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.
Examination/Treatment, Procedure, and Operating Room Classification1
Room Use Design Requirements2
Room Type Location Surfaces
Exam or treatment room Patient care that may require high-level disinfected or sterile instruments but does not require the environmental controls of a procedure room Unrestricted area Accessed from an unrestricted area Flooring: cleanable and wear-resistant for the location; stable, firm, and slip-resistant
Wall finishes: washable
Ceiling: cleanable with routine housekeeping equipment; lay-in ceiling permitted
Procedure Room Patient care that requires high-level disinfected or sterile instruments and some environmental controls but does not require the environmental controls of an operating room Endoscopic procedures Semi-restricted area Accessed from an unrestricted or a semi-restricted area Flooring: cleanable and wear-resistant for the location; stable, firm, and slip-resistant
Floor and wall base assemblies in cystoscopy, urology, and endoscopy procedure rooms: monolithic floor with integral coved wall base carried up the wall a minimum of 6 inches
Wall finishes: washable; free of fissures, open joints, or crevices
Ceiling: smooth and without crevices, scrubbable, non-absorptive, non-perforated; capable of withstanding cleaning chemicals; lay-in ceiling permitted if gasketed or each ceiling tile weighs at least one pound per square foot and no perforated, tegular, serrated, or highly textured tiles
Operating Room Invasive procedures3 Any procedure during which the patient will require physiological monitoring and is anticipated to require active life support Restricted area Accessed from a semi-restricted area Flooring: cleanable and wear-resistant for the location; stable, firm, and slip-resistant
Floor and wall base assemblies: monolithic floor with integral coved wall base carried up the wall a minimum of 6 inches
Wall finishes: washable; free of fissures, open joints, or crevices
Ceiling: monolithic, scrubbable, capable of withstanding cleaning and/or disinfecting chemicals, gasketed access openings
1This table includes a brief description of what clinical services are performed in these room types and a summary of some applicable requirements that appear elsewhere in the 2018 Guidelines for Design and Construction of Hospitals. The table has been provided to help users determine when an examination/treatment, procedure, or operating room is required for a project. "Examination room," "treatment room," "procedure room," and "operating room" are defined in the glossary.
2Other design requirements that apply to these room types include, but are not limited to, ventilation, lighting, and sound transmission requirements. See Part 3 (ANSI/ASHRAE/ASHE Standard 170: Ventilation of Health Care Facilities) for ventilation requirements for these rooms. See Section 2.1-8.3.4.3 (Lighting for specific locations in the hospital) and facility chapters for lighting requirements and Section 1.2-6.1 (Acoustic Design) for noise transmission requirements.
3"lnvasive procedure" is defined in the glossary.
This chapter shall apply to general acute care hospitals.
The general acute care hospital shall meet the standards described in this chapter and the standards in Part 1 of these Guidelines.
Requirements in Chapter 2.1, Common Elements for Hospitals, shall apply to the general acute care hospital as cross-referenced in this chapter.
Table 2.2-2
Classification of Room Types for Imaging Services1
Room Use Design Requirements2
Room Type Location Surfaces
Class 1 imaging room Diagnostic radiography, fluoroscopy, mammography, computed tomography (CT), ultrasound, magnetic resonance imaging (MRI), and other imaging services
Services that use natural orifice entry and do not pierce or penetrate natural protective membranes
Unrestricted area Accessed from an unrestricted area Flooring: cleanable and wear-resistant for the location; stable, firm, and slip-resistant
Wall finishes: washable
Ceiling: cleanable with routine housekeeping equipment; lay-in ceiling permitted
Class 2 imaging room Diagnostic and therapeutic procedures such as coronary, neurological, or peripheral angiography Electrophysiology procedures Semi-restricted area Accessed from an unrestricted or a semi-restricted area Flooring: cleanable and wear-resistant for the location; stable, firm, and slip-resistant
Floor and wall base assemblies: monolithic floor with integral coved wall base carried up the wall a minimum of 6 inches
Wall finishes: washable; free of fissures, open joints, or crevices
Ceiling: smooth and without crevices, scrubbable, non-absorptive, non-perforated; capable of withstanding cleaning chemicals; lay-in ceiling permitted if gasketed or each ceiling tile weighs at least one pound per square foot and no perforated, tegular, serrated, or highly textured tiles
Class 3 imaging room Invasive procedures3 Any Class 2 procedure during which the patient will require physiological monitoring and is anticipated to require active life support Restricted area Accessed from a semi-restricted area Flooring: cleanable and wear-resistant for the location; stable, firm, and slip-resistant
Floor and wall base assemblies: monolithic floor with integral coved wall base carried up the wall a minimum of 6 inches
Wall finishes: washable; free of fissures, open joints, or crevices
Ceiling: monolithic, scrubbable, capable of withstanding cleaning and/or disinfecting chemicals, gasketed access openings
1This table includes a brief description of the imaging services performed in these room types and a summary of some applicable requirements that appear elsewhere in the 2018 Guidelines for Design and Construction of Hospitals. The table has been provided to help users determine when a Class 1, Class 2, or Class 3 imaging room is required for a project.
2Other design requirements that apply to these imaging room types include, but are not limited to, ventilation, lighting, and sound transmission requirements. See Part 3 (ANSI/ASHRAE/ASHE Standard 170: Ventilation of Health Care Facilities) for ventilation requirements for these rooms. See Section 2.1-8.3.4.3 (Lighting for specific locations in the hospital) and facility chapters for lighting requirements and Section 1.2-6.1 (Acoustic Design) for noise transmission requirements.
3"lnvasive procedure" is defined in the glossary.
Appendix Table A2.2-a
Sound Transmission Loss or Attenuation Through Horizontal and Vertical Barriers in NICUs
Adjacency combination STCc
NICU Pedestrian-only corridor 45
NICU Equipment corridor 55
NICU Infant area 40
NICU Reception 55
NICU Meeting room with amplified sound 55
NICU Staff work area 55
NICU Administrative office, conference 45
NICU Non-related area 50
NICU Mechanical area 60—65
NICU Electrical area 50—55
Adapted from J. B. Evans and M. K. Philbin, "Facility and operations planning for quiet hospital nurseries" in Journal of Perinatology 2000; 20(8):S105-12. Used with permission.
  1. Unit types. Most acute care hospitals are composed of some combination of the following units: medical/surgical unit, intermediate care unit, critical care unit, obstetrical unit, nursery, pediatric and adolescent unit, psychiatric unit, and in-hospital skilled patient care unit.
  2. Security. Information specific to the type of patient care unit can be found in Section 02.01, Inpatient Units, in Security Design Guidelines for Healthcare Facilities, published by the International Association for Healthcare Security and Safety (IAHSS).
Patient care units in general hospitals shall meet the minimum design requirements described in Section 2.2-2.2 (Medical/Surgical Patient Care Unit) as amended in the sections for other patient care units in this chapter.
For renovation of patient care units in existing hospitals, see Section 1.1-3 (Renovation) for further guidance.
Where accommodations for care of patients of size are provided, they shall meet the requirements in Section 2.1-2.3 (Accommodations for Care of Patients of Size).
A2.2-2.2 Patient mobility considerations for patient care unit design. See appendix section A2.1-2.1.1 (Accommodations to encourage patient mobility) for mention of this aspect of patient care unit design.
See Section 2.1-2.2 (Patient Room) for requirements in addition to those in this section.
  1. The maximum number of beds per room in a medical/surgical patient care unit shall be one unless the necessity of a two-bed arrangement has been demonstrated. Two beds per room shall be permitted when approved by the authority having jurisdiction.
  2. Where renovation work is undertaken and the present capacity is more than one patient in each room, maximum room capacity shall be no more than the present capacity, with a maximum of two patients in each room.
*(1) Area
(a) Single-patient rooms shall have a minimum clear floor area of 120 square feet (11.15 square meters).
(b) Multiple-patient rooms shall have a minimum clear floor area of 100 square feet (9.29 meters) per bed.
(2) Clearances
(a) The dimensions and arrangement of rooms shall provide a minimum clearance of 3 feet (91.44 centimeters) between the sides and foot of the bed and any wall or any other fixed obstruction.
(b) In multiple-patient rooms, a minimum clearance of 4 feet (1.22 meters) shall be available at the foot of each bed to permit the passage of equipment and beds.
A2.2-2.2.2.2 (1) Area. The clinical services that will be provided in patient rooms often require the room size to exceed the minimum requirements.
See Section 2.1-7.2.2.5 (Windows in patient rooms) for requirements.
See Section 2.1-2.1.2 (Patient Privacy) for requirements.
See Section 2.1-2.2.5 (Hand-Washing Station in the Patient Room) for requirements.
See Section 2.1-2.2.6 (Patient Toilet Room) for requirements.
  1. Bathing facilities shall be provided in the following locations:
    1. In the toilet room directly accessible from each patient room or
    2. In a central bathing facility
  2. Central bathing facilities
    1. General. Each bathtub or shower shall be in an individual room or enclosure that provides privacy for bathing, drying, and dressing.
    2. Number
      1. Where individual bathing facilities are not provided in toilet rooms that are directly accessible from patient rooms, at least one shower or bathtub shall be provided for each patient care unit.
      2. At least one bathing facility with space for an attendant shall be provided to accommodate patients on gurneys, carts, and wheelchairs. This bathing facility shall be permitted to serve multiple patient care units located on separate floors.
    3. The following shall be provided in or directly accessible to each central bathing facility.
      1. Toilet in a separate enclosure
      2. Hand-washing sink
      3. Storage for soap and towels
  3. Where mobile lifts, shower gurney devices, wheelchairs, and other portable wheeled equipment will be used, the following requirements shall be met:
    1. Doorways shall be designed to allow entry of portable/mobile mechanical lifts and shower gurney devices.
    2. Thresholds shall be designed to facilitate use and prevent tipping of wheelchairs and other portable wheeled equipment.
    3. Patient shower rooms shall be designed to allow entry of portable/mobile mechanical lifts and shower gurney devices.
    4. Floor drain grates shall be designed to facilitate use and prevent tipping of wheelchairs and other portable wheeled equipment.
See Section 2.1-2.2.8 (Patient Storage) for requirements.
A2.2-2.2.3 Patient/family-centered care. Where a facility chooses to provide a patient/family-centered care room, the room should be designed to meet the following requirements.
  1. Capacity. The patient/family-centered room should be a single-patient room.
  2. Area and dimensions. A patient/family-centered room should have a minimum clear floor area of 250 square feet (23.22 square meters) with a minimum clear dimension of 15 feet (4.57 meters).
  3. Additional area. Additional area should be provided at a minimum clear floor area of 30 square feet (2.79 square meters) per family member (permitted by the facility).
  4. Environment of care. Consideration for a homelike atmosphere, furniture arrangement, and orientation to the patient bed and room windows should reflect the needs of the patient population.
(1) Space shall be provided in the patient room to support visitation by family members and others, including:
(a) Space for movable seating with a minimum of one seat for a family member or visitor and one seat for the patient
(b) Space for at least one chair for long-term sitting
(2) Where family members or visitors are permitted to sleep in the patient room overnight, space shall be provided for sleeping accommodation.
*(3) Public communication services shall be provided in each patient room.
A2.2-2.2.3.1 Family zone support features
  1. Storage. Storage should be provided for visitors' personal belongings.
  2. Work surface. A horizontal surface sufficient for eating, writing, and supporting a laptop should be provided that is separate and distinct from that used for clinical activities.
  3. Sleeping accommodation. When family members or visitors are permitted to sleep overnight in the patient room, the following additional design issues should be considered:
    • -Furnishing that offers a substantially horizontal, impervious sleep surface designed to accommodate an adult should be provided.
    • -Such furnishings should be sufficiently comfortable for a night's sleep and constructed to accommodate and retain bedding. When deployed, any such accommodation should not intrude into required minimum clearances around the patient bed.
  4. Family shower and changing accommodations. A shower and changing area should be available in the facility.
  5. Meal support. Access to prepared food 24/7 and/or access to usable refrigerator space and a microwave on the patient care unit should be provided.
A2.2-2.2.3.1 (3) Public communication services provided in patient rooms could include internet connections, distributed antenna systems to accommodate cell phone use, or telephones.
  1. For requirements in addition to those in this section, see Section 2.1-2.4.2 (AII Room).
  2. Number
    1. At least one AII room shall be provided in the hospital and in any other specific areas requiring an AII room as identified in the Guidelines.
    2. The number of additional AII rooms for individual patient care units shall be increased based on an ICRA.
*(1) General. When determined by an ICRA, special design considerations and ventilation shall be required to ensure the protection of patients who are highly susceptible to infection.
(2) Number. The number of PE rooms shall be as required by the ICRA.
(3) Location. The location of PE rooms shall be as required by the ICRA.
(4) Each PE room shall comply with Section 2.1-2.4.2 (AII Room) as well as the requirements in this section (2.2-2.2.4.4).
(5) Special design elements
(a) Surfaces. In addition to requirements in Section 2.1-7.2.3 (Surfaces), the following requirements shall be met:
(i) The ceiling shall be monolithic.
(ii) All surfaces shall be cleanable.
(b) Lighting. Lighting fixtures shall have lenses and shall be sealed.
A2.2-2.2.4.4 PE room purpose. The PE room is used to protect the profoundly immunosuppressed patient with prolonged neutropenia (i.e., a patient undergoing an allogeneic or autologous bone marrow/stem cell transplant) from common environmental airborne infectious microbes (e.g., Aspergillus spores). The differentiating factors between PE rooms and other patient rooms are the requirements for filtration and positive air pressure relative to adjoining spaces.
A2.2-2.2.4.4 (1) Many facilities care for patients with an extreme susceptibility to infection (e.g., immunosuppressed patients with prolonged granulocytopenia, most notably bone marrow recipients and patients with hematological malignancies who are receiving chemotherapy and are severely granulocytopenic). Generally, protective environments are not needed in community hospitals unless these facilities take care of these types of patients.
(1) Number. Hospitals with PE rooms shall include at least one combination AII/PE room.
(2) Each combination AII/PE room shall comply with the requirements in 2.2-2.2.4.4 (PE room) as well as the requirements in this section.
(3) Anteroom. Combination AII/PE rooms shall be equipped with an anteroom that meets the following requirements:
*(a) The anteroom shall provide space for persons to don personal protective equipment before entering the patient room.
(b) All doors to the anteroom shall have self-closing devices and/or an audible alarm arrangement that can be activated when the AII/PE room is in use as an isolation room.
A2.2-2.2.4.5 This type of room is for profoundly immunosuppressed patients with prolonged neutropenia (i.e., patients undergoing allogeneic or autologous bone marrow/stem cell transplants) who require a protective environment and have an airborne infectious disease.
A2.2-2.2.4.5 (3)(a) The anteroom may be used for hand hygiene and for storage of personal protective equipment (PPE) (e.g., respirators, gowns, gloves) and clean equipment.
  1. General
    1. Safety and security for planned medical psychiatric rooms shall be provided as indicated in Section 1.2-4.6 (Behavioral and Mental Health Risk Assessment).
    2. Number. The number of rooms provided for medical care of psychiatric patients shall be as required by the behavioral and mental health risk assessment. See Section 1.2-4.6 (Behavioral and Mental Health Risk Assessment).
    3. Location. These rooms shall be permitted to be part of the psychiatric unit described in Section 2.2-2.12 (Psychiatric Patient Care Unit).
  2. Where the room is part of a medical/surgical patient care unit, the provisions of Section 2.2-2.2.2 (Medical/Surgical Patient Care Unit — Patient Room) shall apply, with the following exceptions:
    1. Each room shall be for single patient occupancy.
    2. Each room shall be located to permit staff observation of the entrance.
    3. Each patient room and adjoining patient toilet room shall be designed to minimize the potential for escape, concealment, injury, or suicide.
      1. A lay-in ceiling shall not be permitted.
      2. Security film or glazing shall be provided on window(s).
      3. Where a mirror is provided in the patient toilet room, it shall be shatterproof.
      4. Ceiling and air distribution devices, lighting fixtures, sprinkler heads, and other appurtenances shall be a tamper-resistant type.
    4. Where view panels are used for observation of patients, the arrangement shall provide patient privacy and minimize casual observation by visitors and other patients.
The support areas listed in this section shall be provided in or readily accessible to each patient care unit and meet the requirements in Section 2.1-2.8 (Support Areas for Patient Care Units and Other Patient Care Areas) as amended in this section.
Where hand-washing stations are required, they shall meet the requirements in Section 2.1-2.8.7 (Hand-Washing Station).
Each patient care unit shall have equipment to provide ice for treatments and for nourishment in accordance with Section 2.1-2.8.10 (Ice-Making Equipment).
An examination room shall be provided in accordance with the requirements in Section 2.1-3.2.2 (Single-Patient Examination Room).
  1. Omission of this room shall be permitted if all patient rooms in the patient care unit are single-patient rooms.
  2. A centrally located examination room(s) shall be permitted to serve more than one patient care unit on the same floor.
Support areas shall be provided in accordance with Section 2.1-2.9 (Support Areas for Staff).
A family and visitor lounge that meets the requirements in Section 2.1-2.10.1 (Family and Visitor Lounge) shall be provided.
Toilet rooms(s) used by patients shall meet the requirements in sections 2.1-2.2.6.3 (Patient Toilet Room-Room features) and 2.1-7.2.2.3 (5) (Doors for patient bathing/toilet facilities).
  1. A toilet room(s) with hand-washing station shall be readily accessible to the multipurpose room(s) in Section 2.2-2.2.8.5 (Multipurpose room).
