Section 1224 — [OSHPD 1 & OSHPD 1R]

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 gen- eral acute-care hospital license provided either in a separate unit.

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

1224.2 Application.¶

New buildings and additions, alterations or repairs to existing buildings subject to licensure shall comply with applicable provisions of the California Electri- cal Code, California Mechanical Code, California Plumbing Code, California Energy Code, California Fire Code, Cali- fornia 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 effec- tive date of this section shall not be required to insti- tute corrective alterations or construction to comply

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1224.3 Definitions.¶

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 profes- sional 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 pur- poses of diagnosis.

BASIC SERVICES. Those essential services required for licensure as a hospital, including medical, nursing, surgical, anesthesia, laboratory, 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 requir- ing 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, spe- cific 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 space 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 main- tained to support quality health care.

EXAM ROOM. A room with a bed, stretcher, or examination table and capability for periodic monitoring (e.g., measure- ment of blood pressure or pulse oximetry) in which proce- dures 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,

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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, hav- ing a duly constituted governing body with overall adminis- trative and professional responsibility and an organized medical staff which provides 24-hour inpatient care, includ- ing the basic services.

HANDWASHING STATION. An area that provides a hand- washing fixture, cleansing agents and means for drying hands. 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 psychiatric hospitals.

HOUSEKEEPING. Services anywhere within a health care facility that include general cleaning and tidying and the provision and positioning 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 proce- dures nor the nonroutine disposition of hazardous materials such as potentially toxic drugs or other chemicals and radioactive wastes.)

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 con- nected 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 ser- vice 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, or located in and shared with an adjacent directly accessible unit.

MONOLITHIC. A surface free of fissures, cracks, perfora- tions, and crevices.

MONOLITHIC CEILING. A ceiling constructed with a sur- face 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 hos- pital 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 management of patients.

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OPERATING ROOM. A room specifically designed for the performance of surgical procedures. (In common under- standing, this means most types of surgical procedures, espe- cially those involving the administration of anesthesia, multiple personnel, recovery room access, and a fully con- trolled environment.)

HYBRID OPERATING ROOM. A room that meets the definition of an operating room and is also equipped to enable diagnostic imaging before, during, and after surgi- cal 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

BAY (patient). A space for human occupancy with one hard wall at the headwall and three soft walls (e.g., cubi- cle curtains or portable privacy screen).

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.

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

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

RESTRICTED AREA. A designated space with limited access eligibility. Such space has one or more of the follow- ing attributes: specific signage, physical barriers, security controls and protocols that delineate requirements for moni- toring, maintenance, attire, and use. The term is often applied to specialized procedure suites, such as operating rooms and suites, interventional imaging, cardiac catheterization labs, angiography suites, etc.

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. Other- wise, 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.

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 Sup- plemental Service is provided. The Service Space shall include all the functional area requirements required to deliver the specific Service. Basic Service Spaces are identi- fied in Sections 1224.14 through 1224.27. Supplemental Service Spaces are identified in Sections 1224.28 through 1224.41. 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, sup- port areas or separate Rooms as defined in Section 1224.3. See departmental boundary requirements under Section 1224.4.4.7.6.

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 regula- tion 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.

1224.4 GENERAL CONSTRUCTION.¶

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 Sec- tion 307A.

[OSHPD 1R] Services/systems and utilities shall only originate in, or pass through or under struc- tures which are under the jurisdiction of the Office of Statewide Health 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 Health Planning and Devel- opment (OSHPD).

1224.4.2 Environmental engineering and support service spaces.¶

spaces. Spaces for dietary, laundry, morgue, ambulance entrance, receiving areas, power plants, mechanical equip- ment, incinerator, garbage can cleaning, automobile park- ing 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, phar- macy, physical therapy and service spaces serving only out- patients and similar outpatient service departments shall

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not be located in nursing units, surgical units, perinatal units, nursery areas, central sterilization rooms, food-ser- vice' 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 inpa- tients.

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 facil- ities and the requirements associated with each, as listed below, shall be used unless modified under a specific Ser- vice Space section.

1224.4.4.1 Examination and treatment 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 hand- washing fixture and accommodations for written or electronic documentation shall be provided.

