Part 1 General

Part 2 Outpatient 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.
A2.8-1 Security. The design of the freestanding emergency care facility 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 present the emergency care facility as a secured area that serves as an added layer of protection between other patient care areas, public areas, and treatment areas. Alternate means of egress should be available in the event the main entrance is unavailable. Specific security recommendations can be found in IAHSS Security Design Guidelines for Healthcare Facilities-02.02 Emergency Departments.
A2.8-1.1 A freestanding emergency care facility provides emergency care in a facility that is located away from an acute care hospital. It may be owned by a hospital or a separate entity not affiliated with a hospital. Freestanding emergency care facilities owned by hospitals provide emergency care 24 hours a day, 7 days a week, and receive ambulance patients.
This chapter shall apply to a freestanding emergency care facility that is an emergency department physically separate from (i.e., not located on the same campus as) a hospital emergency department and is intended to provide emergency services 24 hours a day 7 days a week.
The freestanding emergency care facility 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 Outpatient Facilities, shall apply to free-standing emergency care facilities as cross-referenced in this chapter.
See Section 2.1-2 (Accommodations for Care of Patients of Size) for requirements.
Patient care and diagnostic areas for freestanding emergency care facilities shall meet the requirements in this section.
A2.8-3.1 Facilities for emergency care. Basic emergency care is not only for patients with minor illnesses and 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-hours-a-day/7-days-a-week staffing to avoid delays in medical screening, stabilization, and essential treatment.
See Section 2.8-6.2.2 (Reception/Triage Area) for requirements.
Communication connections to emergency medical services (EMS) shall be provided.
Where an EMS base station is provided, it shall be designed to reduce noise, distractions, and interruptions during radio transmissions.
Treatment rooms or areas shall be provided in accordance with Section 2.1-3.2.1.1 (Examination Rooms-General) and the requirements in this section.
Examination/treatment rooms used for pelvic exams shall allow for the foot of the examination table to face away from the door.
  1. Area. Each single-patient treatment room shall have a minimum clear floor area of 120 square feet (11.15 square meters) with a minimum clear dimension of 10 feet (3.05 meters).
  2. Clearances
    1. Room size shall permit a room arrangement with a minimum clearance of 3 feet (91.44 centimeters) at each side and at the foot of the examination table.
    2. A room arrangement in which an examination table, recliner, or chair is placed at an angle, closer to one wall than another, or against a wall to accommodate the type of patient being served shall be permitted.
  3. Where renovation work is undertaken and it is not possible to meet the minimum space requirements in Section 2.1-3.2.1.2 (2) (Single-patient examination room-Space requirements), a minimum clear floor area of 100 square feet (9.29 square meters) shall be permitted.
The treatment room shall contain the following:
  1. Portable or fixed examination light as indicated in Section 2.1-8.3.4.3 (1) (Lighting for exam/treatment/trauma rooms)
  2. Accommodations for written and/or electronic documentation
  3. Space for a visitor's chair
  4. Hand-washing station that complies with Section 2.1-3.8.7.2 (Hand-Washing Station-Design requirements)
  5. Storage for supplies
  6. Space for medical equipment
  7. View panel designed for patient visual privacy adjacent to and/or in the door
  1. Space and provisions for several patients shall be permitted in a multiple-patient treatment room that meets the requirements in this section.
  2. Combining bays to accommodate patients of size shall be permitted. See Section 2.8-3.4.6 (Treatment Room for Patients of Size) for more information.
  1. Area. Multiple-patient treatment rooms shall have separate patient bays or cubicles with a minimum clear floor area of 80 square feet (7.43 square meters) per patient care station.
  2. Clearances. The following minimum clearances shall be provided:
    1. 5 feet (1.52 meters) between the sides of adjacent patient beds
    2. 4 feet (1.22 meters) between the sides of patient beds and adjacent walls or partitions
Each bay or cubicle shall contain the following:
  1. Examination light. See Section 2.1-8.3.4.3 (1) (Lighting for exam/treatment/trauma rooms) for requirements.
  2. Accommodations for written or electronic documentation
  3. Space for a visitor's chair
  1. At least one hand-washing station(s) shall be provided in each multiple-patient treatment room.
  2. Hand-washing stations shall comply with sections 2.1-3.8.7.2 (Hand-Washing Station-Design requirements) and 2.1-3.8.7.3 (Hand-Washing Stations-Additional requirements for hand-washing stations that serve multiple patient care stations).
Storage for supplies shall be provided in the multiple-patient treatment room.