  2. Designation of the toilet room(s) serving the multipurpose rooms(s) for public use shall be permitted.
At least one dedicated quiet space to support meditation, bereavement, or prayer shall be provided.
A2.2-2.3.2 Oncology unit patient rooms should be designed to prevent environmental transmission of communicable microorganisms and to promote a safe healing environment. Ideally, all patient rooms in an oncology unit would be designed as protective environment (PE) rooms. However, as a minimum requirement, the governing body should determine the number of PE rooms required to serve the facility's patient population. An oncology patient care unit could have all PE rooms or some PE rooms.
Patient rooms in an oncology unit shall comply with the requirements of Section 2.2-2.2 (Medical/Surgical Patient Care Unit-Patient Room).
  1. Each oncology patient care unit shall have a minimum of one AII/PE room that meets the requirements of Section 2.2-2.2.4.5 (Combination AII/PE room).
  2. Additional requirements in Section 2.2-2.2.4.4 (Protective environment room) shall be met for patient rooms in an oncology patient care unit that will be used for hematopoietic cell transplantation (HCT) patients. The number of these rooms shall be determined by the services to be provided and an infection control risk assessment.
A2.2-2.3.4 Bone marrow transplant facilities.
General space and staffing requirements are critical for bone marrow transplant facilities. Patients in these units may be acutely aware of the surrounding environment, which is their life support system during the many weeks they are confined in an immunosuppressed condition. Means of controlling unnecessary noise are important. At times, each patient may require individual privacy, although each is required to be under close staff supervision.
  1. Application
    1. Patient rooms in allogeneic/autologous bone marrow/stem cell transplant units shall meet the requirements of Section 2.2-2.2.4.4 (PE room) as well as the requirements in this section.
    2. At least one patient room in these units shall meet the requirements of Section 2.2-2.2.4.5 (Combination AII/PE room).
    3. The requirements in this section shall apply where the infection control risk assessment (ICRA) specifies that both allograft transplant patients and bone marrow/stem cell transplant patients who are not allogeneic transplants will be served.
  2. Location. Bone marrow transplant rooms shall be located in the same building as out-of-unit diagnostic and treatment equipment, particularly diagnostic imaging and radiation therapy equipment.
Each bone marrow/stem cell transplant unit shall provide space to support the following:
  1. Nurses' administrative activities
  2. Report/conference room activities
  3. Doctors' consultation
  4. Drug preparation and distribution
  5. Emergency equipment storage
  6. Closed accessible waiting for family members
(1) Architectural details
(a) All windows in the room shall have fixed sash and be sealed to eliminate infiltration.
*(b) View panels shall be provided in doors or walls for nursing staff observation.
(2) Surfaces and furnishings. Curtains or other means shall be provided to cover windows and view panels when a patient requires visual privacy.
A2.2-2.3.4.3 (1)(b) Glazing should be safety glass, wire glass, or tempered clear plastic to reduce hazards from accidental breakage.
(1) Decorative water features shall not be permitted. See Section 2.1-7.2.2.14 (Decorative water features).
(2) Fish tanks shall not be installed in oncology patient care units.
*(3) Decorative plant boxes or containers with live plants, dirt, or dried flowers shall not be built inside or immediately adjacent to an oncology patient care unit.
A2.2-2.3.7.1 (3) Silk or plastic flowers or plants that are easy to clean and are cleaned regularly may be used.
  1. Frequently touched surfaces in the patient's environment of care shall be planned and designed to facilitate cleaning and disinfection.
  2. Cabinetry, casework, and countertops shall have flush surfaces that are smooth, nonporous, cleanable, wipeable, and durable and that do not scratch easily.
  3. Window treatments and privacy curtains. Window treatments and privacy curtains shall be provided in accordance with sections 2.1-7.2.4.2 (Window treatments in patient rooms and other patient care areas) and 2.1-7.2.4.3 (Privacy curtains in patient rooms and other patient care areas) as amended in this section.
    1. Fabric drapes and privacy curtains shall not be used in oncology units.
    2. Use of wipeable window treatments and privacy curtains shall be permitted.
  1. Light coves, non-flush surfaces, and areas that collect dust shall not be used.
  2. Lighting shall be adjustable to meet standards for high visibility during procedures and still provide for the sleep and comfort of the patient.
The requirements for support areas for medical/surgical units described in Section 2.2-2.2.8 shall apply to oncology units.
Where provided, the following diagnostic and treatment areas shall comply with the cited sections of Section 2.2-3 (Diagnostic and Treatment Facilities). Provision of these services shall be permitted from central departments or from satellite facilities.
  1. Imaging Services (2.2-3.4)
  2. Radiation Therapy (2.2-3.5)
  3. Cancer Treatment/Infusion Therapy (2.2-3.12)
Support areas shall be provided in accordance with Section 2.1-2.9 (Support Areas for Staff).
A family and visitor lounge that meets the requirements in Section 2.1-2.10.1 (Family and Visitor Lounge) shall be provided.
Some portion of the occupied space shall permit privacy for visitors.
Space for visitor privacy shall include the following to promote interaction and resource availability:
  1. Area for communications (e.g., cell phones, computers, wireless Internet access)
  2. Patient-family information stations
  3. Access to beverages and nourishment
Rooms and spaces in the pediatric and adolescent oncology patient care unit shall be provided in accordance with Section 2.2-2.3 (Oncology Patient Care Unit) and shall meet the additional requirements in this section.
Pediatric patient rooms shall include provisions for family support (e.g., hygiene, sleeping, and personal belongings). See appendix section A2.2-2.2.3.1 (Family zone support features) for more information.
Pediatric patient rooms shall be separated from adult populations.
At least one combination AII/PE room shall be provided for each pediatric unit. See Section 2.2-2.2.4.5 (Combination AII/PE room) for requirements.
A2.2-2.4.10 Additional support areas for the pediatric oncology unit
  1. A multipurpose room/space should be provided for dining and classroom space.
  2. Space should be provided to accommodate a washing machine/dryer and a dishwasher for the purpose of laundering and/or washing plush toys and hard plastic toys.
Where provided, play areas shall be constructed of surfaces and materials that are easy to clean and durable (nonporous and smooth).
A2.2-2.5 Intermediate care units, sometimes referred to as stepdown units, are routinely used in acute care hospitals for patients who require frequent monitoring of vital signs and/or nursing intervention that exceeds the level needed in a regular medical/surgical unit but is less than that provided in a critical care unit. Intermediate care units can be progressive care units or specialty care units such as cardiac, surgical (e.g., thoracic, vascular), neurosurgical/neurological monitoring, or chronic ventilator respiratory care units.
These standards shall apply to adult beds designated to provide intermediate care.
In hospitals that provide intermediate care, beds shall be designated for this purpose. These beds shall be located in a separate unit, designated as part of another unit, or designed to flex with other beds in a unit as long as the beds are designed to the requirements of the highest level of acuity.
The following shall apply to all intermediate care units unless otherwise noted.
See Section 2.2-2.2.2.1 (Medical/Surgical Unit: Patient Room-Capacity) for requirements.
  1. Area
    1. Patient rooms shall have a minimum clear floor area of 150 square feet (13.94 square meters) in single-patient rooms and 120 square feet (11.15 square meters) per bed in multiple-patient rooms.
    2. See Section 2.1-2.2.2.1 (Area) for information on minor encroachments.
  2. Clearances
    1. The dimensions and arrangement of rooms shall provide a minimum clearance of 4 feet (1.22 meters) between the sides of the beds and other beds, walls, or fixed obstructions.
    2. A minimum clearance of 4 feet (1.22 meters) shall be available at the foot of each bed to permit the passage of equipment.
  3. Renovation. Where renovation work is undertaken and it is not possible to meet the above minimum standards, authorities having jurisdiction shall be permitted to grant approval to deviate from this requirement. In such cases, patient rooms shall have a minimum clear floor area of 120 square feet (11.15 square meters) in single-patient rooms and 100 square feet (9.29 square meters) per bed in multiple-patient rooms.
Windows shall be provided in accordance with Section 2.1-7.2.2.5 (Windows in patient rooms).
For requirements, see Section 2.1-2.1.2 (Patient Privacy).
See Section 2.1-2.2.5 (Hand-Washing Station in the Patient Room) for requirements.
A toilet room shall be provided in accordance with Section 2.1-2.2.6 (Patient Toilet Room).
Bathing facilities shall be provided in accordance with Section 2.2-2.2.2.7 (Patient bathing facilities).
See Section 2.1-2.2.8 (Patient Storage) for requirements.
  1. At least one AII room shall be provided.
  2. The number of AII rooms shall be determined on the basis of an ICRA.
  3. Each room shall comply with the requirements of Section 2.1-2.4.2 (AII Room).
The support areas noted in this section shall be provided in or readily accessible to each patient care unit and meet the requirements in Section 2.1-2.8 (Support Areas for Patient Care Units and Other Patient Care Areas) in addition to the requirements in this section.
There shall be direct or remote visual observation between the administrative center or nurse station, staffed documentation areas, and all patient beds in the unit.
Equipment storage room(s) or alcove(s), sized to provide a minimum of 20 square feet (1.86 square meters) per patient bed, shall be provided for each intermediate care unit.
The support areas noted in this section shall be provided in accordance with the requirements in Section 2.1-2.9 (Support Areas for Staff) as amended in this section.
  1. The lounge shall be located in or readily accessible to the intermediate care unit.
  2. This lounge shall be permitted to serve more than one patient care unit.
A family and visitor lounge that meets the requirements in Section 2.1-2.10.1 (Family and Visitor Lounge) shall be provided.
A2.2-2.6 Critical care unit
  1. Critical care units require special space and equipment considerations for safe and effective patient care, staff functions, and family participation. Families and visitors to critical care units often wait for long periods, including overnight, under highly stressful situations. Clinical personnel perform in continuously stressful circumstances over long hours. Often, they cannot leave the critical care unit, necessitating space and services to accommodate their personal and staff group needs in close proximity to the unit.
  2. The design of the unit should address such issues as privacy, ambience, and aesthetics for all involved in the care and comfort of patients in critical care units.
Provision of the following services from central departments or from satellite facilities shall be permitted:
  1. Imaging
  2. Respiratory therapy
  3. Laboratory services
  4. Pharmacy services
A2.2-2.6.1.1 Not every hospital will provide all types of critical care. Some hospitals may have a small combined unit; others may have separate, sophisticated units for highly specialized treatments (e.g., coronary, neurointensive, pediatric, surgical trauma).
The following shall apply to all types of critical care units unless otherwise noted.
*(1) The critical care unit shall be located in the same building as services and/or departments (e.g., emergency, respiratory therapy, laboratory, radiology, surgery) required to provide care to critical care patients.
(2) The unit shall be located so that medical emergency resuscitation teams can respond promptly to emergency calls with minimum travel time.
(3) The location shall not permit unrelated traffic of staff, the public, or other patients through the unit except for emergency egress.
A2.2-2.6.1.2 Transportation of patients to and from the critical care unit should ideally be separated from public corridors and visitor waiting areas.
A2.2-2.6.1.2 (1) These services and/or departments should be specified in the functional program.
The following shall apply to all types of critical care units unless otherwise noted.
  1. Each patient care station shall be a single-patient room.
  2. Area. Each critical care patient room shall have a minimum clear floor area of 200 square feet (18.58 square meters) with a minimum headwall width of 13 feet (3.96 meters) per bed.
  3. Clearances. All adult and pediatric critical care patient rooms shall have the following minimum clearances:
    1. 1 foot (30.48 centimeters) from the head of the bed to the wall
    2. 5 feet (1.52 meters) from the foot of the bed to the wall
    3. 5 feet (1.52 meters) on the transfer side
    4. 4 feet (1.22 meters) on the non-transfer side
  4. In renovation of existing critical care units, where it is not possible to meet the above minimum standards, authorities having jurisdiction shall be permitted to grant approval for deviations from these requirements. In such cases, the following standards shall be met:
    1. Patient care stations shall be permitted to be cubicles.
    2. Separate rooms or cubicles for single-patient use shall have a minimum clear floor area of 150 square feet (13.94 square meters).
  5. The patient room or patient care station shall be sized to allow for a minimum of two seated visitors without interfering with providers' access to the patient and equipment.
A2.2-2.6.2.2 Space requirements in the critical care unit. In critical care units, the size of the patient care station should be determined by the intended functional use. Patient care stations in critical care units-especially those serving patients following major trauma or cardiovascular, transplant, or orthopedic procedures and medical patients who simultaneously require ventilation, dialysis, and/or treatment with other large equipment (e.g., intra-aortic balloon pump)-may be undersized if designed to the absolute minimum clear floor area indicated.
  1. See Section 2.1-7.2.2.5 (Windows in patient rooms) for requirements.
  2. Where cubicles are provided, there shall be no more than one intervening patient care station between any patient bed and the window(s).
  3. Windows in renovation projects
    1. Use of clerestory windows equipped with glare and sun control shall be permitted.
    2. Distance from the patient bed to an exterior window shall not exceed 50 feet (15.24 meters).
  1. View panels to the corridor with a means to allow visual privacy shall be provided in critical care patient rooms.
  2. In renovation projects where multiple patient care stations are provided in the same room, each patient care station shall have provisions for visual privacy from casual observation by other patients and visitors.
For design requirements, see Section 2.1-2.8.7.2 (Hand-Washing Station-Design requirements).
  1. A hand-washing station shall be provided in each patient room.
  2. In renovation projects where cubicles are provided, the following requirements shall apply:
    1. At least one hand-washing station shall be provided for every three cubicles in open-plan areas.
    2. A hand-washing station shall be located near the entrance to each patient cubicle.
(1) Each critical care patient room, both adult and pediatric, shall have direct access to an enclosed toilet room or human waste disposal room.
(a) Where a toilet room is provided, it shall be equipped with a toilet with bedpan-rinsing device.
(b) Where a human waste disposal room is provided, it shall be equipped with a flushing-rim clinical sink with bedpan-rinsing device.
*(2) A hand-washing station shall not be required in the toilet room or human waste disposal room.
A2.2-2.6.2.6 (2) For patient and staff safety, a hand-washing station in the patient room is a priority to support standard infection prevention precautions. A sink in the toilet room or human waste disposal room may be provided, but it is not to be used as the primary sink for hand hygiene during patient care.
A toilet room or human waste disposal room accessed from the critical care patient room provides for patient privacy and caregiver protection when disposing of human waste. This arrangement applies only to critical care units and is not to be interpreted as a requirement for standard patient toilet rooms or soiled workrooms.
A nurse call system shall be provided in accordance with Section 2.1-8.5.1 (Call Systems).
A2.2-2.6.2.7 The staff emergency assistance system should be located so it can be reached easily. The system should annunciate at the nurse station with backup from another staffed area from which assistance can be summoned.
  1. At least one AII room shall be provided in the critical care unit, unless provided in another critical care unit. The number of additional AII rooms shall be based on an ICRA.
  2. Each AII room shall comply with the requirements in Section 2.1-2.4.2 (AII Room) except that the bathtub or shower is not required.
The following shall be provided for all types of critical care units unless otherwise noted.
  1. An administrative center or nurse station shall be provided in accordance with Section 2.1-2.8.2 (Administrative Center or Nurse Station).
  2. Visual observation. There shall be direct or remote visual observation between the administrative center, nurse station, or staffed charting stations and all patient care stations in the critical care unit. Such observation shall provide a view of the patient while the patient is in bed.
A2.2-2.6.8.2 Critical care patients should be visually observed at all times. This can be achieved in a variety of ways.
  1. If a central station is chosen, it should be located to allow for complete visual observation of all patient beds in the critical care unit. It should be designed to maximize efficiency in traffic patterns. Patients should be oriented so that they can see the nurse but cannot see the other patients. There should be an ability to communicate with the clerical staff without having to enter the central station.
  2. If a central station is not chosen, the unit should be designed to provide visual observation between nurse and patient. This can be accomplished by positioning sub-charting stations either between patient rooms or in a location that allows staff to observe a group of rooms. Chairs or equipment at sub-charting stations should not infringe on the required corridor width.
Space shall be provided in the unit to accommodate the recording of patient information.
  1. A documentation area shall be provided for each patient in or adjacent to the patient care station.
  2. There shall be a space in the unit for information review located to facilitate concentration.
A2.2-2.6.8.3 The requirements for documenting patient information by providers have become substantial and continue to grow. As providers and others often review patient records in critical care units, supporting confidentiality of patient information is important.
  1. Separate areas need to be designed for unit clerical staff and for staff charting. Planning should consider the potential volume of staff (both medical and nursing) that could be present at any one time and translate that to adequate charting surfaces.
  2. The clerical area should be accessible to all. However, the charting areas may be somewhat isolated to facilitate concentration.
  3. Storage for supplies should be readily accessible to an interdisciplinary team area.
  4. Space for computer terminals and printer and conduit for computer hookup should be provided where automated information systems are in use or planned for the future.
  5. Patient records should be readily accessible to clerical, nursing, and physician staff.
  1. Office space for critical care medical and nursing management/administrative personnel shall be immediately accessible to the critical care unit.
  2. The offices shall be linked with the unit by telephone or an intercommunications system.
Multipurpose room(s) shall be provided in accordance with Section 2.1-2.8.5 (Multipurpose Room).
See Section 2.1-2.8.8 (Medication Safety Zones) for requirements.
  1. The nourishment area shall be provided in accordance with Section 2.1-2.8.9 (Nourishment Area or Room).
  2. More than one critical care unit shall be permitted to share the nourishment area provided access is available from each unit without travel through a public corridor.