1224.4.4.1.2 Treatment room.¶

Unless specified else- where, 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/gur- ney/table and any wall or other fixed obstruction. The room shall contain an examination light, a work counter for medical equipment, a handwashing fix- ture, cabinets, medication storage and counter space for writing or electronic documentation. 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 stor- age facilities, In multi-bed treatment rooms, a hand- washing fixture shall be provided in the room for each three or fewer cubicles.

1224.4.4.1.3 Airborne infection isolation exam/ treatment room.¶

treatment room. When provided, the airborne infec- tion 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 iso- lation exam/treatment room.

3. Gowning and storage area. An area for gown- ing and storage of clean and soiled materials shall be located directly outside or inside the

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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.¶

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-clos- ing devices.

3. The anteroom shall provide storage of per- sonal 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 Seclusion room.¶

Where provided, seclu- sion rooms shall comply with the following require- ments:

1224.4.4.1.4.1 General.

1. Capacity. Each room shall accommodate only one patient.

2. Layout and access. Seclusion rooms shall be accessed through an anteroom or vesti- bule 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).

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.

1224.4.4.1.4.2 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

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(2134 mm) and a maximum wall length of 11 feet (3353 mm).

1224.4.4.1.4.3 Special design elements.¶

Seclu- sion rooms shall be designed and constructed in compliance with the following requirements:

1. The walls, ceiling, and floor of the seclu- sion room shall be designed to withstand direct and forceful impact. If padded mate- rials 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 provisions 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 surveil- lance 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 cen- ters 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 per- mitted for specimen collection.

1224.4.4.3.2 Blood collection facilities.¶

When pro- vided, 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 pro- vided, this room shall be lockable and be directly accessible from the nursing station. When a medi- cine preparation room is to be used to store one or more self-contained medicine dispensing units, the room shall be designed with adequate space to pre- pare medicines with the self-contained medicine dis- pensing unit(s) present. Medicine 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.¶

unit. If provided, a self-contained medicine dispens- ing unit shall be located at the nurses’ 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 pro- vided 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.

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

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

1224.4.4.6 Clean utility/workroom.¶

The clean work- room 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

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1224.4.6.1 Station outlets.¶

Station outlets for oxygen, vac- uum, 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 sys- tems shall conform to Table 1224.4.6.1 and NFPA 99.

1224.4.6.3 Hyperbaric facilities. The design and con- struction of hyperbaric facilities shall conform to NFPA 99; Health Care Facilities 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 psychiatric care of patients who are not bedridden shall have a minimum clear and unobstructed width of 6 feet (1829 mm). For the pur- poses of this section, bedridden patients shall be defined as patients confined to beds who would be transported or evacuated in beds or litters.

1224.4.7.2 Light traffic.¶

Service corridors and hall- ways with anticipated light traffic volume for nonpa- tient use may be reduced to a width of 5 feet (1524 mm) if approved by the enforcing agency.

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

1224.4.7.3 Outpatient services. Outpatient clinics or outpatient departments which contain facilities for out- patient use only, such as laboratory, x-ray, physical therapy or occupational therapy, shall have a minimum corridor or hallway width of 5 feet (1524 mm). Outpa- tient 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 build- ing, 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 hand- rail 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 con- nect all patient rooms and basic services.

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

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 sup- ply 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 California Plumbing Code, Tables 4-2 and 4-3. 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 dedi- cated toilet rooms.

1224.4.4.8.2 Signage.¶

When provided, single-user toilets shall include a door-mounted geometric sym- bol, as identified in Section 11B-703.7.2.6.3, Unisex toilet and bathing facilities, and wall signage desig- nating use for patients, staff or public. When exist- ing 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 toi- lets, drinking fountains and telephones shall be readily accessible.

Note: One waiting area may serve more than one depart- ment or service.

