Section 1224 — [OSHPD 1]—HOSPITALS

1224.1 Scope. [OSHPD 1] The provisions of this section shall apply to general acute-care hospitals and general acute-care hospitals providing only acute medical rehabilitation center services. The provisions of Section 1225 shall apply to distinct part skilled nursing and intermediate-care services on a general acute-care hospital license provided in a separate unit. The provisions of Section 1229 shall apply to distinct part chemical dependency recovery hospitals on a general acute-care license provided in a separate unit.

[OSHPD 1R] This section shall apply to buildings removed from acute care service, in compliance with Part 10, California Existing Build- ing Code, Chapter 3A, and remain under OSHPD jurisdiction.

New buildings and additions, alterations or repairs to existing buildings subject to licensure shall comply with appli- cable provisions of the California Electrical Code, California Mechanical Code, California Plumbing Code, California Energy Code, California Fire Code, California Existing Building Code (Parts 3, 4, 5, 6, 9 and 10 of Title 24) and this section.

Exceptions:

1. Facilities licensed and in operation prior to the effective date of this section shall not be required to institute corrective alter- ations or construction to comply with any new requirements imposed thereby or subsequently, except where specifically required or where the enforcing agency determines that a definite hazard to health and safety exists. Facilities for which preliminary drawings have been submitted to the enforcing agency prior to the effective date of this change shall not be required to comply with such new requirements, provided working drawings are submitted within one year of the effective date of such new requirements. 2. A change in function shall require compliance with all the functional requirements for new construction in this code, includ- ing requirements in Sections 1224, 1225, 1226, 1227 and 1228. 3. The provisions of this section do not prohibit the use of alternate space utilization, new concepts of design, treatment tech- niques, equipment and alternate finish materials provided the intent of this section is accommodated and written approval for such alternative is granted by the enforcing agency. Written substantiating evidence in support of the alternate and a written request for consideration shall be submitted to the enforcing agency. 4. Nothing in this section shall prohibit the provisions of required services from a centralized service facility serving two or more licensed facilities when approved in writing by the licensing agency. Buildings and required spaces for services provided in a separate centralized services facility shall comply with all applicable provisions of these regulations and applicable local codes and ordinances for the services so provided. 5. Acute psychiatric hospitals and general acute-care hospitals providing only acute medical rehabilitation center services may provide for surgical and anesthesia services to be provided by an outside licensed facility when approved by the licens- ing agency. 6. When the Corrections Standards Authority, the Department of Corrections or the Department of Youth Authority determines that a particular requirement for hospitals located in a correctional facility may compromise the safety, security or protec- tion of staff, inmates or property, the enforcement agency shall consider an alternate design.

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1224.2.1 Removed from acute care service [OSHPD 1R]. Hospital buildings removed from acute care service in accordance with Part 10, California Existing Building Code, Section 312A may provide outpatient services and other uses. Required Basic or Supple- mental Services on the hospital’s license may not be provided.

Exceptions: 1. Duplicative hospital services when permitted by California Department of Public Health. 2. Skilled Nursing Services may be provided in conformance with Section 1225. 3. Acute Psychiatric Services may be provided in conformance with Section 1228.

Specific terms and definitions are provided to facilitate consistency in the interpretation and application of these requirements. Some of these terms may have a broader definition in other contexts, but the definitions provided here reflect the use of the terms for OSHPD requirements.

AIR CONDITIONING. The process or system by which simultaneously the temperature, humidity, air motion and quality are maintained within required limits.

AIRBORNE INFECTION ISOLATION ROOM. A single-occupancy patient room where environmental factors are controlled in an effort to minimize the transmission of those infectious agents usually spread from person to person by droplet nuclei associated with coughing and inhalation.

AMBULATORY CARE. A defined health care encounter(s) of less than 24 hours in duration that requires direct professional health care support within a specific facility.

AMBULATORY SURGICAL FACILITY. Any surgical facility organized for the purpose of providing procedural, invasive surgical care to patients with the expectation that they will be recovered sufficiently to be discharged in less than a 24-hour period.

ANGIOGRAPHY. The radiographic visualization of blood vessels following introduction of contrast material for purposes of diagnosis.

BASIC SERVICES. Those essential services required for licensure as a hospital, including medical, nursing, surgical, anesthesia, labora- tory, radiology, pharmacy, dietary services and support services. See “SUPPLEMENTAL SERVICES.”

BIOTERRORISM. The use or threat of use, of biological agents to intimidate a political entity or population group.

CENTRAL AIR-HANDLING SYSTEMS. Any units requiring ductwork on the supply or inlet side and serving more than one room.

CHANGE IN FUNCTION. A change in function is a change in activity, service or licensed service provided, within the project limits, that does not necessarily change the use, specific use and/or occupancy. Conversion of a space that results in a change in activity such that the space will be required to satisfy the functional requirements under a different code sub-section than that of the prior use is consid- ered a change in function.

CLEAR DIMENSION. An unobstructed room dimension exclusive of built-in casework and equipment and available for functional use.

COURT. An open exterior space bounded on three or more sides by the walls of a structure.

ENVIRONMENT OF CARE. Those features in a built health care entity that are created, structured and maintained to support quality health care.

EXAM ROOM. A room with a bed, stretcher or examination table and capability for periodic monitoring (e.g., measurement of blood pres- sure or pulse oximetry) in which procedures that do not require a specialized suite can be performed (e.g., pelvic examination, blood transfusion).

FLOOR AREA, CLEAR. The actual occupied area exclusive of fixed or wall-mounted cabinets, fixed beds and furnishings, built-in shelves, toilet rooms, closets, lockers, wardrobes, alcoves, anterooms or vestibules.

GENERAL ACUTE-CARE HOSPITAL. A hospital, licensed by the California Department of Public Health, having a duly constituted govern- ing body with overall administrative and professional responsibility and an organized medical staff which provides 24-hour inpatient care, including the basic services.

HANDWASHING STATION. A clinical staff-use area that provides a handwashing fixture, cleansing agents and means for drying hands. Handwashing stations shall be immediately accessible to the patient care area they serve without requiring passage through a doorway unless hands-free door operation is provided. Refer to the California Plumbing Code, Section 210.0 for the definition of handwashing fixture.

HOSPITAL. A general acute-care hospital, including those providing only acute medical rehabilitation center services and acute psychi- atric hospitals.

HOUSEKEEPING. Services anywhere within a health care facility that include general cleaning and tidying and the provision and posi- tioning of identified materials, e.g., soaps, towels, etc. (While routine disinfection protocols can be included in such a definition, the definition is not intended to include complex, nonroutine disinfection procedures nor the nonroutine disposition of hazardous materials such as potentially toxic drugs or other chemicals and radioactive wastes.)

INVASIVE PROCEDURE. A procedure that is performed in an aseptic or sterile surgical field and penetrates the protective surfaces of a patient’s body (e.g., subcutaneous tissue, mucous membranes, cornea). Invasive procedures fall into one or more of the following categories: 1. Requires entry into or opening of a sterile body cavity (i.e., cranium, chest, abdomen, pelvis, joint spaces). 2. Involves insertion of an indwelling foreign body into a normally sterile site that results in a high risk of infection. 3. Includes excision and grafting of burns that cover more than 20 percent of total body area.

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4. Does not begin as an open procedure but has a greater than 5 percent probability of requiring conversion to an open procedure.

LDR. Labor, Delivery, Recovery (an unlicensed patient bed)

LDRP. Labor, Delivery, Recovery, Postpartum (a licensed patient bed)

LICENSING AGENCY. The Department of Public Health, Licensing and Certification.

LOCATION TERMINOLOGY (terms for relationship to an area or room)

ADJACENT. Located next to but not necessarily connected to the identified area or room.

DIRECTLY ACCESSIBLE. Connected to the identified area or room through a doorway or other opening without going through an intervening room or public space.

IMMEDIATELY ACCESSIBLE. Available either in the identified area or room, or directly accessible from a room or area located within the same department or service space.

IN. Located within the identified area or room.

READILY ACCESSIBLE. Located within the same department or service space as the identified area or room, located in and shared with an adjacent unit, or within 200 feet (60.96 m) of the department or service space in an accessible corridor.

MONOLITHIC. A surface free of fissures, cracks, perforations and crevices.

MONOLITHIC CEILING. A ceiling constructed with a surface free of fissures, cracks and crevices. Any penetrations such as lights, diffusers and access panels shall be sealed or gasketed. Lay-in ceilings are not considered “monolithic.”

NURSING UNIT. A designated patient care area of the hospital which is planned organized, operated and maintained to function as a unit. It includes patient rooms with adequate support facilities, services and personnel providing nursing care and necessary manage- ment of patients.

OPERATING ROOM. A room specifically designed for the performance of surgical procedures. (In common understanding, this means most types of surgical procedures, especially those involving the administration of anesthesia, multiple personnel, recovery room access and a fully controlled environment.)

HYBRID OPERATING ROOM. A room that meets the definition of an operating room and is also equipped to enable diagnostic imag- ing before, during and after surgical procedures. Imaging equipment is permanently installed in the room and may include MRI, fixed single-plane and bi-plane tomographic imaging systems and computed tomographic equipment.

Note: Use of portable imaging technology does not make an operating room a hybrid operating room.

OUTPATIENT SERVICE. An organizational unit of the hospital, which provides nonemergency healthcare services to patients.

PATIENT CARE LOCATIONS. Multi-patient treatment rooms, where allowed, may provide patient care stations in bays or cubicles as follows:

BAY (patient). A space for human occupancy with one hard wall at the headwall and up to one hard wall at either side, with two to three soft walls (e.g., cubicle curtains or portable privacy screen). The required area for the specific patient care space shall be provided within the cubicle curtain and not overlap with access circulation aisle.

CUBICLE. A space intended for human occupancy that has at least one opening and no door and is enclosed on three sides with full- height or partial-height partitions.

PATIENT CARE STATION. A designated space for a specific patient care function. This term does not imply any structural requirement (e.g., a Post-anesthesia Care Unit (PACU) can have 10 patient care stations of which three are rooms, three are cubicles and four are bays).

PATIENT ROOM. Licensed patient bed rooms or rooms occupied by one or more individuals during an overnight stay over 24 hours in a health facility. Also referred to as a patient bedroom.

PERIOPERATIVE. Patient care and other related supportive activities before, during or after the operative event.

PROCEDURE ROOM. A room designated for the performance of patient care that requires high-level disinfection or sterile instruments and some environmental controls but is not required to be performed with the environmental controls of an operating room.

PROTECTIVE ENVIRONMENT. A bedded unit or patient room where severely immunosuppressed patients are cared for.

RESTRICTED AREA. Applies to 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. Such space has one or more of the following attributes: specific signage, physical barriers, security controls and protocols that delineate requirements for monitoring, maintenance, attire and use.

ROOM. A space enclosed by hard walls and having a door. Where the word “room” or “office” is used, a separate, enclosed space for the one named function is intended. Otherwise, the described area may be a specific space in another room or common area.

SCRUB SINK. A sink used to wash and scrub the hands and arms during the aseptic preparation for surgery and equipped with a supply spout and controls as required for a handwashing fixture. Refer to the California Plumbing Code Sections 210.0 and 221.0.

SEMI-RESTRICTED AREA. Applies to peripheral areas that support surgical services or intermediate level procedures or imaging. These areas may include storage for equipment and clean and sterile supplies; work area for processing instruments; sterile process- ing facilities; hand scrub stations; corridors leading from the unrestricted area to the restricted area of the surgical suite; entrances to

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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. Public access is controlled.

SERVICE SINK. A sink located in a housekeeping room and designed for the purpose of cleaning mops and the disposal of waste water.

SERVICE SPACE. Service Space refers to the distinct area of a health facility where a licensed Basic Service or Supplemental Service is provided. The Service Space shall include all the functional area requirements required to deliver the specific Service. Basic Service Spaces are identified in Sections 1224.14 through 1224.27. Supplemental Service Spaces are identified in Sections 1224.28 through 1224.42. Similar distinctions are made between Basic and Supplemental or Optional Services in Section 1225 through Section 1228. Required functional areas may be a portion of a larger space, one or more Patient Care Locations, support areas or separate Rooms as defined in Section 1224.3. See departmental boundary requirements under Section 1224.4.7.6.

identified in Sections 1224.28 through_ 1224.42. Similar distinctions are made between Basic and Supplemental or Optional Services in Section 1225 through Section 1228. Required functional areas may be a portion of a larger space, one or more Patient Care Locations, support areas or separate Rooms as defined in Section 1224.3. See departmental boundary requirements under Section 1224.4.7.6.

SUB-ACUTE CARE. A segment within a continuum of levels of care determined by patient acuity, clinical stability and resource needs.

SUPPLEMENTAL SERVICE. An inpatient or outpatient service which is not required to be provided by law or regulation for licensure. A supplemental service, when provided, must accommodate the provisions of this section.

Note: See “BASIC SERVICES.”

SURGICAL SERVICE SPACE. A space that includes the operating room(s) and service areas.

TREATMENT ROOM. A room designated for the performance of patient care activities that may require high-level disinfected or sterile instruments but do not require the environmental controls of a procedure room. A treatment room may be used for a variety of functions, patient examination and various treatments or procedures, including wound packing, suture placement, or casting. This room may contain specialized equipment as identified in the functional program.

UNRESTRICTED AREA. Applies to any area of the surgery or medical 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 area; pre- and postoperative patient care areas; or access to procedure rooms. Public access may be limited.

1224.4.1 Jurisdiction.

1224.4.1.1 Services/systems and utilities.

[OSHPD 1] Services/systems and utilities shall comply with California Existing Building Code Section 310A.

[OSHPD 1R] Services/systems and utilities shall only originate in, or pass through or under structures which are under the juris- diction of the Office of Statewide Hospital Planning and Development (OSHPD).

1224.4.1.2 Means of egress.

[OSHPD 1 ] Means of egress shall comply with Part 10, California Existing Building Code, Section 308A.

[OSHPD 1R] Means of egress shall only pass through structures that are under the jurisdiction of the Office of Statewide Hospital Planning and Development (OSHPD).

1224.4.2 Environmental engineering and support service spaces. Spaces for dietary, laundry, morgue, ambulance entrance, receiving areas, power plants, mechanical equipment, incinerator, garbage can cleaning, automobile parking and storage areas for garbage, trash and medical gases shall be located and constructed to minimize noise, steam, odors, hazards and unsightliness in patient-care areas and bedrooms.

1224.4.3 Treatment spaces. Radiology, laboratory, pharmacy, physical therapy and service spaces serving only outpatients and similar outpatient service departments shall not be located in nursing units, surgical units, perinatal units, nursery areas, central sterilization rooms, food-service' areas, power plants, mechanical equipment rooms, maintenance shops, general storage, laundry, employees’ dressing or housekeeping facilities.

Exception: Physical and occupational therapy spaces of a rehabilitation service may serve both outpatients and inpatients.

1224.4.4 Support areas for patient care. Identifiable spaces shall be provided for each function indicated in all Basic and applicable Supplemental Service Space sections with requirements for support areas. The following rooms and spaces are common to most types of health care facilities and the requirements associated with each, as listed below, shall be used unless modified under a specific Service Space section.

1224.4.4.1 Examination, treatment and procedure rooms.

1224.4.4.1.1 Examination room. Unless specified elsewhere, if an exam room is provided, it shall have a minimum clear floor area of 80 square feet (7.4 m [2] ), the least dimension of which shall be 8 feet (2438 mm). The room shall contain a handwashing fixture and accommodations for written or electronic documentation shall be provided.

1224.4.4.1.2 Treatment room. Unless specified elsewhere, if a treatment room is provided, it shall have a minimum clear floor area of 120 square feet (11.15 m [2] ), the least dimension of which shall be 10 feet (3048 mm). A minimum of 3 feet (914 mm) is required between the sides and foot of the bed/gurney/table and any wall or other fixed obstruction. The room shall contain an examination light, a work counter for medical equipment, a handwashing fixture, cabinets, medication storage and counter space for writing or electronic documentation. If used for exercise stress testing, include space for a crash cart and patient resus- citation and omit the exam light. Multi-bed treatment rooms shall have separate patient cubicles with a minimum clear floor area of 80 square feet (7.4 m [2] ) per cubicle. Each cubicle shall contain an examination light, counter and storage facilities. In multi-bed treatment rooms, a handwashing fixture shall be provided in the room for each three or fewer cubicles.

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1224.4.4.1.3 Airborne infection isolation exam/treatment room. When provided, the airborne infection isolation room shall be an exam/treatment room, shall be labeled with the words “Airborne Infection Room”, and provide the following: 1. Capacity. Each airborne infection isolation exam/treatment room shall contain only one examination table or recliner. 2. Handwashing station. A handwashing station shall be located in each airborne infection isolation exam/treatment room. 3. Gowning and storage area. An area for gowning and storage of clean and soiled materials shall be located directly outside or inside the entry door to the airborne infection isolation exam/treatment room. 4. Doors. Room doors shall be self-closing and include latching devices. 5. Sealed-tight room. Room perimeter walls, ceiling, floors, doors and penetration shall be sealed tightly to minimize air infiltration from the outside or from other spaces. 6. Ventilation. The ventilation shall be provided as required by the California Mechanical Code for airborne infection isolation room.

1224.4.4.1.3.1 Airborne infection isolation exam/treatment anteroom. An airborne infection isolation anteroom is not required; however, when an anteroom is provided, it shall meet the following requirements: 1. The anteroom shall provide space for persons to don personal protective equipment before entering the patient

room.

2. All doors to the anteroom shall have self-closing devices. 3. The anteroom shall provide storage of personal protective equipment (e.g., respirators, gowns, gloves) and clean equipment. 4. Ventilation shall be provided in the anteroom as required by the California Mechanical Code for airborne infection isolation anteroom.

1224.4.4.1.4 Procedure room. Unless specified elsewhere, if a procedure room is provided, it shall meet the requirements in this section.

1224.4.4.1.4.1 General.

(1) Application. The governing body shall perform a clinical assessment of the procedures to be performed to deter- mine the appropriate room type and location for these procedures and document this in the Functional Program in compliance with the California Administrative Code, Section 7-119. Where a procedure room is used for multiple procedure types, the room shall meet the most stringent requirements for the space. (2) Location. The procedure room shall meet the requirements of a semi-restricted area. The procedure room shall be permitted to be accessed from a semi-restricted corridor or from an unrestricted corridor. 1224.4.4.1.4.2 Space requirements. (1) Area. Procedure rooms shall have a minimum clear floor area of 130 square feet (12.08 m [2] ). 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 m [2] ). Procedure rooms where procedures will be performed that require addi- tional personnel and/or large equipment shall be sized to accommodate the personnel and equipment planned to be in the room during procedures, including additional personnel and equipment that will be needed for emer-

gency rescue. (2) Clearances. Procedure rooms shall have the following minimum clearances around the table, gurney or procedure chair:

(a) 3 feet 6 inches (1070 mm) on each side. (b) 3 feet (914.4 mm) at the head and foot. Where an anesthesia machine and associated supply cart is used, the clearance at the head shall be a minimum of 6 feet (1830 mm). (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 (305 mm) 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.

1224.4.4.1.4.3 Documentation area.

(1) Accommodations for written and/or electronic documentation 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.

1224.4.4.1.4.4 Patient privacy. Provisions shall be made for patient visual and speech privacy.

1224.4.4.1.4.5 Handwashing station. A handwashing station shall be provided in the procedure room. Where a hand scrub station is directly accessible to the procedure room, omission of the handwashing station is permitted.

1224.4.4.1.5 Seclusion room. Where provided, seclusion rooms shall comply with the following requirements:

1224.4.4.1.5.1 General.

1. Capacity. Each room shall accommodate only one patient. 2. Layout and access. Seclusion rooms shall be accessed through an anteroom or vestibule that also provides access to a toilet room. The door openings to the anteroom and the toilet room shall have a minimum clear width of 3 feet 8 inches (1118 mm).

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3. The room(s) shall be located to permit observation from the nurse station. 4. Seclusion rooms shall be permitted to be grouped together and may share a common vestibule/anteroom. 1224.4.4.1.5.2 Space requirements. Seclusion rooms shall have a minimum clear floor area of 60 square feet (5.57 m [2] ) with a minimum wall length of 7 feet (2134 mm) and a maximum wall length of 11 feet (3353 mm).

Exception: Where a room for restraining patients is authorized by the California Department of Public Health, it shall have a minimum clear floor area of 80 square feet (7.43 m [2] ) with a minimum wall length of 7 feet (2134 mm) and a maximum wall length of 11 feet (3353 mm).

1224.4.4.1.5.3 Special design elements. Seclusion rooms shall be designed and constructed in compliance with the follow- ing requirements: 1. The walls, ceiling and floor of the seclusion room shall be designed to withstand direct and forceful impact. If padded materials are used inside the room, they shall meet the interior finish requirements in Chapter 8, Interior Finishes, of this code. 2. Minimum ceiling height shall be 9 feet (2743 mm).

3. Doors.

3.1. Door hardware shall be ligature resistant. 3.2. The entrance door to the seclusion room shall swing outward. 3.3. Doors shall permit staff observation of the patient through a view panel while also maintaining provi- sions for patient privacy. The maximum sill height shall be 36 inches (914 mm) above the finish floor. The view panel shall be fixed glazing with polycarbonate or laminate on the inside of the glazing. 4. Seclusion rooms shall not contain outside corners or edges. 5. All items in the room (e.g., lighting fixtures, sprinkler heads, HVAC grilles and surveillance cameras, etc.) shall be tamper resistant. 6. Electrical switches and receptacles are prohibited in the seclusion room.

1224.4.4.2 Nurse station(s). This area shall have space for counters and storage and at least one hand-washing station shall be located in or directly accessible to the nurse station. It may be combined with or include centers for reception, charting and communication.

1224.4.4.3 Specimen and blood collection facilities.

1224.4.4.3.1 Specimen collection facilities. When provided, specimen collection facilities shall comply with the following requirements: 1. Urine collection rooms shall be equipped with a water closet and handwashing station. Exception: The handwashing station may be located immediately outside the collection room when the specimen is used for drug testing. 2. Use of the toilet room provided within the examination and treatment room shall be permitted for specimen collection.

ly with the following_ requirements: 1. Urine collection rooms shall be equipped with a water closet and handwashing station. Exception: The handwashing station may be located immediately outside the collection room when the specimen is used for drug testing. 2. Use of the toilet room provided within the examination and treatment room shall be permitted for specimen collection.

1224.4.4.3.2 Blood collection facilities. When provided, blood collection facilities shall comply with the following requirements: 1. Space for a chair and work counter shall be provided. 2. A handwashing station shall be provided.

1224.4.4.4 Medication station. Provision shall be made for distribution of medications. This shall be done from a medication preparation room or from a self-contained dispensing unit.

1224.4.4.4.1 Medication preparation room. If provided, this room shall be lockable. When a medication preparation room is to be used to store one or more self-contained medication dispensing units, the room shall be designed with adequate space to prepare medicines with the self-contained medication dispensing unit(s) present. Medication preparation rooms shall include:

1. Work counter.

2. Handwashing station. 3. Refrigerator. 4. Locked storage for controlled drugs.

1224.4.4.4.2 Self-contained medication dispensing unit. If provided, a self-contained medication dispensing unit shall be located at the nurse station, in the clean utility room, or in an area where access to the self-contained medication dispensing unit is under the monitoring and control of nursing staff. Self-contained medication dispensing units shall be provided with essential power and lighting.

1224.4.4.5 Nourishment area or room. Nourishment areas or rooms required in patient care areas shall include the following:

1. Sink

2. Work counter

3. Refrigerator 4. Storage cabinets 5. Equipment for hot and cold nourishment between scheduled meals. 6. The nourishment shall include space for trays and dishes used for nonscheduled meal service.

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7. Provisions and space shall be included for separate temporary storage of unused and soiled dietary trays not picked up at mealtime.