  1. Each unit shall have equipment to provide ice for treatment and nourishment.
  2. Ice-making equipment shall be provided in accordance with Section 2.1-2.8.10 (Ice-Making Equipment).
A clean workroom or clean supply room shall be provided in each critical care unit.
  1. The clean workroom or clean supply room shall meet the requirements in Section 2.1-2.8.11 (Clean Workroom or Clean Supply Room).
  2. The room shall be permitted to serve more than one critical care unit provided access is available from each unit without travel through a public corridor.
A soiled workroom or soiled holding room shall be provided in each critical care unit.
  1. The soiled workroom or soiled holding room shall meet the requirements in Section 2.1-2.8.12 (Soiled Workroom or Soiled Holding Room).
  2. The room shall be permitted to serve more than one critical care unit provided access is available from each unit without travel through a public corridor.
(1) Clean linen storage. Clean linen storage shall be available in each critical care unit.
(a) Clean linen storage shall be provided in accordance with Section 2.1-2.8.13.1 (Clean linen storage).
(b) A clean linen storage area shall be permitted to serve more than one critical care unit provided access is available from each unit without travel through a public corridor.
*(2) Equipment storage room or alcove. Equipment room(s) or alcove(s) shall be provided for each critical care unit.
(a) Equipment storage room(s) or alcove(s) shall be sized to provide a minimum of 20 square feet (1.86 square meter) per patient care station.
(b) Equipment storage room(s) shall contain space and provisions for recharging equipment.
(3) Wheelchair and gurney storage. Space to store gurneys and wheelchairs shall be provided.
(4) Emergency equipment storage. Space for emergency equipment storage shall be provided in the unit in accordance with Section 2.1-2.8.13.4 (Emergency equipment storage).
A2.2-2.6.8.13 (2) Equipment storage room or alcove
  1. Work areas and storage of critical care supplies should be immediately accessible for use by clinical staff.
  2. Electrical outlets should be provided in sufficient numbers to permit recharging of stored battery-operated equipment.
  3. Alcoves are often provided for storage and rapid retrieval of crash carts and portable monitor/defibrillator units.
An environmental services room(s) shall be provided that meets the requirements in Section 2.1-2.8.14 (Environmental Services Room).
Where an examination room is provided, it shall meet the requirements in Section 2.1-3.2.2 (Single-Patient Examination Room).
A2.2-2.6.8.15 An examination room may be located outside the critical care unit.
  1. Each unit shall contain equipment for physiological monitoring, with visual displays for each patient at the bedside and at the nurse station or centralized monitoring area.
  2. Monitors shall be located to permit easy viewing and access but shall not interfere with access to the patient.
The unit shall have image-viewing capability, which shall be permitted to serve more than one critical care unit.
The following shall be provided for all types of critical care units.
Staff lounge facilities shall be provided in accordance with Section 2.1-2.9.1 (Staff Lounge Facilities).
*(1) The lounge shall be located in or adjacent to the critical care unit.
(2) One lounge shall be permitted to serve adjacent critical care units.
(3) The lounge shall have telephone or intercom and emergency call station connections to the critical care unit it serves.
(4) Furnishings, equipment, and space for seating shall be provided.
(5) The staff lounge shall not be the same space as the multipurpose room required in Section 2.2-2.6.8.5 (Multipurpose room).
A2.2-2.6.9.1 (1) Proximity to the critical care unit allows staff to be recalled to the patient area quickly in an emergency.
A staff toilet room(s) that meets the requirements of Section 2.1-2.9.2 (Staff Toilet Room) shall be readily accessible to the staff lounge.
Facilities for personal use of staff shall be provided in accordance with Section 2.1-2.9.3 (Staff Storage Facilities).
Sleeping and personal care accommodations shall be provided for staff on 24-hour, on-call work schedules. These accommodations shall include the following:
  1. Accommodations for sleeping and rest
    1. Space for a chair
    2. Space for a bed
  2. Individually secured storage for personal items
  3. A communication system
  4. Accommodations for personal hygiene. At least one toilet, shower, and hand-washing station shall be provided.
A family and visitor lounge shall be provided in accordance with the requirements in Section 2.1-2.10.1 (Family and Visitor Lounge).
Pediatric critical care units shall meet the requirements set forth for a general critical care unit in Section 2.2-2.6 (Critical Care Unit) as well as the requirements in this section.
All entries to the pediatric critical care unit shall be secured with controlled access.
(1) Space shall be provided at each bedside for families and visitors in addition to the space provided for staff. The space provided for parental accommodations and for movable furniture shall not limit or encroach on the minimum clearance requirements for staff and medical equipment around the patient's bed station.
*(2) Space shall be provided for recumbent sleep of a parent/visitor. Where the sleeping area is separate from the patient area, a communication system shall be provided.
A2.2-2.7.2.2 Patient rooms designed for specialized procedures requiring additional equipment (e.g., extracorporeal membrane oxygenation) may require clear floor area in addition to that in Section 2.2-2.6.2.2 (2) (Area).
A2.2-2.7.2.2 (2) Parent/visitor sleeping accommodations should be provided in the patient room.
At least one AII room shall be provided in the pediatric critical care unit. The number of additional AII rooms shall be based on an ICRA.
Each AII room shall comply with the requirements in Section 2.1-2.4.2 (AII Room), except that the bathtub or shower is not required.
Support areas shall be provided to meet the requirements in Section 2.2-2.6.8 (Support Areas for the Critical Care Unit) and the requirements in this section.
This room shall be provided in the pediatric critical care unit.
Provisions shall be made for formula and human milk storage.
A2.2-2.7.8.13 Equipment and supply storage
  1. Space allowances for pediatric beds and cribs are greater than those for adult beds because of the variation in bed/crib sizes to accommodate varying patient sizes. Therefore, the pediatric critical care unit may require more general storage than the minimum in Section 2.2-2.6.8.13 (2) (Equipment storage room or alcove).
  2. Formula storage may be located outside the unit but should be available for use at all times.
Where provided, examination rooms shall meet the requirements in Section 2.2-2.6.8.15 (Examination room).
Support areas shall be provided in accordance with Section 2.2-2.6.9 (Support Areas for Staff).
A family and visitor lounge shall be provided in accordance with the requirements in Section 2.1-2.10.1 (Family and Visitor Lounge).
  1. The requirements in this section shall apply to the neonatal intensive care unit (NICU).
  2. In addition, the requirements in Section 2.2-2.6.1.1 (Critical Care Unit-Application) shall apply to the NICU.
*(1) All entries to the NICU shall be secured with controlled access by door locking or by direct or indirect visual observation.
(2) The family entrance and reception area shall be clearly identified.
(3) The reception area shall permit visual observation and contact with all traffic entering the unit.
*(4) The NICU shall be designed to protect the physical security of infants, parents, and staff and to minimize the risk of infant abduction.
A2.2-2.8.1.2 (1) There should be efficient access to the unit from the labor and delivery area and emergency department or other referral entry points.
A2.2-2.8.1.2 (4) Security. See Section 1.2-4.8 (Security Risk Assessment) for information on this aspect of the safety risk assessment.
  1. Area
    1. In multiple-infant rooms, including ones with bays, cubicles, or movable cubicle partitions, each infant care station shall contain a minimum clear floor area of 120 square feet (11.15 square meters) per infant care bed.
    2. Rooms intended for the use of a single infant shall contain a minimum clear floor area of 165 square feet (15.3 square meters).
  2. Aisles
    1. In multiple-infant rooms, there shall be an aisle adjacent to each infant care station with a minimum width of 4 feet (1.22 meters).
    2. Where fixed cubicle partitions are part of the design, an adjacent aisle with a minimum clear width of 8 feet (2.44 meters) shall be provided to permit the passage of equipment and personnel.
  3. Clearances
    1. In multiple-infant rooms, a minimum clearance of 8 feet (2.44 meters) shall be provided between infant care beds.
    2. In all infant care stations, the following minimum clearances shall be provided:
      1. 1 foot (30.48 centimeters) at the head of the infant care bed
      2. 4 feet (1.22 meters) between the sides of infant care beds and any wall or other fixed obstruction
A2.2-2.8.2.2 Space requirements. Infant beds designed for specialized procedures, such as extracorporeal membrane oxygen (ECMO), should contain a minimum clear floor area of 225 square feet (20.9 square meters) in multi-infant areas and 300 square feet (27.87 square meters) in single-infant rooms.
At least one source of daylight shall be visible from infant care areas, either from the infant care station itself or from an adjacent area. Where a window(s) is provided, the following requirements shall be met:
  1. Exterior windows in infant care areas shall be glazed with insulating glass to minimize heat gain or loss.
  2. Exterior windows in infant care areas shall be situated at least 2 feet (60.96 centimeters) from any part of an infant bed and sized to minimize radiant heat loss from the infant.
  3. All daylight sources shall be equipped with shading devices.
A2.2-2.8.2.3 Windows in the NICU. Transparent windows, clerestory windows, and skylights are acceptable sources of light and view. Where provided, shading devices should be a neutral color or opaque to minimize color distortion from transmitted light.
Each infant care station shall be designed to allow visual privacy for the infant and family.
For design requirements, see Section 2.1-2.8.7.2 (Hand-Washing Station-Design requirements).
  1. In a multiple-infant room, every bed position shall be within 20 feet (6.10 meters) of a hand-washing station.
  2. Where infant care stations are single-infant rooms, a hand-washing station shall be provided in each room.
A nurse call system shall be provided in accordance with Section 2.1-8.5.1 (Call Systems).
An AII room shall be provided.
  1. The room shall have provisions for observation of the infant from adjacent area(s) of the NICU.
  2. All AII rooms in the NICU shall comply with the requirements of 2.1-2.4.2 (AII Room) except the requirements for separate toilet, bathtub, or shower.
*(1) Ceilings
(a) Ceilings shall be easily cleanable and nonfriable.
(b) Ceiling construction shall limit passage of particles from above the ceiling plane into the clinical environment.
*(2) Walls. For wall sound isolation requirements, see Section 1.2-6.1.5 (Design Criteria for Performance of Interior Wall and Floor/Ceiling Constructions).
*(3) Floors. For floor sound isolation requirements, see Section 1.2-6.1.5 (Design Criteria for Performance of Interior Wall and Floor/Ceiling Constructions).
A2.2-2.8.7.1 (1) Ceilings in NICUs
  1. Since sound abatement is a high priority in the NICU, use of acoustic ceiling systems is desirable. Acoustic ceiling systems should be selected and designed carefully to meet this standard. In most NICUs, the ceiling offers the largest available area for sound absorption. The standard for ceiling finishes includes areas that communicate with infant rooms and adult sleep areas (e.g., hallways, corridors, storage, and staff work areas) when doors are opened in the course of daily activity.
    Ceilings with high acoustic absorption (i.e., high NRC ratings) do not have a significant barrier effect (in other words, they do not offer protection from sounds transmitted between adjacent areas). A CAC-29 rating provides a moderate barrier effect and allows use of a broad range of ceiling products. Poor barrier effects can result if room-dividing partitions are discontinued above the ceiling, allowing room-to-room cross talk, or if there are noise-producing elements in the ceiling plenum. If the ceiling plenum contains noise sources such as fan-powered boxes, in-line exhaust fans, variable air volume devices, etc., then a CAC rating higher than CAC-29 may be necessary.
  2. High-performance mineral fiber ceiling tiles achieving NRC 0.70 or greater have high sound absorption properties in speech frequencies (500 Hz to 1000 Hz). It is very difficult to achieve NRC 0.95 and CAC-29 in the same ceiling tile, and only a small number of foil-backed glass fiber tiles meet this requirement. The requirement of NRC 0.95 and CAC-29 can be achieved by composite panels that consist of glass fiber facing the occupied space with a mineral fiber backing, but these are not commodity tiles and are more expensive than regular tiles.
  3. VOCs and PBTs such as cadmium are often found in paints and ceiling tiles and should be avoided. Specify low- or no-VOC paints and coatings.
A2.2-2.8.7.1 (2) Acoustically absorptive surfaces reduce reverberation and thus reduce sound levels at a distance from the sound source. Where possible, two perpendicular walls should be covered with sound-absorptive surface materials with an NRC of at least 0.65. Where this is not possible, the upper portions of all four walls (i.e., areas high enough they are unlikely to be damaged by movement of equipment) should be covered with such material. Glass should be limited to the area actually required for sight to leave wall surface available for absorptive surface treatment.
A2.2-2.8.7.1 (3) Although a variety of flooring materials can limit impact noise somewhat, specialized carpeting offers the most protection. Carpeting used in infant areas must have impermeable backing, be monolithic or have chemically or heat-welded seams, and be tolerant of heavy cleaning (including the use of bleach).
  1. Provisions shall be made for indirect lighting and high-intensity lighting in the NICU.
  2. Electric light sources shall have a color rendering index of no less than 80, a full-spectrum color index of no less than 55, and a gamut area of no less than 65 and no greater than 100.
  3. Controls shall be provided to enable lighting to be adjusted over individual patient care spaces.
  4. Darkening for transillumination shall be available.
  5. Direct ambient lighting
    1. No direct ambient lighting shall be permitted in the infant care station.
    2. Any direct ambient lighting used outside the infant care station shall be located or framed to avoid a direct line of sight from the infant to the fixture.
    3. These requirements do not exclude the use of direct procedure lighting.
  6. Lighting fixtures shall be cleanable.
Infant rooms (including airborne infection isolation rooms), staff work areas, family areas, and staff lounge and sleeping areas-and the spaces opening onto them-shall be designed to comply with room noise criteria in Table 1.2-5 (Maximum Design Criteria for Noise in Interior Spaces Caused by Building Systems).
A2.2-2.8.7.3 Noise control in the NICU
  1. The intention is to produce minimal background noise and to contain and absorb much of the transient noise that arises in these spaces. For more information, see Section 1.2-6.1 (Acoustic Design).
    • -Fire alarms in the infant area should be restricted to flashing lights without an audible signal. The audible alarm level in other occupied areas should be adjustable.
    • -Telephones audible from the infant area should have adjustable announcing signals.
    • -Water supply and faucets selected for infant areas should be types that minimize noise and provide instant warm water to minimize time "on."
    • -Loudspeakers located in sensitive areas should be outfitted with adjustable volume controls.
    • -Noise-generating activities and areas (e.g., linen and supply carts, conference areas, clerk's areas, multiple-person work stations, and travel paths not essential to infant care), permanent equipment, and office equipment should be acoustically isolated from the infant area. Vibration isolation pads are recommended under leveling feet of permanent equipment and appliances in noise-sensitive areas and areas in open or frequent communication with them.
    • -With space at a premium, many incompatible adjacencies are possible in NICU designs (e.g., break area, meeting room, or mechanical room sharing a wall with an infant or adult sleep room). Specialized wall and floor/ceiling treatments will help to meet noise criteria in these non-optimal conditions.
    • -The criteria given in appendix table A2.2-a (Sound Transmission Loss or Attenuation Through Horizontal and Vertical Barriers in NICUs) are for sound transmission loss (TL) or attenuation through horizontal barriers (e.g., walls, doors, windows) and vertical barriers (e.g., between floors). The sound transmission class (STC) rating spans speech frequencies and is relevant for separation of spaces with conversational and other occupant-generated noise. The recommended criteria for TL given here apply to barriers between adjacent spaces and infant areas or adult rest or sleep rooms.
    • -Sound transmission from the exterior of the building should meet the noise criteria inside all spaces identified in the Recommended Standards for Newborn ICU Design.
    • -To achieve the required noise levels in NICU areas, building mechanical systems and permanent equipment should conform to a maximum of NC-25 in infant and adult sleep areas and a maximum of NC-30 in staff work areas, family areas, and staff lounge areas.
    • -Building mechanical systems include heating, ventilation, and air conditioning systems (HVAC) and other mechanical systems (e.g., plumbing, electrical, and vacuum tube systems and door mechanisms). Permanent equipment includes refrigerators, freezers, ice machines, storage/supply units, and other large non-medical equipment that is rarely replaced.
    • -Acoustic seals should be provided for doors and exterior openings (e.g., windows, skylights) to meet STC criteria for demising assemblies separating infant rooms, on-call and sleep rooms, family transition rooms, and conference rooms or offices in which sensitive staff and patient-related information is discussed.
    • -The acoustic environment is a function of both the physical environment (e.g., building mechanical systems and permanent equipment, intrusion of exterior sounds, sound containment afforded by doors and walls, and sound absorption afforded by surface finishes) and operations (e.g., the activities of people and function of medical equipment and furnishings).
    • -The acoustic conditions of the NICU should favor speech intelligibility; normal or relaxed vocal effort; speech privacy for staff and parents; and physiologic stability, uninterrupted sleep, and freedom from acoustic distraction for infants and adults. Such favorable conditions encompass more than the absence of noise and require specific planning to be achieved. Speech intelligibility ratings in infant areas, parent areas, and staff work areas should be "good" to "excellent" as defined by the International Organization for Standardization in ISO 9921: Ergonomics-Assessment of speech communication. Speech intelligibility for non-native but fluent speakers and listeners of a second language requires a 4 to 5 dBA improvement in signal-to-noise ratio for similar intelligibility with native speakers. The Leq, L10, and Lmax limits will safeguard this intelligibility and also protect infant sleep.
    • -Sound level descriptors should be measured using slow sound level meter response.
    • -It is advisable to enlist the services of a qualified acoustics expert from the onset of a project through post-construction validation. This specialty service can assist in program and design development, design of mechanical systems, specification of equipment and building construction, and test and balance validation. Enlistment of acoustic services late in the design process often results in fewer and more costly options for meeting performance standards.