1224.4.5.1 Outpatient access. Outpatient access to ser- vices shall not traverse a nursing unit.

1224.4.6 Miscellaneous requirements.

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TABLE 1224.4.6.1¶

STATION OUTLETS FOR OXYGEN, VACUUM (SUCTION), AND MEDICAL AIR SYSTEMS ^{1, 6}

	LOCATIONS	OXYGEN	VACUUM	MEDICAL AIR	WAGD3
1	Patient rooms (medical/surgical unit)	1/bed	1/bed	—	—
2	Examination or treatment (medical/surgical unit and postpartum care)	1/room	1/room	—	—
3	Airborne infection isolation or protective environment rooms (medi- cal/surgical unit)	1/bed	1/bed	—	—
4	Seclusion room (medical/surgical unit and postpartum care)	1/bed	1/bed	—	—
5	Intensive care (general)	3/bed	3/bed	1/bed	—
6	Airborne infection isolation	3/bed	3/bed	1/bed	—
7	Coronary-care service space	3/bed	2/bed	1/bed	—
8	Pediatric intensive care	3/bed	3/bed	1/bed	—
9	Newborn intensive care	3/bassinet	3/bassinet	3/bassinet	—
10	Newborn nursery (full term)	_1/4 bassinets_2	_1/4 bassinets_2	_1/4 bassinets_2	—
11	Pediatric and adolescent	1/bed	1/bed	1/bed	—
12	Pediatric nursery	1/bassinet	1/bassinet	1/bassinet	—
13	Psychiatric patient room	—	—	—	—
14	Seclusion treatment room (psychiatric unit)	—	—	—	—
15	General operating room	2/room	5/room	1/room	1/room
16	Cardio and special procedures	2/room	5/room	1/room	1/room
17	Orthopedic surgery	2/room	5/room	1/room	1/room
18	Surgical cystoscopic and other endo-urologic procedures	1/room	3/room	—	—
19	Post-anesthesia care unit	2/bed	3/bed	1/bed	—
20	Anesthesia workroom	1/workstation	—	1/workstation	—
21	Endoscopy procedure room	1/room	3/room	—	—
22	Postpartum bedroom	1/bed	1/bed	—	—
23	Cesarean operating/delivery room	2/room	4/room	1/room	1/room
24	Recovery space for cesarean delivery	1/bed	3/bed	1/bed	—
25	Infant resuscitation space4	3/bassinet	3/bassinet	3/bassinet	—
26	Labor room	1/room	1/room	—	—
27	OB recovery room	1/bed	3/bed	—	—
28	Labor/delivery/recovery (LDR)5	1/bed	1/bed	—	—
29	Labor/deliver/recovery/postpartum (LDRP)5	1/bed	1/bed	—	—
30	Initial emergency management	1/bed	1/bed	1/bed	—
31	Triage area (definitive emergency care)	1/station	1/station	—	—
32	Definitive emergency care examination or treatment rooms	1/bed	1/bed	1/bed	—
33	Observation unit8	1/bed	1/bed	—	—
34	Trauma/cardiac room(s)	2/bed	3/bed	1/bed	—
35	Orthopedic and cast room	1/room	1/room	—	—
36	Cardiac catheterization lab	2/bed	2/bed	2/bed	—
37	Autopsy room	—	1/workstation	—	—
38	MRI	1/room	1/room	1/room	—
39	Interventional imaging procedure room	2/room	2/room	1/room	—
40	Hyperbaric suite pre-procedure/patient holding area	2/station	2/station	—	—
41	Electroconvulsive therapy procedure room	1/room7	1/room7	—	—

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.

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TABLE 1224.4.6.5¶

[OSHPD 1, 1R, 2, 3, 4 & 5] LOCATION OF NURSE CALL DEVICES

        - **_= Required_**

AREA DESIGNATION	STATION TYPE	1224	1225	1226	1227	1228
*Nursing Units*	*Nursing Units*	*Nursing Units*	*Nursing Units*	*Nursing Units*	*Nursing Units*	*Nursing Units*
Patient toilet room	B
Patient bathing	B
Special bathing	E
Patient bed (nursing service)	P,E,C
Patient bed (intensive care)	P,E,C
Patient bed (LDR/LDRP)	P,E,C
Patient bed (Dementia Unit)	P
Patient bed (SNF/ICF)	P
NICU	E,C
Nursery	E,C
*Support Areas*	*Support Areas*	*Support Areas*	*Support Areas*	*Support Areas*	*Support Areas*	*Support Areas*
Nurse/control station	M
Medication preparation room	D
Soiled workroom/utility/holding	D
Clean workroom/utility/holding	D
*Diagnostic and Treatment Areas*
Seclusion room or vestibule	E
Emergency exam, treatment, triage rooms	P,E
Operating room/Cesarean	E,C
Delivery room/Birthing room	E,C
Observation unit bed/gurney	P,E,C
Pre-op patient care	P,E,C
Post-op patient care/PACU	P,E,C
Imaging exam/procedure room	E,C
Procedure Room, including Endoscopy	E,C
Patient toilet room	B
Electroconvulsive therapy	E,C

