Adopts Without Amendments:

FGI Hospital, 2018

Part 1 General

Part 2 Hospital Facility Types

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

Heads up: There are no amended sections in this chapter.
Appendix material, shown in shaded boxes at the bottom of the page, is advisory only.
A2.4-1 Due to their size of 25 beds or less, most replacement critical access hospitals are being constructed as single-story facilities because, with few exceptions, costs tend to be less for a one-story building. Multi-story construction involves vertical lift expense (elevators), additional life safety code considerations, and increased difficulty in transporting patients. Exceptions to the single-story advantages are in locations where land acquisition is extremely expensive or where topography makes a larger footprint impractical. Also, where replacement involves renovation of existing facilities, a multi-story plan may be necessary.
Individual states establish state Medicare rural hospital flexibility programs, which authorize certain facilities in qualifying rural areas to participate in the Medicare critical access hospital program.
A2.4-1.1 Application. The conditions of participation for the federal critical access hospital program can be found in the Code of Federal Regulations under Title 42, Part 485 (http://ecfr.gpoaccess.gov).
This chapter contains specific requirements for critical access hospitals; however, application of the guidelines herein to any small facility with similar functional program requirements shall be permitted where approved by the authority having jurisdiction (AHJ).
The critical access hospital shall meet the standards described in this chapter and the standards in Part 1 of these Guidelines as amended in this section.
Requirements in Chapter 2.1, Common Elements for Hospitals, and Chapter 2.2, Specific Requirements for General Hospitals, shall apply to the critical access hospital as cross-referenced in this chapter.
The functional program shall describe the various components planned for the critical access hospital and how they will interface with each other. See sections 1.2-2 (Functional Program) and 2.1-1.2 (Functional Program) for requirements.
Combination or sharing of functions shall be permitted as required by community needs.
A2.4-1.2.1 Size and layout. Department sizes and clear floor areas depend on program requirements and organization of services in the facility. When developing the functional program for new or renovated spaces, it is important to consider use of each space for multiple patient care functions. CAH reimbursement is based on patient care provided and not tied to the specific room occupied. Examples include:
  1. Universal care rooms. This room type can vary from ICU to swing bed use. Planning for the highest level of acuity for this room will provide flexibility and use by lower acuity patients would be acceptable.
  2. Swing beds. When the functional program demonstrates the need, the facility may consider initiating a swing bed program. This type of program may require additional support space, such as
    • -Dining, day/activity, or recreation spaces. This may be accomplished in a multipurpose space if explained in the functional program and allowed by the authority having jurisdiction (AHJ).
    • -Treatment/procedure/exam room. This room type may be used for physical therapy treatment and could also be scheduled to provide swing bed support given adjacency to the appropriate department.
    • -Storage and work space. If a swing bed program is being initiated, the location of nutrition space, nursing staff areas, storage/utility space and "on call" rooms should be considered.
  3. Same day surgery/emergency/exam room(s). Where exam room(s) are provided in the emergency department, use of these rooms for other functions during normal business hours (e.g., pre- and post-procedure patient care, exam rooms for visiting physicians, treatment rooms for swing bed patients) should be considered to increase efficient use of space.
Parking for critical access hospitals shall comply with the general requirements in Section 1.3-3.4 (Parking) and the specific requirements in this section.
In the absence of local requirements governing parking, the following shall be provided:
  1. One parking space for each bed
  2. One parking space for each employee normally present on any single weekday shift
A2.4-1.3.4.2 Separate and additional space should be provided for mobile/transportable medical unit service; delivery vehicles; and vehicles providing emergency services, including but not limited to ambulances, law enforcement vehicles, and mass casualty equipment.
Provisions shall be made for the transfer of patients to higher-acuity hospital providers.
Ground ambulance and/or helicopter service shall be provided to facilitate the timely transfer of patients.
A2.4-1.3.7.2 Transfer support features. Features such as garages, landing pads, approaches, lighting, and fencing should follow state and local regulations that govern the placement, safety features, and elements required to accommodate helicopter and ambulance services.