  2. The combination of continuous background sound and operational sound in infant bed rooms and adult sleep areas should not exceed an hourly Leq of 45 dBA and an hourly L10 of 50 dBA. The Lmax (transient sounds) should not exceed 65 dBA in these rooms/areas.
    The permissible noise criteria of an hourly Leq of 45 dBA in infant rooms and adult sleep areas is more likely to be met in a fully operational NICU if building mechanical systems and permanent equipment in those areas and areas in open communication with them are rated to conform to NC-25 or less (see Recommended Standards for Newborn ICU Design of the Committee to Establish Recommended Standards for Newborn ICU Design). NC-25 translates to approximately 35 dBA of facility noise. A realistic addition of 10 dBA of operational noise above this background will result in a Leq of about 45 dBA. Limiting operational noise to only 10 dBA above the background will require conscientious human effort.
    Post-construction validation of specifications for the building mechanical systems and permanent equipment should include noise and vibration measurement, reporting, and remediation. Measurement of NC levels should be made at the location of the infant or adult bed or at the anticipated level of the adult head in other areas. Each bed space must conform to the Recommended Standards for Newborn ICU Design.
  3. The combination of continuous background sound and operational sound in staff work areas, family areas, and staff lounge areas should not exceed an hourly Leq of 50 dBA and an hourly L10 of 55 dBA. Transient sounds as determined using the Lmax should not exceed 70 dBA in these areas.
The following spaces shall be provided:
For requirements, see Section 2.1-2.8.2 (Administrative Center or Nurse Station).
See Section 2.1-2.8.3 (Documentation Area) for requirements.
  1. Multipurpose room(s) shall meet the requirements in Section 2.1-2.8.5 (Multipurpose Room) as amended in this section.
  2. Multipurpose rooms shall be readily accessible to each patient care unit.
A2.2-2.8.8.5 In the NICU, multipurpose rooms are used by staff, patients, and patients' families for patient conferences, reports, education, training sessions, and consultation.
See Section 2.1-2.8.8 (Medication Safety Zones) for requirements.
A clean workroom or clean supply room shall be provided in accordance with Section 2.1-2.8.11 (Clean Workroom or Clean Supply Room).
A2.2-2.8.8.11 Wherever possible, supplies should flow through special supply entrances from external corridors to eliminate traffic through the patient care area.
A soiled workroom or soiled holding room shall be provided in accordance with Section 2.1-2.8.12 (Soiled Workroom or Soiled Holding Room).
A2.2-2.8.8.12 Soiled materials should be sealed and stored in a soiled holding area until removed. This holding area should be located where there will be no need to pass back through the patient care area to remove the soiled materials.
Space for storage of emergency equipment shall be provided in accordance with Section 2.1-2.8.13.4 (Emergency equipment storage).
An environmental services room shall be provided in accordance with Section 2.1-2.8.14 (Environmental Services Room) as amended in this section.
  1. The environmental services room shall not be shared with other patient care units or departments.
  2. The environmental services room shall be directly accessible to the NICU.
Support space shall be provided in the same building for the following when these activities are routinely performed on the unit:
  1. Respiratory therapy
  2. Blood gas lab
  3. Developmental therapy
  4. Social work
  5. Laboratory services
  6. Pharmacy services
  7. Radiology services
  8. Other ancillary services
Space shall be provided immediately accessible to the NICU for lactation support and consultation.
*(1) A hand-washing station and counter shall be provided in the lactation support space.
(2) Provisions shall be made for the following immediately accessible to the NICU:
(a) Refrigeration and freezing
(b) Storage for pump and attachments and educational materials
A2.2-2.8.8.16 (1) Where lactation devices may be cleaned in this room, a minimum of two sinks should be provided (one for hand-washing and one for cleaning the devices).
*(1) General
(a) Location. Space for preparation and storage of formula and additives to human milk and formula shall be provided in the unit or other location away from the patient bedside.
(b) Layout. Work area and equipment layout shall be designed to provide for a flow of materials from clean to soiled to maintain an aseptic preparation space.
(2) Where infant feedings are prepared on-site, the following requirements shall be met:
(a) A feeding preparation room with the following spaces shall be provided:
*(i) Anteroom or anteroom area
(ii) Preparation area
(iii) Storage space
(iv) Cleanup area
*(b) Provision of separate rooms for one or more of these functions shall be permitted.
(3) Where only liquid formula is used, a space for mixing additives into the formula or human milk shall be provided in the unit or in another location away from the patient bedside.
(4) Provisions for human milk storage. Storage for human milk shall be provided in a designated space in the infant feeding preparation room or in designated spaces on the patient care unit.
(5) Special design elements. Surfaces in infant feeding preparation rooms or areas shall comply with the requirements in these sections:
(a) Section 2.1-7.2.3.1 (6) (Surfaces: Flooring and wall bases-Food and nutrition areas)
(b) Section 2.1-7.2.3.2 (3) (Surfaces: Walls and wall protection-Food and nutrition areas)
A2.2-2.8.8.17 Infant feeding preparation facilities.
The requirements in the text of this section are based on the Academy of Nutrition and Dietetics Pediatric Nutrition Practice Group publication Infant Feedings: Guidelines for Preparation of Human Milk and Formula in Health Care Facilities, 2nd ed.
The size of infant feeding preparation locations should be determined by the total number of dispensing units (i.e., bottles, cans, feeding containers) kept in inventory, the types and number of feedings to be prepared, the type of equipment to be used, and staffing levels.
The cleanliness of the floor surface, walls, and ceilings in infant feeding preparation spaces or rooms should be easily maintained. Floor drains are not recommended unless required by local code. Adequate sinks, electrical outlets, and storage should be provided based on individual hospital needs.
Whether to use a laminar flow hood is a decision each hospital should make. Pharmacies are not required to use laminar flow hoods to prepare oral medications. Powdered formulas are not sterile, and preparing them under a laminar flow hood does not improve the sterility of the product.
As recommended in Infant Feedings, all water supplied for feeding preparation should meet federal standards for drinking water and be commercially sterile. Commercially sterile water is preferred because it has eliminated pathogenic and other organisms that, if present, could grow in the product and produce spoilage under normal handling and storage conditions.
A2.2-2.8.8.17 (1) The preparation area and all product storage areas, cabinets, and refrigerators should be securable.
A2.2-2.8.8.17 (2)(a)(i) Anteroom or anteroom area. The main purpose of the anteroom or anteroom area is to serve as a buffer zone between the infant feeding preparation room or area and the rest of the health care facility. It can accommodate both hand hygiene and office procedures and can serve as a location for receiving and storing infant feeding supplies as long as the supplies do not pass through the clean area. For more information, see the Academy of Nutrition and Dietetics publication Infant Feedings: Guidelines for Preparation of Human Milk and Formula in Health Care Facilities.
A2.2-2.8.8.17 (2)(b) If each function is housed in a separate room, an anteroom area should be provided in the preparation room.
A lounge, locker room, and staff toilet shall be provided in or adjacent to the unit for staff use.
  1. Sleeping and personal care accommodations for staff shall be provided in accordance with Section 2.2-2.6.9.4 (Staff accommodations).
  2. Location of these accommodations outside the NICU shall be permitted.
  1. A family and visitor lounge shall be provided in accordance with the requirements in Section 2.1-2.10.1 (Family and Visitor Lounge).
  2. This lounge shall be immediately accessible to the NICU.
A room(s) shall be provided in the NICU that allow(s) parents and infants extended private time together.
  1. The room(s) shall have the following:
    1. Direct, private access to sink, shower, and toilet facilities
    2. Communication linkage with the NICU staff
    3. Electrical and medical gas outlets as specified for other NICU beds
    4. Sleeping facilities for at least one parent
    5. Sufficient space for the infant's bed and equipment
  2. Use of the room(s) for other purposes shall be permitted when it is not required for family use.
  3. Where all NICU rooms are single-infant, omission of this room shall be permitted.
A2.2-2.9.1 Obstetrical program models vary widely in their delivery methodologies. The models are essentially of two types. The following narrative describes the organizational framework of each model.
  1. Labor-Delivery-Recovery Model
    Labor-delivery-recovery rooms (LDRs) are designed to accommodate the birthing process from labor through delivery and recovery of mother and baby. They are equipped to handle most complications, with the exception of cesarean sections.
    After the mother and baby are recovered in the LDR, they are transferred to a mother-baby care unit for postpartum stay.
  2. Labor-Delivery-Recovery-Postpartum Model
    Single-room maternity care in labor-delivery-recovery-postpartum rooms (LDRPs) adds a "P" to the LDR model. Room design and capability to handle most emergencies remain the same as the LDRs. However, the LDRP model eliminates a move to postpartum after delivery. LDRP uses one private room for labor, delivery, recovery, and postpartum stay.
    Equipment is moved into the room as needed, rather than moving the patient to the equipped room. Certain deliveries are handled in a cesarean delivery room (i.e., surgical operative room) should delivery complications occur.
  1. The obstetrical unit shall be designed and located to prohibit nonrelated traffic through the unit and shall be secured with controlled access.
  2. Location of LDR/LDRP rooms shall be permitted in any of the following spaces:
    1. A separate LDR/LDRP suite
    2. A cesarean delivery suite
    3. A postpartum unit
  3. Where cesarean delivery rooms are located in the obstetrical suite, access and service arrangements shall be such that neither staff nor patients must travel through the cesarean delivery area to access other services.
A newborn nursery shall be provided in the obstetrical unit. For requirements, see Section 2.2-2.10.3.1 (Newborn nursery).
Except as permitted otherwise herein, existing facilities being renovated shall, as far as practicable, provide all the required support services.
A2.2-2.9.2 Separation of postpartum and antepartum beds is recommended; however, in some obstetrical services there is a need to use these beds flexibly and to combine them in one unit.
For requirements, see Section 2.2-2.2.2 (Medical/Surgical Patient Care Unit-Patient Room).
  1. The postpartum room shall meet the requirements in Section 2.2-2.2.2 (Patient Room) with the exception of Section 2.2-2.22.2 (1) (Patient Room-Area).
  2. Space requirements. Patient rooms in the postpartum unit shall have a minimum clear floor area of 150 square feet (13.94 square meters) in single-patient rooms and 124 square feet (11.52 square meters) per bed in multiple-patient rooms.
Each LDR or LDRP room shall be single occupancy.
*(1) LDR and LDRP rooms shall have a minimum clear floor area of 325 square feet (30.19 square meters) with a minimum wall width at the head of the bed of 13 feet (3.96 meters). This clear floor area includes an infant stabilization and resuscitation space with a minimum clear floor area of at least 40 square feet (3.7 square meters).
(a) The infant stabilization and resuscitation space shall be an area in the room that is distinct from the mother's area.
(b) Where a crib and a reclining chair for a support person are provided in the LDR or LDRP room, additional space to accommodate them shall be included.
(2) Clearances. LDR and LDRP rooms shall have minimum clearances as follows:
(a) 6 feet (1.52 meters) from the foot of the bed to a wall or fixed obstruction
(b) 5 feet (1.52 meters) on the transfer side of the bed to a wall or fixed obstruction
(c) 4 feet (1.22 meters) on the non-transfer side of the bed to a wall or fixed obstruction
(3) Where renovation work is undertaken and it is not possible to meet the above minimum square-footage standards, existing LDR or LDRP rooms shall be permitted to have a minimum clear floor area of 240 square feet (22.3 square meters).
A2.2-2.9.3.2 (1) A minimum clear dimension of 15 feet (4.57 meters) is preferable to accommodate the equipment and staff needed for complex deliveries.
*(1) See Section 2.1-7.2.2.5 (Windows in patient rooms) for requirements for LDRP rooms.
(2) Omission of the window shall be permitted in LDR rooms.
A2.2-2.9.3.3 (1) The postpartum use of the LDRP room makes it a patient room, which requires a window.
For patient privacy requirements, see Section 2.1-2.1.2 (Patient Privacy).
Each room shall be equipped with a hand-washing station(s).
A2.2-2.9.3.5 Hand-washing stations are acceptable for scrubbing in the LDR/LDRP room.
Each LDR or LDRP room shall have direct access to a private toilet room with shower or tub.
  1. Finishes shall be selected to facilitate cleaning and to withstand strong detergents.
  2. Portable examination lights shall be permitted, provided they are immediately accessible.
  3. Medical gas and vacuum systems
    1. See Table 2.1-3 (Station Outlets for Oxygen, Vacuum, Medical Air, and Instrument Air Systems in Hospitals) for station outlet requirements.
    2. These outlets shall be located in the room so they are accessible to the mother's delivery area and infant resuscitation area.
An AII room is not required for the obstetrical unit. Provisions for the care of the perinatal patient with an airborne infection shall be determined by an ICRA.
The support areas in this section shall be provided for this unit.
See Section 2.1-2.8.2 (Administrative Center or Nurse Station) for requirements.
See Section 2.1-2.8.3 (Documentation Area) for requirements.
See Section 2.1-2.8.8 (Medication Safety Zones) for requirements.
A nourishment area shall be provided in accordance with Section 2.1-2.8.9 (Nourishment Area or Room).
  1. A clean workroom or clean supply room shall be provided in accordance with Section 2.1-2.8.11 (Clean Workroom or Clean Supply Room).
  2. A clean workroom shall be provided where clean materials are assembled in the obstetrical suite prior to use.
  1. A soiled workroom or soiled holding room shall be provided in accordance with Section 2.1-2.8.12 (Soiled Workroom or Soiled Holding Room).
  2. This room shall not be permitted to be shared with other patient care units.
  1. Clean linen storage. This shall be provided in accordance with Section 2.1-2.8.13.1 (Clean linen storage).
  2. Equipment storage area. Each unit shall provide storage area(s) on the patient floor.
    1. This storage area(s) shall provide a minimum of 10 square feet (0.93 square meter) per postpartum room and 20 square feet (1.86 square meters) per labor-delivery-recovery (LDR) or labor-delivery-recovery-postpartum (LDRP) room.
    2. This storage area(s) shall be in addition to any storage in patient rooms.
  3. Storage space for gurneys and wheelchairs shall be provided.
  4. Emergency equipment storage. Emergency equipment storage shall be provided in accordance with Section 2.1-2.8.13.4 (Emergency equipment storage).
  1. An environmental services room shall be provided in accordance with Section 2.1-2.8.14 (Environmental Services Room) as amended in this section.
  2. The environmental services room shall be located in the obstetrical unit and shall not be shared with other patient care units or departments.
  1. Location. Where this room is used for obstetric triage, it shall be immediately accessible to the units where births occur (LDR, LDRP, and cesarean delivery rooms) and not in the postpartum unit.
  2. Space requirements
    1. This room shall have a minimum clear floor area of 120 square feet (11.15 square meters).
    2. Where used only as a multipurpose diagnostic testing room, a minimum clear floor area of 80 square feet (7.43 square meters) per patient shall be permitted.
  3. Patient toilet room
    1. A patient toilet room shall be directly accessible from the examination room.
    2. Where a patient toilet room serves more than one examination room, measures shall be provided to limit patient access to other examination rooms.
The following support areas shall be provided for this unit in accordance with Section 2.1-2.9 (Support Areas for Staff).
A family and visitor lounge shall be provided in accordance with the requirements in Section 2.1-2.10.1 (Family and Visitor Lounge).
  1. General
    1. Number
      1. A minimum of one cesarean delivery room shall be provided for every obstetrical unit.
      2. Omission of the cesarean delivery room shall be permitted in small facilities where direct access to operating rooms is provided for cesarean delivery procedures.
    2. An infant resuscitation space shall be provided in the cesarean delivery room.
  2. Space requirements
    1. A cesarean delivery room shall have a minimum clear floor area of 440 square feet (40.85 square meters) with a minimum clear dimension of 16 feet (4.88 meters). This includes an infant resuscitation space with a minimum clear floor area of 80 square feet (7.4 square meters).
    2. Where an infant resuscitation space is provided in a separate but immediately accessible room (e.g., where cesarean deliveries are performed in an operating room instead of a cesarean delivery room), it shall have a minimum clear floor area of 150 square feet (13.94 square meters).
  3. Receptacles. Receptacles shall be provided for the infant care station in addition to the receptacles required for the mother in accordance with Table 2.1-1 (Electrical Receptacles for Patient Care Areas in Hospitals).
  1. Individual rooms shall be provided as indicated in the following requirements; otherwise, use of alcoves or other open spaces that do not interfere with traffic shall be permitted.
  2. Support areas solely for the cesarean delivery suite. The following areas shall be provided to serve only the cesarean delivery rooms and areas.
    1. A control/nurse station. This shall be located to restrict unauthorized traffic into the suite.
    2. Soiled workroom or soiled holding room. This room shall be provided in accordance with Section 2.1-2.8.12 (Soiled Workroom or Soiled Holding Room).
  3. Support areas permitted to be shared. The following support areas shall be permitted to be shared with surgical facilities:
    1. A supervisor office or station
    2. Hand scrub facilities shall be provided for cesarean delivery rooms in accordance with Section 2.1-2.8.6 (Hand Scrub Facilities).
    3. Medication safety zone. See Section 2.1-2.8.8 (Medication Safety Zones) for requirements.
    4. Clean workroom or clean supply room
      1. Clean workroom. A clean workroom that meets the requirements in Section 2.1-2.8.11.2 (Clean workroom) shall be provided where clean materials are assembled in the obstetrical suite prior to use.