8. Handwashing stations separate from the nourishment sink shall be in the nourishment area or immediately accessible without passing through a door.

1224.4.4.6 Clean utility/workroom. The clean workroom or clean supply room shall be separate from and have no connection with the soiled workroom or soiled holding room. If the room is used for preparing patient care items, it shall contain the following:

1. Work counter

2. Handwashing station 3. Storage facilities for clean and sterile supplies

1224.4.4.6.1 Clean supply room. If the room is used only for storage and holding as part of a system for distribution of clean and sterile materials, the work counter or a handwashing station may be omitted.

1224.4.4.7 Soiled utility/workroom. The soiled workroom or soiled holding room shall be separate from and have no connection with either clean workrooms or clean supply rooms. The soiled utility/workroom shall contain: 1. Clinical sink (or equivalent flushing-rim fixture). 2. Handwashing station

3. Work counter

4. Space for separate covered containers for soiled linen and/or waste

1224.4.4.7.1 Soiled holding room. Rooms used only for temporary holding soiled material may omit the clinical sink and work counter. If the flushing-rim clinical sink is eliminated, facilities for cleaning bedpans shall be provided elsewhere.

1224.4.4.8 Toilet rooms. Separate toilet rooms shall be provided for the use of patients, staff and public.

1224.4.4.8.1 Staff toilets. The number of staff toilets provided in a health facility shall comply with the requirements of the Cali- fornia Plumbing Code, Table 4-2. When staff toilet rooms are required to be dedicated to a specific Service Space, the number of staff toilet rooms provided under the California Plumbing Code shall be based on the number of staff within the specific Service Space served. Satellite service spaces do not require dedicated toilet rooms.

1224.4.4.8.2 Signage. When provided, single-user toilets shall include a door-mounted geometric symbol, as identified in Section 11B-703.7.2.6.3, Unisex toilet and bathing facilities and wall signage designating use for patients, staff or public. When existing toilet rooms are not compliant with Section 11B-603, Toilet and bathing rooms, directional signage in compliance with Section 11B-216.8, Toilet rooms and bathing rooms, shall also be provided.

Exception: Patient toilet rooms accessed directly from patient bedrooms are not required to include signage.

1224.4.5 Outpatient waiting rooms. Waiting rooms for outpatients shall provide a seating area and space for wheelchairs and have public corridor access. Public toilets, drinking fountains and telephones shall be readily accessible.

Note: One waiting area may serve more than one department or service.

1224.4.5.1 Outpatient access. Outpatient access to services shall not traverse a nursing unit.

1224.4.6 Miscellaneous requirements.

1224.4.6.1 Station outlets. Station outlets for oxygen, vacuum and medical air shall comply with Table 1224.4.6.1.

1224.4.6.2 Gas and vacuum systems. The design, installation and testing of medical gas and vacuum systems shall conform to Table 1224.4.6.1 and NFPA 99.

1224.4.6.3 Hyperbaric facilities. The design and construction of hyperbaric facilities shall conform to NFPA 99; Health Care Facil- ities and Section 1224.39.5.

1224.4.6.4 Laboratories. The design and construction of hospital laboratories shall conform to NFPA 99.

1224.4.6.5 Nurse call systems. The location of nurse call devices shall comply with Table 1224.4.6.5. The design of call systems shall comply with the California Electrical Code, Part 3 of Title 24.

1224.4.7 Corridors.

1224.4.7.1 Width. The minimum width of corridors and hallways shall be 8 feet (2438 mm).

Exception: Patient-care corridors and hallways in hospitals for patients who are not bedridden shall have a minimum clear and unobstructed width of 6 feet (1829 mm). For the purposes of this section, bedridden patients shall be defined as patients confined to beds who would be transported or evacuated in beds, stretchers, or litters.

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TABLE 1224.4.6.1—STATION OUTLETS FOR OXYGEN, VACUUM (SUCTION) AND MEDICAL AIR SYSTEMS1, 6

1. For any area or room not described above, the facility clinical staff shall determine outlet requirements after consultation with the enforcing agency.
2. Four bassinets may share one outlet that is accessible to each bassinet.
3. WAGD stands for “waste anesthesia gas disposal” system.
4. When infant resuscitation takes place in a room such as cesarean section/delivery or LDRP, then the infant resuscitation services shall be provided in that room in addition to the
minimum service required for the mother.
5. One outlet for mother and one for each bassinet.
6. Renovation projects of existing spaces where the existing function is not changed, are not required to comply with the requirements of this table.
7. Use of portable equipment shall be permitted.
8. Use of portable equipment is permitted in outpatient observation units provided under Section 1224.39.6.
9. Use of portable equipment in lieu of a piped system shall be permitted.
10. In the GI processing room and the clean work area of the central sterile supply service, an instrument air outlet or portable compressed air shall be provided as required by the
manufacturer of the equipment used. In the soiled work area of the central sterile processing service, an instrument air outlet or portable compressed air is required.
11. Vacuum or instrument air shall be provided if needed for the cleaning methods used.

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TABLE 1224.4.6.5—[OSHPD 1, 2, 3, 4 & 5] LOCATION OF NURSE CALL DEVICES
• = Required

1224.4.7.2 Light traffic. Service corridors and hallways with anticipated light traffic volume for nonpatient use may be reduced to a width of 5 feet (1524 mm) if approved by the enforcing agency.

Exception: Corridors and hallways in administrative and business areas may be reduced to a width of 44 inches (1118 mm).

1224.4.7.3 Outpatient services. Outpatient clinics which contain facilities for outpatient use only, such as laboratory, x-ray, phys- ical therapy or occupational therapy, shall have a minimum corridor or hallway width of 5 feet (1524 mm). Outpatient departments caring for one or more nonambulatory outpatients shall have a minimum corridor or hallway width of 6 feet (1829 mm). Corridors serving gurney or stretcher traffic shall comply with minimum width requirements of Section 1020.3. Outpatient clinics and outpatient departments consisting only of waiting rooms, business offices, doctor’s offices and examining rooms, where there is no traffic through such area to other services or to exits from the building, shall have a minimum corridor or hallway width of 44 inches (1118 mm).

1224.4.7.4 Handrails. Corridors for patient traffic in areas providing skilled nursing, intermediate care or rehabilitation services shall be furnished with a handrail on both sides at a height not less than 30 inches (762 mm) or greater than 36 inches (914 mm).

1224.4.7.5 Connections. Corridor systems shall connect all patient rooms and basic services.

Exception: Covered pedestrian walkways connecting separate buildings are permitted for ambulatory, psychiatric or chemical dependency patients.

1224.4.7.6 Departmental boundaries. Department/service space areas shall be contiguous and include internal circulation to access each of the rooms/spaces associated with it, as identified under the specific Service Space requirements. Identifiable

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spaces are required for each of the indicated functions for all service areas, including their support spaces. Where the words “room” or “offices” are used, a separate, enclosed space for the one named function is intended; otherwise, the described area may be specific space in another room or common area.

Exceptions:

1. Satellite radiology, laboratory, pharmacy and physical and occupational therapy space serving inpatients may be located in nursing units and inpatient treatment areas. 2. Rooms and functional areas specifically noted under the Service Space requirements that may be shared with other units and departments.

1224.4.8 Doors and door openings.

1224.4.8.1 Toilet room doors. Doors to toilet rooms shall have an opening of not less than 32 inches (813 mm) clear in width and shall be equipped with hardware which will permit the door to swing outward or in a manner to negate the need to push against a patient who may have collapsed within the toilet room.

1224.4.8.2 Pocket doors. Pocket sliding doors are not permitted.

Exception: Administration and business areas.

1224.4.9 Windows and screens.

1224.4.9.1 Windows . Rooms approved for the housing of patients shall be provided with natural light by means of exterior glazed openings excluding clerestory windows, obscure glass and skylights, with an area not less than one tenth of the total floor area.

1224.4.9.2 Operation and sills. Patient room windows shall have sills not more than 36 inches (914 mm) above the floor. If operable windows are provided that require the use of tools or keys for operation, the tools or keys shall be located at the nurse station.

Exception: Window sills in special nursing care areas may be up to 60 inches (1524 mm) above the floor. Sill height does not apply to newborn nurseries and rooms intended for occupancy less than 24 hours.

1224.4.9.2.1 Airborne infection isolation or protective environment rooms. If operable windows are provided in airborne infection isolation or protective environment rooms, they shall only be operable by the use of tools or keys which shall be located at the nurse station.

1224.4.9.3 Psychiatric unit windows. Safety glass or plastic glazing materials shall be used in windows in psychiatric patient

areas.

1224.4.9.4 Screens. Windows which may be frequently left in an open position shall be provided with insect screens of 16 meshes to the inch.

1224.4.9.5 Light and ventilation. All portions of a building used by patients, personnel or other persons shall be provided with artificial light and a mechanically operated ventilating system as specified in the California Electrical Code and the California Mechanical Code.

1224.4.10 Ceiling heights.

1224.4.10.1 Minimum height. The minimum height of ceilings shall be 8 feet (2438 mm).

Exception: Closet, toilet room and bathroom minimum ceiling heights and soffits over fixed cabinets and work surfaces, shall not be less than 7 feet (2134 mm).

1224.4.10.2 Minimum height with fixed ceiling equipment. Operating rooms, emergency rooms, delivery rooms, radiographic rooms and other rooms containing ceiling-mounted, major fixed equipment or ceiling-mounted surgical light fixtures shall have ceiling heights to accommodate the equipment or fixtures and their normal movement. Suspended tracks, rails and pipes located in the traffic path for patients in beds and/or on stretchers, including those in inpatient service areas, shall be not less than 7 feet (2134 mm) above the floor.

Exception: Mobile suspended tracks such as traverse rails for overhead patient lifts that may be moved out of the traffic path shall provide a clearance of not less than 6 feet, 8 inches (2032 mm) above the floor when in use.

1224.4.11 Interior finishes. For imaging, examination/treatment, procedure and operating rooms, also see Table 1224.4.11.4a.

1224.4.11.1 Floor finishes. Floor finishes shall be smooth, waterproof and durable. Flooring surfaces shall provide smooth transi- tions between different floor materials. Slip-resistant flooring products shall be used for flooring surfaces in wet areas (e.g., kitchens, shower and bath areas), ramps, stairways, entries from exterior to interior space and other areas as determined by the functional program. Joints for floor openings for pipes, ducts and conduits shall be tightly sealed. Joints of structural elements shall be similarly sealed.

Exception: Upon written appropriate documented requests, the licensing agency may grant approval of the installation of carpets. See Table 1224.4.11.

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TABLE 1224.4.11—ACCEPTABLE CEILING AND CARPET LOCATIONS

Ceilings:
1 – Continuous monolithic surface equal in smoothness to enamel plaster.
2 – Smooth and easily cleanable without perforations or fissures.
3 – Pin perforated, fine fissured or lightly textured.
4 – Any finish meeting code requirements.
Carpets:
Yes = Y
No = N
* Upon approval by the licensing agency with adequate maintenance procedure. However, should the carpet not be maintained adequately, the licensing agency has the right to
have it removed and replaced with another acceptable material.
Footnotes:
1. Carpet permitted in mammography.
2. Except those rooms specified otherwise.
3. For rooms not listed, contact the Office of Statewide Hospital Planning and Development (OSHPD).
4. Table applies to new construction, additions, remodels and conversions. The patching and replacement of existing materials will be permitted.
5. Lay-in ceiling meeting the requirements of Section 1224.4.11.4.1.7 may be substituted in laundry and kitchens.

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TABLE 1224.4.11.4a—EXAMINATION/TREATMENT, IMAGING, PROCEDURE AND OPERATING ROOM CLASSIFICATION1, 2

1. This table includes a brief description of the services performed in these room types and a summary of some applicable requirements that appear elsewhere in the California
Building Code.
2. Other requirements that apply to these room types include, but are not limited to, ventilation, lighting and sound transmission requirements. See California Mechanical Code
Table 4-A and ASHRAE 170 for ventilation requirements. See California Electrical Code, Article 517 for lighting and power requirements. See California Building Code Table
1224.4.19 for noise transmission requirements.
3. “Invasive procedure” is defined in Section 1224.3 definitions.

1224.4.11.1.1 Coved base. Resilient flooring, if used in toilet and bathing rooms, shall be continuous and extend upward onto the wall at least 5 inches (127 mm) to minimize moisture infiltration. Wood bases are prohibited except in waiting areas and administration departments.

1224.4.11.1.2 Food preparation areas. Floors in areas used for food preparation and assembly shall be water-resistant. Floor surfaces, including tile joints, shall be resistant to food acids. Floor construction in dietary and food preparation areas shall be free of spaces that can harbor pests.

1224.4.11.1.3 Wet cleaning. In all areas subject to frequent wet-cleaning methods, flooring materials shall not be physically affected by germicidal or other types of cleaning solutions.

1224.4.11.1.4 Airborne infection isolation, airborne infection isolation exam/treatment and protective environment rooms. These rooms and anterooms shall have seamless flooring with integral coved base.

1224.4.11.2 Wall bases.

1224.4.11.2.1 Material. The material and textures of bases and the installation thereof shall be such as to minimize dust-catch- ing surfaces, moisture, infiltration and the harboring of vermin.

Exception: In locations where carpet is permitted as a floor finish material, the use of carpeted base (coved or strip base) up to a maximum height of 5 inches (127 mm) is also permissible.

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1224.4.11.2.2 Wet cleaning. Floor and wall base assemblies in the following rooms shall be monolithic and have an integral coved wall base that is carried up the wall a minimum of 6 inches (150 mm) and is tightly sealed to the wall: 1. Operating rooms 2. Interventional imaging rooms, including cardiac catheterization labs 3. Cesarean delivery rooms 4. Cystoscopy, urology and minor surgical procedure rooms 5. Endoscopy procedure rooms 6. Endoscopy instrument processing rooms 7. IV and chemotherapy preparation rooms 8. Airborne infection isolation (AII) rooms

9. Protective environment (PE) rooms

10. Anterooms to AII and PE rooms, where provided

11. Cast rooms

The floors and wall bases of kitchens, soiled and clean utility rooms, housekeeping rooms with mop sinks, patient, public and staff sanitary facilities and other areas subject to frequent wet cleaning, shall also be homogeneous, nonabsorbent, smooth, easily cleaned and not physically affected by germicidal cleaning solutions, but may have tightly sealed joints and shall be constructed without voids at the intersection of floor and wall surfaces.

1224.4.11.3 Wall finishes. Wall finishes shall comply with the following requirements: 1. Wall finishes shall be washable. In the vicinity of plumbing fixtures, wall finishes shall be smooth, scrubbable and water- resistant.

2. Wall finishes in areas such as operating rooms, delivery rooms and trauma rooms shall be monolithic, scrubbable and able to withstand cleaning with chemicals. 3. Wall finishes in operating rooms, cesarean delivery rooms, isolation rooms and sterile processing rooms shall be free of fissures, open joints or crevices that may retain or permit passage of dirt particles. 4. Wall finishes in areas such as clean corridors, central sterile supply spaces, specialized radiographic rooms and minor surgical procedure rooms shall be washable, smooth and able to withstand cleaning with chemicals. 5. Wall areas penetrated by pipes, ducts and conduits shall be tightly sealed to minimize entry of rodents and insects. Joints of structural elements shall be similarly sealed. 6. Wall finish requirements of Section 1224.4.11.3 do not apply to boiler rooms, mechanical equipment rooms, administra- tion departments, other offices, enclosed stairways, maintenance shops and similar spaces.

1224.4.11.3.1 Dietary and food preparation areas. Dietary and food preparation areas shall comply with the following requirements: 1. In dietary and food preparation areas, wall construction, finish and trim, including the joints between the walls and the floors, shall be free of spaces that can harbor insects and rodents. 2. Wall surfaces in wet areas (e.g., kitchens, environmental services closets) shall be monolithic and all seams shall be covered and/or sealed.

1224.4.11.4 Ceilings. Ceilings in areas occupied by patients and the public shall be cleanable with the use of routine housekeep- ing equipment. Acoustic and lay-in ceiling, where used, shall not create ledges or crevices.

1224.4.11.4.1 Ceiling finishes. Ceiling finishes shall comply with Table 1224.4.11, Table 1224.4.11.4.1a and the following requirements:

Semirestricted areas:

1. Ceiling finishes in semirestricted areas such as airborne infection isolation exam/treatment rooms, surgical corri- dors, central sterile supply spaces and minor surgical procedure rooms, shall be nonabsorptive, nonperforated, capable of withstanding cleaning with chemicals, and without crevices that can harbor mold and bacterial growth. 2. If a lay-in ceiling is provided in semi-restricted areas, it shall be gasketed or each ceiling tile shall weigh at least one pound per square foot to prevent the passage of particles from the cavity above the ceiling plane into the semirestricted environment. Perforated, tegular, serrated cut or highly textured tiles are not acceptable.

Restricted areas:

3. Ceilings in restricted areas shall be monolithic with no cracks or perforations. 4. Ceilings in restricted areas shall be scrubbable and able to withstand cleaning and/or disinfecting chemicals. 5. All access openings in restricted area ceilings shall be gasketed.

Dietary and laundry areas: 6. Provide either a sealed monolithic and scrubbable gypsum board ceiling or a lay-in ceiling.

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7. If a lay-in ceiling is provided, it shall include the following: a) A rust-free grid. b) Ceiling tiles that weigh at least one pound per square foot and are smooth, scrubbable, nonabsorptive, nonperforated and able to withstand cleaning with chemicals. 8. Ceiling finish requirements of Section 1224.4.11.4.1 do not apply to boiler rooms, mechanical equipment rooms, administration departments, other offices, enclosed stairways, maintenance shops and similar spaces.

1224.4.12 Courts. Where one or more walls of a court contain a door or window of one or more patients’ bedrooms, the least dimen- sion of the court shall be 20 feet (6096 mm) between facing structures.

1224.4.13 Elevators.

1224.4.13.1 Patient. Patient elevators shall have minimum inside platform dimensions of 5 feet by 8 feet (1524 mm by 2438 mm), and a minimum clear door opening of 4 feet 0 inches (1219 mm).

1224.4.13.2 Passenger. Passenger elevators shall have minimum inside platform dimensions of 4 feet 8 inches by 7 feet 4 inches (1422 mm by 2236 mm).

1224.4.13.3 Patient services. Buildings over one story in height with accommodations or services for patients on floors without grade-level entrance shall provide at least one patient elevator.

1224.4.13.4 Low patient capacity. If bed patients are accommodated on one or more floors, other than the main entrance floor or where operating rooms or delivery rooms are above or below the main entrance floor, at least one patient elevator shall be provided.

1224.4.13.5 Medium patient capacity. At least one patient elevator and one service elevator shall be provided in hospitals with a capacity of from 60 to 149 beds on floors other than the main entrance floor.

1224.4.13.6 High patient capacity. At least one patient elevator, one passenger elevator and one service elevator shall be provided in hospitals with a capacity of 150 or more beds on floors other than the main entrance floor.

1224.4.14 Garbage, solid waste and trash storage. Rooms or screening enclosures shall be provided for the washing and cleaning of garbage containers and for the storage of garbage, trash and other solid wastes. Such rooms or screening enclosures shall include the following:

1. A concrete floor with a curb and with a drain connected to the sewer.

2. Steam or hot-water and cold-water supply. 3. A minimum floor area of [1] / 2 square foot (0.046 m [2] ) per bed, but not less than 25 square feet (2.3 m [2] ), the least dimension of which shall be 4 feet (1219 mm). 4. A method of limiting access to the material except by authorized persons. 1224.4.15 Housekeeping room. This room shall be a minimum floor area of 15 square feet (1.4 m [2] ). It shall contain a service sink or floor receptor and provisions for storage of supplies and housekeeping equipment.

1224.4.16 Laundry and trash chutes. Gravity-type laundry and trash chutes shall have a minimum diameter of 2 feet (610 mm) and shall be designed to prevent distribution of airborne contaminating elements to all floors served.

1224.4.17 Telephone. Each floor accommodating patients shall have a telephone installed for patient use. Such telephones shall be readily accessible to patients who are limited to wheel chairs and stretchers. This may not be required in separate buildings having six or fewer beds which are restricted to occupancy by ambulatory patients.

1224.4.18 Grab bars. Each toilet, bathtub and shower serving patients in rooms not required to provide mobility features, shall have conveniently placed grab bars that shall comply with Chapter 11B, Sections 11B-609.2, 11B-609.3, 11B-609.5, 11B-609.6 and 11B- 609.8.

Exception: Excluding facilities designed for use by persons with disabilities, grab bars may be deleted from those facilities serving chemical dependency recovery and psychiatric patients.

1224.4.19 Noise control.

1224.4.19.1 Impact noises. Recreation rooms, exercise rooms, equipment rooms and similar spaces where impact noises may be generated, shall not be located directly over patient bed areas or delivery and operating suites, unless special provisions are made to minimize such noise.

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1224.4.19.2 Noise reduction. The noise reduction criteria shown in Table 1224.4.19 shall apply to partitions, floors and ceiling construction in patient areas.

TABLE 1224.4.19-SOUND TRANSMISSION LIMITATIONS IN HOSPITALS

Technology and medical communication rooms shall comply with the California Electrical Code, California Mechanical Code, California Plumbing Code and the requirements of this section.

1224.5.1 Telecommunications service entrance room. The telecommunications service entrance room houses the point at which outside carrier data and voice circuits and services enter the facility and outdoor cabling interfaces with the building’s internal cabling infrastructure. Each hospital facility shall have at least one telecommunications service entrance room, and each room that is provided shall be dedicated to the telecommunications function with related support facilities and meet the requirements of this section.

1224.5.2 Technology equipment center.

1224.5.2.1 Number. Each hospital shall have at least one technology equipment center space that is not used for any purpose other than electronic data storage, processing and networking.

1224.5.2.2 Size. The technology equipment center shall be sized to provide space to meet the service requirements for the required equipment.

1224.5.2.3 Location. The technology equipment center shall be located to minimize the risk of water damage, both from internal and external sources. The technology equipment center shall be located above any floodways or flood hazard areas as described in the National Flood Insurance Program.

1224.5.3 Technology distribution room.

1224.5.3.1 Number. There shall be a minimum of one technology distribution room on each floor of the facility.

Exception: For existing facilities not undergoing major renovation, a technology distribution room may serve adjacent floors.

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1224.5.3.2 Size.

1. Technology distribution rooms shall be sized based on the area of the floor being served, with minimum clear dimensions as follows:

Area Served in Square Feet (m [2] ) Minimum Technology Distribution Room Size

≤ 8,000 square feet (740 m [2] ) 10 feet by 10 feet (3.05 m by 3.05 m)

8,001 – 15,000 square feet (1400 m [2] ) 10 feet by 12 feet (3.05 m by 3.66 m)

15,001 – 25,000 square feet (2325 m [2] ) 10 feet by 14 feet (3.05 m by 4.27 m)

> 25,000 square feet (2325 m [2] ) 12 feet by 14 feet (3.66 m by 4.27 m)

2. Where ceilings are provided, the minimum clear height shall be 9 feet (2.75 m). Exception: Existing buildings shall be permitted to have a minimum clear height of 8 feet (2.44 m).

1224.5.3.3 Location. Technology distribution rooms shall be provided throughout the facility as necessary to meet the maximum cable distance requirement for the cabling system specified.

1224.5.4 SPC/NPC compliance. The location of spaces required by this section shall meet the requirements of California Existing Building Code, Section 310A, Compliance Alternatives for Services/Systems and Utilities.

1224.5.5 Access. Access to the spaces required by this section shall be controlled and not require passage through patient-care or sterile space.

1224.5.6 Combining spaces. The combining of the telecommunications service entrance room, technology equipment center and technology distribution room shall be permitted, provided that the requirements for each of the individual spaces are met.