Station Types

P = Patient Station, B = Bath Station, E = Staff Emergency, C = Code Call, M = Master, D = Duty

1224.4.7.6 Departmental boundaries.¶

Department/ser- vice 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 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 serv- ing 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 depart- ments.

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 hard- ware 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.

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1224.4.9 Windows and screens.¶

1224.4.9.1 Windows . Rooms approved for the hous- ing 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 nurses’ station.

Exception: Window sills in intensive-care units may be 60 inches (1524 mm) above the floor.

1224.4.9.2.1 Airborne infection isolation or protec-tive environment rooms.¶

tive environment rooms. If operable windows are provided in airborne infection isolation or protec- tive environment rooms, they shall only be operable by the use of tools or keys which shall be located at the nurses ’ 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 mechani- cally operated ventilating system as specified in the California Electrical Code and the California Mechan- ical 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 mini- mum ceiling heights shall not be less than 7 feet (2134 mm).

1224.4.10.2 Minimum height with fixed ceiling equip-ment.¶

ment. Operating rooms, emergency rooms, delivery rooms, radiographic rooms and other rooms contain- ing 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 ser- vice areas, shall be not less than 7 feet (2134 mm) above the floor.

Exception: Mobile suspended tracks such as tra- verse rails for overhead patient lifts that may be moved out of the traffic path shall provide a clear-

ance of not less than 6 feet, 8 inches (2032mm) above the floor when in use.

1224.4.11 Interior finishes.¶

1224.4.11.1 Floor finishes. Floor finishes shall be smooth, waterproof and durable. Flooring surfaces shall provide smooth transitions 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 deter- mined by the functional program. Joints for floor open- ings for pipes, ducts and conduits shall be tightly sealed. Joints of structural elements shall be similarly sealed.

Exception: Upon written appropriate docu- mented requests, the licensing agency may grant approval of the installation of carpets. See Table

1224.4.11.¶

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 adminis- tration 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 con- struction 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, air- borne infection isolation exam/treatment and pro- tective environment rooms. These rooms and anterooms shall have seamless flooring with inte- gral 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-catching surfaces, moisture, infiltra- tion and the harboring of vermin.

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

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TABLE 1224.4.11¶

ACCEPTABLE CEILING AND CARPET LOCATIONS

AREAS/ROOMS 3,4	GENERAL ACUTE CARE HOSPITAL CEILING/CARPET		ACUTE PSYCHIATRIC HOSPITAL CEILING/ CARPET		SKILLED NURSING AND INTERMEDIATE-CARE FACILITIES CEILING/CARPET		CLINIC CEILING/ CARPET
Patient bedrooms	3	*	3	*	3	*	—	—
Patient corridors/hallways	3	*	3	*	3	*	3	*
Airborne infection isolation rooms	2	N	2	N	2	N	2	N
Protective environment rooms	1	N	1	N	1	N	-	_ -_
Nurses’ or administration station	3	Y	3	Y	3	Y	3	Y
Utility rooms	2	N	2	N	2	N	2	N
Surgical units2 Operation rooms Surgical corridors/hallways	2 1 2	N N N	— — —	— — —	— — —	— — —	2 1 2	N N N
Recovery	3	N	—	—	—	—	3	N
Radiological unit2 X-ray rooms1	3 3	* N	3 3	* N	— —	— —	3 3	— N
Treatment rooms2	2	N	3	N	2	N	2	N
Examination rooms	3	*	3	*	3	*	3	*
Administration	4	Y	4	Y	4	Y	4	Y
Central sterile supply	2	N	2	N	2	N	2	N
Clinical laboratories	3	N	3	N	—	—	3	_N _
Pharmacy	3	*	3	*	3	*	3	*
Morgue and autopsy	3	N	—	—	—	—	—	—
General storage rooms	3	N	3	N	3	N	3	N
Housekeeping rooms	2	N	2	N	2	N	2	N
Laundry	15	N	15	N	15	N	—	—
Soiled linen	2	N	3	N	3	N	3	N
Clean linen	3	N	3	N	3	N	3	N
Kitchens	15	N	15	N	15	N	15	N
Dining rooms	3	*	3	*	3	*	3	*
Dishwasher rooms	2	N	2	N	2	N	2	N
Dietary day storage	2	N	2	N	2	N	—	—
Catheterization laboratory	1	N	—	—	—	—	—	—
Chronic dialysis	3	*	—	—	—	—	3	*
Coronary care	3	*	—	—	—	—	—	—
Dental	3	*	—	—	—	—	3	*
Hydrotherapy	2	N	2	N	2	N	2	N
Intensive-care nursery	3	*	—	—	—	—	—	—
Intensive care	3	*	—	—	—	—	—	—
Occupational therapy	3	*	3	*	3	*	3	*
Obstetrical unit2 Delivery rooms Labor rooms, LDRP and LDR	3 1 3	* N N	— — —	— — —	— — —	— — —	— — —	— — —
Nurseries	3	N	—	—	—	—	—	—
Physical therapy	3	*	3	*	3	*	3	*
Radiation therapy	3	*	—	—	—	—	3	_* _
Speech pathology and audiology	3	Y	3	Y	3	Y	3	Y

