms where view panels are provided to the corridor.
*(i) Central control of night-lights such as a common switch at the nurse station or time clock shall be prohibited.
*(ii) The night-light shall be located for staff and patient use to illuminate both the path from the room entrance to the bedside and the path between the bed and the toilet room.
(c) Lighting for critical care bed areas shall permit staff observation of the patient while minimizing glare.
(2) Patient care unit corridors. Corridors in patient care units shall have general illumination with provisions for reducing light levels at night.
(3) Exam/treatment/trauma rooms. A portable or fixed examination light shall be provided for examination, treatment, and trauma rooms.
(4) Operating and delivery rooms
(a) Operating and delivery rooms shall have general lighting in addition to special lighting units provided at surgical and obstetrical tables.
(b) General lighting and special lighting shall be on separate circuits.
(5) Medication safety zone work areas and pharmacy areas. See Section 2.1-2.8.8.1 (2)(d) (Medication Safety Zones: Design requirements-Lighting) for lighting requirements for medication safety zones and pharmacy areas.
*(6) Food and nutrition areas. Kitchen and serving area lighting shall have a shatterproof or protective cover.
*(7) Uplight fixtures installed in patient care areas shall be covered.
A2.1-8.3.4.3 (1)(b) Night-lighting
  1. Night-lights with lamps that have a warm-up time or a delay in reaching the intended light level should be avoided.
  2. The night-light should be mounted on the wall near the floor to avoid disturbing the patient.
A2.1-8.3.4.3 (1)(b)(i) The night-light should be controlled at the room entrance. Night-long use of night-lights is typically patient dependent. Some patients prefer dark rooms and are disturbed by night-lights. Patient control of the night-light may also be provided via three-way switching or low-voltage controls.
A2.1-8.3.4.3 (1)(b)(ii) Indirect lighting should be provided to reduce glare on surfaces to accommodate vision issues for patient comfort.
A2.1-8.3.4.3 (6) Lighting in food and nutrition areas
  1. Vertical and horizontal conduits should be concealed in counters and walls.
  2. Occupancy lighting sensors should be provided for all offices, staff restrooms, and storage areas, including walk-in coolers and freezers.
  3. Natural daylighting should be considered for food preparation and serving areas where temperatures can be maintained to reduce lighting requirements and enhance staff productivity.
A2.1-8.3.4.3 (7) Using a translucent cover, such as a lens, prevents dust from getting into the fixture and facilitates cleaning of the top of the fixture.
Any required hand-washing station or scrub sink that depends on the building electrical service for operation shall be connected to the essential electrical system.
A2.1-8.3.5.1 Refer to NFPA 99: Health Care Facilities Code for a description of the essential electrical system.
This equipment shall be provided with an uninterruptible power supply.
A2.1-8.3.5.2 EHR system servers and storage. Such systems may include electronic health record (EHR), order entry, and computerized provider order entry (CPOE) systems. The uninterruptible power supply is needed to prevent data loss during transition between normal and emergency power.
  1. Duplex-grounded receptacles for general use shall be installed approximately 50 feet (15.24 meters) apart in all corridors and within 25 feet (7.62 meters) of corridor ends.
  2. Receptacles in pediatric and psychiatric unit corridors shall be of the tamper-resistant type.
Receptacles shall be provided according to Table 2.1-1 (Electrical Receptacles for Patient Care Areas in Hospitals).
A2.1-8.3.6.2 Height of electrical receptacles. Consideration should be given for the above finished floor (AFF) height to the center of the electrical receptacles to minimize the need for staff to bend over to reach them. Potential high-use receptacles (e.g., those proximal to beds, gurneys, and exam tables) should be positioned at a minimum AFF height of 30 inches to the center of the electrical outlet.
  1. Electrical receptacle cover plates or electrical receptacles supplied from the essential electrical system shall be distinctively colored or marked for identification.
  2. If color is used for identification purposes, the same color shall be used throughout the facility.
In the absence of local and state plumbing codes, all plumbing systems shall be designed and installed in accordance with the International Plumbing Code.