BASIC SERVICES

1224.14.1 Patient rooms.

1224.14.1.1 Capacity. No patient room shall be designed to accommodate more than four beds.

Exception: Where renovation of existing individual patient rooms is undertaken in facilities built under the 2013, or prior, Cali- fornia Building Code, maximum room capacity shall be no more than the present capacity, to a maximum of eight patients per patient room. Placement of beds shall not be more than three deep from the exterior window. 1224.14.1.2 Space requirements. In new construction, patient rooms shall have a minimum of 100 square feet (9.29 m [2] ) of clear floor area per bed in multiple-bed rooms and 120 square feet (11.15 m [2] ) of clear floor area for single-bed rooms. The dimensions and arrangement of rooms shall be such that there is a minimum of 3 feet (914 mm) between the sides and foot of the bed and any wall or any other fixed obstruction. In multiple-bed rooms, a minimum clearance of 3 feet (914 mm) shall be provided between beds and a clearance of 4 feet (1219 mm) shall be available at the foot of each bed to permit the passage of equipment and beds.

Exception: Where renovation of existing patient rooms is undertaken in facilities built under the 2001 or prior California Building Code, patient rooms shall have no less than 80 square feet (7.43 m [2] ) of clear floor area per bed in multiple-bed rooms and 110 square feet. (10.22 m [2] ) of clear floor area in single-bed rooms.

1224.14.1.3 Windows. Each patient room shall have a window in accordance with Section 1224.4.9.

1224.14.1.4 Arrangement. Patient rooms shall not be designed to permit the placement of beds more than three deep from the exterior window, but shall be of such shape and dimensions to allow for the performance of routine functions, including the easy transfer of patients to and from bed to wheelchair or wheeled gurney.

1224.14.1.5 Outside exposure. All patient bedrooms shall have an outside exposure and shall not be below ground level.

1224.14.1.6 Handwashing stations. A handwashing station shall be provided in the patient room. This handwashing station shall be located at or adjacent to the entrance to the patient room with unobstructed access for use by health care personnel and others entering and leaving the room. Water spouts used shall have clearances adequate to avoid contaminating utensils and the contents of carafes, etc. In multiple-bed rooms the handwashing station shall be located outside of the patient’s cubicle curtain so that it is immediately accessible to staff. Where renovation of patient rooms is undertaken a handwashing station shall be located in the patient toilet room or patient room.

1224.14.1.7 Toilet room. Each patient shall have access to a toilet room without having to enter the general corridor area. One toilet room shall serve no more than four beds and no more than two patient rooms. The toilet room shall contain a water closet

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and a lavatory and the door shall swing outward or be double acting. Unless located in a toilet room, bedpan-washing fixtures shall be installed in dedicated rooms, separate from patient care areas.

1224.14.1.8 Patient storage. Each patient room shall include a separate wardrobe, locker or closet for storing clothing and personal effects for each patient.

1224.14.1.9 Privacy. A method of assuring visual privacy for each patient shall be maintained in patient rooms and in tub, shower and toilet rooms. Windows or doors within a normal sightline that would permit observation into the room shall be arranged or curtained as necessary for patient privacy. In multiple-bed rooms, visual privacy from casual observation by other patients and visitors shall be provided for each patient. The design for privacy shall not restrict patient access to the entrance, lavatory or toilet

room.

1224.14.1.10 Grab bars. Grab bars shall be installed in accordance with Section 1224.4.18.

1224.14.1.11 Room identification. Each patient room shall be labeled with an identification number, letter or combination of the

two.

1224.14.2 Support areas. The size and location of each support area will depend upon the numbers and types of beds served. If it has direct access to the unit, some support areas may be arranged and located to serve more than one nursing unit as indicated below, but, unless noted otherwise, at least one such support area shall be provided on each nursing floor.

1224.14.2.1 Nurse station(s). Nurse station(s) shall be provided in each nursing unit and shall comply with Section 1224.4.4.2.

1224.14.2.2 Nurse or supervisor office. A nurse or supervisor office shall be provided and may be shared between adjacent nurs- ing units on the same floor.

1224.14.2.3 Toilet room(s) for staff use. Staff toilet rooms may be shared between adjacent nursing units on the same floor.

1224.14.2.4 Multipurpose room(s) Multipurpose rooms shall be provided for staff, patients, patients’ families for patient confer- ences, reports, education, training sessions and consultation. These rooms must be readily accessible to each nursing unit. One such room may serve several nursing units and/or departments.

1224.14.2.5 Examination or treatment room(s). Examination or treatment rooms are optional. If provided, provision shall be made to preserve patient privacy from observation from outside the exam room though an open door.

1224.14.2.6 Clean utility/workroom. Clean utility/workroom shall be provided and shall comply with Section 1224.4.4.6.

1224.14.2.7 Soiled workroom or soiled holding room. A soiled workroom or soiled holding room shall be provided and shall comply with Section 1224.4.4.7.

1224.14.2.8 Medication station. A medication station shall be provided in each nursing unit and shall comply with Section 1224.4.4.4.

1224.14.2.9 Clean linen storage. Each nursing unit shall contain a designated area for clean linen storage. This may be within the clean utility room or a separate closet.

1224.14.2.10 Nourishment area. A nourishment area or room shall be provided for each nursing unit and shall comply with Section 1224.4.4.5.

1224.14.2.11 Ice machine. Each nursing unit shall have equipment to provide ice for treatments and nourishment. Ice making equipment may be in the clean utility room/holding room or at the nourishment station. Ice intended for human consumption shall be from self-dispensing icemakers.

1224.14.2.12 Equipment storage room. Appropriate room(s) shall be provided for storage of equipment necessary for patient care with not less than 10 square feet (0.93 m [2] ) per patient bed.

1224.14.2.13 Gurneys and wheelchairs. Provide a storage room or alcove for gurneys and wheelchairs which shall be a minimum of 15 square feet (1.39 m [2] ).

1224.14.2.14 Centralized bathing facilities. When individual bathing facilities are not provided in patient rooms, there shall be at least one shower and/or bathtub for each 12 beds without such facilities. Each bathtub or shower shall be in an individual room or enclosure that provides privacy for bathing, drying and dressing. Each centralized bathing facility shall have direct access to a patient toilet and handwashing fixture.

1224.14.2.15 Special bathing facilities. If provided, special bathing facilities for patients on gurneys, carts and wheelchairs shall include space for an attendant.

1224.14.2.16 Patient toilet room(s). Common patient toilet room(s), in addition to those serving bed areas, should be located adjacent to multipurpose room(s) and within, or directly accessible to each central bathing facility.

1224.14.2.17 Emergency equipment storage. Space shall be provided for emergency equipment that is under direct control of the nursing staff, such as a cardiopulmonary resuscitation (CPR) cart. This space shall be directly accessible from the nursing station, but out of normal traffic.

1224.14.2.18 Housekeeping room. Housekeeping rooms may be shared between adjacent compatible nursing units.

1224.14.2.19 Grab bars. Grab bars shall be installed in accordance with Section 1224.4.18.

1224.14.3 Airborne infection isolation rooms.

1224.14.3.1 General. Single rooms shall be provided for the isolation of patients with airborne communicable disease at a ratio of one room for each 35 licensed beds, and for each major fraction thereof. At least one airborne infection isolation room shall be

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provided. Airborne infection isolation rooms shall be labeled with the words “Airborne Infection Room” on or adjacent to the ante- room side of the door between the isolation room and the anteroom.

Exceptions: 1. Acute psychiatric hospitals shall provide airborne infection isolation rooms at the ratio of one room for each 50 beds, or major fraction thereof. 2. Airborne infection isolation rooms are not required for chemical dependency recovery services.

1224.14.3.2 Anteroom doors. Airborne infection isolation room(s) shall have self-closing and latching devices on all anteroom doors.

1224.14.3.3 Anteroom. A separate anteroom shall be provided between the airborne infection isolation room and the corridor, which shall constitute the primary entrance to the airborne infection isolation room. This anteroom shall have a handwashing station, work counter at least 3 feet (914 mm) long, cabinets and space to gown and to store clean and soiled materials. There shall be a view window from the anteroom to the isolation room and means to allow for airflow from the anteroom into the airborne infection isolation room. Doors shall be aligned to allow large equipment to be wheeled into the airborne infection isola- tion room unless a secondary door complying with Section 1224.14.3.2 is provided. One anteroom may serve no more than two airborne infection isolation rooms.

1224.14.3.4 Secondary entry. When a secondary entry is provided, the secondary doors shall be provided with locking devices which are readily operable from the room side and which are readily operable by the facility staff on the other side. When key locks are used on isolation rooms, keys shall be located at the nurse station in a prominent readily accessible location.

1224.14.3.5 Sealed-tight room. Airborne infection isolation room perimeter walls, ceilings, floors, doors and penetrations shall be sealed tightly to minimize air infiltration from the outside or from other spaces.

1224.14.3.6 Adjoining toilet room. Each isolation room shall have its own directly accessible toilet room with an emergency nurse call system, a lavatory, a shower providing a seat or a space for a shower chair and a toilet equipped with a bedpan flushing attachment with a vacuum breaker.

1224.14.4 Protective environment room(s).

1224.14.4.1 General. Protective environment rooms for the protection of certain immunosuppressed patients may be provided by the facility. Protective environment rooms shall be labeled “Protective Environment Room” on or adjacent to the anteroom side of the door between the isolation room and the anteroom. Protective environment rooms shall contain only one bed.

1224.14.4.2 Anteroom doors. Protective environment room (s) shall have self-closing and latching devices on all anteroom doors.

1224.14.4.3 Anteroom. A separate anteroom shall be provided between the protective environment room and the corridor, hall- way or adjoining space which shall constitute the only entrance to the protective environment room. This anteroom shall have a handwashing station, work counter at least 3 feet (914 mm) long, cabinets and space to gown and to store clean and soiled mate- rials. There shall be a view window from the anteroom to the protective environment room. There shall be means to allow for airflow from the protective environment room into the anteroom. Anteroom doors shall be aligned so that large equipment can be wheeled into the protective environment room. One anteroom may serve no more than one protective environment room.

Exception: Alternate designs for protective environment rooms, without individual anterooms, may be approved by the enforce- ment agency when it can be demonstrated that the alternate design meets the requirements of the California Mechanical Code and does not compromise or alter any health or fire protection component, assembly or system.

1224.14.4.4 Adjoining toilet room. Room shall meet the requirements of Section 1224.14.3.6.

1224.14.4.5 Sealed-tight room. Protective environment room perimeter walls, ceiling, floors, doors and penetrations shall be sealed tightly to minimize air infiltration from the outside or from other spaces.

1224.14.5 Seclusion room(s). If provided, the hospital shall provide one or more single bedrooms for patients needing close supervision for medical and/or psychiatric care. This may be part of the psychiatric unit described in Section 1224.31. If the single bedroom(s) is part of the acute-care nursing unit, the provisions of Section 1224.14.1 shall apply, with the following exceptions: each room shall be for single occupancy; each shall be located to permit staff observation of the entrance, preferably adjacent to the nurse station; and each shall be designed to minimize the potential for escape, hiding, injury or suicide. If vision panels are used for observation of patients, the arrangement shall insure patient privacy and prevent casual observation by visitors and other patients.

1224.15.1 General. The surgical service space shall be divided into two designated areas: 1) semi-restricted areas (e.g., storage areas for clean and sterile supplies, sterile processing rooms, scrub stations and corridors leading to restricted areas of the surgical suite, etc.); and 2) restricted areas (e.g., operating rooms, hybrid operating rooms, sterile procedure rooms, cardiac catheterization labs, sterile cores, etc.) that can be reached only through a semi-restricted area. The surgical service space shall be located and arranged to provide direct support from the anesthesia/recovery service space with a common door to prevent nonrelated traffic through the surgical service space.

An operating room suite design with a sterile core shall provide for no cross traffic of staff and supplies from the decontami- nated/soiled areas to the sterile/clean areas. The use of facilities outside the operating room for soiled/decontaminated processing and clean assembly and sterile processing shall be designed to move the flow of goods and personnel from dirty to clean/sterile with- out compromising universal precautions or aseptic techniques in either department.

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The number of operating rooms and recovery beds, and the sizes of the support areas, shall be based on the expected surgical workload. Hospitals shall maintain at least the number of operating rooms in ratio to licensed bed capacity as follows:

Licensed Bed Capacity Number of Operating Rooms

Less than 25 One

25 to 99 Two

100 or more Three

For each additional 100 beds, and for each major fraction thereof, at least one additional operating room shall be maintained, unless approved to the contrary by the Department of Public Health. Required operating rooms are in addition to special operat- ing rooms, cystoscopy rooms and fracture rooms which are provided by the hospital. Beds in a distinct-part skilled nursing service, intermediate care service or psychiatric unit shall be excluded from calculating the number of operating rooms required.

Exception: Surgical service space is not required in a rural general acute care hospital, if the hospital maintains written transfer agreements with one or more general acute care hospitals that provide surgical and anesthesia services. Written transfer agree- ments shall be approved by the Department of Public Health, Licensing and Certification.

1224.15.2 Surgery. 1224.15.2.1 General operating room(s). Each room shall have a minimum clear floor area of 400 square feet (37.16 m [2] ) with a minimum of 20 feet (6096 mm) clear dimension between fixed cabinets and built-in shelves; and a system for emergency communi- cation with the surgical service space control station. X-ray or imaging viewing capabilities shall be provided.

.15.2 Surgery.**_ 1224.15.2.1 General operating room(s). Each room shall have a minimum clear floor area of 400 square feet (37.16 m [2] ) with a minimum of 20 feet (6096 mm) clear dimension between fixed cabinets and built-in shelves; and a system for emergency communi- cation with the surgical service space control station. X-ray or imaging viewing capabilities shall be provided.

Exception: Where renovation of existing operating rooms is undertaken in facilities built under the 2001 or prior California Build- ing Code, each operating room shall have a minimum clear floor area of 324 square feet (30.10 m [2] ) with a minimum of 18 feet (5486 mm) clear dimension between fixed cabinets and built-in shelves.

1224.15.2.2 Procedure room(s). Where a procedure room is provided, it shall comply with Section 1224.4.4.1.4 unless specified elsewhere.

1224.15.2.2.1 Surgical cystoscopic and other endo-urologic procedures. Each room shall have a minimum clear floor area of 250 square feet (23.23 m [2] ) with a minimum of 15 feet (4572 mm) clear dimension between fixed cabinets and built-in shelves. X- ray viewing and/or other imaging modality capabilities shall be provided

Exception: Where renovation of operating rooms is undertaken in facilities built under the 2001 or prior California Building Code rooms for surgical cystoscopy shall have a minimum clear floor area of 180 square feet (16.72 m [2] ). Cast rooms for open reductions, if provided, shall have a minimum clear floor area of 180 square feet (16.72 m [2] ), no dimension of which shall be less than 11 feet (3353 mm).

1224.15.3 Service areas. Services, except for the enclosed soiled workroom referenced in Section 1224.15.3.7 and the housekeeping room referenced in Section 1224.15.3.12, may be shared with the obstetrical facilities. Service areas, when shared with delivery rooms, shall be designed to avoid the passing of patients or staff between the operating room and the delivery room areas. The following shall be provided in support of the surgical service space:

1224.15.3.1 Control station. Control stations shall be located to permit visual observation of all traffic into the surgical service space. Staff locker rooms may be provided at a location with alternative controlled access.

1224.15.3.2 Supervisor’s office or station.

1224.15.3.3 Sub-sterile areas. If provided within the surgery suite, a sub-sterile area(s) shall be equipped with a flash sterilizer, warming cabinet, countertop and handwashing station. If a sterilizing facility(ies) with high-speed sterilizer(s) or other sterilizing equipment for immediate or emergency use are provided, they shall be directly accessible from the operating room(s) it serves or shall be located inside the clean core if the clean core is directly accessible from the operating room(s). This room shall be accessi- ble without traveling through any operating room. Other facilities for processing and sterilizing reusable instruments, etc., may be located in another hospital department such as central sterile supply.

ly accessible from the operating room(s) it serves or_ shall be located inside the clean core if the clean core is directly accessible from the operating room(s). This room shall be accessi- ble without traveling through any operating room. Other facilities for processing and sterilizing reusable instruments, etc., may be located in another hospital department such as central sterile supply.

1224.15.3.4 Medication station. A medication station shall be provided in accordance with Section 1224.4.4.4.

1224.15.3.5 Scrub facilities. Scrub sinks shall be located outside of sterile areas. A minimum of two scrub sinks shall be provided in a surgical unit containing one operating room. Four scrub sinks shall be provided in surgical units containing two operating rooms. One additional scrub sink shall be provided for each additional operating room. Scrub sinks shall have water supply controls not requiring direct contact of the hands for operation.

1224.15.3.6 Clock. A direct-wired or battery-operated clock or other equivalent timing device shall be visible from the scrub-up sinks.

1224.15.3.7 Soiled workroom. An enclosed soiled workroom (or soiled holding room that is part of a system for the collection and disposal of soiled material) for the exclusive use of the surgical service space shall be provided. The soiled workroom shall contain a flushing-rim clinical sink or equivalent flushing-rim fixture, a handwashing station, a work counter and space for waste recepta- cles and soiled linen receptacles. Rooms used only for temporary holding of soiled material may omit the flushing-rim clinical sink and work counters. However, if the flushing-rim clinical sink is omitted, other provisions for disposal of liquid waste shall be provided. The room shall not have direct connection with operating rooms. Soiled and clean utility room or holding rooms shall be

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separated. The soiled workroom shall provide 24 square feet (2.23 m [2] ) per operating room up to eight operating rooms and shall have a minimum area of 48 square feet (4.46 m [2] ), with no dimension less than 6 feet (1829 mm).

1224.15.3.8 Clean utility room. This room shall not be used for food preparation.

A clean utility room is required when clean materials are assembled within the surgical service space prior to use or following the decontamination cycle. It shall contain a work counter, a handwashing station, storage facilities for clean supplies and a space to package reusable items. The storage for sterile supplies must be separated from this space. If the room is used only for storage and holding as part of a system for distribution of clean supply materials, the work counter and handwashing station may be omitted. Soiled and clean utility rooms or holding rooms shall be separated.

1224.15.3.9 Anesthesia workroom. Provide an anesthesia workroom for cleaning, testing and storing anesthesia equipment. This room shall contain work counter(s) and sink(s) and racks for cylinders.

1224.15.3.10 Equipment storage room(s) for equipment and supplies used in surgical service space. Each surgical service space shall provide sufficient storage area to keep its required corridor width free of equipment and supplies, but not less than 150 square feet (13.94 m [2] ) or 50 square feet (4.65 m [2] ) per operating room, whichever is greater.

1224.15.3.11 Staff clothing change areas. Appropriate areas shall be provided for male and female staff working within the surgical service space. The areas shall contain lockers, showers, toilets, handwashing stations and space for donning surgical attire. These areas shall be arranged to ensure a traffic pattern so that personnel entering from unrestricted area outside the surgical service space enter, change their clothing and move directly into the surgical service space semi-restricted corridor.

1224.15.3.12 Housekeeping room. Shall be provided for the exclusive use of the surgical service space. It shall be directly accessi- ble from the service space.

1224.16.1 General . The anesthesia/recovery service space shall provide perioperative support services to the surgical service space as required under this section. Perioperative services shall include preoperative patient care and post-operative recovery with a Post- Anesthesia Care Unit (PACU). The anesthesia/recovery service space shall be located adjacent to the surgical service space with direct access to the surgical suite’s semi-restricted corridor.

Exception: In a rural general acute care hospital, when the surgical service space is not provided, the anesthesia service space is not required. The hospital must maintain written transfer agreements with one or more general acute care hospitals that provide surgical and anesthesia services. Written transfer agreements shall be approved by the Department of Public Health, Licensing and Certification.

1224.16.2 Preoperative patient holding area(s). In facilities with two or more operating rooms, area(s) with patient care stations shall be provided to accommodate gurney patients or sitting space for ambulatory patients not requiring gurneys. The preoperative area is an unrestricted area and shall be under the direct visual control of the nursing staff and may be part of the recovery space. If the preoperative patient care area will serve other purposes, such as overflow PACU or holding area, applicable requirements in Section 1224.16.3 PACU shall be met.

1224.16.2.1 Space requirements. Each station shall have a minimum clear floor area of 80 square feet (7.43 m [2] ) and a minimum clearance of 3 feet (914 mm) shall be provided between the sides and foot of patient lounge chairs/gurneys and adjacent walls, partitions or fixed elements. A minimum width of 6 feet (1829 mm) of access/circulation outside the curtain shall be provided.

1224.16.2.2 Patient privacy. Provisions for patient privacy such as cubicle curtains shall be made.

1224.16.2.3 Handwashing stations. Handwashing station(s) shall be provided in the preoperative service area at a ratio of one for each 4 stations, and for each major fraction thereof, in open bay areas. A handwashing station shall be provided in each single care station room.

1224.16.3 Recovery and Post-Anesthesia Care Unit (PACU). The recovery area and Post-Anesthesia Care Unit is an unrestricted area and located such that at least one door to the recovery room shall provide access directly from the surgical service space with- out crossing unrestricted corridors. A minimum of 1.5, or major fraction thereof, post-anesthesia care stations per operating room shall be provided. If pediatric surgery is provided, pediatric recovery stations shall be provided. They shall be separate from adult stations, and shall include space for family or visitors and be visible from the nurse station.

the surgical service space with-_ out crossing unrestricted corridors. A minimum of 1.5, or major fraction thereof, post-anesthesia care stations per operating room shall be provided. If pediatric surgery is provided, pediatric recovery stations shall be provided. They shall be separate from adult stations, and shall include space for family or visitors and be visible from the nurse station.

1224.16.3.1 Space requirements. A minimum of 4 feet (1218 mm) clearance shall be provided between the sides and the foot of patient gurneys or beds and adjacent walls or other fixed elements. A minimum clear floor area of 80 square feet (7.43 m [2] ) shall be provided for each station in an open-bay plan. A minimum clearance of 5 feet (1524 mm) shall be provided between sides of gurneys or beds, and a minimum of 3 feet (914 mm) clearance shall be provided between the foot of the gurney or bed, to a closed cubicle curtain. A minimum width of 6 feet (1829 mm) of access/circulation outside the curtain shall be provided. See Patient Bay under Patient Care Locations in Section 1224.3.

1224.16.3.2 Patient privacy. Provisions for patient privacy such as cubicle curtains shall be made.

1224.16.3.3 Handwashing stations. Handwashing stations shall be provided in the post-anesthesia care unit with at least one for every four patient positions, and for each major fraction thereof, uniformly distributed to provide equal access from each patient station. A handwashing station shall be provided in each single care station room.

1224.16.4 Reserved.

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1224.16.5 Support areas for patient care.

1224.16.5.1 Nurse station. A nurse station shall be provided in postoperative patient care areas, and shall allow direct observa- tion of the patients and charting facilities. The nurse station shall comply with the requirements of Section 1224.4.4.2.

1224.16.5.2 Clinical sink. A clinical sink shall be provided in postoperative patient care areas with provisions for bedpan cleaning.

1224.16.5.3 Medication station. Each Post-Anesthesia Care Unit shall contain a medication station. The medication station shall comply with the requirements of Section 1224.4.4.4.

1224.16.5.4 Ice-making. Ice-making equipment shall be provided in the perioperative service space. Ice-making equipment is permitted to be located in preoperative or postoperative patient care areas, however, it shall not be located in semi-restricted

areas.

1224.16.5.5 Storage. Storage shall be provided for gurneys, supplies and equipment.

1224.16.6 Support areas for staff . Staff toilet rooms shall be immediately accessible to the postoperative patient care area(s) to maintain staff availability to patients.

1224.16.7 Support areas for patients, families and visitors.

1224.16.7.1 Waiting area. A waiting area, in compliance with Section 1224.4.5, shall be provided.

1224.16.7.2 Patient change area. A changing area shall be provided for outpatient use in perioperative areas in support of surgi- cal suites that provide outpatient procedures. The changing area shall include space for changing or gowning, provisions for storing patients’ belongings during the procedure, and access to patient toilet(s).