Patient care units shall be permitted to accommodate multiple patient modalities.
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).
The number of patient rooms contained in the patient care unit shall not exceed 25 beds.
See Section 2.2-2.2.2 (Medical/Surgical Patient Care Unit-Patient Room) for requirements.
Where a dedicated AII room is required by the infection control risk assessment, it shall meet the requirements in Section 2.1-2.4.2 (Airborne Infection Isolation Room).
Where a PE room is required by the infection control risk assessment, it shall meet the requirements in Section 2.2-2.2.4.4 (Protective environment room).
Patient rooms that will also be used as critical care rooms shall meet the following:
  1. Electrical receptacle requirements for a critical care unit in Table 2.1-1 (Electrical Receptacles for Patient Care Areas in Hospitals)
  2. Nurse call requirements for a critical care unit patient bed in Table 2.1-2 (Locations for Nurse Call Devices in Hospitals)
  3. Station outlet requirements for "critical care-general" Table 2.1-3 (Station Outlets for Oxygen, Vacuum, Medical Air, and Instrument Air Systems in Hospitals)
  1. Where LDR/LDRP rooms are provided, they shall meet the requirements in Section 2.2-2.9.3.2 (LDR and LDRP Rooms-Space requirements)
  2. Storage. Where labor/delivery/recovery (LDR) or labor/delivery/recovery/postpartum (LDRP) functions are programmed for a critical access hospital, a storage area for case carts, delivery equipment, and bassinets shall be provided.
  1. A minimum of one cesarean delivery room that meets the requirements in Section 2.2-2.9.11 (Cesarean Delivery Suite) shall be provided.
  2. The cesarean delivery room(s) shall be immediately accessible to LDR/LDRP-capable rooms.
  3. An operating room(s) shall be permitted to meet this requirement as long as the operating room is immediately accessible to LDR/LDRP-capable rooms.
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.
Hand-washing stations shall meet the requirements in Section 2.1-2.8.7 (Hand-Washing Station).
See Section 2.1-2.8.8 (Medication Safety Zones) for requirements.
See Section 2.1-2.8.9 (Nourishment Area or Room) for requirements.
See Section 2.1-2.8.10 (Ice-Making Equipment) for requirements.
A clean workroom or clean supply room that meets the requirements in Section 2.1-2.8.11 (Clean Workroom or Clean Supply Room) shall be provided.
See Section 2.1-2.8.12 (Soiled Workroom or Soiled Holding Room) for requirements.
Equipment and supply storage. Equipment and supply storage shall be provided. For requirements, see Section 2.1-2.8.13 (Equipment and Supply Storage).
An environmental services room that meets the requirements in Section 2.1-2.8.14.2 (Environmental services room features) shall be provided.
A staff lounge shall be provided that meets the following requirements:
  1. Size. The lounge provided for staff shall be programmatically sized.
  2. Location. The staff lounge shall be located as close as possible to the centralized nurse station or, if the nurse station is decentralized, in close proximity to the work core of the patient care unit.
See Section 2.1-2.9.2 (Staff Toilet Room) for requirements.
Securable lockers, closets, and cabinet compartments for the personal articles of staff shall be located in or near the nurse station and staff lounge.
A2.4-2.2.10 Provision of an area for overnight stay for a patient's significant other or for a patient's selected family caregiver should be considered. Spaces for sitting, lounging, and visiting should be provided. Support areas for families, visitors, and patients may be combined with the facility's general lounge areas.
A family and visitor lounge that meets the requirements in Section 2.1-2.10.1 (Family and Visitor Lounge) shall be provided.
Where the critical access hospital includes a distinct psychiatric patient care unit, the unit shall meet the requirements in Section 2.2-2.12 (Psychiatric Patient Care Unit) as amended in this section.
The psychiatric patient care unit shall provide a therapeutic environment to support the types of medical and psychiatric therapies provided.
Safety and security measures to support patient and staff safety and the planned treatment programs shall be provided for the psychiatric patient care unit. For requirements, see Section 1.2-4.6 (Behavioral and Mental Health Risk Assessment).
In no case shall adult psychiatric and pediatric/adolescent psychiatric populations be mixed. This does not exclude sharing of nursing stations or support areas as long as the separation of units and safety of patients can be maintained.
See Section 2.5-2.2.2 (Patient Bedroom) for requirements.
Where a seclusion room is provided for short-term occupancy, it shall meet the requirements in Section 2.1-2.4.3 (Seclusion Room).
Where support areas in Section 2.5-2.2.8 (Support Areas for the Psychiatric Patient Care Unit) are provided, they shall meet the requirements in that section.
  1. Support areas intended for patient use, or for staff support functions necessary for direct patient care, shall be immediately accessible to the psychiatric patient care unit.