      2. Clean supply room. If clean materials are not assembled in the obstetrical suite, provision of a clean supply room for storage and distribution of clean and sterile supplies shall be permitted. See Section 2.2-2.9.11.8 (3)(e) for sterile storage requirements.
    5. Equipment and supply storage. Storage room(s) shall be provided for equipment and supplies used in the obstetrical suite. Equipment and supply storage rooms shall include the following:
      1. A clean sterile storage area readily available to the delivery room. The size shall be based on the level of usage, functions provided, and supplies received from the hospital central distribution area.
      2. Medical gas storage facilities. See Section 2.2-3.3.8.13 (5) (Medical gas storage) for requirements.
      3. An area for storing gurneys out of the path of normal traffic
    6. Environmental services room. An environmental services room shall be provided in accordance with Section 2.1-2.8.14 (Environmental Services Room).
    7. Sterile processing room. Where sterilization processes are conducted in the obstetrical suite, sterile processing facilities that meet requirements in Section 2.1-5.1.2 (Facilities for On-Site Sterile Processing) shall be provided.
The following support areas shall be permitted to be shared with surgical facilities. Where shared, areas shall be arranged to avoid direct traffic between the delivery and operating rooms.
  1. Staff lounge facilities. A lounge for obstetrical staff that meets the requirements in Section 2.1-2.9.1 (Staff Lounge Facilities) shall be immediately accessible to the labor, delivery, and recovery areas.
  2. Staff toilet room. A staff toilet room that meets the requirements in Section 2.1-2.9.2 (Staff Toilet Room) shall be immediately accessible to the labor, delivery, and recovery areas.
  3. Staff changing areas
    1. Staff changing area(s) shall be provided.
    2. Changing areas shall contain:
      1. Lockers
      2. Showers
      3. Toilets
      4. Hand-washing stations
      5. Space for donning and doffing scrub suits and booties
  4. Support person changing areas. Changing areas, designed as described above, shall be provided for male and female support persons accompanying the mother.
  5. Staff accommodations
    1. Sleeping and personal care accommodations for staff shall be provided in accordance with Section 2.2-2.6.9.4 (Staff accommodations), except the requirement for a shower.
    2. Location of these accommodations elsewhere in the facility shall be permitted.
  1. A family and visitor lounge shall be provided in accordance with the requirements in Section 2.1-2.10.1 (Family and Visitor Lounge).
  2. This lounge shall be permitted to be shared with surgery facilities.
  1. Number
    1. A minimum of two recovery patient care stations shall be provided.
    2. Where labor-delivery-recovery (LDR) or labor-delivery-recovery-postpartum (LDRP) rooms are located in or directly accessible to the cesarean delivery suite, they shall be permitted to serve as the required recovery patient care stations.
  2. Area. Each patient care station shall have a minimum clear floor area of 80 square feet (7.43 square meters).
  3. Hand-washing station. Each recovery room shall include a hand-washing station that meets the requirements in Section 2.1-2.8.7 (Hand-Washing Station).
  • (1) Reserved
  • (2) Nurse station and documentation area. The recovery room shall have a nurse station with documentation area located to permit visual observation of all patient care stations.
  • (3) — (7) Reserved
  • (8) Medication safety zone. See Section 2.1-2.8.8 (Medication Safety Zones) for requirements.
  • (9) — (12) Reserved
  • (13) Equipment and supply storage. Storage for equipment and supplies shall be available.
  • (14) Clinical sink. A clinical sink with a bedpan-rinsing device shall be directly accessible to the recovery room.
Infants shall be housed in nurseries that comply with the standards in this section.
All nurseries shall be located in the obstetrical unit or immediately accessible to the NICU.
  1. The nurseries shall be located and arranged to preclude the need for unrelated pedestrian traffic.
  2. No nursery shall open directly onto another nursery.
  1. All nurseries shall be designed to protect the physical security of infants, parents, and staff and to minimize the risk of infant abduction.
  2. All entries to the nursery shall be controlled.
The requirements in this section shall apply to all nurseries in Section 2.2-2.10 (Nursery Unit).
Enough space shall be provided for parents to stay 24 hours.
A2.2-2.10.2.2 Family zone support features. For more information on providing patient/family centered care, see appendix section A2.2-2.2.3.1 (Family zone support features).
Where viewing windows are provided, a means to provide visual privacy shall be provided.
At least one hand-washing station shall be provided for each eight or fewer infant stations.
Storage for linens and infant supplies shall be provided at each nursery room.
(1) Capacity
(a) Each newborn nursery room shall contain no more than 16 infant stations.
*(b) Where a rooming-in program is used, the total number of infant care stations in these units shall be permitted to be reduced, but the new-born nursery shall not be omitted in its entirety from any facility that includes delivery services.
(2) Area. The minimum clear floor area shall be 24 square feet (2.23 square meters) per infant care station, exclusive of auxiliary work areas.
A2.2-2.10.3.1 (1)(b) For facilities that use a rooming-in program in which all infants are returned to the nursery at night, a reduction in nursery size may not be practical.
  1. General
    1. In hospitals with step-down care for infants, a continuing care nursery or continuing care infant care stations that meet the requirements in this section shall be provided to meet the needs of the step-down care offered.
    2. Location of continuing care infant care stations in a defined area in the hospital NICU shall be permitted.
    3. Sharing of support spaces with adjacent nurseries shall be permitted.
  2. Space requirements
    1. Area. A continuing care nursery shall have a minimum clear floor area of 120 square feet (11.2 square meters) per infant care station.
    2. Clearances. The following minimum clearances shall be provided:
      1. 8 feet between adjacent bassinets/infant beds
      2. 4 feet between bassinets/infant beds and walls or other fixed objects
      3. 4 feet between the foot of bassinets/infant beds and cubicle curtains
A2.2-2.10.3.2 Some hospitals provide continuing care for infants requiring close observation (e.g., low birth-weight babies who are not ill but require more hours of nursing care than normal infants). Multiple levels of step-down care exist and are based on the availability of specialized equipment and staff.
An airborne infection isolation room shall be provided in or near at least one level of nursery care.
  1. The room shall be enclosed and separated from the nursery unit with provisions for observation of the infant from adjacent nurseries or control area(s).
  2. All airborne infection isolation rooms shall comply with the requirements of Section 2.1-2.4.2 (AII Room) except the requirements for separate toilet, bathtub, or shower.
The requirements in this section shall apply to nurseries.
This area shall be provided in accordance with Section 2.1-2.8.3 (Documentation Area).
Each nursery room shall be served by a connecting workroom.
  1. The workroom shall contain the following:
    1. Hand-washing station and gowning facilities at the entrance for staff and families
    2. Work counter
    3. Refrigerator
    4. Storage for supplies
  2. One workroom shall be permitted to serve more than one nursery room.
  3. Omission of the workroom serving the newborn and continuing care nurseries shall be permitted if equivalent work and storage areas and facilities, including those for scrubbing and gowning, are provided in that nursery. Space required for work areas located in the nursery is in addition to the area required for infant care.
  4. Provision shall be made for storage of emergency cart(s) and equipment out of traffic.
  5. Provision shall be made for the sanitary storage and disposal of soiled waste.
  6. Visual control shall be provided via view panels between the staff work area and each nursery.
A2.2-2.10.8.5 Where a mother-baby couplet approach to nursing care is practiced, the workroom functions described above may be incorporated into the nurse station that serves the postpartum patient rooms.
See Section 2.1-2.8.8 (Medication Safety Zones) for requirements.
  1. A soiled workroom or soiled holding room shall be provided in accordance with Section 2.1-2.8.12 (Soiled Workroom or Soiled Holding Room).
  2. A flushing-rim clinical service sink shall not be required in nurseries where only disposable diapers are used.
An environmental services room shall be provided in the nursery.
  1. The environmental services room shall not be shared with other patient care units or departments.
  2. The environmental services room shall be provided in accordance with Section 2.1-2.8.14 (Environmental Services Room).
Where an infant examination area is provided, it shall contain the following:
  1. Work counter
  2. Storage facilities
  3. Hand-washing station
Space for lactation support and consultation shall be immediately accessible to the nursery.
  1. The lactation support space shall meet the requirements in Section 2.2-2.8.8.16 (Lactation support space).
  2. This ancillary area shall be permitted to be shared for other purposes.
The unit shall meet the following standards:
A2.2-2.11 In view of their unique physical and developmental needs, pediatric and adolescent patients, to the extent their condition permits, should be grouped together in distinct units or distinct areas of general units separate from adults.
  1. The maximum number of beds per room shall be one unless the necessity of a two-bed arrangement has been demonstrated. Two beds per room shall be permitted where approved by the authority having jurisdiction.
  2. Where renovation work is undertaken and the present capacity is more than one bed, the maximum room capacity shall be two beds.
The space requirements for pediatric patient beds shall be the same as for adult beds due to the size variation and the need to change from cribs to beds and vice-versa. See Section 2.2-2.2.2.2 (Medical/Surgical Patient Care Unit: Patient Room-Space requirements) for requirements.
See Section 2.1-7.2.2.5 (Windows in patient rooms) for requirements.
Additional provisions for hygiene, toilets, sleeping, and personal belongings shall be made where parents will be allowed to remain with children. (See Section 2.2-2.7 for pediatric critical care units and Section 2.2-2.10.3.1 for newborn nurseries.)
A2.2-2.11.3 Family support spaces, including family sleep rooms, pantry, toilets, showers, washers and dryers, and access to computers, phones, and copy machines, should be provided. See appendix section A2.2-2.2.3.1 (Family zone support features) for more information.
  1. At least one AII room shall be provided in each pediatric unit. The total number of infection isolation rooms shall be determined by an ICRA.
  2. Airborne infection isolation room(s) shall comply with the requirements of Section 2.1-2.4.2 (AII Room).
Support areas in pediatric and adolescent patient care units shall conform to the requirements in Section 2.2-2.2.8 (Support Areas for Medical/Surgical Patient Care Units) and shall also meet the requirements in this section.
Multipurpose activity room(s) for dining, education, and developmentally appropriate play and recreation shall be provided in or adjacent to areas serving pediatric and adolescent patients.
  1. These rooms shall provide access and accommodate equipment for patients with physical restrictions.
  2. Insulation, isolation, and structural provisions shall minimize the transmission of impact noise through the floor, walls, or ceiling of the multipurpose room(s).
A2.2-2.11.8.5 Individual activity room. Provision of an individual room to allow for confidential parent/family comfort, consultation, and teaching should be considered.
Storage for human milk and formula shall be provided.
  1. Storage closets or cabinets shall be provided for toys and educational and recreational equipment.
  2. Storage space shall be provided in the facility to permit exchange of cribs and adult beds.
  3. Provisions shall also be made for storage of equipment and supplies (including cots or recliners, extra linen, etc.) for parents who stay with the patient overnight.
  1. An examination room shall be provided for pediatric and adolescent patients in accordance with Section 2.1-3.2.2 (Single-Patient Examination Room).
  2. Omission of this room shall be permitted if the patient care unit has all single-patient rooms.
Staff support areas in pediatric and adolescent patient care units shall meet the requirements in Section 2.1-2.9 Support Areas for Staff).
Support areas for patients shall meet the requirements in Section 2.2-2.2.10 (Medical/Surgical Patient Care Units-Support Areas for Patients, Families, and Visitors).
In addition to toilet rooms serving bed areas, toilet room(s) with hand-washing station(s) shall be immediately accessible to multipurpose room(s) and to each central bathing facility.
Provisions shall be made in the design to adapt the patient care unit for the types of medical and psychiatric therapies described in the behavioral and mental health elements of the safety risk assessment. For requirements, see Section 1.2-4.6 (Behavioral and Mental Health Risk Assessment).
The facility shall provide a therapeutic environment appropriate for the planned treatment programs.
A2.2-2.12.1.2 The environment should be characterized by a feeling of openness with emphasis on natural light. In every aspect of building design and maintenance it is essential to make determinations based on the potential risk to the specific patient population served.
Safety and security appropriate for the planned treatment programs shall be provided. See Section 1.2-4.6 (Behavioral and Mental Health Risk Assessment).
A2.2-2.12.1.3 A safe environment is critical; however, no environment can be entirely safe and free of risk. Each organization will need to determine the appropriate environment for the treatment programs it provides and the patients it serves.
The majority of persons who attempt suicide suffer from a treatable mental disorder, a substance abuse disorder, or both. Patients of inpatient psychiatric treatment facilities are considered at high risk for suicide; the environment should avoid physical hazards while maintaining a therapeutic environment. The built environment, no matter how well designed and constructed, cannot be relied on as an absolute preventive measure. Staff awareness of their environment, latent risks of that environment, and the behavior risks and needs of the patients served in the environment are absolute necessities. Different organizations and different patient populations will require greater or lesser tolerance for risk.
  1. In psychiatric patient care unit design, consideration should be given to visual control (including electronic surveillance) of corridors, dining areas, and social areas such as dayrooms and activity areas. Hidden alcoves and blind corners or areas should be avoided.
  2. The openness of the nurse station will be determined by the planned treatment program. Consideration should be given to patient privacy and also to staff safety.
In no case shall adult and pediatric patient populations be mixed. This does not exclude sharing of nurse stations or support areas, as long as the separation and safety of the units can be maintained.
See Section 2.5-2.2.2 (Specific Requirements for Psychiatric Hospitals-Patient Bedroom) for requirements.
Where ECT therapy is provided in the hospital, it shall meet the requirements in Section 2.5-3.4 (Electroconvulsive Therapy).
See Section 2.1-2.4.3 (Seclusion Room) for requirements.
For requirements, see sections 2.5-7.2 (Architectural Details, Surfaces, and Furnishings) and 2.5-8 (Building Systems).
See Section 2.5-2.2.8 (Support Areas for the Psychiatric Patient Care Unit) for requirements.
See Section 2.5-2.2.9 (Support Areas for Staff) for requirements.
See Section 2.5-2.2.10 (Support Areas for Patients and Visitors) for requirements.
A2.2-2.13 In-hospital skilled nursing patient care unit. These extended stay unit beds are licensed hospital beds for patients requiring skilled nursing care as part of their recovery process. Many of these facilities are intended for elderly patients undergoing various levels of rehabilitation and recuperating stroke victims or brain trauma victims requiring rehabilitation.
The unit shall be located in the same building as the rehabilitation therapy department.
A2.2-2.13.1.1 Location of skilled nursing patient care unit. Wherever possible, the unit should be located to provide access to outdoor spaces that can be used for both respite and therapeutic purposes.
The unit shall be located to control unnecessary and unrelated staff, public, or patient traffic through the unit.
The requirements contained in Section 2.2-2.2.2 (Medical/Surgical Patient Care Unit-Patient Room) shall apply to patient rooms in the in-hospital skilled nursing patient care unit.
For handrail requirements, see Section 2.1-7.2.2.10 (Handrails).
In addition to the support areas required in Section 2.2-2.2.8 (Support Areas for Medical/Surgical Patient Care Units), the following rooms and support elements shall be provided:
  1. At least 5 square feet (0.46 square meters) of storage per bed shall be provided.
  2. Storage spaces shall be located in or adjacent to the unit to accommodate walking aids, portable mechanical patient lifting devices, and other patient transport devices as indicated in the patient handling and movement assessment (PHAMA). See appendix section A1.2-4.3.2.2 (8) (Storage for patient-handling and movement equipment and accessories) for recommendations.
  1. Where the patient care unit is not readily accessible to the facility's rehabilitation therapy department, a physical rehabilitation area shall be provided for the use of the skilled nursing patient care unit.
  2. The size of this rehabilitation area shall accommodate the treatment provided and equipment used.
The support areas required in Section 2.1-2.9 (Support Areas for Staff) shall be provided.
*(1) Space requirements
(a) New construction
(i) The total area for dining, patient lounges, and recreation/rehabilitation functions shall be no less than 25 square feet (2.32 square meters) per bed with a minimum total area of 225 square feet (20.90 square meters).
(ii) No less than 20 square feet (1.86 square meters) per bed shall be available for dining.
(b) Renovation. Where renovation work is undertaken and it is not possible to meet the above minimum standards, deviation from this requirement shall be permitted if approved by the authority having jurisdiction. In such cases, at least 14 square feet (1.30 square meters) per bed shall be available for dining.
A2.2-2.13.10.1 (1) Space requirements for dining and recreation spaces
  1. The following factors should be considered in determining the space needed for dining and recreation:
    • -The needs of patients who use adaptive equipment and mobility aids and receive assistance from support and service staff
    • -The extent to which support programs are centralized or decentralized
    • -The number of patients to be seated for dining at one time
  2. Additional space may be required for outpatient day care programs in both new construction and renovation projects.
Where private space is provided in the unit for individual patients, family, and caregivers to discuss the specific patient's needs or private family matters, it shall meet the following requirements:
  1. This space shall have a minimum clear floor area of 250 square feet (23.23 square meters).
  2. This space shall be permitted to be considered part of the square footage per bed outlined in Section 2.2-2.13.10.1 (1) (Dining and recreation spaces-Space requirements).
Where a room for patient grooming is provided, it shall meet the following requirements:
  1. The area in this room shall not be considered part of the aggregate area outlined in Section 2.2-2.13.10.1 (1) (Dining and recreation spaces-Space requirements).
  2. This room shall provide spaces for hair-washing station(s), hair clipping and hair styling, and other grooming needs.
  3. A hand-washing station, mirror, work counter(s), storage shelving, and sitting area(s) for patients shall be provided as part of the room.