A trauma/resuscitation room(s) for emergency procedures shall be provided and shall meet the following requirements:
A2.8-3.4.4 Access should be convenient to the ambulance entrance.
  1. For a single-patient trauma/resuscitation room:
    1. Area. Each trauma/resuscitation room shall have a minimum clear floor area of 250 square feet (23.23 square meters).
    2. Clearances. A minimum clearance of 5 feet (1.52 meters) shall be provided around all sides of the gurney.
  2. For a multiple-patient trauma/resuscitation room, where one is provided:
    1. 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).
    2. 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.
The trauma/resuscitation room shall contain the following:
(1)  Space for storage of supplies
(2)  PACS, film illuminators, or other systems to allow viewing of images and films in the room
(3)  A hand-washing station(s) that meets the requirements in Section 2.1-3.8.7 (Hand-Washing Station)
(4)  Space for a code cart
(5)  Examination lights
*(6)  Accommodations for written or electronic documentation for both the licensed independent practitioner and other staff
(7)  Physiological monitoring equipment
(8)  Storage for personal protective equipment
A2.8-3.4.4.2 (6) Documentation areas. 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).
Doorways leading from the ambulance entrance to the trauma/resuscitation room shall have a minimum clear width of 72 inches (183 centimeters) and a height of 83.5 inches (212 centimeters).
A2.8-3.4.4.3 Door openings. 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.
Where dedicated pediatric rooms are provided, they shall meet the requirements in this section.
(1)  Location. Treatment rooms designated for pediatric patients shall be located adjacent to a family waiting area and toilet.
*(2)  Space requirements. Each treatment room shall meet the requirements in Section 2.8-3.4.2 (Single-Patient Treatment Room) or Section 2.8-3.4.3 (Multiple-Patient Treatment Room).
A2.8-3.4.5.1 Particular attention should be paid to soundproofing for pediatric treatment rooms.
A2.8-3.4.5.1 (2) 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.
A trauma/resuscitation room that complies with the requirements in Section 2.8-3.4.4 (Trauma/Resuscitation Room) shall be provided.
Where there is a dedicated pediatric emergency service, a playroom or play area shall be provided in the waiting room or area.
All emergency departments shall provide treatment rooms that can accommodate patients of size.
These rooms shall meet the following requirements as amended in this section:
  1. Section 2.1-2.1 (Accommodations for Care of Patients of Size-General)
  2. Section 2.1-2.7 (Accommodations for Care of Patients of Size-Single-Patient Examination/Observation Room)
  3. Section 2.1-2.10 (Special Design Elements for Spaces for Care of Patients of Size)
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.
A2.8-3.4.6.2 Transfer side clearance. The 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, more clearance is needed because patients may arrive on a stretcher and need a lateral transfer from stretcher or gurney to the patient table or bed.
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.
Where geriatric treatment rooms or areas are provided, they shall be designed to accommodate the needs of geriatric patients.
A2.8-3.4.7.1 Design issues for accommodation of geriatric patients. 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 in FGI's Beyond Fundamentals library.
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).
A2.8-3.4.7.2 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) and 2.1-7.2.3.1 (Flooring and wall bases). 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.
Capacity for patient decontamination shall be provided. This shall be permitted to be either of the following:
This mobile unit shall meet the requirements in Section 2.8-3.4.8.2 (A human decontamination room) and Chapter 2.13 (Specific Requirements for Mobile/Transportable Medical Units).
  1. Location
    1. 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.
    2. The internal door of this room shall provide direct access into a corridor of the emergency facility or into a treatment room, swing into the room, and be lockable against ingress from the corridor or treatment room.
    3. This section does not preclude provision of additional decontamination capability at other entrances.
  2. Space requirements. The room shall have a minimum clear floor area of 80 square feet (7.43 square meters).
  3. Special architectural details
    1. The room shall have all smooth, nonporous, scrubbable, nonabsorptive, nonperforated surfaces.
    2. The floor of the decontamination room shall be self-coving to a height of 6 inches (15.24 centimeters).
  4. Special plumbing system requirements
    1. 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.
    2. Fixtures shall be acid resistant.
    3. Portable or hard-piped oxygen shall be provided. Portable suction shall also be available.
A2.8-3.4.8.2 Human decontamination room. A decontamination room in the facility should provide:
  1. 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 freestanding emergency care facility wall; the word "DECON" should be painted within these boundaries.