1224.17.1 General requirements. All hospitals shall provide space and equipment to perform urinalysis, complete blood counts, hemoglobin blood typing and cross matching. If laboratory facilities for bacteriological, serological, pathological and additional hematological procedures are not available in the community, then space, equipment and supplies for such procedures shall be provided.

1224.17.2 Laboratory work areas. The following laboratory work areas shall be provided:

1224.17.2.1 Laboratory workstation(s). Space shall be provided to accommodate equipment used and, at minimum, shall include a laboratory work counter and a sink. All work counter(s) in areas used for specimen handling, preparation of specimens or reagents, and laboratory testing shall be constructed of nonporous materials. Access to the following shall be provided as required:

1. Tele/data service.

2. Electrical service.

3. Computer/printer.

1224.17.2.2 Handwashing station(s).

1224.17.2.2.1. If there is one work station, a handwashing station shall be provided at the workstation.

1224.17.2.2.2. If more than one work station is provided, a handwashing station shall be provided within 25 feet (762 mm) of all testing and specimen-handling areas.

1224.17.2.2.3. A handwashing station shall be provided in each enclosed room where bio-hazardous specimens and/or hazard- ous chemicals are handled.

1224.17.2.3 Refrigerated storage facilities. Refrigerated blood storage facilities for transfusions shall be provided. Blood stor- age refrigerators shall be equipped with temperature-monitoring and alarm signals that are monitored continuously.

1224.17.2.4 Storage facilities. 1. Storage for reagents, specimens, flammable materials, acids, bases and other supplies shall be provided as necessary. 2. Separate facilities shall be provided for such incompatible materials as acids and bases. 3. Vented storage shall be provided for volatile solvents.

1224.17.2.5 Terminal sterilization. Facilities and equipment may be provided for terminal sterilization of bio-hazardous waste before transport (autoclave or electric oven).

Notes:

1. Terminal sterilization is not required for waste that is incinerated on-site. 2. Terminal sterilization is subject to other state and federal regulatory requirements.

Exception: Terminal sterilization facilities are not required when it can be demonstrated to the licensing agency that transport and terminal sterilization can be effectively contracted to an independent medical waste treatment facility.

1224.17.2.6 Radioactive material handling. If radioactive materials are employed, facilities for long-term storage and disposal of these materials shall be provided.

1224.17.3 Specimen collection facilities.

1224.17.3.1 General. Space shall be provided for specimen collection. Facilities for this function shall be located outside the labo- ratory work area.

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1224.17.3.2 Facility requirements. At a minimum, specimen collection facilities shall have the following: 1. A blood collection area with a work counter, space for patient seating, handwashing station(s) and supply storage. 2. A urine and feces collection facility equipped with a toilet and a handwashing station. 3. Storage spaces for specimen collection supplies. 4. Work counters for labeling and computerized data entry. 5. Storage for specimens awaiting pickup.

1224.17.4 Administrative areas. Office(s) and space for clerical work, filing and record maintenance and storage shall be provided.

Space and equipment shall be provided to accommodate all required elements, and any additional imaging modalities included in the service space, as required in this section. To differentiate the design and construction requirements needed to achieve the environmental controls and other requirements that support the amount of intervention to be provided, imaging rooms shall be classified as described in Table 1224.4.11.4a (Examination/Treatment, Imaging, Procedure and Operating Room Classification). Where an imaging room will be used for Class 1 and Class 2 procedures, the more stringent requirements for the higher class room shall apply. Where imaging procedures meeting Class 3 criteria are performed, rooms that meet the requirements for the applicable imaging suite and for an operating room per Section 1224.15.2.1 or hybrid operating room per Section 1224.28.5 shall be provided. If Class 3 interventional or image-guided procedures are performed in the imaging services area, additional provisions shall be as described in Section 1224.28 Supplemental Surgery and other Special Procedure Services. If nuclear medicine is provided in the imaging services area, spaces shall also comply with the requirements described in Section 1224.34 Nuclear Medicine.

1224.18.1 Minimum requirements. Hospital shall provide a minimum of: 1. One fluoroscopy room or CT room on approval of Licensing Agency, which can also provide x-ray examination services. 2. Space for processing or viewing images. 3. A toilet room shall adjoin and be directly accessible to each fluoroscopy room. In addition to the fluoroscopy toilet rooms, common patient toilet room facilities shall be located in the radiological/diagnostic imaging service space. 4. An office or other suitable area for viewing and reporting radiographic examination. 5. Storage spaces for all image equipment, supplies and copies of reports. 6. Handwashing stations located within the unit. a) Handwashing station(s) shall be provided within the unit to serve imaging spaces not served by a dedicated hand- washing station within the imaging room or scrub facility located directly outside the imaging/procedure room. b) A handwashing station shall be provided in Class 1 imaging rooms, unless specified otherwise for a specific imaging modality. c) A handwashing station or hand scrub facility shall be provided for Class 2 imaging rooms. If a handwashing station is provided, it shall be directly accessible to the imaging room. If a hand scrub facility is provided, it shall be directly outside the entrance to the imaging room. d) Hand scrub facilities shall be provided directly outside the entrance to a Class 3 imaging room. 7. Dressing room facilities.

r hand scrub facility shall be provided for Class 2 imaging rooms. If a handwashing station is_ provided, it shall be directly accessible to the imaging room. If a hand scrub facility is provided, it shall be directly outside the entrance to the imaging room. d) Hand scrub facilities shall be provided directly outside the entrance to a Class 3 imaging room. 7. Dressing room facilities.

1224.18.1.1 Radiation protection. A certified physicist or other qualified expert shall specify the type, location and amount of radiation protection to be installed in accordance with the final approved department layout and equipment selections. Where protected alcoves with view windows are required, a minimum of 1'-6" (0.45 meter) between the view window and the outside partition edge shall be provided. Radiation protection requirements shall be incorporated into the construction documents and comply with Chapter 31C and the requirements of California Radiation Control Regulations, California Code of Regulations, Title 17, Division 1, Chapter 5 and Subchapter 4. 1. The control alcove or room shall be, at minimum, sized and configured in compliance with the manufacturer’s recom- mendations for installation, service and maintenance.

2. A control alcove or room shall be permitted to serve more than one imaging room, provided the manufacturer’s recom- mendations for installation, service and maintenance are accommodated for all rooms served.

3. The control alcove or room shall include a shielded view window, as specified in the physicist’s report, designed to provide a full view of the examination/procedure table and the patient at all times, including a full view of the patient during imaging activities (e.g., when the table is tilted or the chest x-ray is in use). 4. The control room shall be physically separated from a Class 2 or Class 3 imaging room with walls and a door. 5. Where an imaging room requires positive (or negative) pressure, a door shall be provided between the control room and the imaging room.

1224.18.1.2 Multiple-modality devices. Where two or more individual imaging or therapy modalities are integrated into one imaging device (e.g., PET/CT, SPECT/CT or PET/MRI), the minimum requirements for that room shall include the criteria for each individual contributing modality. Refer to Section 1224.34 for modalities not included under Section 1224.18.

1224.18.2 Angiography. If provided, diagnostic angiography space shall accommodate the following: 1. A control room with a view window to permit full view of the patient. 2. A scrub sink located outside the staff entry to the procedure room.

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3. Patient holding area shall accommodate at least one patient gurney with a minimum of 3-foot (914 mm) clearance on the long side. 4. Storage for portable equipment and catheters shall be provided.

1224.18.2.1 Interventional angiography procedures. If interventional angiography procedures are to be performed in the angi- ography room, the suite shall comply with interventional imaging requirements in Section 1224.28.4. If cardiac catheterization procedures are performed refer to Section 1224.28.2.

1224.18.3 Computerized tomography (CT) scanning. If provided, CT space shall accommodate the following:

1224.18.3.1 Spaces required. If provided, CT scan spaces shall accommodate the equipment with a minimum of 3 feet (914 mm) on the sides and foot of the equipment as well as required service clearance at the rear, together with the following: 1. A control room or alcove shall be provided that is designed to accommodate the computer and other controls for the equipment. A view window shall be provided to permit view of the patient. 2. A patient toilet room readily accessible to the procedure room.

1224.18.3.2 Intraoperative computerized tomography. If provided, intraoperative CT scanning spaces shall comply with Section 1224.28.5.

1224.18.4 Magnetic resonance imaging (MRI). If provided, the MRI room shall accommodate the equipment with a minimum of 3 feet (914 mm) on all sides of the equipment, together with the following: 1. A control room shall be provided with full view of the patient in the MRI scanner. The control console shall be positioned so the operator has a full view of the approach and entrance to the MRI scanner room. 2. An anteroom or area visible from the control room shall be located outside the MRI scanner room so that patients, health care personnel and other employees must pass through it before entering the scanning area and control room. The room or area shall be outside the restricted areas of the MRI’s magnetic field. 3. Safety Zones One through Four shall be identified. a) Zone One consists of all areas freely accessible to the general public. This zone includes the entrance to the MR facility. b) Zone Two acts as a buffer between Zone One and the more restrictive Zone Three. Patients are under the general supervision of MR personnel. Zone Two may include the reception area, dressing room and interview room. c) Zone Three should be restricted by a physical barrier. The MR control room and/or computer room are located within Zone Three.

d) Zone Four is strictly the area within the walls of the MR scanner room. Access into the MR scanner room should only be available by passing through Zone Three. 4. An imaging equipment room shall be provided if needed for the operation of the MRI.

1224.18.4.1 Handwashing station. Handwashing station(s) shall be immediately accessible to the MRI scanner room.

1224.18.4.2 Wall, floor and ceiling assemblies. Wall, floor and ceiling assemblies shall accommodate the installation of required radio frequency (RF)-shielded assemblies. All doors, windows and penetrations into the RF-shielded enclosure shall be RF- shielded. As well as RF shielding, individual sites may also require magnetic shielding on some or all surfaces to contain portions of the magnetic field not contained by the RF shield.

1224.18.4.3 Lighted sign. MRI rooms shall be clearly marked with a red light and lighted sign stating, “The Magnet Is On”. This light and sign are to be lighted at all times and have a backup energy source to remain illuminated for at least 24 hours in the event of a loss of power.

1224.18.4.4 Magnetic field strength identification. Facilities shall use finishes or markings to identify the critical values of the magnetic field surrounding the MRI scanner, including the 5-gauss exclusion zone or other magnetic field strength values that may impair the operation of equipment.

1224.18.4.5 Special ventilation requirements. Where superconducting MRI scanners are installed, an insulated cryogen quench exhaust pipe as well as room exhaust and pressure equalization shall be provided to protect occupants in the event of a cryogen breach.

1224.18.4.6 Intraoperative magnetic resonance imaging. If provided, the intraoperative magnetic resonance imaging (iMRI) suite shall comply with Section 1224.28.5.

1224.18.5 Ultrasound. When provided, the ultrasound room shall comply with the following:

1224.18.5.1 Space requirements. 1. Area. Rooms used for ultrasound examination/treatment shall have a minimum clear floor area of 120 square feet (11.15 m [2] ). 2. Clearances. A minimum clear dimension of 3 feet (914 mm) shall be provided on three sides of the table/stretcher.

1224.18.5.2 Handwashing station. A handwashing station shall be provided within the exam room.

1224.18.5.3 Patient toilet(s). A patient toilet shall be directly accessible to the ultrasound exam room. The patient toilet may be permitted to serve more than one ultrasound exam room. If exams performed are limited to cardiology, vascular, breast ultra- sound or used only for image guided procedures, then the toilet is not required to have direct access.

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1224.18.5.4 Processing room. If provided, a processing room shall contain distinct areas for cleaning and decontaminating instruments. The cleaning area shall provide for flow of instruments from the contaminated area to the clean area and then to storage.

1224.18.5.4.1 The decontamination area shall be equipped with the following: 1. One freestanding handwashing station. 2. Work counter space(s). 3. Separate storage room or cabinets for HLD probes.

1224.18.6 Mammography. When provided, the mammography room shall comply with the following:

1224.18.6.1 Space requirements. 1. Area. Mammography rooms shall be a minimum of 100 square feet (9.3 m [2] ). 2. Shielded alcove. Each x-ray room shall include a shielded control alcove. For mammography machines with built-in shielding for the operator, omission of the alcove shall be permitted when approved by the certified physicist.

1224.18.6.2 Handwashing station . A handwashing station shall be provided within the procedure room.

1224.18.7 Support spaces. The following spaces are common to the imaging service area and are minimum requirements unless stated otherwise:

1224.18.7.1 Patient’s toilet room(s). In service spaces with procedure rooms that do not have dedicated patient toilets, provide a minimum of one patient toilet room within the service space.

1224.18.7.2 Patient dressing areas. Dressing areas shall be provided adjacent to the imaging rooms.

1224.18.7.3 Staff facilities. In service space of three or more procedure rooms, staff toilet room(s) internal to the service space shall be provided.

1224.18.7.4 Film storage (active). If film systems are used, provide the following: 1. A room with cabinet or shelves for filing patient film for immediate retrieval shall be provided. 2. Storage facilities for unexposed film which shall include protection of film against exposure or damage.

1224.18.7.5 Locked storage. Provision shall be made for locked storage of medications and drugs.

1224.19.1 General. Facilities shall be provided to accommodate services and equipment associated with the drug distribution system used, the number of patients to be served, and the extent of shared or purchased services as licensed by the California Board of Pharmacy. Hospital pharmacies shall comply with the requirements of Section 1250 and include the functional spaces under Sections 1224.19.2 through 1224.19.7. Exempt hospitals shall provide a drug room and the supporting spaces, in compliance with Section 1224.19.1.2.

1224.19.1.1 Licensed pharmacy. All hospitals having a licensed capacity of 100 or more beds shall have a pharmacy on the prem- ises licensed by the California Board of Pharmacy.

Note: See General Acute Care Hospitals §70263(a), Article 3, Chapter 1, Division 5, Title 22, California Code of Regulations, for requirements concerning hospitals with fewer than 100 beds. The pharmacy room or service space shall conform to the require- ments of § 1751, Article 7, Division 17, Title 16, California Code of Regulations as enforced by the California Board of Pharmacy.

1224.19.1.2 Less than 100-bed exemption. Hospitals under a Hospital Pharmacy Permit Exemption issued by the Board of Phar- macy, associated with Business and Professions Code Section 4056, shall provide all basic pharmaceutical services in compliance with Section 1224.19.1.2.

1224.19.1.2.1 Drug room. Licensed pharmaceutical space with drug distribution shall be under the supervision of a physician and be monitored by a pharmacist consultant. The drug room shall include the following:

1224.19.1.2.1.1. A room or area for receiving, breakout and inventory control of drugs used in the hospital.

1224.19.1.2.1.2. Cleanable work counters and space for automated and/or manual dispensing activities.

1224.19.1.2.1.3. Reserved.

1224.19.1.2.1.4. An area for reviewing and recording.

1224.19.1.2.1.5. An area for storage, exchange and restocking of carts.

1224.19.1.2.1.6. Security provisions for drugs and personnel in the dispensing counter area.

1224.19.1.2.2 Handwashing station. A hand-washing station shall be provided in the area where medication(s) are handled or be immediately accessible, without going through a door unless the door is equipped with hands-free operation.

1224.19.1.2.3 Storage. Cabinets, shelves and/or separate rooms or closets shall be provided for the following:

1224.19.1.2.3.1. Bulk storage.

1224.19.1.2.3.2. Active storage.

1224.19.1.2.3.3. Refrigerated storage.

1224.19.1.2.3.4. Storage for volatile fluids and alcohol in accordance with applicable fire safety codes for the substances involved.

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1224.19.1.2.3.5. Secured lockable storage for controlled drugs.

1224.19.1.2.3.6. Equipment and supply storage for general supplies and equipment not in use.

1224.19.2 Pharmacy areas.

1224.19.2.1 Dispensing facilities. Hospital pharmacies shall provide the following areas for patient-specific compounding and dose repackaging of non-sterile preparations.

1224.19.2.1.1 Receiving. A room or area for receiving, breakout and inventory control of materials used in the pharmacy.

1224.19.2.1.2 Dispensing. Work counters and space for automated and/or manual dispensing activities shall be provided to serve the volume of doses per day for in-patient and out-patient needs.

1224.19.2.1.3 Non-sterile compounding areas. An extemporaneous compounding/dose repackaging area shall be located next to bulk storage and include the following:

1224.19.2.1.3.1 Size. Work stations shall have sufficient counter space for drug preparation.

1224.19.2.1.3.2 Handwashing station. Handwashing station(s) shall be in or immediately accessible to all areas where pharmaceuticals are handled without going through a door unless the door is equipped with hands-free operation.

1224.19.2.1.3.3 Utility sink. A utility sink shall be provided.

1224.19.2.1.3.4. If carousel or analogous robotic technologies are used, the area shall respond to the special system requirements.

1224.19.2.1.4 Recording. An area for reviewing and recording shall be provided. The area shall include counter space and elec- tronic workstation(s).

1224.19.2.1.5 Temporary storage. An area for temporary storage, exchange and restocking of carts.

1224.19.2.1.6 Security. Security provisions shall be provided for drugs and personnel in the dispensing counter area.

1224.19.2.2 Reserved.

1224.19.2.3 Storage. The following storage facilities shall be provided in the pharmaceutical service area.

1224.19.2.3.1 Bulk storage. A separate bulk storage area, or room, may be provided.

1224.19.2.3.2 Active storage. Active storage in support of repackaging and dispensing activities shall be provided.

1224.19.2.3.3 Refrigerated storage. Refrigeration/freezer area shall be provided.

1224.19.2.3.4 Hazardous materials. Storage for volatile fluids and alcohol shall comply with Section 307.

1224.19.2.3.5 Secured storage. Secured lockable storage shall be provided for narcotics and controlled drugs.

1224.19.2.3.6 Equipment and supplies. Equipment and supply storage for general supplies and equipment not in use.

1224.19.2.3.7 Hazardous drug (HD) storage. Where hazardous drugs are stored outside of an HD buffer room or HD segregated compounding area, an HD storage room under negative pressure and externally ventilated per the California Mechanical Code shall be provided. Hazardous drugs must be stored in a manner that prevents spillage, breakage or falling from shelves. Hazard- ous drugs shall not be stored on the floor. Refrigerated hazardous drugs must be stored in a dedicated refrigerator located in the Hazardous buffer room, hazardous segregated compounding area or hazardous storage room.

1224.19.3 Sterile compounding areas.

1224.19.3.1 General. If sterile compounding areas are provided, the requirements in this section shall be met. Buffer rooms (also known as clean rooms) and their anterooms, and Segregated Compounding Areas (SCA) are classified as semi-restricted areas. The pharmacy shall be laid out to preclude unrelated traffic to hazardous and nonhazardous preparation rooms. The buffer room, anteroom and SCA must be separated from areas not directly related to compounding and must be appropriately controlled to achieve and maintain required air quality classifications. A monitoring system shall be used in a cleanroom suite to continuously monitor the pressure differential between the anteroom(s) and buffer room(s) and between the ante-room and the general phar- macy area. Sterile compounding areas in hospitals shall comply with Sections 1735 and 1751 in Article 4.5 of Division 17 of Title 16 of the California Code of Regulations and US Pharmacopeia (USP) Chapters 797 and 800, and the requirements in this section.

Note: Where robotic systems are used in the preparation of IV solutions in either the positive pressure nonhazardous preparation room or the negative pressure hazardous prep room, the robotics shall be separate systems and not pass through from one area to the other.

1224.19.3.2 Nonhazardous sterile preparation area. If IV solutions are prepared in the pharmacy, a sterile compounding work area with a laminar airflow workstation designed for product protection shall be provided in accordance with Title 16, Section 1735, and USP Chapter 797 and include the following.

1224.19.3.2.1 Workstation. The Primary Engineering Control (PEC) shall be a laminar airflow work bench or isolator (CAI) as required. The workstation shall have a visible pressure gauge for detection of filter leaks or defects. All exposed sides of the work- station shall be accessible for cleaning and allow for reach behind the unit if not built against a wall. If built against a wall, the space behind the unit shall be sealed to prevent intrusion of moisture, contaminants and bacteria growth.

1224.19.3.2.2 Buffer room. Workstations shall be located in a Secondary Engineering Control (SEC) room. The SEC shall be a buffer/clean room, with the following requirements:

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1224.19.3.2.2.1 Air quality. Nonhazardous buffer rooms shall be sealed tight, and be under positive pressure relative to the anteroom. Air supply shall be laminar airflow with a low-level return. Refer to California Mechanical Code Table 4A, Title 16 Section 1735 and USP Chapter 797 for additional requirements.

1224.19.3.2.2.2 Finishes. The buffer room is considered a semi-restricted area with non-porous and cleanable surfaces, ceilings, walls and floors subject to wet cleaning. The surfaces of ceilings, walls, floors, fixtures, shelving, work surfaces, counters and cabinets shall be smooth, seamless, impervious, free from cracks and crevices and be non-shedding. Ceilings shall be monolithic or utilize cleanroom style scrubbable panels, able to withstand cleaning with chemicals. If ceilings consist of inlaid panels, the panels must be caulked around each panel to seal them to the support frame. Junctures of ceil- ings to walls shall be coved or caulked to avoid cracks and crevices where dirt can accumulate. Sprinkler systems shall be recessed, covered, easily cleanable and of a type suitable for a cleanroom environment. Wall finishes shall be 2-coat epoxy- covered gypsum board, seamless vinyl or other impervious covering. Work surfaces, shelving and cabinets shall be constructed of smooth, impervious materials, such as stainless steel or molded plastic, so that they are easily cleaned and disinfected. Plastic laminate finish over a pervious substrate is not permitted.

1224.19.3.2.2.3 Eyewash station. If provided in the buffer room, the eyewash station shall be located just inside the door from the anteroom, and must be dry, unless in use. Drains are not permitted in the buffer room.

1224.19.3.2.2.4 Sealed tight room. Room perimeter walls, ceiling, floors, doors and penetrations shall be sealed tightly to minimize air infiltration from the outside or from other rooms. Buffer room doors shall be glass, metal or other phenolic material, self-closing and with hands-free door operation. Normal operation may include automatic door controls sequenc- ing such that only the buffer room door or the anteroom door is open at one time. Egress provisions shall not be impeded.

1224.19.3.2.2.5 Pass-throughs. If a pass-through is used, both doors shall not be capable of being open at the same time, and the doors should be interlocking.

1224.19.3.2.3 Anteroom. Nonhazardous buffer rooms shall be accessed through an anteroom with the following requirements:

1224.19.3.2.3.1 Size. The anteroom shall be of adequate size to accommodate a demarked area for donning and doffing, and anticipated staging of carts and supplies. The minimum size for the anteroom is 120 square feet (11.15 m [2] ).

Note: A common anteroom may be shared between hazardous and nonhazardous buffer rooms. The anteroom must comply with both 1224.19.3.2.3 and 1224.19.3.3.3, provide a minimum of 5 feet (1524 mm) between the buffer room doors, and provide automatic door controls sequencing such that only one of the buffer room doors may be open at one time. Egress provisions shall not be impeded.

1224.19.3.2.3.2 Air quality. Nonhazardous ante-rooms shall be under negative pressure relative to the buffer room and positive pressure relative to nonrestricted areas. Refer to California Mechanical Code Table 4A, Title 16 Section 1735 and USP Chapter 797 for additional requirements.

1224.19.3.2.3.3 Handwashing station. A handwashing station, with hands-free controls and nonrefillable closed soap dispensing system, providing support for scrubbing up to the elbows, shall be located in or adjacent to the anteroom.

1224.19.3.2.3.4 Eyewash station. An eyewash station shall be provided in the anteroom if one is not provided in the buffer room.