Where a bariatric patient care unit is provided, it shall meet the requirements in Section 2.2-2.2 (Medical/Surgical Patient Care Unit) and the requirements in Section 2.1-2.3 (Accommodations for Care of Patients of Size).
Facilities for emergency care range from basic emergency care units to emergency departments to free-standing emergency facilities. For requirements for freestanding emergency facilities, see Chapter 2.3 (Specific Requirements for Freestanding Emergency Care Facilities).
A2.2-3.1.1 Classification of facilities for emergency services. This section of the Guidelines is separated into requirements for a basic emergency care unit and requirements for a full emergency department.
A dedicated emergency department may be part of a state or American College of Surgeons (ACS) trauma system with a Level I-IV designation. Trauma-level designations are awarded based on the capabilities and services provided by the hospital. All emergency departments, regardless of trauma-level designation, need to be able to provide for the initial evaluation and stabilizing treatment of all trauma patients.
The following ACS reference provides detailed descriptions of Level I-IV trauma centers: "Descriptions of Trauma Center Levels and Their Roles in a Trauma System," chapter 2 in Resources for Optimal Care of the Injured Patient. State designations have their own criteria but often mimic the ACS requirements for each level.
The extent and type of emergency services provided in an emergency department vary according to patient population and hospital capabilities. All hospitals need to provide assessment of presenting condition, stabilization and treatment, and transfer to higher level of care when the emergency is beyond the hospital's capabilities.
At minimum, a hospital needs to provide a medical screening exam conducted by qualified medical personnel to determine if an emergency condition exists and, if required, stabilization and treatment within the capability of the hospital. If the patient's condition requires further inpatient treatment, the hospital needs to arrange for admission to the hospital or transfer to an appropriate facility for additional treatment.
Space for basic emergency assessment and stabilization shall be provided at every hospital.
At minimum, basic emergency care includes provisions for emergency treatment for staff, employees, and visitors as well as for persons who may be unaware of or unable to immediately reach services in other facilities. This is not only for patients with minor illnesses or injuries who may require minimal care but also for persons with severe illnesses and injuries who must receive immediate emergency care and stabilization prior to transport to other facilities.
Facilities for basic emergency care should accommodate equipment needed for the services identified in the organization's functional program and support 24-hour/7-day-a-week staffing to ensure no delay in medical screening, stabilization, and essential treatment.
  1. A well-marked, illuminated, and covered entrance shall be provided at grade level. The emergency vehicle entry cover shall provide shelter for both the patient and the emergency medical crew during transfer between an emergency vehicle and the building.
  2. Ambulance entrances shall provide a minimum of 6 feet (1.83 meters) in clear width to accommodate gurneys for patients of size, mobile patient lift devices, and accompanying attendants.
  3. Where lifts for patients of size are provided in the covered ambulance bay, they shall be positioned to provide assistance with patient transfers.
These areas shall be located so staff can observe pedestrian and ambulance entrances and public waiting areas and control access to the treatment room.
(1) Provisions shall be made for a public waiting area, to include the following:
(a) Public toilet room with hand-washing station(s)
*(b) Access to public communications services
(c) Access to drinking water
(2) These provisions shall be permitted to be shared.
A2.2-3.1.2.4 (1)(b) Public communications services include provisions for telephone access, wireless internet connectivity, and distributed antenna systems to support cell phone use.
Communication connections to local and other emergency medical service (EMS) systems shall be provided.
  1. At least one treatment room shall be provided in accordance with Section 2.1-3.2 (Examination Room or Emergency Department Treatment Room) as amended in this section.
  2. Each treatment room shall be sized to contain space for the medical equipment to be used in the room.
A patient toilet room with hand-washing station(s) shall be immediately accessible to the emergency care area.
  1. Storage shall be provided for medical and surgical emergency care, including supplies, medications, and equipment.
  2. Storage shall be located out of traffic and under staff control.
A2.2-3.1.3 Emergency departments
  1. Surge capacity for NBC hazards events. When consistent with agreements between the organization and local and regional emergency preparedness planning agencies, acute care facilities with an emergency department can function as receiving, triage, and treatment centers during an unplanned event affecting the community. These facilities should have the capacity to handle anticipated types and numbers of patients above the current emergency department capacity and should designate specific area(s) for these functions.
    Planning for a disaster should include identification of space at the facility or an alternate site to be used for triage and management of incoming patients. Utility support and additional capacity for these areas (e.g., oxygen, water, electrical) should be considered. Patient rooms are used to provide surge capacity; additional medical gas and suction outlets and electrical receptacles for patient rooms should be considered to increase capacity in the event of a disaster.
    Areas identified for triage should be able to provide a negative pressure environment to help control aerosolized infectious particulate with 100 percent exhaust capability.
    • -If 100 percent exhaust cannot be achieved, appropriate proven portable technology should be used to reduce airborne particles by > 95 percent.
    • -If patient care areas in the hospital are to be used to house these patients, the route to the patient care unit should minimize the potential for cross-contamination.
    • -Existing smoke control areas could be used to meet ventilation requirements. Air-handling systems should be designed to provide required pressure differentials.
    • -Written protocols should be developed to assure proper performance of the means to accomplish intended goals.
      Facilities may designate an area outside and adjacent to the emergency department to serve as a primary decontamination area, which should include appropriate plumbing fixtures (e.g., hot and cold water) and drainage. See appendix section A2.2-3.1.3.6 (8) (Human decontamination room) for more information.
    • -Use of screens and tents in these areas may be needed and should be accessible for rapid deployment.
    • -Other contingencies may require airborne infection isolation, removal of chemicals, and temporary container storage of contaminated materials.
    • -Availability of hand-washing and shower capabilities and personal protective equipment (PPE) are key to controlling transmission of infectious agents to staff and others in the area,
  2. Security. The design of the emergency department should promote an all-hazards approach to the safety and security of those working in, visiting, or seeking emergency services. The layout and design should provide secured access or the ability to lock down the emergency department. Specific security recommendations can be found in IAHSS Security Design Guidelines for Healthcare Facilities-02.02 Emergency Departments.
Hospitals that offer more than basic emergency care services shall have facilities that meet the requirements in this section for the services they provide.
Entrances shall be provided in accordance with Section 2.1-6.2.1 (Vehicular Drop-Off and Pedestrian Entrance) except as amended in this section.
(1) The site design shall provide a signed route from public roads that directs ambulance traffic to the ambulance entrance to the emergency department and vehicle traffic to the public entrance.
*(2) Paved emergency access to permit discharge of patients from automobiles and ambulances shall be provided.
(3) The emergency department entrance shall be clearly marked.
(4) Where a raised platform/dock is used for ambulance discharge, a ramp or elevator/lift to grade level shall be provided for pedestrian and wheelchair access.
(5) The emergency vehicle entry cover/canopy shall provide shelter for both the patient and the emergency medical crew during transfer between an emergency vehicle and the building.
(6) The emergency bays shall be sized so they are compatible with horizontal and vertical vehicle clearances of EMS providers.
*(7) Emergency department ambulance entrances shall provide a minimum of 6 feet (1.83 meters) in clear width to accommodate stretchers/gurneys and expanded-capacity stretchers/gurneys, mobile patient lift devices, and accompanying attendants.
(8) Where required by the patient handling and movement assessment (see Section 1.2-4.3-PHAMA), lifts for patients of size shall be provided.
A2.2-3.1.3.2 Public vehicle access should be located a sufficient distance from the entrance to provide for safe movement of pedestrians and/or wheelchair traffic.
A2.2-3.1.3.2 (2) The paved emergency access should accommodate short-term parking close to the entrance of the emergency department.
A2.2-3.1.3.2 (7) Where the emergency department does not have separate public and ambulance entrances, clearances should be provided that are sufficient to accommodate pedestrian, wheelchair, gurney, and stretcher movement at the emergency department entrance.
The emergency department shall be designed to ensure that access control can be maintained at all times.
(1) Reception or triage areas shall be located to provide a means for observation of the main entrance to the department and the public waiting area.
(2) Public access points to the treatment area shall be under direct observation of the reception and triage areas.
*(3) The triage area shall include the following:
(a) Access to language translation services
(b) Provisions for patient privacy
(c) Eland-washing stations. Hand-washing stations shall be provided in accordance with Section 2.1-2.8.7.2 (Hand-Washing Station-Design requirements).
(i) A hand-washing station shall be provided in each triage room.
(ii) In triage areas, one hand-washing station shall be provided for every four triage bays or cubicles.
(d) A hand sanitation station shall be provided for each triage bay or cubicle.
(e) Access to a panic button for security emergencies
(f) A code button. For requirements, see Table 2.1-2 (Locations for Nurse Call Devices in Hospitals).
(g) Electrical outlets for equipment used in triage. For requirements, see Table 2.1-1 (Electrical Receptacles for Patient Care Areas in Hospitals).
(h) Oxygen, vacuum, and medical air station outlets. For requirements, see Table 2.1-3 (Station Outlets for Oxygen, Vacuum, Medical Air, and Instrument Air Systems in Hospitals).
(4) As the location of initial assessment for patients with undiagnosed and untreated airborne infections, the triage area shall be designed and ventilated to reduce the exposure of staff, patients, and families to airborne infectious diseases. For requirements, see Part 3 (ANSI/ASHRAE/ASHE 170: Ventilation of Health Care Facilities).
A2.2-3.1.3.3 The exterior perimeter of the emergency department should have the capability to be secured to control access and provide safety in the event of a disaster or situations requiring a higher level of security.
A2.2-3.1.3.3 (3) Consider providing a separate area for patients waiting for triage. This area should have appropriate ventilation and be clearly visible from the triage station.
(1) A public waiting area with the following shall be provided:
(a) Toilet facilities
(b) Provisions for drinking water
(c) Provisions for telephone access
*(2) Where required by the hospital ICRA (see Section 1.2-4.2), special measures to reduce the risk of airborne infection transmission shall be provided in the emergency department waiting area.
A2.2-3.1.3.4 (2) Measures to reduce the risk of airborne infection transmission may include enhanced general ventilation and air disinfection similar to inpatient requirements for airborne infection isolation rooms. See the CDC documents "Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings" and "Guidelines for Environmental Infection Control in Health-Care Facilities."
  1. Communication connections to emergency medical services (EMS) shall be provided.
  2. Where an EMS base station is provided, it shall be designed to reduce noise, distractions, and interruptions during radio transmissions.
(1) General
(a) For oxygen and vacuum requirements, see Table 2.1-3 (Station Outlets for Oxygen, Vacuum, Medical Air, and Instrument Air Systems in Hospitals).
(b) Examination/treatment rooms used for pelvic exams shall allow for the foot of the examination table to face away from the door.
(2) Single-patient treatment room(s). Single-patient treatment rooms shall be provided in accordance with Section 2.1-3.2.2 (Single-Patient Examination Room), unless otherwise noted in this section.
(a) Space requirements. Where renovation work is undertaken and it is not possible to meet the minimum space requirements in Section 2.1-3.2.2.1 (Single-Patient Examination Room-Space requirements), a minimum clear floor area of 100 square feet (9.29 square meters) shall be permitted.
(b) In addition to the requirements listed in Section 2.1-3.2.2.2 (Single-Patient Examination Room-Room features), each treatment room shall contain the following:
(i) Space for medical equipment
(ii) View panel designed for patient visual privacy adjacent to and/or in the door
(3) Multiple-patient treatment room(s)
(a) Space and provisions for several patients shall be permitted in compliance with Section 2.1-3.2.3 (Multiple-Patient Examination Room) except as noted in this section.
(b) Combining bays to accommodate patients of size shall be permitted. See Section 2.2-3.1.3.6 (6) (Treatment room for patient of size) for more information.
*(4) Trauma/resuscitation room. A trauma/resuscitation room(s) for emergency procedures shall be provided and shall meet the following requirements:
(a) Space requirements for a single-patient trauma/resuscitation room
(i) Area. Each trauma/resuscitation room shall have a minimum clear floor area of 250 square feet (23.23 square meters).
(ii) Clearances. A minimum clearance of 5 feet (1.52 meters) shall be provided around all sides of the gurney.
(b) Space requirements for a multiple-patient trauma/resuscitation room. Where a trauma/resuscitation room for multiple patients is provided, the following requirements shall be met:
(i) Area. The minimum clear floor area for each patient care station defined by privacy curtains (a bay) shall be 200 square feet (18.58 square meters).
(ii) Clearances. A minimum clearance of 5 feet (1.52 meters) shall be provided around all sides of the gurney, with 10 feet (3.04 meters) between each patient bed or gurney.
(c) The trauma/resuscitation room shall contain the following:
(i) Space for storage of supplies
(ii) PACS, film illuminators, or other systems to allow viewing of images and films in the room
(iii) A hand-washing station(s) that meets the requirements in Section 2.1-2.8.7 (Hand-Washing Station)
(iv) Space for a code cart
(v) Examination lights
*(vi) Accommodations for written or electronic documentation for both the licensed independent practitioner and other staff
(vii) Physiological monitoring equipment
(viii) Storage for personal protective equipment
*(d) Door openings. Doorways leading from the ambulance entrance to the trauma/resuscitation room shall have a minimum clear width of 70.25 inches (178.44 centimeters) and a height of 83.25 inches (211.45 centimeters).
(e) Renovation
(i) In renovation projects, if it is not possible for existing trauma/resuscitation rooms to meet the minimum square-footage standards in paragraphs 2.2-3.1.3.6 (4)(a) and (b), the authority having jurisdiction shall be permitted to grant approval to deviate from this requirement.
(ii) In renovation projects, if it is not possible for existing trauma/resuscitations rooms to meet the minimum door opening width standard in Section 2.2-3.1.3.6 (4)(d) (Door openings), the authority having jurisdiction shall be permitted to grant approval to deviate from this requirement provided the opening has a minimum clear width of 4 feet (1.22 meters).
(5) Pediatric facilities. Where dedicated pediatric rooms are provided, they shall meet the requirements in this section.
*(a) Pediatric treatment rooms
(i) Location. Treatment rooms designated for pediatric patients shall be located adjacent to a family waiting area and toilet.
*(ii) Space requirements. Each treatment room shall meet the requirements in Section 2.2-3.1.3.6 (2) (Single-patient treatment room) or Section 2.2-3.1.3.6 (3) Multiple-patient treatment room).
(b) Pediatric trauma/resuscitation rooms. A pediatric trauma/resuscitation room shall comply with the requirements in Section 2.2-3.1.3.6 (4) (Trauma/resuscitation room).
(c) Where there is a dedicated pediatric emergency service, a playroom or play area shall be provided in the waiting area.
(6) Treatment room for patients of size. All emergency departments shall provide treatment rooms that can accommodate patients of size.
(a) These rooms shall meet the following requirements as amended in this section:
(i) 2.1-2.3.1 (Accommodations for Care of Patients of Size-General)
(ii) 2.1-2.3.7 (Accommodations for Care of Patients of Size-Single-Patient Examination or Treatment Room)
(iii) 2.1-2.3.10 (Special Design Elements for Spaces for Care of Patients of Size)
*(b) Where ceiling-or wall-mounted lifts are provided, a clearance of 5 feet 6 inches (1.67 meters) from the edge of the expanded-capacity patient table or bed shall be provided on the transfer side.
(c) When not in use for a patient of size, this treatment room shall be permitted to be subdivided with cubicle curtains or movable partitions to accommodate more than one patient if each resulting bay or cubicle meets all electrical and medical gas requirements for emergency department treatment areas.
(7) Geriatric treatment room or area
*(a) Where geriatric treatment rooms or areas are provided, they shall be designed to accommodate the needs of geriatric patients.
*(b) Design of emergency department geriatric treatment rooms or areas shall be assessed for patient fall risks as part of the safety risk assessment. For additional requirements, see Section 1.2-4.4 (Fall Prevention Assessment).
*(8) Human decontamination room
(a) Location
(i) In new construction, a decontamination room shall be provided with an outside entry door located as far as practical, but no less than 10 feet (3.05 meters), from the closest other entrance.
(ii) The internal door of this room shall provide direct access into a corridor of the emergency department or a treatment room, swing into the room, and be lockable against ingress from the corridor.
(iii) This section does not preclude provision of additional decontamination capability at other hospital locations or entrances.
(b) Space requirements. The room shall have a minimum clear floor area of 80 square feet (7.43 square meters).
(c) Special architectural details
(i) The room shall have all smooth, nonporous, scrubbable, nonabsorptive, nonperforated surfaces.
(ii) The floor of the decontamination room shall be self-coving to a height of 6 inches (15.24 centimeters).
(d) Special plumbing system requirements
(i) The room shall be equipped with two hand-held shower heads with temperature controls and a floor drain. A dedicated holding tank shall be provided if required by the local authorities having jurisdiction.
(ii) Fixtures shall be acid resistant.
(iii) Portable or hard-piped oxygen shall be provided. Portable suction shall also be available.
(9) Fast-track area. Where provided, the fast-track area shall meet the requirements in Section 2.1-3.2 (Examination Room or Emergency Department Treatment Room) as amended in this section:
(a) Single-patient examination rooms with a minimum clear floor area of 100 square feet (9.29 square meters) shall be permitted.
(b) Where a waiting area is designated for the fast-track area, it shall provide the following:
(i) An immediately accessible patient toilet room
(ii) A minimum of two chairs per treatment room
A2.2-3.1.3.6 (4) Access should be convenient to the ambulance entrance.
A2.2-3.1.3.6 (4)(c)(vi) Because of the speed with which care is provided in a trauma/resuscitation room, two documentation stations/areas are needed: one for the licensed independent practitioner (resident) and one for other staff members (e.g., nurse, respiratory therapist, imaging staff, environmental services staff).