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 Health 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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1224.4.11.2.2 Wet cleaning.¶

Floor and wall base assemblies in the following rooms shall be mono- lithic 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 car- diac catheterization labs

3. Cesarean delivery rooms

4. Cystoscopy, urology, and minor surgical pro- cedure 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 per- mit passage of dirt particles.

4. Wall finishes in areas such as clean corridors, central sterile supply spaces, specialized radiographic rooms and minor surgical pro- cedure 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 struc- tural elements shall be similarly sealed.

6. Wall finish requirements of Section

1224.4.11.3 do not apply to boiler rooms,¶

mechanical equipment rooms, administration departments, other offices, enclosed stair- ways, 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 con- struction, 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, envi- ronmental 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 housekeeping 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 and the following requirements:

Semirestricted areas:

1. Ceiling finishes in semirestricted areas such as airborne infection isolation exam/treatment rooms, surgical corridors, central sterile sup- ply spaces and minor surgical procedure rooms, shall be nonabsorptive, nonperforated, capable of withstanding cleaning with chemi- cals, 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 pas- sage of particles from the cavity above the ceiling plane into the semirestricted envi- ronment. Perforated, tegular, serrated cut or highly textured tiles are not acceptable.

Restricted areas:

3. Ceilings in restricted areas shall be mono- lithic with no cracks or perforations.

4. Ceilings in restricted areas shall be scrub- bable and able to withstand cleaning and/ or disinfecting chemicals.

5. All access openings in restricted area ceil- ings shall be gasketed.

Dietary and laundry areas:

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

7. If a lay-in ceiling is provided, it shall include the following:

a) A rust-free grid.

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b) Ceiling tiles that weigh at least one

pound per square foot and are smooth, scrubbable, nonabsorptive, nonperfo- rated 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, administra- tion 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’ bed- rooms, the least dimension 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 mini- mum 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 deliv- ery 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 pro- vided 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 eleva- tor 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 con- nected 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.

INTERIOR ENVIRONMENT

1224.4.15 Housekeeping room.¶

This room shall be a min- imum 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 laun- dry and trash chutes shall have a minimum diameter of 2 feet (610 mm) and shall be designed to prevent distribu- tion 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 tele- phones shall be readily accessible to patients who are lim- ited 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 shall have conveniently placed grab bars that shall comply with Chapter 11B.

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.

1224.19.1 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 operat- ing suites, unless special provisions are made to mini- mize such noise.

1224.19.2 Noise reduction. The noise reduction crite- ria shown in Table 1224.4.19 shall apply to partitions, floors, and ceiling construction in patient areas.

1224.5 Communications Systems.¶

Technology and medical communication rooms shall comply with the California Elec- trical Code, California Mechanical Code, California Plumb- ing 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 cir- cuits and services enter the facility and outdoor cabling interfaces with the building’s internal cabling infra- structure. Each hospital facility shall have at least one telecommunications service entrance room, and each room that is provided shall be dedicated to the telecom- munications 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 require- ments for the required equipment.