1224.19.3.2.3.5 Housekeeping. Dedicated environmental services, materials and supplies for the buffer room and the anteroom shall be located in the anteroom.

1224.19.3.2.3.6 Finishes. The anteroom room is considered a semi-restricted area with non-porous and cleanable surfaces, ceilings, walls and floors subject to wet cleaning. The surfaces of ceilings, walls, floors, fixtures, shelving, work surfaces, counters and cabinets shall be smooth, seamless, impervious, free from cracks and crevices and be non-shedding. Ceilings shall be monolithic or utilize cleanroom style scrubbable panels, able to withstand cleaning with chemicals. If ceilings consist of inlaid panels, the panels must be caulked around each panel to seal them to the support frame. Junctures of ceil- ings to walls shall be coved or caulked to avoid cracks and crevices where dirt can accumulate. Sprinkler systems shall be recessed, covered, easily cleanable and of a type suitable for a cleanroom environment. Wall finishes shall be 2-coat epoxy- covered gypsum board, seamless vinyl or other impervious covering. Work surfaces, shelving and cabinets shall be constructed of smooth, impervious materials, such as stainless steel or molded plastic so that they are easily cleaned and disinfected. Plastic laminate finish over a pervious substrate is not permitted.

1224.19.3.2.3.7 Sealed tight room. Room perimeter walls, ceiling, floors, doors and penetrations shall be sealed tightly to minimize air infiltration from the outside or from other rooms. Buffer room doors shall be glass, metal or other phenolic material, self-closing and with hands-free door operation.

1224.19.3.2.4 Segregated Compounding Area (SCA). When provided in lieu of a buffer/clean room and anteroom, a segre- gated compounding area, with a limitation on permitted compounded sterile preparations and allowable time of use, shall comply with the requirements of Title 16, Section 1735 and USP Chapter 797. The SCA shall include the PEC and extend to a line of demarcation between the PEC and other surrounding areas with a minimum clearance of 3.281 feet (1 meter) between the PEC and the line of demarcation.

1224.19.3.2.4.1 Air quality. Nonhazardous Segregated Compounding Areas shall provide airflow from clean to less clean areas. Refer to California Mechanical Code Table 4A, Title 16 Section 1735 and USP Chapter 797 for additional requirements.

1224.19.3.2.4.2 Handwashing station. A handwashing station, with hands-free controls and nonrefillable closed soap dispensing system, providing support for scrubbing up to the elbows, shall be located in or adjacent to the SCA with a mini- mum clearance of 3.281 feet (1 meter) between the rim of the sink and the PEC.

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1224.19.3.2.4.3 Finishes. The segregated compounding area is considered a semi-restricted area with nonporous and cleanable surfaces, ceilings, walls and floors subject to wet cleaning. The surfaces of ceilings, walls, floors, fixtures, shelving, work surfaces, counters and cabinets shall be smooth, seamless, impervious, free from cracks and crevices and be non- shedding. Ceilings shall be monolithic or utilize cleanroom style scrubbable panels, able to withstand cleaning with chemi- cals. If ceilings consist of inlaid panels, the panels must be caulked around each panel to seal them to the support frame. Junctures of ceilings to walls shall be coved or caulked to avoid cracks and crevices where dirt can accumulate. Sprinkler systems shall be recessed, covered and easily cleanable. Wall finishes shall be 2-coat epoxy-covered gypsum board, seam- less vinyl or other impervious covering. Work surfaces, shelving and cabinets shall be constructed of smooth, impervious materials, such as stainless steel or molded plastic so that they are easily cleaned and disinfected. Plastic laminate finish over a pervious substrate is not permitted.

1224.19.3.3 Hazardous drug (HD) sterile preparation room. If hazardous drugs are used in compounding activities, a separate room shall be provided for preparation of hazardous admixtures in accordance with Title 16, Sections 1735 and 1751 and USP Chapters 797 and 800.

1224.19.3.3.1 Workstation. The Primary Engineering Control (PEC) shall be a negative pressure biological safety cabinet or isolator (CACI) as required. The workstation shall have an exhaust to the outside with a visible pressure gauge for detection of filter leaks or defects. All exposed sides of the workstation shall be accessible for cleaning and allow for reach behind the unit if not built against a wall. If built against a wall, the space behind the unit shall be sealed to prevent intrusion of moisture, contam- inants and bacteria growth.

1224.19.3.3.2 Hazardous buffer room. Workstations shall be located in a Secondary Engineering Control (SEC) room. The SEC shall be a buffer/clean room, with the following requirements:

1224.19.3.3.2.1 Reserved.

1224.19.3.3.2.2 Air quality. Hazardous buffer rooms shall be sealed tight and be under negative pressure relative to the anteroom. Air supply shall be laminar airflow with a low-level return. Refer to California Mechanical Code Table 4A, Title 16 Section 1751 and USP Chapter 800 for additional requirements.

1224.19.3.3.2.3 Finishes. The buffer room is considered a semirestricted area with nonporous and cleanable surfaces, ceil- ings, walls and floors subject to wet cleaning. The surfaces of ceilings, walls, floors, fixtures, shelving, work surfaces, counters and cabinets shall be smooth, seamless and impervious, free from cracks and crevices and be nonshedding. Ceil- ings shall be monolithic or utilize cleanroom style scrubbable panels, able to withstand cleaning with chemicals. If ceilings consist of inlaid panels, the panels must be caulked around each panel to seal them to the support frame. Juncture of ceil- ings to wall shall be coved or caulked to avoid cracks and crevices where dirt can accumulate. Sprinkler systems shall be recessed, covered, easily cleanable and of a type suitable for a cleanroom environment. Wall finishes shall be 2-coat epoxy covered gypsum board, seamless vinyl or other impervious covering. Work surfaces, shelving and cabinets shall be constructed of smooth, impervious materials, such as stainless steel or molded plastic so that they are easily cleaned and disinfected. Plastic laminate finish over a pervious substrate is not permitted.

1224.19.3.3.2.4 Eyewash station. If provided in the buffer room, the eyewash station shall be located just inside the door from the anteroom, a minimum clearance of 3.281 feet (1 meter) from the PEC, and must be dry, unless in use. Drains are not permitted in the buffer room.

1224.19.3.3.2.5 Refrigerator. Refrigerated storage may be provided in the negative pressure buffer room. Clearance around the refrigerator shall be accessible for cleaning.

1224.19.3.3.2.6 Doffing area. An area for doffing with a hamper shall be demarked inside the buffer/clean room at the door to the anteroom.

1224.19.3.3.2.7 Sealed tight room. Room perimeter walls, ceiling, floors, doors and penetrations shall be sealed tightly to minimize air infiltration from the outside or from other rooms. Buffer room doors shall be glass, metal or other phenolic material, self-closing and with hands-free door operation. Normal operation may include automatic door controls sequenc- ing such that only the buffer room door or the anteroom door is open at one time. Egress provisions shall not be impeded.

1224.19.3.3.2.8 Pass-throughs. If a pass-through is used between the buffer and anteroom, both doors should not be capable of being open at the same time, and the doors should be interlocking. A refrigerator pass-through shall not be used.

1224.19.3.3.2.9 Housekeeping. Dedicated environmental services, materials and supplies shall be located in the buffer

room.

1224.19.3.3.3 Anteroom. Hazardous buffer rooms shall be accessed through an anteroom with the following requirements:

1224.19.3.3.3.1 Size. The anteroom shall be of adequate size to accommodate a demarked area for donning and doffing, and anticipated staging of carts and supplies.

Note: A common anteroom may be shared between hazardous and nonhazardous buffer rooms. Refer to note under Section 1224.19.3.2.3.1.

1224.19.3.3.3.2 Air quality. Hazardous ante-rooms shall be under positive pressure relative to the buffer room and positive pressure relative to nonrestricted areas. Refer to California Mechanical Code Table 4A, Title 16 Section 1751 and USP Chap- ter 800 for additional requirements.

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1224.19.3.3.3.3 Handwashing station. A handwashing station with hands-free controls and nonrefillable closed soap dispensing system, providing support for scrubbing up to the elbows, shall be located in the anteroom, with a minimum clearance of 3.281 feet (1 meter) between the rim of the sink and the door opening to the buffer room.

1224.19.3.3.3.4 Eyewash station. An eyewash station shall be provided in the anteroom if one is not provided in the buffer

room.

1224.19.3.3.3.5 Housekeeping. Dedicated environmental services, materials and supplies shall be located in the

anteroom.

1224.19.3.3.3.6 Finishes. The anteroom is considered a semi-restricted area with nonporous and cleanable surfaces, ceil- ings, walls and floors subject to wet cleaning. The surfaces of ceilings, walls, floors, fixtures, shelving, work surfaces, counters and cabinets shall be smooth, seamless and impervious, free from cracks and crevices and be nonshedding. Ceil- ings shall be monolithic or utilize cleanroom style scrubbable panels, able to withstand cleaning with chemicals. If ceilings consist of inlaid panels, the panels must be caulked around each panel to seal them to the support frame. Juncture of ceil- ings to wall shall be coved or caulked to avoid cracks and crevices where dirt can accumulate. Sprinkler systems shall be recessed, covered, easily cleanable and of a type suitable for a cleanroom environment. Wall finishes shall be 2-coat epoxy- covered gypsum board, seamless vinyl or other impervious covering. Work surfaces, shelving and cabinets shall be constructed of smooth, impervious materials, such as stainless steel or molded plastic so that they are easily cleaned and disinfected. Plastic laminate finish over a pervious substrate is not permitted.

1224.19.3.3.3.7 Sealed tight room. Room perimeter walls, ceiling, floors, doors and penetrations shall be sealed tightly to minimize air infiltration from the outside or from other rooms. Buffer room doors shall be glass, metal or other phenolic material, self-closing and with hands-free door operation.

1224.19.3.3.4 Hazardous segregated compounding area (SCA). When provided in lieu of a buffer/clean room and anteroom, a segregated compounding area, with a limitation on permitted compounded sterile preparations and allowable time of use, shall comply with the requirements of Title 16 Section 1751 and USP Chapter 800. The SCA shall include the PEC and be located in a negative pressure room dedicated to this use.

gregated compounding area (SCA).**_ When provided in lieu of a buffer/clean room and anteroom, a segregated compounding area, with a limitation on permitted compounded sterile preparations and allowable time of use, shall comply with the requirements of Title 16 Section 1751 and USP Chapter 800. The SCA shall include the PEC and be located in a negative pressure room dedicated to this use.

1224.19.3.3.4.1 Air quality. Hazardous Segregated Compounding Areas shall be under negative pressure and provide airflow from clean to less clean areas. Refer to California Mechanical Code Table 4A, Title 16 Section 1735 and USP Chapter 797 for additional requirements.

1224.19.3.3.4.2 Handwashing station. A handwashing station, with hands-free controls and nonrefillable closed soap dispensing system, providing support for scrubbing up to the elbows, shall be located in the SCA with a minimum clearance of 3.281 feet (1 meter) between the rim of the sink and the PEC.

1224.19.3.3.4.3 Finishes. The segregated compounding area is considered a semi-restricted area with nonporous and cleanable surfaces, ceilings, walls and floors subject to wet cleaning. The surfaces of ceilings, walls, floors, fixtures, shelving, work surfaces, counters and cabinets shall be smooth, seamless, impervious, free from cracks and crevices and be nonshed- ding. Ceilings shall be monolithic or utilize cleanroom style scrubbable panels, able to withstand cleaning with chemicals. If ceilings consist of inlaid panels, the panels must be caulked around each panel to seal them to the support frame. Juncture of ceilings to wall shall be coved or caulked to avoid cracks and crevices where dirt can accumulate. Sprinkler systems shall be recessed, covered and easily cleanable. Wall finishes shall be 2-coat epoxy-covered gypsum board, seamless vinyl or other impervious covering. Work surfaces shall be constructed of smooth, impervious materials, such as stainless steel or molded plastic so that they are easily cleaned and disinfected. Plastic laminate finish over a pervious substrate is not permitted.

1224.19.4 – 1224.19.5. Reserved.

1224.19.6 Support areas for the pharmacy.

1224.19.6.1 Access to information.

1224.19.6.1.1 Patient information. Provisions shall be made for cross-checking medication and drug profiles of individual patients.

1224.19.6.1.2 Pharmacological information. Provisions shall be made for access to poison control, reaction data and drug information.

1224.19.6.2 Office. A separate room shall be provided for the Chief Pharmacist’s office.

1224.19.6.3 Education and training. A multipurpose room shared with other departments shall be permitted to serve this

purpose.

1224.19.6.4 Outpatient medication consultation. If medication is dispensed to outpatients from the hospital pharmacy, an area for consultation and patient education shall be provided.

1224.19.6.5 Additional equipment and supply storage. If a dose procedure is used, additional space and equipment shall be provided to accommodate supplies, packaging, labeling and storage, including space for carts.

1224.19.7 Support areas for staff.

1224.19.7.1 Lounge, locker and toilet facilities. Provide pharmacy staff lounge, toilet rooms and lockers that are readily accessible.

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1224.20.1 General. Food and nutrition facilities shall be provided to support food services provided for staff, visitors and patients. Adequate space for the preparation and serving of food shall be provided. Equipment shall be placed so as to provide aisles of sufficient width to permit easy movement of personnel, mobile equipment and supplies. Food service facilities and equipment shall conform to these stan- dards, the standards of the National Sanitation Foundation and the requirements of the local public health agency.

1224.20.2 Functional elements. On-site conventional food service preparation shall be provided as follows in the size and number appropriate for the type of food service selected:

1224.20.2.1 Location. Patient food preparation areas shall be directly accessible to the entry for food supply deliveries and for the removal of kitchen wastes, interior transportation, storage, etc., without traversing patient or public circulation. Food prepara- tion, service and storage shall be inaccessible to nondietetic service staff.

1224.20.2.2 Receiving/control stations. Provide an area for the receiving and control of incoming dietary supplies. Space shall be provided for the delivery and transport equipment used, such as receiving carts/jacks, transport carts and returnables. The exterior door into the receiving area shall have a minimum clear width of 4 feet (1.22 m) and a minimum clear height of 7 feet (2.14 m).

1224.20.2.3 Storage. 1. Food storage space shall be readily accessible to the receiving area and shall be located to exclude traffic through the food preparation area to reach them. Storage spaces for bulk, refrigerated and frozen foods shall be provided. At least one week’s (7 days) supply of staple foods and at least two (2) days’ supply of frozen and two (2) days’ supply of perish- able foods shall be maintained on the premises. Food storage components shall be grouped for convenient access from receiving and to the food preparation areas. All food shall be stored clear of the floor. Lowest shelf shall be not less than 12 inches (305 mm) above the floor or shall be closed in and sealed tight for ease of cleaning. As a minimum, dietary storage space shall be provided in accordance with the following schedule:

mises. Food storage components shall be grouped for convenient access from_ receiving and to the food preparation areas. All food shall be stored clear of the floor. Lowest shelf shall be not less than 12 inches (305 mm) above the floor or shall be closed in and sealed tight for ease of cleaning. As a minimum, dietary storage space shall be provided in accordance with the following schedule:

Licensed Bed Capacity Storage Space 1 to 99 beds 2 square feet (0.19 m [2] ) per bed 100 to 199 beds 200 square feet (18.58 m [2] ) plus 1 square foot 0.0929 m [2] ) per bed in excess of 100 beds 200 beds and over 300 square feet (27.99 m [2] ), plus [1] / 2 square foot (0.0465 m [2] ) per bed in excess of 200 beds Space to allow refrigeration for the storage of frozen and chilled foods shall be provided at a minimum of 2 cubic feet (0.057 m [3] ) of usable space per bed. 2. Additional storage space for dietetic service supplies, such as paper products, equipment, tray delivery carts, etc., shall be provided. 3. Storage areas and sanitizing facilities for cans, carts and mobile-tray conveyors shall be provided. 4. Waste storage and recycling facilities (per local requirements) shall be located in a separate room immediately accessi- ble to the outside for direct pickup or disposal.

1224.20.2.4 Cleaning supplies storage. Provide a separate storage room for the storage of nonfood items such as cleaning supplies that might contaminate edibles.

1224.20.2.5 Food preparation workspaces. Provide workspaces for food preparation, cooking and baking. These areas shall be as close as possible to the user (i.e., tray assembly and dining). Provide additional spaces for thawing and portioning.

1224.20.2.6 Assembly and distribution. The patient tray assembly area shall be immediately accessible to the food preparation and distribution areas.

1224.20.2.7 Food service carts. A cart distribution system shall be provided with spaces for storage, loading, distribution, receiv- ing and sanitizing of the food service carts. The cart traffic shall be designed to eliminate any danger of cross-circulation between outgoing food carts and incoming soiled carts and the cleaning and sanitizing process. Cart circulation shall not be through food preparation areas.

1224.20.2.8 Dining area. Provide dining space(s) for patients, staf and visitors. These spaces shall be separate from the food preparation and distribution areas. 1224.20.2.8.1 Employee dining. Where separate employee dining space is provided, a minimum of 15 square feet (1.4 m [2] ) of floor area per person served, including serving area, shall be maintained.

1224.20.2.9 Vending services. If vending devices are used for unscheduled meals, provide a separate room that can be accessed without having to enter the main dining area.

1224.20.2.10 Ware-washing facilities. Ware-washing space shall be provided in a room separate from food preparation and serving areas. It shall be designed to prevent contamination of clean wares with soiled wares through cross-traffic. The clean wares shall be transferred for storage or use in the dining room area without having to pass through food preparation areas. 1. Commercial-type ware-washing equipment shall be provided. 2. Space shall be provided for receiving, scraping, sorting and stacking soiled tableware separate from food preparation

areas.

3. Handwashing stations shall be provided in the ware-washing space.

1224.20.2.11 Pot washing facilities. Pot washing shall include three-compartmented sinks.

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1224.20.2.12 Waste storage room. A food waste storage room shall be readily accessible to the food preparation and ware wash- ing areas but not within the food preparation area. It shall have direct access to the hospital’s waste collection and disposal facilities.

1224.20.2.13 Handwashing stations. Handwashing stations shall be provided within 20 feet (6096 mm) of each food preparation or serving area.

1224.20.2.14 Office and administrative space. An office shall be provided for the dietician or dietetic service supervisor. Dietetic service administrative staff shall have offices or other suitable space necessary to conduct business related to the dietetic service. Such office and administrative space shall: 1. Provide privacy and accommodate the preparation and maintenance of menus, reports and records. 2. Be located to provide an unobstructed view of the food preparation area. Note: This location requirement applies to all new dietetic service space.

1224.20.2.15 Toilet room(s) and locker spaces. Toilet rooms shall be provided for the exclusive use of the dietary staff. They shall not open directly into the food preparation areas, but shall be readily accessible to them. An enclosed, separate locker area shall be provided for dietetic service employee’s clothing and personal belongings.

1224.20.2.16 Housekeeping room. A housekeeping room, meeting the requirements of Section 1224.4.15, shall be provided within the dietary department for the exclusive use of the dietary department.

1224.20.3 Outside service. On approval of the Licensing Agency, when food is provided by an outside food service, all applicable licensing and certification requirements shall be met. The facility shall maintain adequate space, equipment and food supplies to accommodate required functional elements listed in Section 1224.20.2, as required to provide patient food service in the event that outside food service is interrupted. A temporary mobile kitchen approved by the licensing agency can be used to meet the require- ments of Section 1224.20.2 during construction.

SUPPORT SERVICES.

1224.21.1 Administration. An administration area shall be provided which shall provide for the following functions: 1. A lobby with reception and information counter or desk, waiting space, men’s and women’s public toilet room facilities, tele- phones and drinking fountain. 2. Offices for administrator and admitting.

1224.21.2 Records. Hospitals shall provide a health record service which shall accommodate the following functions: 1. Work area for sorting and recording records for either paper or electronic media. 2. Storage area for records for either paper or electronic media.

1224.22.1 Minimum requirements. A central supply and sterilizing area shall be provided. Rooms or distinct spaces shall accommo- date the following services and equipment: 1. Soiled work area. A receiving and gross cleaning area which shall contain work space and equipment for cleaning medical and surgical equipment and for disposal of or processing of soiled material. 2. Clean work area. A clean work area which shall contain work space and equipment for sterilizing medical and surgical equipment and supplies. 3. Sterilizing space. 4. Storage. Provide storage space for sterile supplies and unsterile supplies.

Exception: Section 1224.22.1 does not apply to hospitals which serve psychiatric or alcoholism patients exclusively.

1224.22.2 All sterilizers and autoclaves which emit steam exhaust shall be vented to the outside of the building. Such vents shall be independent from the plumbing vent system.

Exception: Small instrument sterilizers.

1224.23.1 General storage. Hospitals shall provide general storage space of at least 20 square feet (1.86 m [2] ) per bed in addition to specialized storage spaces. All storage spaces shall be located within a conforming hospital building and readily accessible to the connecting corridor required under Section 1224.4.7.5. Required storage, including but not limited to patient, dietary, etc., shall accommodate at least 72 hours of storage capacity in a conforming building. Storage beyond this requirement may be in a non- hospital or nonconforming building.

1224.23.2 Specialized storage. Specialized storage spaces shall include the following:

1224.23.2.1 Linen. Provide separate and enclosed facilities for clean and soiled linen in each nursing unit. The clean linen storage space shall have a minimum area of 10 square feet (0.93 m [2] ) and may be within the clean utility room. The soiled linen collection space shall have an area of no less than 10 square feet (0.93 m [2] ), except where linen chutes are provided, and may be within the soiled utility room. 1224.23.2.2 Supply. One supply storage space having a minimum area of 15 square feet (1.39 m [2] ) shall be provided in each nursing unit. Supply storage may be within the clean utility room used only as part of a system for distributing clean and sterile supplies.

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1224.23.2.3 Wheelchairs. A room or space shall be provided in each nursing unit for wheelchairs and gurneys. The wheelchair and gurney space shall have a minimum area of 15 square feet (1.39 m [2] ).

1224.23.2.4 Sterile and unsterile supplies shall be stored separately.

1224.23.2.5 Food storage shall be as described in Section 1224.20.

1224.24.1 General acute-care hospitals with a licensed bed capacity of 50 to 99 beds shall provide a morgue with autopsy facilities.

Exception: This may not be required if it can be demonstrated to the licensing agency that morgue and autopsy facilities are available locally.

1224.24.2 General acute-care hospitals with a licensed bed capacity of 100 or more shall provide a morgue with autopsy facilities. 1224.24.3 Minimum requirements. The morgue and autopsy space shall have a minimum of 250 square feet (23.23 m [2] ) of floor area, no dimension of which shall be less than 10 feet (3048 mm), and provide for: 1. Handwashing station or scrub sink. 2. Space for refrigerated compartments if human remains are held unembalmed. Refrigerated rooms and prefabricated body refrigerator temperatures shall not be higher than 45°F (25°C).

1224.25.1 Minimum facilities. Hospitals shall provide the following: 1. Separate dressing rooms for male and female personnel with lockers and a toilet room. 2. Additional dressing rooms for the surgical service and as required within any of the supplemental services.

Shall be provided to serve each department and nursing unit, and may be shared by compatible departments, except when specifically required by other sections.

1224.27.1 If a laundry is to be provided, the following is required in addition to the laundry room: 1. A separate soiled linen receiving, holding and sorting room with handwashing fixture. 2. A separate clean linen storage, issuing and holding room. 3. Storage for laundry supplies.

1224.27.2 Outside service. If linen is processed off site, the following shall be provided within the hospital: 1. Soiled linen holding room. 2. Clean linen receiving room. 3. Clean linen storage room.

SUPPLEMENTAL SERVICES.