  2. The spatial requirements and medical support services of a standard emergency area airborne infection isolation room, with air externally exhausted separate from the freestanding emergency care facility 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.
  3. 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.
  4. Two freestanding emergency care facility telephones and two duplex electrical outlets, secured appropriately for a wet environment
  5. Curtains or other devices to allow patient privacy, to the extent possible
  6. HVAC suitable for a room with an external door and very high relative humidity
  7. Water drainage that is contained and disposed of in a way that prevents contaminated water from entering freestanding emergency care facility or community drainage systems. There should be a "saddle" at the floor of the door buck to prevent efflux.
  8. 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.
Where provided, the fast-track area shall meet the requirements in Section 2.8-3.4.2 (Single-Patient Treatment Room) as amended in this section:
Single-patient examination rooms with a minimum clear floor area of 100 square feet (9.29 square meters) shall be permitted.
Where a waiting area is designated for the fast-track area, it shall provide the following:
  1. A patient toilet room that is immediately accessible
  2. A minimum of two chairs per patient treatment room
At least one AII room that meets the requirements in Section 2.1-3.3.2 (AII Room) shall be provided. The need for additional AII rooms shall be determined by an ICRA.
Where a secure holding room is provided, it shall meet the requirements in this section.
A2.8-3.5.3 Secure holding room. Consideration should be given to the emergency care facility'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.).
The location of the secure holding room(s) shall facilitate staff observation and monitoring of patients in these areas.
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).
This room shall be designed to prevent injury to patients.
  1. All finishes, light fixtures, vents and diffusers, and sprinklers shall be impact-, tamper-, and ligature-resistant.
  2. There shall not be any electrical outlets, medical gas outlets, or similar devices.
  3. There shall be no sharp corners, edges, or protrusions, and the walls shall be free of objects or accessories of any kind.
  4. Patient room doors shall swing out and shall have hardware on the exterior side only.
  5. A small impact-resistant view panel or window shall be provided in the door for discreet staff observation of the patient.
The minimum clear door opening for secure holding rooms shall be 44.5 inches (113 centimeters).
At least one observation bed with full cardiac monitoring shall be provided. See Section 2.5-3.3 (Observation Facilities) for more information.
At minimum, radiography facilities shall be provided. See Section 2.1-3.5.4 (Radiography Facilities) for requirements.
Where other imaging services are provided, they shall meet the requirements for those services in Section 2.1-3.5 (Imaging Services).
An administrative center or nurse station for staff work and charting shall be provided in accordance with Section 2.1-3.8.2 (Nurse Station) as amended in this section.
Nurse master station and central monitoring equipment shall be provided.
Decentralized nurse stations near clusters of treatment rooms shall be permitted.
Where feasible, visual observation of all traffic into the unit and of all patients shall be provided from the nurse station.
A clean supply room(s) shall be provided in accordance with Section 2.1-3.8.11 (Clean Workroom or Clean Supply Room).
Where pediatric patients will be treated, 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 care facility in accordance with Section 2.1-3.8.12 (Soiled Workroom or Soiled Holding Room).
A2.8-3.8.12 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. Reserved
  2. Storage shall be provided for general medical/surgical emergency supplies, medications, and equipment. This storage shall be located out of traffic and under staff control.
  3. 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.
  4. Emergency equipment storage. Emergency equipment storage shall be provided in accordance with Section 2.1-3.8.13.4 (Emergency equipment storage).
An environmental services room(s) directly accessible from patient care and diagnostic areas shall be provided in accordance with Section 2.1-5.3.1 (Environmental Services Room).
Provisions for disposal of liquid waste shall be provided that meet the requirements in Section 2.1-3.8.12.2 (2) (Soiled workroom-Where a fluid management system...).
A clinical sink with a bedpan-rinsing device in the soiled workroom in Section 2.8-3.8.12 (Soiled Workroom or Soiled Holding Room) shall be permitted to serve this function.
Where a security station is provided, it shall be located near the emergency entrances and triage/reception area and have a means of observing public waiting areas and emergency department entrances, including pedestrian and ambulance entrances, as well as a means of controlling access.
A2.8-3.8.16 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 Security Design Guidelines for Healthcare Facilities — 02.02: Emergency Departments.
  1. The system should include visual monitoring devices installed both inside the emergency care facility and outside at entrance sites and parking lots.
  2. Special requirements for a security station should include accommodation for the freestanding emergency care facility 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 an emergency power backup system.
Staff lounge, lockers, and toilets shall be immediately accessible to patient care and diagnostic areas.