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TABLE 1224.4.19 SOUND TRANSMISSION LIMITATIONS IN HOSPITALS

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:

NEW CONSTRUCTION	AIRBORNE SOUND TRANSMISSION CLASS (STC)1
*NEW CONSTRUCTION*	*Partitions*	*Floors*
Patient room to patient room	45	50
Public space to patient room3	50	40
Service areas to patient room4	60	45
Patient room access corridor5	35	45
Exam room to corridor	35
Exam room to exam room	502
Exam room to public space3	50
Treatment room to room	50
Treatment room to corridor	35
Toilet room to public space3	45
Consultation rooms/conference rooms to public space	50
Consultation rooms/conference rooms to patient rooms	50
Consultation room to corridor	35
Patient room to MRI room	60
Exam room to MRI room	60
Public space to MRI room	50
Staff lounges to patient rooms	45

1. Sound Transmission Class (STC) shall be determined by tests in accordance with methods set forth in ASTM 90 and ASTM 413. Where partitions do not extend to the structure above, sound transmission through ceilings and composite STC performance shall be considered. 2. Treatment rooms shall be treated the same as patient rooms. STC rating may be reduced to 40 dBA for rooms with electronic masking. Electronic masking shall provide a maximum background level of 48 dBA. 3. Public space includes corridors (except patient room access corridors), lobbies, dining rooms, recreation rooms, and similar space. 4. Service areas for the purposes of this table include kitchens, elevators, elevator machine rooms, laundries, garages, maintenance rooms, boiler and mechanical equipment rooms, and similar spaces of high noise. Mechanical equipment located on the same floor or above patient rooms, offices, nurses stations, and similar occupied space shall be effectively isolated from the floor. 5. Patient room access corridors contain composite walls with doors/ windows and have direct access to patient rooms. 6. Renovation projects of existing spaces where the existing function is not changed, are not required to comply with the requirements of Table 1224.4.19.

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 technol- ogy equipment center shall be located above any flood- ways 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.

Area Served in Square Feet (m2)	Minimum Technology Distribution Room Size
_ 8,000 square feet_ (740 m2)	10 feet by 10 feet (3.05 m by 3.05 m)
8,001 – 15,000 square feet (1400 m2)	10 feet by 12 feet (3.05 m by 3.66 m)
15,001 – 25,000 square feet _(2325 m2) _	10 feet by 14 feet (3.05 m by 4.27 m)
> 25,000 square feet (2325 m2)	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 permit- ted 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 Building Code, Section 3416A Compliance Alternatives for Services/Systems and Utilities.

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

1224.5.6 Combining spaces. The combining of the tele- communications service entrance room, technology equip- ment center and technology distribution room shall be permitted, provided that the requirements for each of the individual spaces are met.

BASIC SERVICES

1224.6 Reserved¶

1224.7 Reserved¶

1224.8 Reserved¶

1224.9 Reserved¶

1224.10 Reserved¶

1224.11 Reserved¶

1224.12 Reserved¶

1224.13 Reserved¶

1224.14 NURSING SERVICE SPACE.¶

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, California Building Code, maxi- mum room capacity shall be no more than the pres-

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ent 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 min- imum 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 clear- ance 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 uten- sils 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 gen- eral 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 and a lava- tory and the door shall swing outward or be double act- ing. Unless located in a toilet room, bedpan-washing fixtures shall be installed in dedicated rooms, separate from patient care areas.

INTERIOR ENVIRONMENT

1224.14.1.8 Patient storage. Each patient shall have within his or her room a separate wardrobe, locker, or closet suitable for hanging full-length garments and for storing personal effects.

1224.14.1.9 Privacy. A method of assuring visual pri- vacy 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 cur- tained 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 provision for the support areas listed below shall be in each nursing unit, unless noted otherwise. The size and location of each support area will depend upon the numbers and types of beds served. 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 in each nursing unit.

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 conferences, reports, education, training ses- sions, 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). Exam- ination 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 in each nursing unit and shall comply with to Section 1224.4.4.6.