When provided, the following supplemental surgery and special procedure services shall meet the requirements below:

1224.28.1 Cardiovascular and other special procedures. When provided, the cardiovascular room shall have a minimum clear floor area of 650 square feet (60.39 m [2] ), with a minimum of 20 feet (6096 mm) clear dimension. Orthopedic surgical and other special proce- dure rooms shall have a minimum clear floor area of 600 square feet (55.74 m [2] ), with a minimum of 20 feet (6096 mm) clear dimension. When open-heart surgery is performed, an additional room in the restricted area of the surgical service space, that is directly accessible to this operating room, shall be designated as a pump room where extra corporeal pump(s), supplies and accesso- ries are stored and serviced. Appropriate plumbing and electrical connections shall be provided in the cardiovascular, pump and storage rooms.

1224.28.1.1 Service areas. Shall be provided in accordance with Section 1224.15.3.

Exception: Where renovation work is undertaken in facilities built under the 2001 or prior California Building Code, existing rooms for cardiovascular, and other special procedures may have a minimum clear floor area of 500 square feet (46.45 m [2] ). Orthopedic surgical rooms shall have a minimum clear floor area of 360 square feet (33.44 m [2] ) and a minimum dimension of 18 feet (5486 mm).

1224.28.2 Cardiac catheterization.

1224.28.2.1 Procedure room. A procedure room with a minimum clear floor area of 400 square feet (37.16 m [2] ) for the procedure room in addition to spaces for control, monitoring and recording equipment and imaging equipment power and controls and a minimum of one scrub sink for each catheterization laboratory. This space does not include the control room.

1224.28.2.1.1 Emergency response space. Where electrophysiology studies are performed, dedicated space and equipment for emergency resuscitation and stabilization shall be immediately accessible to the procedure room.

1224.28.2.2 Control room. A control room or area shall be provided. A view window permitting full view of the patient from the control console shall be provided.

1224.28.2.3 Equipment space. An equipment space or enclosure large enough to contain imaging equipment transformers, power modules and associated electronics and electrical gear shall be provided.

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1224.28.2.4 Scrub facilities. Scrub facilities with hands-free operable controls shall be provided adjacent to the entrance of procedure rooms.

1224.28.2.5 Staff clothing change areas. Appropriate areas shall be provided for male and female staff working within the surgi- cal service space. The areas shall contain lockers, showers, toilets, handwashing stations and space for donning surgical attire. These areas shall be arranged to ensure a traffic pattern so that personnel entering from outside the service space can enter, change their clothing and move directly into the cardiac catheterization service space. The staff change area may be combined with the surgical staff change area.

1224.28.2.6 Patient holding. A patient preparation, holding, and recovery area or room shall be provided and arranged to provide visual observation before and after the procedure. This may occur in a unit outside of the catheterization service space.

1224.28.2.7 Clean utility room. A clean utility room shall be provided. If the room is used for preparing patient care items, it shall contain a work counter and handwashing station. If the room is used only for storage and holding of clean and sterile supply materials, the work counter and handwashing station shall be permitted to be omitted. The clean utility room may be shared with an adjacent surgical unit.

1224.28.2.8 Soiled utility room. A soiled utility room shall be provided which shall contain a handwashing station and a clinical sink (or equivalent flushing rim fixtures). When the room is used for temporary holding or soiled materials, the clinical sink and handwashing station shall be permitted to be omitted. The soiled utility may be shared with an adjacent surgical unit. 1224.28.2.9 Housekeeping room. Shall be a minimum floor area of 15 square feet (1.4 m [2] ). It shall contain a service sink or floor receptor and provisions for storage of supplies and housekeeping equipment. This may be shared with an adjacent surgical unit.

1224.28.3 Freestanding cardiac catheterization laboratory service space. A general acute care hospital referenced in Health and Safety Code Section 1255 (d)(3)(E) may provide cardiac catheterization laboratory service in a freestanding nonhospital building in conformance with this section and Section 1226.2.2. In addition, the service space shall comply with Section 1224.28.2 and applicable requirements in Section 1224.15.3 that are not covered by this section.

1224.28.3.1 Outpatient support areas. Outpatient support areas shall include outpatient waiting rooms in compliance with Section 1224.4.5. A separate space shall be provided where outpatients change from street clothing and are prepared for a proce- dure. This space shall include provisions for clothing storage, toilet room(s), sink and an area for clothing change and gowning.

1224.28.3.2 Connection to hospital. The freestanding cardiac catheterization laboratory service space shall be located in the nonhospital building such that the service space has a direct connection to the general acute care hospital providing cardiac surgery by a patient corridor link in compliance with Section 1224.4.7. The corridor link shall have a minimum width of 8 feet (2438 mm) as required under Section 1224.4.7.1. The corridor link shall connect to the hospital corridor system with access to all basic services as required under Section 1224.4.7.5.

1224.28.3.3 Control station. Control station(s) shall be located to permit visual observation of all traffic into the semi-restricted service space from unrestricted corridors and/or passageways.

1224.28.3.4 Essential electrical system. Cardiac catheterization laboratories shall meet the provisions for ambulatory surgical clinics required in the California Electrical Code including the requirements of Article 517.45 for an essential electrical system.

1224.28.3.5 Services/systems and utilities. Services/systems and utilities that support the catheterization laboratory space include, but are not limited to: normal power; emergency power; nurse call; communication and data systems; space heating systems; cooling systems; domestic hot and cold water systems; building drain and sewer systems; and medical gas systems. When these systems serve other portions of the building, any alteration to the system shall be subject to review by the Office of Statewide Hospital Planning and Development.

1224.28.4 Interventional imaging. Image-guided interventional procedures shall be performed in procedure rooms in compliance with this section. Cardiac catheterization operating rooms shall be in compliance with Section 1224.28.2, and hybrid operating rooms shall be in compliance with Section 1224.28.5.

1224.28.4.1 Space requirements. The procedure room shall meet the space, clearance and storage requirements for the imaging equipment contained in the room and the following: 1. A minimum clear dimension of 18 feet (5486 mm). 2. The procedure room shall also be sized to allow a minimum clearance of 4 feet (1219 mm) on all sides of the procedure table.

1224.28.4.2 Pre-procedure and recovery. Pre-procedure and recovery areas shall be immediately accessible to procedure rooms and separate from corridors. The pre-procedure and recovery areas shall comply with the requirements of Section 1224.16 Anes- thesia/recovery Service Space.

1224.28.4.3 Interventional MRI facilities. Interventional and intraoperative magnetic resonance imaging (I-MRI) procedure rooms shall comply with Section 1224.28.5 Hybrid Operating Rooms.

1224.28.4.4 Control room or area. A control room or area shall be provided. 1. The control room or area shall be sized to accommodate the image-recording and viewing equipment. 2. A shielded view window permitting direct observation of the patient from the control console shall be provided. 3. The shielded control room shall be configured to prevent radiation exposure into occupied areas of the control room when ionizing radiation modalities are used.

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4. Where the procedure room requires positive (or negative) pressure, a door shall be provided between the control room and the procedure room or between the combined control room/procedure room and other adjacent space. 5. Where control functions for ionizing radiation exposures take place in the procedure room, storage for personal radia- tion protection devices shall be provided.

1224.28.4.5 Scrub facilities. Scrub sinks shall be located outside of sterile areas. A minimum of one scrub sink station shall be provided for each interventional imaging procedure room. Scrub sinks shall have water supply controls not requiring direct contact of the hands for operation.

1224.28.4.6 Medication station. A medication station shall be provided in compliance with the requirements in Section 1224.4.4.4.

1224.28.4.7 Reading room. A reading room for reviewing images shall be available for use by the interventional imaging suite.

1224.28.4.8 Imaging equipment room. Imaging equipment room or enclosures large enough to contain x-ray transformers, power modules and associated electronics and electrical gear shall be provided. Sharing of imaging equipment rooms by multiple procedure rooms is permitted.

1224.28.4.9 Clean utility room. A clean utility room shall be provided in accordance with the requirements in Section 1224.4.4.6.

1224.28.4.10 Soiled workroom. A soiled workroom shall be provided in accordance with Section 1224.4.4.7.

1224.28.4.11 Housekeeping room. A housekeeping room shall be provided in accordance with the requirements of Section 1224.4.15.

1224.28.4.12 Staff changing areas. Male and female staff changing areas shall be provided and arranged to ensure a traffic pattern so that personnel can enter from an unrestricted area, change their clothing and move directly into the interventional imaging suite.

1224.28.5 Hybrid operating room(s). Hybrid operating rooms shall comply with the requirements of Section 1224.15 and comply with the requirements in this section.

1224.28.5.1 Space requirements. Each hybrid operating room shall meet the space, clearance and storage requirements for the imaging equipment contained in the room and the following: 1. A minimum clear floor area of 650 square feet (60.39 m [2] ) is required for a hybrid operating room unless the imaging equipment requires a larger area. 2. The minimum clear dimension shall be 24 feet (7315 mm) unless the requirements for the specific imaging equipment require a greater distance. 3. If mobile storage units are used in lieu of fixed cabinets, the minimum clear dimension shall be available between such units when they are parked against a permanent partition.

1224.28.5.2 Control room. If required, a control room shall be provided that accommodates the imaging system control equip- ment and the following requirements: 1. The control room shall have a minimum clear floor area of 120 square feet (11.15 m [2] ), which may include fixed work surfaces.

2. The room shall be physically separated from the hybrid operating rooms with walls and a door. 3. The room shall have viewing windows that provide for a full view of the patient and the surgical team. Cameras shall be permitted to provide for full view of patient while positioned inside bore. 4. If the control room is adjacent to a restricted area, it must be physically separated from the restricted area with walls and a door.

1224.28.5.3 Imaging equipment room. An imaging equipment room shall be provided for each hybrid operating room.

1224.28.5.4 Radiation protection. If the imaging equipment emits ionizing radiation, protection shall be provided in accordance with Section 1224.18.1.1.

1224.28.5.5 Requirements for specific types of hybrid operating rooms.

1224.28.5.5.1 CT. Hybrid operating rooms with intraoperative computerized tomography (CT) systems shall have control rooms that comply with Section 1224.18.3.1.

1224.28.5.5.2 iMRI. Hybrid operating rooms with intraoperative magnetic resonance imaging (iMRI) systems shall comply with the following: 1. Space and configuration requirements in Section 1224.18.4, except the clearances shall meet the requirements of 1224.28.5.1.

2. The control room shall comply with Section 1224.18.4, Item 1. 3. The anteroom shall comply with Section 1224.18.4, Item 2. 4. Entry doors to iMRI hybrid rooms shall swing outward from inside the room.

1224.28.5.5.3 Vascular imaging. Hybrid operating rooms with vascular imaging systems shall comply with Section 1224.28.4.

1224.28.5.6 Pre-procedure and recovery. Pre-procedure and recovery areas shall be immediately accessible to procedure rooms and separate from corridors. The pre-procedure and recovery areas shall comply with the requirements of Section 1224.16 (Anes- thesia/recovery Service Space).

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1224.28.6 Electroconvulsive Therapy. If electroconvulsive therapy (ECT) is provided, the requirements of this section shall be met. Where a psychiatric unit is part of a general acute care hospital (Section 1224.31 Psychiatric Nursing Unit), all the requirements in this section shall be permitted to be accommodated in a procedure suite that complies with the requirements in this section or in an oper- ating room in a surgical suite that meets the requirements in Section 1224.15.

1224.28.6.1 General. The ECT procedure area may be a single procedure room or a suite of procedure rooms.

1224.28.6.2 ECT procedure room. 1. Space requirements. Each ECT procedure room shall have a minimum clear floor area of 200 square feet (18.6 m [2] ) with a minimum clear dimension of 14 feet (4267 mm).

2. Handwashing station. A handwashing station shall be provided. 3. Documentation area. Accommodation for written or electronic documentation shall be provided.

1224.28.6.3 Pre-procedure and recovery area. When ECT services have a low-volume of procedures, the ECT procedure room may be used for pre-procedure patient care and recovery. If a pre-procedure and recovery areas are provided they shall comply with the requirements of Section 1224.16.

1224.28.6.4 Emergency equipment storage. Space shall be provided in the procedure room(s) for storage of emergency equip- ment such as a CPR cart. A separate emergency equipment storage is permitted to serve more than one ECT procedure room.

1224.28.6.5 Patient support areas. A waiting area and changing area shall be provided for outpatient use in perioperative areas in support ECT suites that provide outpatient procedures. The waiting room shall comply with Section 1224.4.5. The changing area shall include space for changing or gowning, provisions for storing patients’ belongings during the procedure and access to patient toilet(s).

1224.29.1 General. The following shall apply to all types of intensive care service spaces, acute respiratory-care service spaces, burn center spaces, critical-care units, coronary-care service spaces, pediatric intensive-care service spaces unless otherwise noted. Each unit shall comply with the following provisions:

1224.29.1.1 Service space. Each intensive-care unit shall contain not less than four or more than 12 beds.

Exception: When approved by the licensing agency a small or rural hospital intensive care unit may consist of less than four but not less than two patient beds.

1224.29.1.2 Patient space. In new construction, each patient space (whether separate rooms, cubicles or multiple bed space) shall have a minimum of 200 square feet (18.58 m [2] ) of clear floor area with a minimum headwall width of 13 feet (3962 mm) per bed. There shall be a minimum clear dimension of 1 foot (305 mm) clear space from the head of the bed to the wall, a minimum of 5 feet (1524 mm) clear space from the foot of the bed to the wall, a minimum of 5 feet (1524 mm) clear space on one side of each bed for patient transfer, a mini- mum of 4 feet (1218 mm) clear width on the non-transfer side and a minimum of 8 feet (2438 mm) clear space between beds.

Exception: Where renovation of existing intensive care units is undertaken, in facilities approved under the 2001 or prior Califor- nia Building Code, existing patient space (whether separate rooms, cubicles or multiple bed space) may be renovated or replaced in kind one for one in the renovated space. Such patient space shall have no less than 132 square feet (12.26 m [2] ) with no dimension less than 11 feet (3353 mm), and with 4 feet (1219 mm) of clearance at each side and the foot of the bed, and with a minimum of 8 feet (2438 mm) between beds. The space shall be designed so that all beds shall be placed in relation to the nurse station or work area to permit, enable or allow maximum observance of patients.

1224.29.1.3 Private rooms. When private rooms or cubicles are provided, view panels to the corridor shall be required with a means to provide visual privacy. Where only one door is provided to a bed space, it shall be arranged to minimize interference with movement of beds and large equipment. Sliding doors shall not have floor tracks. Where sliding doors are used for access to cubi- cles within a service space, a 3-foot-wide (914 mm) swinging door may also be provided for personnel communication.

1224.29.1.4 Modular toilet. Modular toilet/sink combination units located within a privacy curtain may be used within each patient space or private room. The toilet fixture shall be completely contained within cabinetry when not in use. This fixture shall not be equipped with a bedpan washing attachment. Exhaust ventilation requirements shall comply with the California Mechanical Code.

1224.29.1.5 Visitors and visual privacy. Each patient bed area shall have space at each bedside for visitors, and provisions for visual privacy from casual observation by other patients and visitors. For both adult and pediatric units, there shall be a minimum of 8 feet (2438 mm) between beds.

1224.29.1.6 Outside environment. Each patient bed shall have visual access, other than clerestory windows and skylights, to the outside environment with not less than one outside window in each patient bed area.

1224.29.1.6.1 Distance. The distance from the patient bed to the outside window shall not exceed 50 feet (15 240 mm). When partitioned cubicles are used, patients’ view to outside windows may be through no more than two separate clear vision panels.

1224.29.1.7 Handwashing stations. Handwashing stations shall be directly accessible to nurse stations and patient bed areas. There shall be at least one handwashing station for every three beds in open plan areas, and one in each patient room. The hand- washing station shall be located near the entrance to the patient cubicle or room.

1224.29.1.8 Nurse station. This area shall have space for counters and storage. It may be combined with or include centers for reception and communication.

1224.29.1.9 Nurses’ work area. There shall be direct visual observation between either a centralized or distributed nurse station or work station and the heads of all patient beds in the intensive care unit.

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1224.29.1.10 Monitoring. Each unit shall contain equipment for continuous monitoring. Monitors shall be located to permit easy viewing but not interfere with access to the patient.

1224.29.1.11 Emergency equipment storage. Space that is easily accessible to the staff shall be provided for emergency equip- ment such as a CPR cart.

1224.29.1.12 Medication station. A medication station shall be provided in accordance with Section 1224.4.4.4. Refrigerated stor- age is required.

1224.29.1.13 Airborne infection isolation room. At least one airborne infection isolation room shall be provided per unit. The room shall comply with the requirements of Section 1224.14.3; however, the adjoining toilet room is not required. Modular toilet units located within a privacy curtain may be used within the airborne infection isolation room. The modular toilet fixture shall comply with Section 1224.29.1.4.

Exception: When approved by the licensing agency an airborne infection isolation room is not required for small or rural hospi- tals or protected environment units.

1224.29.1.14 Additional service spaces. The following additional service spaces shall be immediately accessible within each inten- sive care service space. These may be shared by more than one intensive care unit provided that direct access is available from each.

1224.29.1.14.1 Clean utility/workroom. Clean utility/workroom shall be provided in accordance with Section 1224.4.4.6.

1224.29.1.14.2 Clean linen storage. There shall be a designated area for clean linen storage. This may be within the clean util- ity room or a separate closet.

1224.29.1.14.3 Soiled utility/workroom. Soiled workroom or soiled holding room shall be provided in accordance with Section 1224.4.4.7.

1224.29.1.14.4 Nourishment area. A nourishment area or room shall be provided in accordance with Section 1224.4.4.5.

1224.29.1.14.5 Ice machine. Each unit shall have equipment to provide ice for treatments and nourishment. Ice-making equip- ment may be in the clean utility room or at the nourishment station. Ice intended for human consumption shall be from self- dispensing icemakers.

1224.29.1.14.6 Equipment storage room. Appropriate room(s) shall be provided for storage of large items of equipment neces- sary for patient care. Each intensive care unit shall provide not less than 20 square feet (1.86 m [2] ) per patient bed.

1224.29.1.15 Support. The following shall be provided and shall be located immediately accessible to the unit: 1. Visitors’ waiting room. 2. Office space. 3. Staff lounge(s) and toilet room(s). 4. Multipurpose room(s). Provide for staff, patients and patients’ families for patient conferences, reports, education, training sessions and consultation. 5. Housekeeping room. Provide within or immediately accessible to the intensive care unit. It shall not be shared with other nursing units or departments. 6. Gurney and wheelchair storage. Provide a minimum 15 square feet (1.39 mm) per each nursing unit.

1224.29.2 Newborn intensive care units (NICU). The NICU shall comply with all the requirements of Section 1224.29.1 except as supplemented, amended or modified below.

1224.29.2.1 Entrance. The NICU shall have a clearly identified entrance and reception area for families. The area shall permit visual observation and contact with all traffic entering the unit.

1224.29.2.2 Handwashing station(s). Provide one handwashing station for each four infants and for each major fraction thereof. In a multiple-bed room, every bed position shall be within 20 feet (6096 mm) of a handwashing station. Where an individual room concept is used, a handwashing station shall be provided within each infant care room.

1224.29.2.3 Doors. At least one door to each patient room shall be a minimum of 44 inches (1118 mm) wide.

1224.29.2.4 View windows. When viewing windows are provided, provision shall be made to control casual viewing of infants. Controls shall be provided to enable lighting to be adjusted over individual patient care spaces. Darkening sufficient for transillu- mination shall be available when necessary.

1224.29.2.5 Control station. A central area shall serve as a control station, and shall have space for counters and storage, and direct access to a handwashing station and gowning. It may be combined with or include centers for reception, communication and patient monitoring. 1224.29.2.6 Area. Each patient care space shall contain a minimum of 120 square feet (11.15 m [2] ) of clear floor area per bassinet excluding handwashing fixtures and aisles with a minimum width of 11 feet (3353 mm) at headwall. There shall be an aisle for circulation adjacent to each patient care space with a minimum width of 4 feet (1219 mm). Where multi-patient rooms are used, a separate treatment area of 120 square feet (15.15 m [2] ) shall be provided in compliance with Section 1224.4.4.1.2.

Exception: Where renovation of existing NICUs is undertaken in facilities built under the 2001 or prior California Building Code, patient care areas shall have no less than 80 square feet (7.43 m [2] ) of clear floor area per bassinet exclusive of space for nurse control, scrubbing and gowning and reception area.

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1224.29.2.6.1 Treatment area/room. A treatment area/room, with temperature control, shall be provided immediately acces- sible to the general patient care space.

1224.29.2.7 Ceilings. Ceilings shall have a noise reduction coefficient (NRC) of at least 0.90.

1224.29.2.8 Airborne infection isolation room. Shall comply with the requirements of Section 1224.29.1.13 except for separate toilet, bathtubs or shower. 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).

1224.29.2.9 Lactation. Space shall be provided for lactation support and consultation in or immediately accessible to the NICU.

1224.29.2.10 Infant formula facilities. Nourishment area required under Section 1224.29.1.14.4 not required. Newborn intensive care units shall include infant formula facilities complying with the following requirements:

1224.29.2.10.1 Location.

1. Where infant formula is prepared on site, direct access from the formula preparation room to any infant care room is prohibited. 2. The formula preparation room shall be located in or adjacent to the NICU. The formula preparation room may be located at another location as approved by the Licensing Agency.

1224.29.2.10.2 Formula preparation room. The formula preparation room shall be securable, facilitate workflow that supports aseptic technique, and include the following: 1. A separate cleanup area for washing and sanitizing. This area shall include a handwashing station, a work counter and work space and equipment for washing, rinsing and sanitizing bottles, other feeding utensils and equipment. 2. A separate area for preparing infant formula. This area shall contain a refrigerator, a freezer, a work counter, a formula sterilizer, storage facilities and a handwashing station.

area for washing and sanitizing. This area shall include a handwashing station, a work counter_ and work space and equipment for washing, rinsing and sanitizing bottles, other feeding utensils and equipment. 2. A separate area for preparing infant formula. This area shall contain a refrigerator, a freezer, a work counter, a formula sterilizer, storage facilities and a handwashing station.

1224.29.2.10.3 Refrigerated storage and warming facilities for infant formula. Shall be accessible for use by NICU personnel at all times.

1224.29.2.10.4 Commercial infant formula. Where only commercially prepared infant formula is used, omission of the formula preparation room may be permitted. Storage and handling may occur in the NICU workroom or in a formula preparation area adjacent to the nursing unit. The preparation area shall not have direct access to any infant care room and shall include the following:

1. A work counter

2. A hand-washing station 3. Storage facilities

1224.29.2.10.5 Cleaning equipment and supplies storage. Separate provisions for dedicated cleaning equipment and supplies shall be readily available to the formula preparation room and the formula preparation area.

1224.29.2.11 Emergency equipment storage. Space shall be provided for emergency equipment that is under direct control of the nursing staff, such as a CPR cart.

1224.29.2.12 Housekeeping room. Shall be directly accessible from the unit and be dedicated for the exclusive use of the neona- tal intensive care unit.

1224.29.2.13 Daylight. In addition to meeting the requirements in Section 1224.4.9, at least one source of daylight shall be visible from newborn care areas.

1. External windows in infant care rooms shall be glazed with insulating glass to minimize heat gain or loss. 2. External windows in infant care rooms shall be situated at least 2 feet (610 mm) away from any part of a baby’s bed to minimize radiant heat loss from the baby. 3. All external windows shall be equipped with easily cleaned shading devices that are neutral color or opaque to minimize color distortion from transmitted light.

A pediatric nursing unit shall be provided if the hospital has eight or more licensed pediat- ric beds. Pediatric patient area and adolescent patient area shall be separate from each other and shall be separate from adult nursing units. Common areas including exam and treatment rooms, service areas and playrooms may be shared and used by pediatric and adolescent patients at different times. The unit shall meet the following standards:

1224.30.1 Patient rooms. Patient rooms shall have direct visual observation between either a centralized or distributed nurse station or workstation or by other means if approved by licensing agency. Each patient room shall meet the following standards:

1224.30.1.1 Beds. The space requirements for pediatric patient beds shall be the same as required by Section 1224.14.1.2.