Lounge facilities of no less than 100 square feet (9.29 square meters) shall be provided.
A staff toilet room shall be readily accessible to the patient care and diagnostic areas.
Each staff toilet room shall contain a toilet and a hand-washing station.
Staff toilet rooms shall be permitted to be unisex.
Securable closets or cabinet compartments for the personal articles of staff shall be located in or near the nurse station. At minimum, they shall be large enough for purses and billfolds.
Where coat storage is provided, storage of coats in closets or cabinets on each floor or in a central staff locker area shall be permitted.
A minimum of one patient toilet room per six treatment rooms and for each fraction thereof shall be provided, with a hand-washing station(s) in each toilet room.
See Section 2.1-4.1 (Laboratory Services) for requirements.
At minimum, a medication preparation room shall be provided. See Section 2.1-3.8.8 (Medication Safety Zones) for requirements.
Where a pharmacy is provided, see Section 2.1-4.2 (Pharmacy Services) for requirements.
See Section 2.1-4.3 (Sterile Processing) for requirements.
See Section 2.1-4.4 (Linen Services) for facility requirements.
See Section 2.1-3.8.9 (Nourishment Area or Room) for requirements.
See Section 2.1-5.1 (Materials Management) for facility requirements.
See Section 2.1-5.2 (Waste Management) for facility requirements.
See Section 2.1-5.3 (Environmental Services) for requirements.
See Section 2.1-5.4 (Engineering and Maintenance Services) for facility requirements.
For requirements, see Section 2.1-6 (Public and Administrative Areas) as amended in this section.
The emergency department shall be designed to ensure that access control can be maintained at all times.
A2.8-6.1.2 The exterior perimeter of the emergency facility should be able to be secured to control access and provide safety in the event of a disaster or situations requiring a higher level of security.
  1. A well-marked, illuminated, and covered primary entrance shall be provided at grade level.
  2. The primary entrance cover shall provide shelter extending at least over the passenger side of the vehicle.
  1. A separate ambulance entrance shall be provided at grade level.
  2. 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.
  3. Ambulance entrances shall provide a minimum of 6 feet (1.83 meters) in clear width to accommodate expanded-capacity stretchers and gurneys, mobile patient lift devices, and accompanying attendants.
A reception/triage area that meets the requirements in this section shall be provided based on the facility's service area needs and targeted population.
  1. The reception and triage area shall be located near both pedestrian and vehicular drop-off entrances and shall be designed to allow staff to monitor entrances.
  2. Public access points to the treatment area shall be under direct observation of the reception and triage areas.
The triage area shall include the following:
  1. Access to language translation services
  2. Provisions for patient privacy
  3. Hand-washing stations. Hand-washing stations shall be provided in accordance with Section 2.1-3.8.7.2 (Hand-Washing Station-Design requirements) as amended here.
    1. A hand-washing station shall be provided in each triage room.
    2. In triage areas, one hand-washing station shall be provided for every four triage bays or cubicles.
  4. Hand sanitation dispenser. A hand sanitation dispenser shall be provided for each triage bay or cubicle.
  5. Access to a panic button for security emergencies
  6. Electrical outlets for equipment used in triage. For requirements, see Table 2.1-1 (Electrical Receptacles for Patient Care Areas in Outpatient Facilities).
  7. Oxygen, vacuum, and medical air station outlets. For requirements, see Table 2.1-2 (Station Outlets for Oxygen, Vacuum, Medical Air, and Instrument Air Systems in Outpatient Facilities).
  8. A code button. For requirements, see Table 2.1-3 (Locations for Nurse Call Devices in Outpatient Facilities).
A2.8-6.2.2.2 Consider providing a separate area for patients waiting for triage. This area should have appropriate ventilation and be clearly visible from the triage station.
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).
A public waiting area with the following shall be provided:
  1. Immediately accessible public toilet room(s) with hand-washing station(s)
  2. Provisions for drinking water
  3. Provisions for telephone access
Where required by the freestanding emergency care facility ICRA (see Section 1.2-4.2), special measures to reduce the risk of airborne infection transmission shall be provided in the waiting area.
A2.8-6.2.3.2 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."
Space(s) shall be provided for the interview and intake process.
These areas shall provide speech and visual privacy.
These areas shall be permitted to be used as part of the triage process.
See Section 2.1-6.3.5 (Medical Records) for requirements.
See Section 2.1-7 (Design and Construction Requirements) for requirements.
See Section 2.1-8 (Building Systems) for requirements.
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