  2. Support areas intended for psychiatric patient use shall not be shared with other patient care units or departments in the hospital.
  3. Staff support areas necessary for the direct medical/clinical care of psychiatric patients shall be permitted to be shared with other psychiatric patient care units consistent with Section 2.4-2.14.1.4 (Shared facilities).
  4. Staff support areas that are not necessary for the direct medical/clinical care of psychiatric patients shall be permitted to be shared with other patient care units and departments in the hospital, provided the space is located outside the psychiatric patient care unit.
See Section 2.5-2.3 (Child Psychiatric Patient Care Unit) for requirements.
See Section 2.5-2.4 (Alzheimer's and Other Dementia Patient Care Unit) for requirements.
See Section 2.5-2.5 (Forensic Psychiatric Patient Care Unit) for requirements.
Where swing beds are part of the critical access hospital's services, the following requirements shall be met:
Each swing bed room shall meet the requirements for a patient room in Section 2.4-2.2.2 (Critical Access Patient Care Unit-Patient Room).
In addition to the spaces in Section 2.4-2.2 (Critical Access Patient Care Unit), the following areas shall be provided:
A2.4-2.18.2 Swing bed services. Other swing bed services may include transitional living units, a room for patient grooming, and patient laundry facilities with an automatic washer and dryer. Where transitional living units are provided, their design should include operable residential-type equipment and fixtures. For more information, see appendix section A2.4-1.2.1-b (Size and layout-Swing beds).
  1. A minimum of 55 square feet (5.11 square meters) per bed shall be provided for dining, recreation, and day spaces.
  2. These areas shall be permitted to be separate or adjoining spaces.
Where physical therapy or other treatment modalities are provided, the therapy space(s) shall be sized to accommodate the equipment used.
  1. At least one individual treatment room with a minimum clear floor area of 80 square feet (7.43 square meters) shall be provided.
  2. Treatment bays or cubicles shall have a minimum size of 70 square feet (6.51 square meters).
For therapy spaces where services such as thermotherapy, diathermy, ultrasonics, hydrotherapy, etc. are provided, cubicle curtains shall be provided around each individual therapy area.
A hand-washing station(s) shall be immediately accessible to the therapy room or area.
Facilities for collection of wet and soiled linen and other material shall be provided.
The elements in this section shall be provided as needed to accommodate the clinical services provided.
Where provided, examination rooms shall meet the requirements in Section 2.1-3.2 (Examination Room or Emergency Department Treatment Room).
  1. Where provided, rooms for the isolation of patients deemed at risk for self-harm or harm to others shall be located to allow observation from a nurse or control station.
  2. Modification of an examination room to accommodate this function shall be permitted.
A2.4-3.1.3.1 Locating observation rooms where they are visible from a nurse or control station permits close observation of patients and minimizes the possibility that patients can hide, escape, injure themselves, or commit suicide.
Space requirements. These rooms shall have a minimum clear floor area of 80 square feet (7.43 square meters).
Toilet room. A toilet room with hand-washing station shall be immediately accessible.
Support areas shall be permitted to be shared with other program elements where physical and functional adjacencies are provided.
A nurse station that controls all ingress and egress to the unit shall be provided.
  1. The nurse station shall have the following:
    1. Work counter
    2. Communications system
    3. Space for supplies
    4. Provisions for charting
  2. Where a fully integrated electronic information management system is planned, additional alcoves or spaces in individual rooms to accommodate the information technology equipment needed to accomplish the integration shall be provided.
Medication safety zones shall meet the requirements in Section 2.1-2.8.8 (Medication Safety Zones).
See Section 2.1-2.8.11 (Clean Workroom or Clean Supply Room) for requirements.
See Section 2.1-2.8.12 (Soiled Workroom or Soiled Holding Room) for requirements.
  1. Wheelchair storage. Wheelchair storage spaces shall be provided.
Emergency facilities shall meet the requirements for basic emergency services in Section 2.2-3.1.2 (Basic Emergency Care) as amended in this section.
At least one observation bed with full cardiac monitoring that meets the requirements in Section 2.2-3.2.2 (Observation Unit-Patient Care Stations) shall be provided.
Where a secure holding room is provided as an element of the emergency service, it shall meet the criteria established in Section 2.2-3.1.4.3 (Secure holding room).
A2.4-3.2.2.2 Secure holding room considerations.