1224.30.1.2 Windows. Each patient room shall have a window in accordance with Section 1224.4.9.

1224.30.2 Examination room and treatment rooms. An exam room and treatment room shall be provided in or adjacent to the pediatric unit for pediatric and adolescent patients. A separate area for infant examination and treatment may be provided within the pediatric nursery workroom.

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1224.30.3 Service areas. The service areas in the pediatric and adolescent nursing units shall conform to Section 1224.14.2 and shall also provide the following:

1224.30.3.1 Playroom. A playroom shall be provided and have direct visual observation between either a centralized or distrib- uted nurse station or workstation or by other means if approved by licensing agency.

1224.30.3.2 Infant formula. Space for preparation and storage of infant formula shall be provided immediately accessible to the unit.

1224.30.3.3 Toilet rooms. Patient toilet room(s) with a lavatory in each room, in addition to those serving bed areas, shall be located adjacent to play area(s) and in or directly accessible to each central bathing facility.

1224.30.3.4 Storage. Closets or cabinets for toys, educational and recreational equipment shall be provided.

1224.30.3.5 Airborne infection isolation room. At least one airborne infection isolation room shall be provided within each pedi- atric unit; minimum of one per 15 beds. Airborne infection isolation room(s) shall comply with the requirements of Section 1224.14.3.

1224.30.3.6 Clean and soiled workrooms. Separate clean and soiled workrooms or holding rooms shall be provided as described in Sections 1224.14.2.6 and 1224.14.2.7.

1224.31.1 Psychiatric unit space. A psychiatric unit shall be housed in a separate nursing unit and shall provide the following:

1224.31.1.1 General. A psychiatric nursing unit shall meet the requirements of Section 1224.14 for a unit that provides acute medical care. A non-medical psychiatric nursing unit shall meet the requirements of Sections 1228.4, 1228.13 and 1228.14 based on the functional program. Specific application shall respond to the patient injury and suicide prevention component of the Patient Safety Risk Assessment prepared under California Administrative Code (Part 1 of Title 24) Section 7-119. If a unit provides acute medical care, the unit shall be located in a building that is compliant with California Administrative Code Chapter 6 for OSHPD-1.

1224.31.1.2 Windows. Windows modified to prevent patients from leaving the unit.

1224.31.1.3 Access control. Entrances and exits which may be locked if necessary.

1224.31.1.4 Seclusion room(s). Seclusion rooms shall be provided and comply with Section 1224.4.4.1.4.

1224.31.1.5 Consultation room(s). Used for interviewing patients.

1224.31.1.6 Dining and recreation. Provide spaces for dining and recreation. The total area for these purposes shall be not less than 30 square feet (2.8 m [2] ) per patient.

1224.31.1.7 Storage. Storage closets or cabinets for recreational and occupation therapy equipment.

1224.31.1.8 Exam or treatment room. A room for physical examinations and medical treatment.

1224.31.1.9 Activity spaces. Psychiatric rehabilitation activity space shall be provided in compliance with Section 1228.13.1 except as modified as follows:

1224.31.1.9.1 Indoor activity rooms. Two separate activity rooms shall be provided; one may be the recreation room required by Section 1224.31.1.11, and one shall be for quiet activities to serve as a patient lounge. The patient lounge shall be a minimum 120 square feet (11.15 m [2] ).

1224.31.1.9.2 Outdoor activity area. The outdoor activity area shall be dedicated for use by the psychiatric nursing unit.

1224.31.1.10 Occupational therapy. Facilities for occupational therapy shall comply with Section 1224.35.3, Items 1, 2 and 3. 1224.31.1.11 Recreation. A recreation room with a minimum of 100 square feet (9.3 m [2] ) in each building, and on each floor of a building accommodating six or more psychiatric patients.

1224.31.1.12 Nurse call. Refer to Section 1224.4.6.5.

1224.31.1.13 Privacy. Visual privacy in multibed rooms (e.g., cubicle curtains) is not required.

1224.31.1.14 Tamper resistant. The ceiling and the air distribution devices, lighting fixtures, sprinkler heads and other appurte- nances shall be of a tamper-resistant type.

1224.31.1.15 Toilet rooms. Each patient room shall be provided with a private toilet room that meets the following requirements:

1. The door shall not be lockable from within.

2. The door shall be capable of swinging outward. 3. The ceiling shall be of tamper-resistant construction and the air distribution devices, lighting fixtures, sprinkler heads and other appurtenances shall be of the tamper-resistant type.

1224.31.1.16 Handwashing stations. Handwashing stations located in patient rooms and patient toilet rooms may include anti- ligature features that do not compromise compliance with the hot and cold water supply controls, laminar flow and sink require- ments of Section 210.0 and Table 4-2 of the California Plumbing Code. Handwashing stations within patient rooms and patient toilet rooms in psychiatric nursing units are not required to be equipped with gooseneck spouts and the discharge point may be less than 5 inches (127 mm) above the fixture rim.

1224.31.1.17 Administrative center(s) or nurse station(s). The distance between the nurse station’s entrance and the center of the doorway of the most remote patient bedroom shall not exceed 90 linear feet (27 432 mm). Refer to Section 1224.4.4.2.

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1224.31.2 Education. If a unit treats children of school age over a period of one month or more, it shall provide physical facilities for an educational program, such as classrooms and an office for the teacher.

1224.31.3 Service areas. The standards noted in Section 1224.14.2 shall apply to service areas for psychiatric nursing units.

1224.32.1 General. The obstetrical facility, including cesarean operating room(s) and delivery room(s), shall be located and designed to prohibit nonrelated traffic through the unit.

1224.32.2 Antepartum and postpartum unit .

1224.32.2.1 Patient bedrooms. Antepartum and postpartum bedrooms shall comply with Section 1224.14.1.

1224.32.2.2 Service areas. Shall be provided in accordance with Section 1224.14.2 with the following additions: 1. Staff lounge. 2. Staff storage. Lockable closets or cabinets for personal articles of staff. 3. Consultation/conference room(s).

1224.32.3 Cesarean delivery and delivery service space. When cesarean operating rooms are located in the obstetrical suite, access and service arrangements shall be such that neither staff nor patients are required to travel through the cesarean delivery area to access other services.

1224.32.3.1 Cesarean delivery suite. A minimum of one cesarean operating room shall be provided in the obstetrical unit, unless a surgical operating room is designated specifically for cesarean delivery procedures. The cesarean delivery suite shall include the following: 1224.32.3.1.1 Cesarean operating room(s). Provide a minimum clear floor area of 360 square feet (33.45 m [2] ) with a minimum dimension of 16 feet (4877 mm). There shall be a minimum of one such room.

1224.32.3.1.2 Scrub facilities . Scrub sinks shall be located outside of sterile areas and meet the requirements of Section 1224.32.3.8.2.4.

1224.32.3.1.3 Control/nurse station. A control station shall be provided in accordance with Section 1224.15.3.1 and shall be located to restrict unauthorized traffic into the suite.

1224.32.3.1.4 Soiled workroom . A soiled workroom shall be provided in accordance with Section 1224.15.3.7.

1224.32.3.1.5 Housekeeping. A housekeeping room shall be provided for the use of the cesarean delivery suite.

1224.32.3.1.6 Perioperative support services. Preoperative patient holding and post-anesthesia recovery shall be provided in accordance with Section 1224.16. Post-anesthesia care shall provide direct access to the cesarean surgical service space with- out crossing unrestricted corridors.

1224.32.3.2 Delivery room(s). At least one delivery room shall be provided in the obstetrical unit. Delivery rooms shall have a minimum clear floor area of 300 square feet (27.87 m [2] ). An emergency communication system shall be connected with the obstetri- cal facilities control station.

1224.32.3.2.1 Postpartum bed ratio. Delivery rooms, which are used for no other purpose, shall be provided at the ratio of one per 12 postpartum beds and for each major fraction thereof.

Exceptions: 1. If LDR or LDRP beds are provided, each LDR or LDRP may be counted as a delivery room in the postpartum bed ratio. This does not exempt the delivery room required per Section 1224.32.3.2. 2. When approved by the licensing agency, the operating room of small or rural hospitals with a licensed bed capac- ity of 50 or less may serve as the delivery room.

1224.32.3.3 Clocks. Shall be provided as follows: 1. A direct-wired or battery-operated clock with sweep second hand and lapsed time indicators in each cesarean operating and delivery room. 2. A direct-wired or battery-operated clock or other equivalent timing device, visible from the scrub-up sinks.

1224.32.3.4 Surgical lights. Provide a surgical light in each cesarean operating or delivery room.

1224.32.3.5 Infant resuscitation. Provide within cesarean operating rooms and delivery rooms a minimum clear floor area of 80 square feet (7.43 m [2] ) in addition to the required area of each room or may be provided in a separate but immediately accessible room with a clear floor area of 150 square feet (13.94 m [2] ). Six single or three duplex electrical outlets shall be provided for the infant in addition to the facilities required for the mother.

1224.32.3.6 Labor room(s) (LDR or LDRP rooms may be substituted). Where LDRs or LDRPs are not provided, a minimum of two labor beds shall be provided for each cesarean operating room. Each room shall be designed for either one or two beds with a minimum clear floor area of 120 square feet (11.15 m [2] ) per bed. Each labor room shall contain a handwashing station and have access to a toilet room. One toilet room may serve two labor rooms, Labor rooms shall have controlled access with doors that are arranged for observation from a nursing station. At least one shower (which may be separate from the labor room if under staff

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control) for use of patients in labor shall be provided. Windows in labor rooms, if provided, shall be located, draped or otherwise arranged, to preserve patient privacy from casual observation from outside the labor room.

Exception: Where renovation of labor rooms is undertaken in facilities built under the 2001 or prior California Building Code, existing labor rooms shall have a minimum clear floor area of 100 square feet (9.29 m [2] ) per bed.

1224.32.3.7 Recovery room(s) (LDR or LDRP rooms may be substituted). Each recovery room shall contain at least two patient care stations and have a nurse station, with charting facilities, located to permit visual observation of all beds. Each room shall include a handwashing station and a medication station. A clinical sink with bedpan flushing device shall be directly accessible, as shall storage for supplies and equipment. Provide visual privacy of the new family.

very room shall contain at least two patient_ care stations and have a nurse station, with charting facilities, located to permit visual observation of all beds. Each room shall include a handwashing station and a medication station. A clinical sink with bedpan flushing device shall be directly accessible, as shall storage for supplies and equipment. Provide visual privacy of the new family.

1224.32.3.8 Service areas. Individual rooms shall be provided as indicated in the following standards; otherwise, alcoves or other open spaces that do not interfere with traffic may be used.

1224.32.3.8.1 Services. The following services shall be provided: 1. Control/nurse station. This shall be located to restrict unauthorized traffic into the service space. 2. Soiled workroom or soiled holding room. See Section 1224.4.4.7. 3. Fluid waste disposal.

1224.32.3.8.2 Shared services. The following services shall be provided and may be shared with the surgical facilities. Where shared, areas shall be arranged to avoid direct traffic between the delivery and operating rooms. 1224.32.3.8.2.1 Supervisor’s office or station. Office or station shall be a minimum of 80 square feet (7.43 m [2] ) and have a desk.

1224.32.3.8.2.2 Waiting room. This room shall have toilet rooms, telephone(s) and drinking fountains that are immedi- ately accessible. The toilet rooms shall contain a lavatory.

1224.32.3.8.2.3 Drug distribution station. The drug distribution station shall have a handwashing station and provisions for controlled storage, preparation and distribution of medication.

1224.32.3.8.2.4 Scrub facilities for cesarean operating or delivery rooms(s). Two positions shall be provided adjacent to entrance to the first cesarean operating room. Provide one additional scrub sink per cesarean or delivery operating room. Scrub facilities shall be arranged to minimize any splatter on nearby personnel or supply carts. In new construction, provide view windows at scrub stations to permit the observation of room interiors.

1224.32.3.8.2.5 Clean utility room. A clean utility room shall be provided if clean materials are assembled within the obstetrical service space prior to use. If a clean utility room is provided see Section 1224.4.4.6.

1224.32.3.8.2.6 Storage. 1. Clean sterile storage area readily accessible to the delivery room. 2. Equipment storage room(s) for equipment and supplies used in the obstetrical service space.

1224.32.3.8.2.7 Workroom. An anesthesia workroom for cleaning, testing and storing anesthesia equipment. It shall contain a work counter, sink and provisions for separation of clean and soiled items.

1224.32.3.8.2.8 Male and female staff clothing change areas. The clothing change area shall be designed to ensure a traffic pattern so that personnel entering from unrestricted area outside the delivery service space enter, change their cloth- ing and move directly into the delivery service semi-restricted area, and eliminate cross-traffic between clean and contaminated personnel. The area shall contain lockers, showers, toilets, handwashing stations and space for donning and disposing scrub suits and booties.

1224.32.3.8.2.9 Staff lounge. Lounge and toilet room facilities for obstetrical staff shall be readily accessible to cesarean operating rooms(s), delivery room(s), labor rooms(s) and recovery room(s). Each toilet room shall contain a handwashing station.

1224.32.3.8.2.10 On-call room. An on-call room(s) for physician and/or staff shall be provided, but may be located else- where in the facility.

1224.32.3.8.2.11 Housekeeping room.

1224.32.4 LDR and LDRP facilities.

1224.32.4.1 Location. LDR room(s) may be located in a separate LDR service space or as part of the cesarean/delivery service space. The postpartum unit may contain LDRP rooms. 1224.32.4.2 Space requirements. These rooms shall have a minimum of 250 square feet (23.23 m [2] ) of clear floor area with a mini- mum dimension of 13 feet (3962 mm). There shall be space for crib and sleeping space for support person. If an infant resuscitation room is not provided elsewhere, service space shall be provided in this room per Section 1224.32.3.5 in addition to the minimum service required for the mother. The medical gas outlets shall be located in the room so that they are accessible to the mother’s delivery area and infant resuscitation area.

1224.32.4.3 Occupancy. Each LDR or LDRP room shall be for single occupancy.

1224.32.4.4 Shower or tub. Each LDR or LDRP room shall have direct access to a private toilet room with shower or tub.

1224.32.4.5 Handwashing stations. Each LDR or LDRP room shall be equipped with handwashing stations.

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1224.32.5 Newborn/well baby nurseries.

1224.32.5.1 General. Infants shall be housed in nurseries that comply with the standards below. All nurseries shall be immedi- ately accessible to the postpartum unit and obstetrical facilities. The nurseries shall be located and arranged to preclude the need for unrelated pedestrian traffic. No nursery shall open directly onto another nursery. Each nursery shall contain the following:

1224.32.5.1.1 Handwashing stations. At least one handwashing station shall be provided for each six infant bassinets.

1224.32.5.1.2 Storage. Storage for linens and infant supplies at each nursery room.

1224.32.5.1.3 Lactation. A consultation/demonstration/breast feeding or pump room shall be provided in a location that is readily accessible to the nursery. Provisions shall be made, either within the room or immediately accessible to the room, for a sink, counter, refrigeration and freezing, storage for pump and attachments and educational materials. This area may be shared between units.

1224.32.5.1.4 Workroom(s). Each nursery shall be served by a connecting workroom. The workroom shall contain gowning facilities at the entrance for staff and housekeeping personnel, work counter, refrigerator, storage for supplies and a handwash- ing station. One workroom may serve more than one nursery room provided that required services are convenient to each. Adequate provision shall be made for storage of emergency cart(s) and equipment out of traffic and for the sanitary storage and disposal of soiled waste.

1224.32.5.1.5 Housekeeping room. A housekeeping room shall be provided for the exclusive use of the nursery unit. It shall be directly accessible from the unit.

1224.32.5.1.6 Charting space. Charting facilities shall have linear surface space to ensure that staff and physicians may chart and have simultaneous access to information and communication systems.

1224.32.5.2 Space requirements. Each newborn nursery room shall contain no more than 16 infant stations. Nurseries shall provide a minimum of 25 square feet (2.32 m [2] ) of floor area per bassinet, with at least 3 feet (914 mm) between bassinets and at least 6 inches (152 mm) from a wall.

1224.33.1 Definition. Levels of emergency care range from initial emergency management as Standby Emergency Medical Service, with a Physician on call; to definitive emergency care as Basic Emergency Medical Service, with a Physician on duty; to a Comprehen- sive Emergency Medical Service as an Emergency Department.

1224.33.2 Standby Emergency Medical Service. If provided, initial emergency management shall be provided in a specifically designated area of the hospital which shall include the following elements:

1224.33.2.1 Exterior entrance. A well-marked, illuminated and covered entrance, at grade level. The emergency vehicle entry cover shall provide shelter for both the patient and the emergency medical crew during transfer from an emergency vehicle into the building. This exterior entrance shall not be substituted for the required accessible entrance to the hospital, protected from the weather by canopy or roof overhang assigned for passengers loading zone. Ambulance entrances shall provide a minimum of 6 feet (183 mm) in clear width to accommodate bariatric stretchers, mobile patient lift devices and accompanying attendants. Reception shall be located to permit staff observation and control of access to treatment area, pedestrian and ambulance entrances and public waiting area.

1224.33.2.2 Treatment room. Standby emergency service shall include at least one treatment room with the following elements: 1. The area shall not be less than 120 square feet (11.15 m [2] ) of clear floor area, exclusive of toilet room(s), waiting area and storage. 2. Each treatment room shall contain an examination light, work counter and handwashing station. 3. Medical equipment, cabinets, medication storage and counter space for writing. 4. The dimensions and arrangement of treatment rooms shall be such that there is a minimum of 3 feet (914 mm) between the sides and foot of the bed/gurney and any wall or any other fixed obstruction. The treatment room may have addi- tional space and provisions for several patients with cubicle curtains for privacy. 5. Multiple-station treatment rooms shall provide a minimum of 80 square feet (7.43 m [2] ) per patient gurney, with a mini- mum 8 foot width (2,438 mm) and 3 feet (914 mm) at the foot of the bed/gurney, with a minimum of 3 feet to any wall or fixed obstruction, and a minimum of 5 feet (1524 mm) between patient gurneys. Patient gurneys shall be separated from adjoining patient care stations by curtains. A minimum width of 6 feet (1829 mm) of access/circulation outside the curtain shall be provided. Handwashing stations shall be provided for each four treatment stations and for each major fraction thereof in multiple-station areas. These shall be uniformly distributed to provide equal access from each patient station.

neys shall be separated from_ adjoining patient care stations by curtains. A minimum width of 6 feet (1829 mm) of access/circulation outside the curtain shall be provided. Handwashing stations shall be provided for each four treatment stations and for each major fraction thereof in multiple-station areas. These shall be uniformly distributed to provide equal access from each patient station.

Exception: Where renovation of existing treatment rooms is undertaken in facilities approved under the 2001 or prior California Building Code, existing treatment rooms may be renovated, or replaced in kind one for one in the renovated space. Such treat- ment rooms shall have no less than 80 square feet (7.43 m [2] ) of clear floor area, the least dimension of which shall be 8 feet (2438 mm).

1224.33.2.3 Storage. Equipment and supply storage shall be provided and be sized for general medical/surgical emergency supplies, medications and equipment such as ventilator, defibrillator, splints, etc. This storage shall be located in an alcove or room, out of corridor or hallway traffic and under staff control.

1224.33.2.4 Lobby. Provisions for reception, control and public waiting, including a public toilet room(s) with handwashing fixture(s) and public telephone.

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1224.33.2.5 Toilet room(s). Patient toilet room(s) with handwashing station(s) shall be immediately accessible to the treatment room(s).

1224.33.2.6 Communication. Communication connections to the Poison Control Center and local EMS system shall be provided. 1224.33.2.7 Observation area. A patient station with a minimum clear floor area of 100 square feet (9.29 m [2] ) shall be provided under the visual control of an emergency service staff work area. The patient station shall have space at bedside for visitors and shall have provision for visual privacy from casual observation by other patients and visitors. The dimensions and arrangement of rooms with multiple beds/gurneys shall be such that there is a minimum of 3 feet (914 mm) between the sides and any wall or any other fixed obstruction. A minimum clearance of 3 feet (914 mm) shall be provided between beds, and a clearance of 4 feet (1219 mm) shall be available at the foot of each bed to permit the passage of equipment and beds. A handwashing station shall be located in each room, and at least one handwashing station shall be provided for every four patient stations, and for each major fraction thereof, in open-bay areas. These shall be uniformly distributed to provide equal access from each patient station.

Exception: For small and rural hospitals, the observation area need not be dedicated solely for that purpose.

1224.33.2.7.1 Behavioral health observation area. If provided, a patient station with a minimum clear floor area of 40 square feet (12.19 m [2] ) shall be provided under the visual control of an emergency service staff work area. The patient station shall have provision for visual privacy from casual observation by other patients and visitors. The dimensions and arrangement of rooms with multiple recliners, beds or gurneys shall be such that there is a minimum of 3 feet (914 mm) clearance on one side. A mini- mum clearance of 3 feet (914 mm) shall be provided between patient stations, and a clearance of 4 feet (1219 mm) shall be available at the foot of each patient station to permit the passage of equipment and beds. A handwashing station shall be located in each room, and at least one handwashing station shall be provided for every eight patient stations, and for each major fraction thereof, in open-bay areas. These shall be uniformly distributed to provide equal access from each patient station.

1224.33.2.8 Airborne infection isolation exam/treatment room. If provided, the airborne infection isolation exam/treatment room shall comply with the requirements of Section 1224.4.4.1.3.

1224.33.3 Basic Emergency Medical Service. When 24-hour basic emergency service is to be provided, at a minimum , all the provi- sions of Standby Emergency Service under Section 1224.33.2 and the following shall be provided:

1224.33.3.1 Exterior entrance. In addition to the requirements of Section 1224.33.2.1 the emergency entrance shall have direct access from public roads for ambulance and vehicle traffic conforming with the requirements of the local authorities having juris- diction. Entrance and driveway shall be clearly marked. If a raised platform is used for ambulance discharge, provide a ramp for pedestrian and wheelchair access.

1224.33.3.2 Patient access. Paved emergency access shall be provided to permit discharge of patients from automobiles and ambulances, and temporary parking convenient to the entrance.

1224.33.3.3 Reception, triage and control station(s). This area shall be located to permit staff observation and control of access to treatment areas, pedestrian and ambulance entrances and public waiting area.

1224.33.3.4 Wheelchair and gurney storage. Storage for wheelchairs and gurneys for arriving patients shall be located out of circulation paths with access to emergency entrances.

1224.33.3.5 Public waiting area. A public waiting area shall be provided in compliance with Section 1224.4.5 and include provi- sion of public toilet room(s), drinking fountains and telephone adjacent to the waiting area, dedicated to, and within, the Emergency Service Space.

1224.33.3.6. Examination and treatment room(s). Examination and treatment rooms shall meet the requirements under Section 1224.33.2.2.

1224.33.3.7 Trauma/cardiac rooms. These rooms are for emergency procedures, including emergency surgery, and shall have at least 250 square feet (23.23 m [2] ) of clear floor space. A minimum clearance of 5 feet (152 mm) shall be provided around all sides of the procedure table or gurney. Each room shall have cabinets and emergency supply shelves, image viewing capability, examina- tion lights and counter space for writing. Additional space with cubicle curtains for privacy may be provided to accommodate more than one patient at a time in the trauma room with a minimum clear floor area of 200 square feet (18.58 m [2] ) for each patient bay defined by the privacy curtains. There shall be storage provided for immediate access to attire used for universal precautions. Doors leading from the ambulance entrance to the cardiac trauma room shall have an opening with a minimum width of 5 feet (1524 mm). At least one scrub sink shall be located outside the entrance to each trauma room. One scrub station consisting of two scrub positions is permitted to serve two trauma rooms if located adjacent to the entrance of each procedure room. The place- ment of scrub sinks shall not restrict the minimum required corridor width. If a handwashing station is provided within the trauma room, it does not satisfy the requirement for a scrub sink. The handwashing station shall have a minimum of 5 feet (1524 mm) clearance from the procedure table and not located between any curtained procedure area and the entrance to a multi-bay

trauma room.