A2.2-3.1.3.6 (4)(d) The door opening is sized to simultaneously accommodate gurneys, equipment, and personnel. The doorways in the emergency department should be able to accommodate the size of gurneys and equipment used by EMS personnel.
A2.2-3.1.3.6 (5)(a) Particular attention should be paid to sound-proofing for pediatric treatment rooms.
A2.2-3.1.3.6 (5)(a)(ii) A clear floor area of more than 120 square feet (11.15 square meters) may be needed to accommodate the escorts and additional equipment that accompany pediatric cases.
A2.2-3.1.3.6 (6)(b) Transfer side clearance. As indicated in Section 2.1-2.3.7.2 (Single Patient Examination or Treatment Room-Space requirements), transfer side clearance for an exam room with a ceiling- or wall-mounted lift is 5 feet (1.52 meters) because it is anticipated patients will be transferred from a wheelchair to a sitting position on the exam table or chair. In an emergency facility treatment room, 5 feet 6 inches is required because more clearance is needed when patients arrive on a stretcher or gurney and need a lateral transfer from stretcher or gurney to the patient table or bed.
A2.2-3.1.3.6 (7)(a) Geriatric treatment design issues. For relevant information, including recommendations on lighting, surfaces, acoustics, and equipment, see the "Geriatric Emergency Department Guidelines" developed by the American College of Emergency Physicians, the American Geriatrics Society, the Emergency Nurses Association, and the Society for Academic Emergency Medicine. Look for additional design recommendations for a geriatric treatment room or area on the FGI website.
A2.2-3.1.3.6 (7)(b) Patient fall prevention. Falls represent a major traumatic mechanism for geriatric patients. Prevention of falls in this population is an important goal of the safety risk assessment team. Surfaces and furnishings should be selected in accordance with sections 1.2-4.4 (Fall Prevention Assessment), 2.1-7.2.3.1 (Flooring and wall bases) and 2.1-7.2.4.1 (Built-in furnishings). When selecting furniture, special consideration should be given to padding and softness in addition to the choice of non-porous, smooth, easily-cleanable upholstery materials.
A2.2-3.1.3.6 (8) Human decontamination room
  1. A decontamination room on the exterior perimeter should:
    • -Ideally be located 150 feet (45.72 meters) from the ambulance entrance (if required by the constraints of the structures involved, this may be no less than 30 feet (9.14 meters) from the ambulance entrance).
    • -Be located where no windows or doors abut the defined area or where all doors are securable from the outside and all windows are capable of being shuttered.
    • -Have defined boundaries on a paved ground surface that are marked with a yellow paint line and the word "DECON" painted within the boundaries.
    • -Have at least two shower heads, temperature-controlled and separated by at least 6 feet (1.83 meters) with a separate spigot for attachment of a hose.
    • -Have semi-permanent or portable/collapsible structures (e.g., curtains, tents, etc.) that offer shelter from the environment, privacy, and some containment of the contaminant/infectious agent.
    • -Have secured access to the hospital telephone system and a duplex electrical outlet for each two shower heads and no closer than 4 feet (1.22 meters) to any shower.
    • -Have storage for decontamination and personal protective equipment that is immediately accessible to the emergency department.
    • -Have exterior lighting that is appropriate for use in wet/shower facilities to maximize visibility.
    • -Safely contain and dispose of water runoff to prevent contaminated water from entering community drainage systems. This should be accomplished either by graded floor structures leading to a drain with a collection system separate from that of the hospital or with plastic pools or specialized decontamination stretchers.
  2. A decontamination room in the facility should provide:
    • -A separate, independent, secured external entrance adjacent to the ambulance entrance, but no less than 30 feet (9.14 meters) distant. This entrance should be lighted and protected from the environment in the same way as the ambulance entrance. It should also have a yellow painted boundary line 3 feet (0.91 meter) from each side of the door that extends 6 feet (1.83 meters) from the hospital wall; the word "DECON" should be painted within these boundaries.
    • -The spatial requirements and medical support services of a standard emergency area airborne infection isolation room, with air externally exhausted separate from the hospital system. This room should contain a work counter, hand-washing station with hands-free controls, an area for personnel gowning, and a storage area for supplies as well as equipment for the decontamination process.
    • -Ceiling, wall, and floor finishes that are nonslip, without crevices or seams, and capable of withstanding cleaning with and exposure to harsh chemicals. The surface of the floor should be self-finished and require no protective coating for maintenance.
    • -Two hospital telephones and two duplex electrical outlets, secured appropriately for a wet environment
    • -Curtains or other devices to allow patient privacy, to the extent possible
    • -HVAC suitable for a room with an external door and very high relative humidity
    • -Water drainage that is contained and disposed of in a way that prevents contaminated water from entering hospital or community drainage systems. There should be a "saddle" at the floor of the door buck to prevent efflux.
    • -Radiation protection of the type, location, and amount indicated in the final approved department layout, state regulatory requirements, and manufacturer's technical specifications and specified by a certified physicist or other qualified expert representing the organization or the state agency. The expert's specifications should be incorporated into the plans.
At least one patient toilet room with a hand-washing station shall be provided for each six treatment rooms and for each fraction thereof.
Access to imaging and laboratory services shall be provided.
  1. At least one AII room shall be included as part of basic emergency care facilities and in emergency departments. The need for additional AII rooms or for protective environment rooms as described in Section 2.2-2.2.4.4 (Protective environment room) shall be determined by an ICRA.
  2. The AII room(s) shall meet the requirements in sections 2.1-2.4.2.1 (3) (AII Room-Location) and 2.1-2.4.2.4 (1) (AII Room-Architectural details).
  3. AII room(s) shall be visible from a nurse station.
Where a secure holding room is provided, it shall meet the following requirements.
(1) The location of the secure holding room(s) shall facilitate staff observation and monitoring of patients in these areas.
*(2) The secure holding room shall have a minimum clear floor area of 60 square feet (5.57 square meters) with a minimum wall length of 7 feet (2.13 meters) and a maximum wall length of 11 feet (3.35 meters).
(3) This room shall be designed to prevent injury to patients.
(a) All finishes, light fixtures, vents and diffusers, and sprinklers shall be impact-, tamper-, and ligature-resistant.
(b) There shall not be any electrical outlets, medical gas outlets, or similar devices.
(c) There shall be no sharp corners, edges, or protrusions, and the walls shall be free of objects or accessories of any kind.
(d) Patient room doors shall swing out and shall have hardware on the exterior side only.
(e) A small impact-resistant view panel or window shall be provided in the door for discreet staff observation of the patient.
(4) Door openings shall be provided in accordance with Section 2.1-7.2.2.3 (2)(a)(i) (Door openings-Minimum … for patient rooms and diagnostic and treatment areas…).
A2.2-3.1.4.3 Secure holding room. Consideration should be given to the emergency department's procedures for providing care to patients with psychiatric conditions. Attention should be paid to the location of secure holding rooms as well as to the methods used in monitoring patients in these areas (e.g., cameras, windows, etc.).
A2.2-3.1.4.3 (2) 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
  1. An administrative center or nurse station for staff work and charting shall be provided in accordance with Section 2.1-2.8.2 (Administrative Center or Nurse Station) as amended in this section.
  2. Nurse master station and central monitoring equipment shall be provided.
  3. Decentralized nurse stations near clusters of treatment rooms shall be permitted.
  4. Where feasible, visual observation of all traffic into the unit and of all patients shall be provided from the nurse station.
  1. A clean supply room(s) shall be provided in accordance with Section 2.1-2.8.11.3 (Clean supply room).
  2. If the area serves children, additional storage shall be provided to accommodate equipment and supplies in the range of sizes required for pediatrics.
A soiled workroom(s) or soiled holding room(s) shall be provided for the exclusive use of the emergency department in accordance with Section 2.1-2.8.12 (Soiled Workroom or Soiled Holding Room).
A2.2-3.1.8.12 Soiled workroom or soiled holding room. Disposal space for regulated medical waste (e.g., gauzes/linens soaked with body fluids) should be separate from routine disposal space.
  1. Wheelchair and gurney storage. A storage area for wheelchairs and gurneys for arriving patients shall be located out of traffic with access to emergency entrances.
  2. Emergency equipment storage. Emergency equipment storage shall be provided in accordance with Section 2.1-2.8.13.4 (Emergency equipment storage).
An environmental services room(s) directly accessible from the unit shall be provided in accordance with Section 2.1-2.8.14.2. (Environmental services room features).
Where a security station is provided, it shall be located near the emergency entrances and triage/reception area and have a means of observing the public waiting areas and emergency department entrances, including pedestrian and ambulance entrances, as well as a means of controlling access.
A2.2-3.1.8.16 Security station. A security station and/or system should be located to maximize visibility of the treatment areas, waiting areas, and key entrance sites. Specific security recommendations can be found in IAHSS Design Guidelines for Healthcare Facilities — 02.02: Emergency Departments.
  1. The system should include visual-monitoring devices installed in both the emergency department and outside at entrance sites and parking lots.
  2. Special requirements for a security station should include accommodation for hospital security staff, local police officers, and monitoring equipment.
  3. Design consideration should include installation of silent alarms, panic buttons, intercom systems, and physical barriers such as doors to patient entry areas.
  4. The security monitoring system should be connected to the hospital's emergency power backup system.
  1. Provisions for disposal of solid and liquid waste shall be provided in the emergency department.
  2. A clinical sink with a bedpan-rinsing device in the soiled workroom in Section 2.2-3.1.8.12 (Soiled workroom or soiled holding room) shall be permitted to serve this function.
Staff support areas immediately accessible to the emergency department shall be provided in accordance with Section 2.1-2.9 (Support Areas for Staff).
Provision of support areas for patients and their patient advocates shall be considered.
A2.2-3.1.10 Support areas for families, patients, and visitors in the emergency department
  1. Family consultation room. At least one family consultation room should be accessible from both the emergency treatment corridor and the emergency waiting area. This room should be comfortable enough to allow consultation with the family and should have a minimum sound transmission class (STC) of 65 for the walls and 45 for the floors and ceiling. The room should be provided with Internet capability, electrical outlets, and a telephone.
  2. Provisions for patient hygiene. Provision of a shower, toilet, and hand-washing station should be considered.
Where an observation unit is provided for patients requiring observation (e.g., a clinical decision unit or chest pain center), the unit shall comply with the requirements in this section.
The unit shall be permitted to be located in the emergency department or elsewhere in the hospital.
All patient care stations (bays, cubicles, or single-patient rooms) designed to accommodate observation beds shall be provided in accordance with Section 2.1-3.2.2.1 (Single-Patient Examination Room—Space requirements) or Section 2.1-3.2.3.1 (Multiple-Patient Examination Room—Space requirements).
A2.2-3.2.2.2 Additional space in patient care stations. Additional space may be required for equipment and furnishings.
For requirements, see Section 2.1-2.1.2 (Patient Privacy).
Hand-washing stations shall be provided in accordance with Section 2.1-2.8.7 (Hand-washing station).
At least one toilet room shall be provided for each six patient care stations and for each major fraction thereof.
One shower room shall be provided for each 12 treatment cubicles or major fraction thereof; combination of the shower room and toilet room in the same room shall be permitted.
Each observation unit shall contain the following:
  1. A nurse station positioned to allow staff to observe each patient care station or room
  2. A nourishment area that meets the requirements of Section 2.1-2.8.9 (Nourishment Area or Room). Sharing of this area with another unit shall be permitted.
  3. Equipment and supply storage
    1. Storage space for gurneys, supplies, and equipment shall be provided.
    2. Where emergency equipment storage is provided in the unit, it shall be in accordance with Section 2.1-2.8.13.4 (Emergency equipment storage).
The observation unit shall either contain or, if it is an extension of an adjacent clinical unit, shall be permitted to share the following:
  1. Nurse or supervisor work space. A minimum of one nurse or supervisor work space shall be provided.
  2. Medication safety zone. See Section 2.1-2.8.8 (Medication Safety Zones) for requirements.
  3. Clean workroom or clean supply room. A clean workroom or clean supply room shall be provided in accordance with Section 2.1-2.8.11 (Clean Workroom or Clean Supply Room).
  4. Soiled workroom or soiled holding room. A soiled workroom or soiled holding room shall be provided in accordance with Section 2.1-2.8.12 (Soiled Workroom or Soiled Holding Room).
  5. Environmental services room. An environmental services room shall be available in accordance with Section 2.1-2.8.14 (Environmental Services Room).
  6. Examination room
    1. An examination room shall be provided in accordance with the requirements of Section 2.1-3.2 (Examination Room or Emergency Department Treatment Room).
    2. Omission of the examination room shall be permitted if all patient care stations are single-patient rooms.
  7. A picture archiving and communications system (PACS) and/or x-ray illuminators. These shall be immediately accessible to the observation unit.
A minimum of one staff toilet room shall be located in the observation unit and shall be provided in accordance with Section 2.1-2.9 (Support Areas for Staff).
A2.2-3.2.9.2 Although a nurse is "not available" when in the staff toilet room, if the toilet is located in the unit the nurse does not have to leave the unit and is more available to patients.
(1) The semi-restricted and restricted areas of the surgery department shall be located and arranged to prevent unrelated traffic through those spaces.
(2) The clinical practice setting shall be designed to facilitate movement of patients and personnel into, through, and out of defined areas in the surgery department.
(3) Signs that clearly indicate where surgical attire is required shall be provided at all entrances to semi-restricted areas.
*(4) The surgery department shall be divided into three designated areas-unrestricted, semi-restricted and restricted-that are defined by the physical activities performed in each area.
A2.2-3.3.1.1 (4) Surgery department areas
  1. Unrestricted area: Any area of the surgery department that is not defined as semi-restricted or restricted. These areas may include a central control point for designated personnel to monitor the entrance of patients, personnel, and materials into the semi-restricted areas; staff changing areas; a staff lounge; offices; waiting rooms or areas; pre- and postoperative patient care areas; and access to procedure rooms (e.g., endoscopy procedure rooms, laser treatment rooms). Street clothes are permitted in these areas. Public access to unrestricted areas may be limited based on the facility's policy and procedures.
  2. Semi-restricted area: Peripheral areas that support surgical services. These areas may include storage for equipment and clean and sterile supplies; work areas for processing instruments; sterile processing facilities; hand scrub stations; corridors leading from the unrestricted area to the restricted area of the surgical suite; and entrances to staff changing areas, pre- and postoperative patient care areas, and sterile processing facilities. The semi-restricted area of the surgical suite is entered directly from the unrestricted area past a nurse station or from other areas. Semi-restricted areas have specific HVAC design requirements associated with the intended use of the space (see Part 3: ANSI/ASHRAE/ASHE 170: Ventilation of Health Care Facilities). Personnel in the semi-restricted area should wear surgical attire and cover all head and facial hair. Access to the semi-restricted area should be limited to authorized personnel and patients accompanied by authorized personnel.
  3. Restricted area: A designated space contained within the semi-restricted area and accessible only through a semi-restricted area. The restricted area includes operating and other rooms in which operative or other invasive procedures are performed. Restricted areas have specific HVAC design requirements associated with the intended use of the space (see Part 3: ASHRAE/ASHE 170). Personnel in the restricted area should wear surgical attire and cover head and facial hair. Masks should be worn when the wearer is in the presence of open sterile supplies or of persons who are completing or have completed a surgical hand scrub. Only authorized personnel and patients accompanied by authorized personnel should be admitted to this area.
  1. Surfaces. See Section 2.1-7.2.3 (Surfaces) for requirements.
  2. Electrical receptacles. See Table 2.1-1 (Electrical Receptacles for Patient Care Areas in Hospitals) for requirements.
  3. Emergency communication system. For nurse call device requirements, see Table 2.1-2 (Locations for Nurse Call Devices in Hospitals).
  4. Medical gas requirements. See Table 2.1-3 (Station Outlets for Oxygen, Vacuum, Medical Air, and Instrument Air Systems in Hospitals) for requirements.
Where a procedure room is provided in a surgery department, it shall meet the requirements in this section.
(1) Application
*(a) This section shall apply to a procedure room as defined in the glossary.
(i) The governing body shall perform a clinical assessment of the procedures to be performed to determine the appropriate room type and location for these procedures and document this in the functional program.
(ii) Where it is determined the design requirements for a procedure room as shown in Table 2.2-1 (Examination/Treatment, Procedure, and Operating Room Classification) and in Part 3 (ANSI/ASHRAE/ASHE 170: Ventilation of Health Care Facilities) are appropriate, the requirements in this section shall be met.
(b) Where a procedure room is used for multiple procedure types, the room shall meet the most stringent requirements for the space.
*(c) Where procedures that require a negative pressure environment are performed, a procedure room(s) with negative pressure shall be provided and identified with a sign. See Part 3 (ANSI/ASHRAE/ASHE 170: Ventilation of Health Care Facilities) for more information.
(2) Location
(a) The procedure room shall meet the requirements of a semi-restricted area.
(b) The procedure room shall be permitted to be accessed from a semi-restricted corridor or from an unrestricted corridor.
A2.2-3.3.2.1 (1)(a) Procedures that are not defined as invasive in the glossary may be performed in an operating room. However, invasive procedures should not be performed in a procedure room even if it is located in the semi-restricted area.
A2.2-3.3.2.1 (1)(c) Procedures that require different pressure relationships cannot be provided in the same procedure room. For example, procedure rooms where bronchoscopies will be performed require negative pressure; if these rooms are also used for other procedures, the other procedures must be able to be performed in a negative pressure environment. Signage identifying rooms with negative pressure can help users choose appropriate rooms for procedures such as bronchoscopy.