1224.14.2.7 Soiled workroom or soiled holding room. A soiled workroom or soiled holding room shall be pro- vided in each nursing unit and shall comply with Sec- tion 1224.4.4.7.

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1224.14.3 Airborne infection isolation rooms.

1224.14.3.1 General. Single rooms shall be provided for the isolation of patients with airborne communica- ble 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 provided. Airborne infection isolation rooms shall be labeled with the words “Airborne Infection Room” on or adjacent to the anteroom side of the door between the isolation room and the anteroom.

Exceptions:

1. Acute psychiatric hospitals shall provide air- borne 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 ser- vices.

1224.14.3.2 Anteroom doors. Airborne infection iso- lation 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 pri- mary entrance to the airborne infection isolation room. This anteroom shall have a handwashing sta- tion, work counter at least 3 feet (914 mm) long, cabi- nets 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 infec- tion isolation room. Doors shall be aligned to allow large equipment to be wheeled into the airborne infec- tion isolation room unless a secondary door comply- ing with Section 1224.14.3.2 is provided. One anteroom may serve no more than two airborne infec- tion 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 facil- ity staff on the other side. When key locks are used on isolation rooms, keys shall be located at the nurses’ 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 min- imize 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.

INTERIOR ENVIRONMENT

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 in 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 nour- ishment. Ice making equipment may be in the clean util- ity 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. Each unit shall provide 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 facil- ity shall have direct access to a patient toilet and handwashing fixture.

1224.14.2.14.1 Special bathing facilities. Special bathing facilities, including space for attendant, shall be provided for patients on gurneys, carts, and wheelchairs at the ratio of one per 100 beds or a fraction thereof. The special bathing facility may be located in a nursing unit on a separate floor.

1224.14.2.15 Patient toilet room(s). Common patient toilet room(s), in addition to those serving bed areas, shall be located adjacent to multipurpose room(s) and within, or directly accessible to each central bathing facility.

1224.14.2.16 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.

1224.14.2.17 Housekeeping room. Housekeeping rooms may be shared between adjacent compatible nursing units.

1224.14.2.18 Grab bars. Grab bars shall be installed in accordance with Section 1224.4.18.

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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 environ- ment 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, hallway or adjoining space which shall constitute the only entrance to the protective environment room. This anteroom shall have a hand- washing 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 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 equip- ment can be wheeled into the protective environment room. One anteroom may serve no more than one pro- tective environment room.

Exception: Alternate designs for protective envi- ronment rooms, without individual anterooms, may be approved by the enforcement agency when it can be demonstrated that the alternate design meets the requirements of the California Mechani- cal 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 pene- trations shall be sealed tightly to minimize air infiltra- tion 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 psychiat- ric 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 nurses’ 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.

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1224.15 SURGICAL SERVICE SPACE.¶

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 operat- ing rooms, sterile procedure rooms, cardiac catheteriza- tion labs, 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 decontaminated/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 without compro- mising universal precautions or aseptic techniques in either department.

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 operating rooms, cys- toscopy 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 oper- ating rooms required.

Exception: Surgical service space is not required in a rural general acute care hospital, if the hospital main- tains 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.

1224.15.2 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)

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clear dimension between fixed cabinets and built-in shelves; and a system for emergency communication 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 Building Code, each oper- ating 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 cabi- nets and built-in shelves.

1224.15.2.2 Surgical cystoscopic and other endo-uro- logic 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 view- ing 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 fol- lowing 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.

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 equip- ment 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 accessible with- out traveling through any operating room. Other facili- ties 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 contain- ing one operating room. Four scrub sinks shall be pro- vided 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 mate- rial) 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 receptacles and soiled linen recepta- cles. 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 sepa- rated. The soiled workroom shall provide 24 square feet (2.23 m ² ) per operating room up to eight operat- ing 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 materi- als 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 sup- plies 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 anes- thesia workroom for cleaning, testing and storing anes- thesia equipment. This room shall contain work counter(s) and sink(s) and racks for cylinders.

1224.15.3.10 Equipment storage room(s) for equip- ment 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 operat- ing room, whichever is greater.

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one door to the recovery room shall provide access directly from the surgical service space without crossing unrestricted corridors. A minimum of 1.5, or major frac- tion 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 adja- cent 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 clear- ance of 5 feet (1524 mm) shall be provided between patient 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.