A secure holding room may be required in the emergency department for short-term observation and assessment of patients whose condition is deemed inappropriate for care in the emergency department's standard care and treatment areas and requires them to be separated from other patients. Rooms for secure holding should be designed to accommodate the physical separation of such patients from the balance of the emergency department until such time as a reasonable assessment can be made regarding the patient's potential for physical harm or disruption from behaviors resulting from the patient's condition, including but not limited to mental health and substance abuse issues.
While a major goal for such rooms is physical separation of the patient, strong consideration should also be given to ease of staff observation and monitoring, preventing unauthorized patient elopement, and safety of the patient. Such rooms may be shared with other limited-frequency-of-use functions where the requirements of each programmed use are compatible.
Facilities for radiography and fluoroscopy services shall be provided. See Section 2.2-3.4.4 (Radiography Facilities) for requirements.
  1. The semi-restricted and restricted areas of the surgery department shall be arranged to prevent unrelated traffic through those spaces.
  2. Patient care areas 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.
Facilities for diagnostic services shall be provided on- or off-site for pre-admission tests required for the procedures performed in the hospital.
Where an examination room is provided, it shall comply with the requirements in Section 2.1-3.2.2 (Single-Patient Examination Room) as amended in this section.
  1. Area. Each examination room shall have a minimum clear floor area of 80 square feet (7.43 square meters).
  2. Clearances. The size of the exam room shall accommodate a minimum clearance of 2 feet 8 inches (81.28 centimeters) at each side and at the foot of the examination table, recliner, or examination chair.
Where a procedure room(s) is provided, it shall meet the requirements in Section 2.2-3.3.2 (Procedure Room).
Where surgical services are provided in the critical access hospital, operating rooms shall meet the criteria for the level of care to be provided as described in Section 2.2-3.3.3 (Operating Rooms).
Where pre- and postoperative patient care area(s) are provided, they shall meet the requirements in Section 2.1-3.4 (Pre- and Post-Procedure Patient Care).
See the following sections for requirements:
  1. Section 2.2-3.3.5.8 (Support areas for pre- and postoperative patient care areas)
  2. Section 2.2-3.3.5.9 (Support areas for staff)
  3. Section 2.2-3.3.5.10 (Support areas for patients and visitors)
See Section 2.2-3.3.6 (Support Areas in the Semi-Restricted Area) for requirements.
See Section 2.2-3.3.7 (Support Areas Directly Accessible to the Semi-Restricted Area) for requirements.
See Section 2.2-3.3.8 (Other Support Areas in the Surgery Department) for requirements.
See Section 2.2-3.3.9 (Support Areas for Surgery Department Staff) for requirements.
  1. Space shall be provided for patients to change from street clothing into hospital gowns and to prepare for surgery.
    1. This changing area shall be permitted to consist of private holding room(s) or cubicle(s) and/or a separate changing area.
    2. A patient care station in the preoperative patient care area shall be permitted to serve this function.
  2. Where a separate changing area is provided, it shall include the following:
    1. Provisions for secure storage of patients' belongings
    2. Access to toilet(s) without passing through a public space
    3. Space for changing or gowning
Where a separate changing area is not provided, provisions shall be made for secure storage of patients' belongings.
See Section 2.2-3.4 (Imaging Services) for facility requirements for the imaging services provided.
Where telemedicine services are provided, spaces to support the telemedicine functions shall be planned in conjunction with information technology spaces.
See Section 2.1-3.3 (Accommodations for Telemedicine Services) for requirements for telemedicine areas in addition to those in this section.
Telemedicine areas shall contain the following:
  1. Satellite linkages
  2. Communication and viewing rooms and consoles
  3. Consultation spaces
  4. Electronic interview rooms
  5. Satellite hookups in telemedicine area
Where mobile/transportable medical units are used to provide services, they shall meet the requirements in Chapter 2.8 (Specific Requirements for Mobile/Transportable Medical Units).
A2.4-3.6 Mobile/transportable medical unit facility requirements. Critical access hospitals may solely depend on the services of a mobile/transportable medical unit for some services (e.g., imaging). In some regions, health care providers share the costs of a mobile/transportable medical unit among hospitals in the region, taking the scheduled services where they are needed. However, as indicted in Chapter 2.8, mobile/transportable medical units must meet the space requirements indicated in the chapter that covers the services to be provided.
Facilities for clinical laboratory and anatomic pathology testing shall be provided in the hospital or through a contract arrangement with another hospital or reference lab.