(1) Area
(a) Procedure rooms shall have a minimum clear floor area of 130 square feet (12.08) square meters).
(b) Procedure rooms where anesthesia will be administered using an anesthesia machine and supply carts shall have a minimum clear floor area of 160 square feet (14.86 square meters).
(c) Procedure rooms where procedures will be performed that require additional personnel and/or large equipment shall be sized to accommodate the personnel and equipment planned to be in the room during procedures, including any additional personnel and equipment that will be needed for emergency rescue.
(2) Clearances
(a) Procedure rooms shall have the following minimum clearances around the table, gurney, or procedural chair:
(i) 3 feet 6 inches (1.07 meters) on each side
(ii) 3 feet (91.44 centimeters) at the head and foot
*(b) Where an anesthesia machine and associated supply cart are used, the clearance at the head shall be 6 feet (1.83 meters).
(3) Fixed encroachments into the minimum clear floor area. Fixed encroachments shall be permitted to be included when determining the minimum clear floor area for a procedure room as long as:
(a) The encroachments do not extend more than 12 inches (30.5 centimeters) into the minimum clear floor area.
(b) Where a sterile field is provided, the encroachment shall not extend into the sterile field.
(c) The encroachment width along each wall does not exceed 10 percent of the length of that wall.
A2.2-3.3.2.2 (2)(b) Anesthesia work zone. On the outside edge of the anesthesia work zone, 2 feet × 8 feet (61 centimeters × 2.44 meters) may serve as part of the circulation pathway.
  1. Accommodations for written and/or electronic documentation that meet the requirements in Section 2.1-2.8.3 (Documentation Area) shall be provided in the procedure room.
  2. Where a built-in feature is provided for documentation, it shall allow for direct observation of the patient.
Provisions shall be made for patient privacy in accordance with Section 2.1-2.1.2 (Patient Privacy).
  1. A hand-washing station shall be provided in the procedure room in accordance with Section 2.1-2.8.7 (Hand-Washing Station).
  2. Where a hand scrub station is directly accessible to the procedure room, omission of the hand-washing station shall be permitted.
A2.2-3.3.3 Provisions for patients with airborne infectious diseases. When invasive procedures need to be performed on persons who are known or suspected of having airborne infectious disease and the procedure must be performed in an operating room, follow recommendations outlined in the CDC "Guidelines for Environmental Infection Control in Health-Care Facilities" or the CDC "Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings."
*(1) Application. This section shall apply to rooms designated for the performance of invasive procedures as defined in the glossary.
(2) The operating room shall meet the requirements of a restricted area.
A2.2-3.3.3.1 (1) Procedures not defined as an "invasive procedure" in the glossary may be performed either in an operating room, a procedure room, or an examination/treatment room; see Table 2.2-1 (Examination/Treatment, Procedure, and Operating Room Classification) for details. Nothing in the Guidelines requires a facility where invasive procedures are not performed to have an operating room.
(1) Operating room
(a) Area. Each operating room shall have a minimum clear floor area of 400 square feet (37.20 square meters).
(b) Clearances. The following minimum clearances shall be provided around the operating table, gurney, or procedural chair:
(i) 8 feet 6 inches (2.59 meters) on each side
(ii) 6 feet (1.83 meters) at the head. This dimension shall result in an anesthesia work zone with a clear floor area of 6 feet × 8 feet (1.83 meters × 2.4 meters).
(iii) 7 feet (2.13 meters) at the foot
(c) An operating room used for cesarean and other delivery procedures shall meet the requirements in Section 2.2-2.9.11.1 (Cesarean delivery room).
*(2) Operating room for image-guided surgery using portable imaging equipment or surgical procedures that require additional personnel and/or large equipment
(a) An operating room of this type shall:
(i) Be sized to accommodate the personnel and equipment planned to be in the room during procedures.
(ii) Have a minimum clear floor area of 600 square feet (55.74 square meters) with a minimum clear dimension of 20 feet (6.10 meters).
(b) Where renovation work is undertaken and it is not possible to meet the above minimum standards, these rooms shall have a minimum clear floor area of 500 square feet (46.50 square meters) with a minimum clear dimension of 20 feet (6.10 meters).
(3) Fixed encroachments into the minimum clear floor area. Fixed encroachments shall be permitted to be included when determining the minimum clear floor area for an operating room as long as:
(a) There are no encroachments into the sterile field.
(b) The encroachments do not extend more than 12 inches (30.5 centimeters) into the minimum clear floor area outside the sterile field.
(c) The encroachment width along each wall does not exceed 10 percent of the length of that wall.
A2.2-3.3.3.2 Determining operating room space requirements. Operating room size should be based on the procedures to be performed, including the number of staff required and the amount and size of equipment to be used.
  1. The minimum clear floor area requirements for an operating room in the main text were determined by combining the following:
    • -Sterile field: 3 feet (91.44 centimeters) on each side and at the foot of an operating table, gurney, or procedural chair
    • -Circulation pathway: 3 feet (91.44 centimeters) on both sides and 2 feet (60.96 centimeters) at the foot of the sterile field
    • -Movable equipment zone: 2 feet 6 inches (76.20 centimeters) on the sides and 2 feet at the foot of the circulation pathway
    • -Anesthesia work zone: 48 square feet (4.46 square meters) at the head of the operating table, gurney, or procedural chair
      The sterile field includes the OR table (measuring 3 × 7 feet or 91.44 centimeters × 2.13 meters), a 3-foot (91.44-centimeter) clearance on each side to accommodate personnel and outstretched patient armrests, and a 3-foot (91.44-centimeter) clearance at the foot for personnel.
      The circulation pathway includes space for two people to meet and pass each other without touching either non-sterile surfaces (e.g., walls, people, or equipment) on one side or personnel wearing sterile attire who are standing at the sterile field on the other side. The circulation pathway on all four sides is to provide space for personnel to set up a sterile field prior to the procedure, assist with safe patient evacuation using a stretcher in case of an emergency, pass between the back table and the wall during the procedure, and pass at the head of the patient without interfering with care being provided by the anesthesia care provider(s).The anesthesia work zone is a 6 × 8-foot space at the head of the table, but when the anesthesia care provider(s) is not actively setting up sedation of the patient 2 feet (60.96 centimeters) at the top of that zone can be used as part of the circulation pathway.
      The movable equipment zone includes 2 feet 6 inches (76.20 centimeters) on each side and 2 feet (60.96 centimeters) at the foot of the table to accommodate the minimum equipment for a surgical procedure.
  2. The minimum equipment for a surgical procedure includes the following:
    • -Anesthesia machine (usually on a cart)
    • -Anesthesia supply cart
    • -Chair for the anesthesia care provider
    • -Intravenous pole or table
    • -Case cart/equipment delivery system cart
    • -Prep stand
    • -Portable documentation station with chair
    • -Back instrument table
    • -Ring stand
    • -Two trash containers
    • -Soiled linen container
    • -Hazardous waste receptacle
    • -Mayo stand
    • -Kick bucket
    • -Surgical field suction
    • -Image viewers
    • -Sharps disposal receptacle
      When calculating the space needed to accommodate the minimum amount of required equipment, it was assumed that all equipment would fit tightly together; however, this frequently is not possible due to the shape of the equipment, so more space may be needed.
  3. Required personnel include the surgeon, scrub nurse/technician, circulating nurse, and anesthesia care provider(s).
A2.2-3.3.3.2 (2) Operating rooms for image-guided surgery or procedures requiring more space for personnel or equipment. Image-guided surgery occurs in rooms equipped with advanced audiovisual technology. Surgical procedures that may require additional personnel and/or large equipment include some cardiovascular, orthopedic, and neurological procedures.
  1. Accommodations for written and/or electronic documentation shall be provided.
  2. Where a built-in feature is provided for documentation, it shall allow for direct observation of the patient.
Medical image viewers (e.g., x-ray film or digital) shall be provided.
  1. Electrical receptacles. See Table 2.1-1 (Electrical Receptacles for Patient Care Areas in Hospitals) for requirements.
  2. Medical gas outlets. See Table 2.1-3 (Station Outlets for Oxygen, Vacuum, Medical Air, and Instrument Air Systems in Hospitals) for requirements.
  3. Communications system
    1. All operating rooms shall be equipped with an emergency communication system that incorporates push activation of an emergency call switch.
    2. Each operating room shall have a system for emergency communication with the surgery department control station.
    3. For nurse call requirements, see Table 2.1-2 (Locations for Nurse Call Devices in Hospitals).
Where open-heart or complex orthopedic and neurosurgical surgery is performed, equipment storage rooms shall be provided in the semi-restricted area of the surgery department for storage of the large equipment used to support these procedures.
A2.2-3.3.3.6 Equipment storage rooms for ORs that require additional equipment. Equipment storage rooms for these specialty operating rooms should be located adjacent to the OR.
A2.2-3.3.4 Hybrid operating room. The hybrid operating room is a rapidly evolving environment. Intraoperative imaging has long been recognized as an essential supporting technology for a variety of surgical procedures. Many equipment manufacturers now offer highly specialized, proprietary imaging systems that can be permanently integrated into the operating room. Intraoperative CT, MRI, and vascular imaging technologies are common examples. In many cases, these modalities are capable of physically moving into and out of the surgical field via floor or ceiling assemblies, allowing for a clear zone when imaging technology is not required. Hybrid operating room imaging technologies present additional spatial, structural, patient and staff safety, and infection prevention considerations that must be addressed by the entire project team. The project team should involve representatives from the imaging equipment manufacturer as early as possible and throughout design and construction.
Early in project planning, the project team should ensure that all members thoroughly understand how the hybrid operating room is intended to function. The team must understand and account for end-user functional requirements in addition to the imaging equipment manufacturer's site specifications. While not unique to hybrid operating rooms, many of the following considerations (as well as a host of other factors) become more complex in such environments:
  • -Patient and staff maneuvering space
  • -Equipment delivery requirements
  • -Structural loading
  • -Equipment movement paths and clearances
  • -Utility requirements
  • -Radiation or magnetic field safety requirements
  • -Ancillary equipment movement and storage
  • -Space to accommodate ventilation requirements
Inevitably, new hybrid operating systems will be introduced for which no precedent exists. The project team may consider opening dialogues with local and state authorities having jurisdiction early in a project to determine whether such technologies will trigger unforeseen regulatory processes.
Hybrid operating rooms (Class 3 imaging rooms) shall be designed to comply with the requirements in Section 2.2-3.3.3 (Operating Rooms), except for Section 2.2-3.3.3.2 (1) (Space requirements: Operating room), and the requirements in Section 2.2-3.4 (Imaging Services) that apply to the imaging modality used in the hybrid operating room.
A2.2-3.3.4.1 Access route(s). Access route(s) for equipment installation and replacement should comply spatially and structurally with the manufacturer's technical specifications.
  1. Each hybrid operating room shall meet the clear floor area, clearance, and storage requirements for the imaging equipment contained in the room.
  2. Where mobile storage units are used in lieu of fixed cabinets, placement of the storage units shall not encroach on the clear floor area and clearances needed for the equipment used.
A2.2-3.3.4.2 Determining hybrid operating room size. The size of a hybrid operating room is highly dependent on the functional requirements of the room as an operating environment as well as the requirements of the imaging equipment it contains, which generally increase the room area requirements. For example, in some hybrid operating rooms, imaging equipment is capable of sliding into and out of the surgical field to optimize clear floor area when it is not needed. In other examples, the hybrid operating room contains dual surgical fields-one adjacent to fixed imaging equipment and another outside of this sector.
The interaction of the imaging equipment, surgical field, ancillary fixed equipment (e.g., lights, service columns, etc.), and clear floor area for staff, floor equipment, and circulation should all be considered when determining the actual room size. The project team is strongly encouraged to perform a full-scale mockup of the room during design to ensure it will function properly as designed.
Where required, a control room shall be provided that accommodates the imaging system control equipment.
  1. All control rooms shall be sized and configured in compliance with manufacturer recommendations for installation, service, and maintenance.
  2. The room shall be physically separated from the hybrid operating room with walls and a door. The door shall not be required where the control room serves only one operating room and is built, maintained, and controlled the same as the operating room.
  3. A control room shall be permitted to serve more than one hybrid operating room, provided that manufacturer recommendations for installation, service, and maintenance are accommodated for all rooms served.
  4. The control room shall have view panels that provide for a view of the patient and the surgical team.
The floor and (if applicable) ceiling structures shall be designed to support the weight of the imaging equipment as well as other fixed ancillary equipment (e.g., lights, service columns) and movable ancillary equipment.
A2.2-3.3.4.4 The design team should consider the long-term flexibility of the room when designing equipment supports. In lieu of customized supports for each suspended item, a regularly spaced grid of overhead structural members may enable rapid changes to the room, such as repositioning surgical lights and service columns, and facilitate future equipment replacement.
The hybrid operating room shall be protected from disruptive environmental vibrations and other disturbances in accordance with the imaging equipment manufacturer's technical specifications.
A2.2-3.3.4.5 Protection from environmental disruptions
  1. Many imaging systems are highly sensitive to vibration, electromagnetic interference, and other forces that arise from adjacent equipment movement, electrical rooms, and unassociated building equipment. These forces can result in serious degradation of images. Project teams should consult with equipment manufacturers to determine whether site readiness testing is required prior to equipment installation and, also, to strategize about control mechanisms to mitigate such forces.
  2. Many imaging systems are cooled via closed liquid-based cooling loops that must necessarily cross into surgical environments. Such cooling loops require protective means to reduce the possibility of water leakage into ceiling or wall cavities surrounding hybrid operating rooms. The design team should consider double-jacketing horizontal or vertical cooling lines and installing protective drip pans below lines in ceiling cavities.
  1. A system component room that meets the requirements in Section 2.2-3.4.2.5 (System component room) shall be provided for each hybrid operating room.
  2. The system component room shall be permitted to be shared among multiple hybrid operating rooms.
If the imaging equipment emits ionizing radiation, protection shall be provided in accordance with Section 2.2-3.4.1.3 (Imaging Services-Radiation protection).
  1. Hybrid operating rooms with intraoperative computerized tomography (CT) systems shall have control rooms that comply with Section 2.2-3.4.1.3 (1) (Shielded control alcove or room).
  2. Hybrid operating rooms with intraoperative MRI (iMRI) systems shall comply with the following:
    1. Configuration and space requirements: Section 2.2-3.4.5.1 (Configuration of the MRI suite) and Section 2.2-3.4.5.2 (MRI scanner room)
    2. For the control room: Section 2.2-3.4.5.4 (MRI control room)
    3. For design of the room: Section 2.2-3.4.5.9 (Special design elements for the MRI scanner room)
  3. Hybrid operating rooms with vascular imaging systems shall comply with Section 2.2-3.4.1.3 (1) (Shielded control alcove or room).
Pre- and postoperative patient care area(s) shall meet the requirements in Section 2.1-3.4 (Pre- and Post-Procedure Patient Care).
  • (1) General. The support areas in this section shall be provided in or directly accessible to the pre- and postoperative patient care areas as noted.
  • (2) Nurse station with documentation area. See Section 2.1-2.8.2 (Administrative Center or Nurse Station) and 2.1-2.8.3 (Documentation Area) for requirements.
  • (3) — (6) Reserved
  • (7) Clinical sink
  • (8) Medication safety zone
    • (a) This shall be provided in postoperative patient care areas.
    • (b) See Section 2.1-2.8.8 (Medication Safety Zones) for requirements.
  • (9) Nourishment area
    • (a) This shall be provided in an unrestricted patient care area.
    • (b) See Section 2.1-2.8.9.2 (Nourishment Area or Room-Features) for other requirements.
  • (10) Ice-making equipment
    • (a) Ice-making equipment shall be provided in accordance with Section 2.1-2.8.10 (Ice-Making Equipment).
    • (b) Ice-making equipment shall not be located in the semi-restricted area.
  • (11) Reserved
  • (12) Provisions for soiled linen and waste holding. See Section 2.2-3.3.7.12 (Soiled workroom or soiled holding room) for requirements.
  • (13) Equipment and supply storage
    • (a) Location of storage for equipment and supplies in the clean equipment and supply room required in Section 2.2-3.3.7.13 (Clean equipment and supply storage) shall be permitted. See Section 2.2-3.3.7.13 for requirements.
    • (b) Emergency equipment storage shall be provided in accordance with Section 2.1-2.8.13.4 (Emergency equipment storage).
A staff toilet room shall be located in the postoperative patient care area(s) to maintain staff availability to patients.
  1. Patient toilet room
    1. Location
      1. A patient toilet room shall be directly accessible to the pre- and postoperative patient care area.
      2. Where separate pre- and postoperative patient care areas are provided, the patient toilet room(s) shall be permitted to be shared if directly accessible to preoperative and Phase II recovery areas.
      3. Where pre- and postoperative patient care stations that are single-patient rooms are used for airborne infection isolation patients, the toilet room shall be directly accessible from the patient care station.
    2. Number
      1. Additional toilets shall be provided at the ratio of one patient toilet for each eight patient care stations or fewer and for each major fraction thereof.
      2. Pre- and postoperative patient care stations that are single-patient rooms with directly accessible toilet rooms that serve only that private room shall not contribute to the patient care station count when determining the number of patient toilets to be provided.
  2. Visitor seating in Phase II recovery area. Where visitor seating is allowed in the recovery area, space for at least one seat for a visitor shall be provided within the boundaries of each patient care station.