1224.33.3.8 Orthopedic and cast work. At least one orthopedic or cast room shall be provided within the emergency service space. Provisions shall include storage for splints and other orthopedic supplies, traction hooks, image viewing capability and examination lights. If a sink is used for the disposal of plaster of paris, a plaster trap shall be provided. The clear floor space for this area shall be a minimum of 180 square feet (16.7 m [2] ).

1224.33.3.9 Poison Control Center and EMS communications center. Communication connections shall be provided as required under Section 1224.33.2.6. The communications center may be a part of the staff work and charting area.

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1224.33.3.10 Emergency equipment storage space. Equipment and supply storage shall be provided as required under Section 1224.33.2.3.

1224.33.3.11 Patients’ toilet room. A patient toilet room with a lavatory shall be immediately accessible to the treatment room(s). Where there are more than eight treatment stations, a minimum of two toilet rooms, with a lavatory in each toilet room, shall be required.

1224.33.3.12 Storage. Provide rooms for clean, soiled or used supplies.

1224.33.3.12.1 Soiled workroom or soiled holding room. See Section 1224.4.4.7. This room is for the exclusive use of the emer- gency service space.

1224.33.3.12.2 Clean utility room. See Section 1224.4.4.6.

1224.33.3.13 Administrative center or nurse station for staff work and charting. These areas shall have space for counters, cabinets and shall be provided with handwashing stations. They may be combined with or include centers for reception and communication.

1224.33.3.14 Medication preparation room. A minimum of one medication preparation room shall be provided in accordance with Section 1224.4.4.4.1. Self-contained medication dispensing units may be provided in addition.

1224.33.3.15 Staff lounge. A staff lounge shall be located within the Emergency Department.

1224.33.3.16 Staff clothing change areas. Appropriate areas shall be provided for male and female staff working within the emergency service space. The areas shall contain lockers, showers, toilets and handwashing stations.

1224.33.3.17 Housekeeping room. A housekeeping room, compliant with Section 1224.4.15, shall be located within the unit and dedicated to the emergency service space.

1224.33.3.18 Airborne infection isolation exam/treatment room. If provided shall comply with the requirements of Section 1224.4.4.1.3.

1224.33.3.19 Secured holding room. When a secure holding room is provided, it shall meet the following requirements. 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, diffusers and fire protection/alarm components shall be tamper resistant 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 of the door only. The minimum width shall be 44 inches (1120 mm).

5. A small impact-resistant view panel or window shall be provided in the door for discreet staff observation of the patient.

1224.33.4 Comprehensive Emergency Medical Service. When 24-hour comprehensive emergency service is to be provided, an Emergency Department shall be provided. At a minimum, all the provisions of Stand-by Emergency Service under Section 1224.33.2, the provisions of Basic Emergency Service under Section 1224.33.3, and all of the following shall be provided:

1224.33.4.1 Triage stations. In addition to the requirements of Section 1224.33.3.3, the triage area shall include triage station(s) with the following minimum requirements: 1. 100 square feet (9.29 m [2] ) minimum clear floor area for each private triage room and 80 square feet (7.4 m [2] ) minimum clear floor area for each station in open-bay triage areas. 2. Provisions for patient privacy. 3. Handwashing station in each triage room. In open-bay triage areas, one handwashing station shall be provided for every four triage stations. 4. Immediate access to emergency call and code call stations. 5. Medical gas outlets for triage areas in compliance with Table 1224.4.6.1.

1224.33.4.2 Fast-track area. A fast-track area may be used for treating patients presenting simple and less serious conditions. If a fast-track area is provided, it shall meet the following requirements: 1. Space requirements – each fast-track room shall have a minimum 100 square feet (9.29 m [2] ) of clear floor area. In open- bay fast-track areas, each station shall have a minimum 80 square feet (7.4 m [2] ) of clear floor area. 2. Each patient care station shall include a work/documentation counter and an examination light. 3. Each fast-track room shall include a handwashing station. In open-bay fast-track areas, one handwashing station shall be provided for every four beds. 4. Provisions for patient privacy. 5. Storage areas for supplies and medication. 6. A separate procedure room may be provided. It shall have a minimum clear floor area of 120 square feet (11.15 m [2] ).

1224.33.4.3 Pre-screening stations. A pre-screening area may be used prior to admission to the Emergency Department. If pre- screening is provided, each station must have a minimum of 80 square feet (7.4 m [2] ) of clear floor area, a handwashing station,

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documentation counter and a storage cabinet. In open bay pre-screening areas, one handwashing station shall be provided for every four patient stations. Pre-screening stations, whether private rooms or open bays, are considered a part of the waiting area and must meet the same ventilation requirements.

1224.33.4.4 Diagnostic service areas. Radiological/Imaging services shall be readily accessible. The Emergency Department shall be supported by Clinical Laboratory services. A STAT lab may be provided within the emergency medical service space in addition to more comprehensive support provided by the Clinical Lab.

1224.33.4.5 On-call room(s). Provisions shall be made to accommodate on-call sleeping room(s) for physicians and/or medical staff within the Emergency Department.

1224.33.4.6 Police and press room. Provisions shall be made to accommodate police briefing/debriefing and press releases. This may be located outside the Emergency Department.

1224.33.5 Other space considerations.

1224.33.5.1 Observation units. Observation rooms for the monitoring of patients up to 24 hours may be provided as a distinct unit within, the emergency department. If provided the unit shall have the following: 1. Handwashing stations shall be provided in each patient room and for each four treatment stations, and for each major fraction thereof. These shall be uniformly distributed to provide equal access from each patient station. Handwashing stations shall be directly accessible to nurse stations and patient care areas. 2. Each patient station shall provide space at each bedside for visitors and provision for visual privacy from casual observa- tion by other patients and visitors. Single station rooms shall have a minimum of 120 square feet (11.15 m [2] ) of clear floor area. Multiple-station rooms shall provide a minimum of 80 square feet (7.43 m [2] ) per patient station with a minimum 8- foot width (2438 mm). A minimum distance of 3 feet (914 mm) between the sides and any wall or any other fixed obstruc- tion shall be provided. A minimum distance of 3 feet (914 mm) shall be provided between beds and 4 feet (1219 mm) at the foot of each bed to permit the passage of equipment and beds. Patient gurneys shall be separated from adjoining patient stations by curtains. 3. One toilet room shall be provided for each six treatment stations and for each major fraction thereof. 4. An administrative center/nurse station, in compliance with Section 1224.4.4.2, positioned to allow staff to observe each patient care station or room. 5. A nourishment area in compliance with Section 1224.4.4.5.

1224.34.1 General. If nuclear medicine is provided, the following shall be provided:

1224.34.1.1 Radiation protection. A certified physicist shall specify the type, location and amount of radiation protection to be installed in accordance with final approved department layout and equipment selection. A physicist report shall also address dosing areas and circulation paths of dosed patients, including within multi-bay scanner rooms. Radiation protection require- ments shall be incorporated into the construction documents and comply with Chapter 31C and the requirements of California Radiation Control Regulations, California Code of Regulations, Title 17, Division 1, Chapter 5, and Subchapter 4.

1224.34.1.2 Nuclear medicine room. Shall be sized to accommodate the equipment and a gurney.

When provided, the following facilities shall meet the requirements below:

1224.34.1.2.1 Scintigraphy (Gamma Camera) Facilities. Shall include the following: 1. Scanner room. The scanner room shall provide a minimum clearance of 4 feet (1218 mm) at each side and the foot of the table.

2. Handwashing stations shall be provided throughout the gamma camera suite at locations of patient contact and at locations where radiopharmaceutical materials are handled, prepared or disposed of.

1224.34.1.2.2 Positron Emission Tomography (PET). Shall include the following: 1. Scanner room shall provide a minimum clearance of 4 feet (1218 mm) at each side and the foot of the table. Additional space shall be provided when PET is combined with CT and include compliance with Section 1224.18.3 and shielding requirements in Section 1224.34.1.1. 2. Cyclotron room. Where radiopharmaceuticals are prepared on-site, a cyclotron shall be provided. Cyclotron facilities shall be located in access-restricted areas. Shielding requirements for cyclotron facilities shall comply with Section 1224.34.1.1.

3. Control room. If a control room is required based on the physicist’s report, it shall be provided with a full direct view of the patient in the PET scanner. 4. Patient uptake/cool-down room. A shielded room with access to a dedicated patient toilet, to accommodate radioac- tive waste, and lavatory shall be provided. 5. Handwashing stations shall be provided throughout the PET suite at locations of patient contact and at locations where radiopharmaceutical materials are handled, prepared or disposed of. 6. Pre-procedure patient care and recovery area shall be provided to accommodate at least two stretchers. This area shall comply with Section 1224.34.2.6. 7. Imaging equipment room shall be provided in support of the equipment provided.

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8. Contaminated (hot) soiled holding shall be provided and operationally integrated to minimize incidental exposure to ionizing radiation.

1224.34.1.2.3 Single-Photon Emission Computed Tomography (SPECT) Facilities. When provided shall include the following: 1. Scanner room shall provide a minimum clearance of 4 feet (1218 mm) at each side and the foot of the table. Additional space shall be provided when SPECT is combined with CT and include compliance with Section 1224.18.3 and shield- ing requirements in Section 1224.34.1.1. In multi-bay scanner rooms, a minimum clearance of 4 feet (1218 mm) shall be provided between each scanner and any mobile screen used between bays. 2. If a control room is required based on the physicist’s report, it shall be provided with a full view of the patient in the SPECT scanner.

3. Imaging equipment room shall be provided in support of the equipment provided. 4. Handwashing stations shall be provided throughout the SPECT suite at locations of patient contact and at locations where radiopharmaceutical materials are handled, prepared or disposed of.

1224.34.1.3 Radiopharmacy. If radiopharmaceutical preparation is performed, an area adequate to house a radiopharmacy shall be provided with appropriate shielding. This area shall include adequate space for storage of radionuclides, chemicals for preparation, dose calibrators and record keeping. If preprepared materials are used, storage and calculation area may be consid- erably smaller than that for on-site preparation. Space shall provide adequately for dose calibration, quality assurance and record keeping. The area may still require shielding from other portions of the facilities.

1224.34.2 Support areas for nuclear medicine services. The nuclear medicine area shall provide the following support areas. If nuclear medicine is provided within the imaging department, compatible areas may be shared with other imaging modalities:

1224.34.2.1 Entrance. Space shall be adequate to permit entry of gurneys, beds, and able to accommodate imaging equipment, electronic consoles, and if present, computer terminals.

1224.34.2.2 Cleanup. Provisions for cleanup shall be located within the service space and be readily accessible. They shall include a service sink or floor receptacle as well as storage space for equipment and supplies.

1224.34.2.3 Consultation. A consultation area may be provided.

1224.34.2.4 Waiting. Waiting areas shall be provided out of traffic, under staff control. If the department is routinely used for outpatients and inpatients at the same time, separate waiting areas shall be provided with screening or visual privacy between the waiting areas.

1224.34.2.5 Dose administration area. Provide a dose administration area that is immediately accessible to the preparation area. Since as much as several hours may elapse for the dose to take effect, the area shall provide for visual privacy from other

areas.

1224.34.2.6 Pre-procedure/holding area. A pre-procedure/holding area for patients on gurneys or beds shall be provided out of traffic and under control of staff and may be combined with the dose administration area with visual privacy between the areas.

1224.34.2.7 Patient dressing rooms. Patient dressing rooms shall be immediately accessible to the waiting area and procedure rooms. Each dressing room shall include a seat or bench, a mirror, and provisions for hanging patients’ clothing and for securing valuables.

1224.34.2.8 Patient toilet room(s). Patient toilet rooms shall be reserved for nuclear medicine patients and shall be immediately accessible to waiting and procedure rooms.

1224.34.2.9 Staff toilet rooms. Staff toilet rooms shall be readily accessible to the nuclear medicine laboratory.

1224.34.2.10 Handwashing stations. Handwashing stations shall be located within each procedure room.

1224.34.2.11 Control desk and reception.

1224.34.2.12 Storage area for clean linen.

1224.34.2.13 Soiled and contaminated material. Provisions with handwashing stations shall be made for holding soiled mate- rial. Separate provisions shall be made for holding contaminated material.

1224.34.2.14 Hot lab for scintigraphy (gamma camera), PET and SPECT facilities. A securable area or room shall be provided in which radiopharmaceuticals can be safely stored and doses can be calculated and prepared. 1. A single hot lab shall be permitted to serve multiple scanners and nuclear medicine modalities. 2. The hot lab shall be shielded in compliance with Section 1224.34.1.1. 3. A source storage area, a dose area and a storage area for syringe shields shall be provided.

1224.34.3 Radiotherapy service space.

1224.34.3.1 Radiation therapy space. If radiation therapy is provided, the following shall be accommodated: 1. Patient reception and waiting areas. 2. Space for medical and physics staff functions. 3. Space for equipment and supplies. 4. Housekeeping room. 5. Direct access to space provided for radiation measurement and calibration equipment, including a calibration constancy instrument and access to a secondary standard dose meter.

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5.1. A megavoltage treatment unit capable of delivering x-rays or gamma rays of effective energy 500 KeV or more and conforming to the requirements of Chapter 31C and the California Radiation Control Regulations, Califor- nia Code of Regulations, Title 17, Division 1, Chapter 5, Subchapter 4. 5.2. Access to a medium voltage or superficial treatment unit delivering 500 KeV or less, but otherwise having the same functional characteristics as the above mega-voltage units and conforming to the requirements of Chap- ter 31C and the California Radiation Control Regulations, California Code of Regulations, Title 17, Division 1, Chapter 5, Subchapter 4. 5.3. Direct access to space provided for brachytherapy equipment which shall meet the requirements of Chapter 31C and the California Radiation Control Regulations, California Code of Regulations, Title 17, Division 1, Chap- ter 5, Subchapter 4. 5.4. Shielding of the rooms shall meet the requirements of Chapter 31C and the California Radiation Control Regula- tions. California Code of Regulations, Title 17, Division 1, Chapter 5, Subchapter 4.

1224.34.3.2 Radiation protection. Cobalt, linear accelerators, hot lab and high dose rate brachytherapy rooms and simulation rooms require radiation protection. All rooms that provide radiation treatment shall be appropriately shielded. A certified physi- cist shall specify the type, location and amount of protection to be installed in accordance with final approved department layout and equipment selection. Radiation protection requirements shall be incorporated into the construction documents and comply with Chapter 31C and the requirements of California Radiation Control Regulations, California Code of Regulations, Title 17, Divi- sion 1, Chapter 5 and Subchapter 4.

1224.34.3.3 Room sizes. Rooms shall be sized as follows:

1. Cobalt rooms and linear accelerators shall be sized in accordance with equipment requirements and shall accommo- date a gurney for litter borne patients. Layouts shall provide for preventing the escape of radioactive particles. Openings into the room, including doors, ductwork, vents and electrical raceways and conduits, shall be baffled to prevent direct exposure to other areas of the facility. 2. Simulator, accelerator and cobalt rooms shall be sized to accommodate the equipment with patient access on a gurney, medical staff access to the equipment and patient, and service access. 3. Where a table is used, the room shall be sized to provide a minimum clearance of 4 feet (1218 mm) on three sides of the table to facilitate bed transfer and provide access to the patient. The door swing shall not encroach on the equipment space, patient circulation space or transfer space. 4. Minimum room size shall be 260 square feet (24.15 m [2] ) for the simulator room; 680 square feet (63.17 m [2] ), including the maze, for accelerator rooms; 200 square feet (18.58 m [2] ) for brachytherapy rooms; and 450 square feet (41.81 m [2] ) for cobalt rooms.

nt. The door swing shall not encroach on the equipment_ space, patient circulation space or transfer space. 4. Minimum room size shall be 260 square feet (24.15 m [2] ) for the simulator room; 680 square feet (63.17 m [2] ), including the maze, for accelerator rooms; 200 square feet (18.58 m [2] ) for brachytherapy rooms; and 450 square feet (41.81 m [2] ) for cobalt rooms.

1224.34.3.4 General support area. The following areas shall be provided: 1. A gurney hold area adjacent to the treatment rooms, screened for privacy and combined with a seating area for outpatients. 2. Exam or treatment room shall be provided with a minimum of 100 square feet (9.29 m [2] ) with a minimum dimension of 8 feet (2438 mm). Each exam room shall be equipped with a handwashing station.

Exceptions: 1. Where renovation of existing treatment rooms is undertaken in facilities built under the 2001 or prior California Building Code, treatment rooms shall have no less than 80 square feet (7.43 m [2] ) of clear floor area. 2. Darkroom is optional. If provided, shall be readily accessible to the treatment room(s) 3. Patient gowning area with provision for safe storage of valuables and clothing and with direct access to toilet room(s). At least one space shall be large enough for staff-assisted dressing. 4. Film files area is optional. If provided shall have storage for unprocessed film.

1224.34.4 Additional support areas for linear accelerator.

1224.34.4.1 Mold room with exhaust hood and handwashing fixture.

1224.34.4.2 Block room with storage. The block room may be combined with the mold room.

1224.34.5 Additional support areas for cobalt room.

1224.34.5.1 Hot lab. A hot lab shall be provided in accordance with Section1224.34.2.14.

1224.34.6 Radiosurgery suite. If radiosurgery (gamma knife/cyber knife) is provided, the following shall be provided:

1224.34.6.1 General. The radiosurgery suite shall be located near the imaging services suite to facilitate image acquisition prior to radiosurgery treatment. Location of gamma knife or cyber knife treatment rooms in a radiation therapy suite shall be permitted.

1224.34.6.2 Radiosurgery treatment rooms. Radiosurgery (gamma knife/cyber knife) treatment rooms shall provide a minimum clearance of 4 feet (1218 mm) shall be provided on all sides of the treatment table/chair. The door shall not encroach on the equipment or on patient circulation or transfer space. A handwashing station shall be provided in each radiosurgery treatment room.

1224.34.6.3 Pre-procedure/recovery accommodations. If provided, pre-procedure/recovery patient care stations shall meet the following requirements: 1. Pre-procedure and recovery area(s) shall be immediately accessible to procedure rooms and separate from corridors. The pre-procedure and recovery patient area or room shall be arranged to permit visual observation of the patient by

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staff before and after the procedure. Bays, cubicles or single-bed rooms shall be permitted to serve as patient care stations.

2. Area. Where open bays are used, each patient care station shall have a minimum clear floor area of 80 square feet (7.43 m [2] ). 3. Clearances. Each bay or cubicle shall have a minimum clearance of 3 feet (914 mm) between walls or partitions and the sides and foot of gurneys or patient beds. Each bay shall have a minimum clearance of 4 feet (1218 mm) between sides of gurneys or patient beds. A minimum width of 6 feet (1829 mm) of access/circulation outside the curtain shall be provided. 4. Patient privacy. Provisions such as cubicle curtains shall be provided for patient privacy. 5. Handwashing station. A handwashing station shall be provided within the pre-procedure/recovery area.

1224.34.6.4 Support areas for radiosurgery treatment rooms. The following shall be provided: 1. Space for sterilization of head-frames. 2. Area for target planning.

3. Medication station.

4. Nourishment area.

5. Head-frame storage. 6. Toilet room(s) for patients, staff and the public. 7. Area for sedation of pediatric patients.

Where two or more rehabilitation services are provided, facilities and equipment between services may be shared. Rehabilitation therapy services may be provided as part of a dedicated inpatient nursing unit in a rehabilitation center or as outpatient services, or both.

1224.35.1 Rehabilitation center space. If provided, a rehabilitation center space shall be designed to meet the requirements of Section 1224.14, except as follows: 1. Patient bedrooms shall contain a minimum of 110 square feet (10.22 m [2] ) of clear floor area per bed, exclusive of toilet room(s), closets, lockers, wardrobes, alcoves or vestibules, with greater space provided for special needs such as circ-o-elec- tric beds.

2. Space for group dining shall be provided at the minimum rate of 20 square feet (1.86 m [2] ) per bed. 3. Space for group recreation or patient’s lounge shall be provided at the minimum rate of 20 square feet (1.86 m [2] ) per bed. 4. Space for staff conferences, patient evaluation and progress reports. 5. A classroom space. 6. Outpatient rehabilitation services shall be provided. An examination and treatment room shall be adjacent or directly accessible to an office for the physician in charge of the outpatient service. 7. For outpatient rehabilitation services, a patient waiting area with access to telephone, drinking fountain and men’s and women’s toilet room facilities shall be in or adjacent to the rehabilitation outpatient service area. Outpatients shall not traverse an inpatient nursing unit. 8. Access to an outside area to be used for therapeutic procedures for patients. 9. At least one training toilet room in each patient unit with minimum dimensions of 5 feet by 6 feet (1524 mm by 1829 mm). 10. Patient bathtubs, where provided, of standard height and located to provide access to both sides and one end of the tub. 11. Patient showers, where provided in centralized bathing facilities, shall comply with Section 11B-608.2.2, no dimension of which shall be less than 4 feet (1219 mm), be equipped with handrails, privacy curtains, and designed for ease of accessibil- ity. The floor shall be sloped to provide drainage. 12. As a minimum, physical therapy, occupational therapy and speech therapy shall be provided. The space for these individual services shall be designed to meet the requirements of Sections 1224.35.2, 1224.35.3 and 1224.35.4, respectively.

feet (1219 mm), be equipped with handrails, privacy curtains, and designed for ease of accessibil-_ ity. The floor shall be sloped to provide drainage. 12. As a minimum, physical therapy, occupational therapy and speech therapy shall be provided. The space for these individual services shall be designed to meet the requirements of Sections 1224.35.2, 1224.35.3 and 1224.35.4, respectively.

1224.35.2 Physical therapy service space. If physical therapy is part of the service, the following shall be included: 1. The minimum floor area for a physical therapy space shall be 300 square feet (27.87 m [2] ) with no dimensions less than 12 feet (3658 mm) in addition to any provided therapy stations. Each individual patient care station shall have a minimum clear floor area of 60 square feet (5.57 m [2] ), except individual patient care stations formed with permanent partitions shall have a minimum clear floor area of 80 square feet (7.43 m [2] ). Each individual patient care station shall have privacy screens or curtains.

2. Handwashing stations for staff shall be provided in each treatment room. At least one handwashing station shall be provided for every four patient care stations, and for every major fraction thereof, in an open treatment area. One hand- washing station may serve several treatment stations.

3. Exercise area and facilities.

4. Clean linen and towel storage. 5. Storage for equipment and supplies. 6. Separate storage for soiled linen, towels and supplies. Exception: When approved by the licensing agency small or rural hospitals are exempt from Sections 1224.35.2.1 through 1224.35.2.6.

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1224.35.3 Occupational therapy service space. If this service is provided, the following shall be included:

1. Work areas and counters suitable for wheelchair access.

2. Handwashing stations. 3. Storage for supplies and equipment. 4. An area for teaching daily living activities shall be provided. It shall contain an area for a bed, kitchen counter with appli- ances and sink, bathroom and a table/chair.

1224.35.4 Speech pathology and/or audiology service space. If a speech pathology service is provided, space shall be provided for: 1. Tables and chairs to conduct interviews, consultations and treatment, and to accommodate patients in wheelchairs and stretchers.

2. A waiting area with access to public toilet room(s) if outpatients are being served. 3. Handwashing stations. 4. Testing unit. If an audiology service is provided, there shall be, in addition to Items 1, 2 and 3 above, a minimum of one two- room testing unit that meets the American National Standards Institute, ANSI/ASA S-3.1, 1999, (2008) Maximum Permissible Ambient Noise Levels for Audiometric Test Rooms.