A2.4-4.1.1.1 The testing for which facilities are provided may include, but is not limited to, urinalysis, blood glucose, arterial blood gasses, and electrolytes. Physicians may take skin biopsies or fine needle aspirations of suspicious lumps and bumps during routine examinations.
  1. Where laboratory services are provided on contract, the support spaces included in this section (2.4-4.1, Laboratory Services) shall be provided.
  2. Where specific laboratory services are provided, see Section 2.1-4.1 (Laboratory Services) for facility requirements.
A laboratory room containing the following shall be provided:
  1. Work counter(s)
  2. Sink(s)
  3. Hand-washing station
  4. Emergency equipment (e.g., flood shower and eyewash station)
  5. Tele/data and electrical services
Blood storage facilities that meet the requirements of the Clinical Laboratory Improvement Amendments (CLIA) standards for blood banks shall be provided.
Storage shall be provided for reagents, specimens, flammable materials, acids, bases, and other supplies used in the laboratory.
Specimen collection facilities shall be provided in accordance with Section 2.1-4.1.3 (Specimen Collection Facilities).
At minimum, a medication preparation room shall be provided. See Section 2.1-2.8.8 (Medication Safety Zones) for requirements.
Where a pharmacy is provided, see Section 2.1-4.2 (Pharmacy Services) for requirements.
Provisions for serving patient and staff meals shall be provided. A kitchen or a satellite serving facility shall be permitted.
A2.4-5.1 Sterile processing procedures may be performed on-site or off-site as long as the off-site location meets the health care organization's infection control criteria for sterilizing locations and transportation and handling methods for sterilized supplies. Disposable supplies may be used to satisfy the facility's needs.
Each critical access hospital shall have provisions for sterile processing.
Where sterile processing occurs on-site, see Section 2.1-5.1.2 (Facilities for On-Site Sterile Processing) for requirements.
For hospitals where sterile processing services are provided off-site, see Section 2.1-5.1.3 (Support Areas for Hospitals Using Off-Site Sterile Processing) for requirements.
See Section 2.1-5.2 (Linen Services) for requirements.
See Section 2.1-5.3 (Materials Management) for requirements.
See Section 2.1-5.4 (Waste Management) for requirements.
At minimum, one environmental services room shall be provided. See Section 2.1-2.8.14 (Environmental Services Room) for requirements.
See Section 2.1-5.6 (Engineering and Maintenance Services) for requirements.
See Section 2.1-6 (Public and Administrative Areas) for requirements.
In addition to the requirements in Section 2.1-7.2 (Architectural Details, Surfaces, and Furnishings), the requirements in this section shall be met.
The requirements in Section 2.1-7.2.2.1 (Corridor width) shall be met as amended in this section:
  1. Public corridors shall have a minimum width of 5 feet (152 centimeters).
  2. Where patients are transported on gurneys or beds, at least one corridor that connects the surgical suite and the PACU to an exit shall have a minimum width of 6 feet (183 centimeters).
  3. The corridor connecting the semi-restricted area of the surgical suite and the PACU shall have a minimum width of 8 feet (244 centimeters) to accommodate transport of patients between pre-operative, procedure, and post-anesthesia recovery areas.
  4. Staff-only corridors shall be permitted to be a minimum of 3 feet 8 inches (112 centimeters) wide unless a greater width is required by occupant load calculations per local and state building codes.
In psychiatric patient rooms, toilet rooms, and seclusion rooms, ceiling and air distribution devices, lighting fixtures, sprinkler heads, and other appurtenances shall be of a tamper- and ligature-resistant type.
See Section 2.1-8.3 (Electrical Systems) for requirements.
See Section 2.1-8.4 (Plumbing Systems) for requirements.
Call systems shall meet the requirements in Section 2.1-8.5.1 (Call Systems).
Locations for terminating telecommunications and information system devices shall be provided.
A central equipment space shall be provided that meets manufacturer requirements for the following:
  1. Temperature range
  2. Air filtration
  3. Humidity control
  4. Voltage regulation
The emergency communication system shall meet the requirements in Section 2.1-8.5.3 (Emergency Communication System).
A fire alarm system shall be provided in accordance with Section 2.1-8.6.1 (Fire Alarm Systems).
When performing the security risk assessment, the need for active and passive security systems shall be considered. See Section 1.2-4.8.2 (Security Elements of the Safety Risk Assessment) for requirements.
Locking arrangements, security alarms, and monitoring devices shall not interfere with life safety requirements.
Linked Resources
P
P Premium Feature

This feature is included in the premium subscription. Visit the feature page to learn more.

Learn More
Bookmarks
P
P Premium Feature

This feature is included in the premium subscription. Visit the feature page to learn more.

Learn More