  1. All piping, except control-line tubing, shall be identified.
  2. All valves shall be tagged, and a valve schedule shall be provided to the facility owner for permanent record and reference.
  3. No plumbing piping shall be exposed overhead or on walls where possible accumulation of dust or soil may create a cleaning problem or where leaks would create a potential for food contamination.
*(1) General
(a) In new construction and renovation in any hospital where hemodialysis or hemoperfusion is routinely performed, the following shall be provided:
(i) Separate treated water distribution system
(ii) Drainage system independent from the tap water
(b) If the dialysis equipment used includes sufficient water treatment provisions, use of domestic cold water without special piping (rather than a separate treated water system) shall be permitted.
(2) Treated water distribution system. Where provided, a separate treated water distribution system shall meet the following requirements:
(a) The treated water system shall be in accordance with ANSI/AAMI/ISO 26722: Water Treatment Equipment for Hemodialysis Applications and Related Therapies.
(b) Treated water distribution outlets shall be provided for these areas:
(i) Each individual hemodialysis treatment bay
(ii) Hemodialysis equipment repair area
(iii) Dialysate preparation area
(c) Treated water systems for hemodialysis and related therapies shall meet the current requirements of ANSI/AAMI/ISO 13959: Water for Hemodialysis and Related Therapies.
(3) Dialysis equipment or water system components shall meet FDA 510 (k) approval and the requirements of class 2 medical device(s).
(4) The liquid waste and disposal system for the hemodialysis treatment area shall be designed to minimize odor and prevent backflow.
(5) All hemodialysis distribution piping shall be readily accessible for inspection and maintenance.
A2.1-8.4.2.2 (1) Separate treated water distribution system. Use of portable water treatment equipment or integrated hemodialysis machines (with water treatment as part of the machine) does not require a separate treated water distribution system. However, the water purification requirements (i.e., chemical and microbial quality of product water) are the same, whether portable units or a separate treated water system supplying multiple dialysis stations/machines is used.
(1) Capacity
(a) Systems shall be designed to supply water at sufficient pressure to operate all fixtures and equipment during maximum demand.
(b) Supply capacity for hot- and cold-water piping shall be determined on the basis of fixture units, using recognized engineering standards.
(c) Where the ratio of plumbing fixtures to occupants is proportionally more than required by the building occupancy and is in excess of 1,000 plumbing fixture units, use of a diversity factor to calculate capacity shall be permitted.
*(2) Valves. Each water service main, branch main, riser, and branch to a group of fixtures shall have valves.
(a) Stop valves shall be provided for each fixture.
(b) Access shall be provided for all valve locations.
(3) Backflow prevention
(a) Systems shall be protected against cross-connection in accordance with American Water Works Association (AWWA) Backflow Prevention and Cross-Connection Control: Recommended Practices.
(b) Vacuum breakers or backflow prevention devices shall be installed on hose bibs and supply nozzles used for connection of hoses or tubing in laboratories, housekeeping sinks, bedpan-rinsing attachments, autopsy tables, etc.
(4) Potable water storage. Potable water storage vessels (hot and cold) not intended for constant use shall not be installed, except as required for disaster preparedness or similar emergency supply use.
*(5) Provisions shall be made to provide potable water to the facility in the event of a utility failure or a disaster.
(a) A well, storage tank, or building system piping connection shall be permitted to serve this purpose.
(b) Any equipment required to provide potable water in the event of a utility failure or disaster shall be served by the essential electrical system (i.e., emergency power).
A2.1-8.4.2.3 (2) Reduced pressure zone (RPZ). Where hooked up to a patient care device such as the AER (automated endoscope reprocessor), the reduced pressure zone after the RPZ valve should have a design feature that allows for automatic flushing of chlorinated water.
A2.1-8.4.2.3 (5) Services to be provided in the event of a utility failure or disaster should be defined in the owner's facility operations plan (e.g., cooling tower or boiler makeup water, minimal clinical uses).