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

1224.16.3.3 Handwashing stations. Handwashing sta- tions 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.

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 observation 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 pro- vided in postoperative patient care areas with provi- sions for bedpan cleaning.

1224.16.5.3 Medication station. Each Post-Anesthesia Care Unit shall contain a medication station. The med- ication 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 preop- erative 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 gur- neys, 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 visi- tors.

1224.16.7.1 Waiting area. A waiting area, in compli- ance with Section 1224.4.5, shall be provided.

1224.15.3.11 Staff clothing change areas. Appropriate areas shall be provided for male and female staff work- ing within the surgical service space. The areas shall contain lockers, showers, toilets, handwashing sta- tions, 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 accessible from the service space.

1224.16 ANESTHESIA/RECOVERY 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 main- tain written transfer agreements with one or more gen- eral 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 facil- ities 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 unre- stricted 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.

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

1224.16.2.3 Handwashing stations. Handwashing sta- tion(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 sta- tion 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

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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 licens- ing agency that transport and terminal sterilization can be effectively contracted to an independent med- ical waste treatment facility.

1224.17.2.6 Radioactive material handling. If radioac- tive materials are employed, facilities for long-term storage and disposal of these materials shall be pro- vided.

1224.17.3 Specimen collection facilities.

1224.17.3.1 General. Space shall be provided for spec- imen collection. Facilities for this function shall be located outside the laboratory work area.

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.

1224.18 RADIOLOGICAL/DIAGNOSTIC IMAGING SER-VICE SPACE.¶

VICE SPACE. Space and equipment shall be provided to accommodate all required elements, and any additional imag- ing modalities included in the service space, as required in this section. If interventional or image-guided procedures are per- formed 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 com- ply 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, which can also provide x-ray examination services.

2. Space for processing images.

3. A toilet room shall adjoin and be directly accessible to each fluoroscopy room. In addition to the fluoros- copy toilet rooms, common patient toilet room facil- ities shall be located in the radiological/diagnostic imaging service space.

INTERIOR ENVIRONMENT

1224.16.7.2 Patient change area. A changing area shall be provided for outpatient use in perioperative areas in support of surgical suites that provide outpa- tient 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 CLINICAL LABORATORY SERVICE SPACE.¶

1224.17.1 General requirements. All hospitals shall pro- vide space and equipment to perform urinalysis, complete blood counts, hemoglobin blood typing and cross match- ing. 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 labora- tory work areas shall be provided:

1224.17.2.1 Laboratory workstation(s). Space shall be provided to accommodate equipment used and, at mini- mum, 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 hand- washing station shall be provided at the worksta- tion.

1224.17.2.2.2. If more than one work station is pro- vided, 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 pro- vided in each enclosed room where bio-hazardous specimens and/or hazardous chemicals are handled.

1224.17.2.3 Refrigerated storage facilities. Refriger- ated blood storage facilities for transfusions shall be provided. Blood storage refrigerators shall be equipped with temperature-monitoring and alarm sig- nals 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 sol- vents.

1224.17.2.5 Terminal sterilization. Facilities and equipment may be provided for terminal sterilization of

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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.

7. Dressing room facilities.

1224.18.1.1 Radiation protection. A certified physi- cist 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 win- dow and the outside partition edge shall be provided. Radiation protection requirements shall be incorpo- rated 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 Sub- chapter 4.

1224.18.2 Angiography. If provided, diagnostic angiogra- phy 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.

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 proce- dures. If interventional angiography procedures are to be performed in the angiography room, the suite shall comply with interventional imaging requirements in Section 1224.28.4. If cardiac cathe- terization 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 mini- mum of 3 feet (914 mm) on all sides of the equipment, together with the following:

1. A control room shall be provided that is designed to accommodate the computer and other controls for the equipment. A view window shall be pro- vided to permit view of the patient.

2. A patient toilet room convenient to the procedure room.

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

1224.18.4 Magnetic resonance imaging (MRI). If pro- vided, the MRI room shall accommodate the equipment

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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. A computer room shall be provided.

1224.18.4.1 Handwashing station. Handwashing sta- tion(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 insu- lated 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 imag- ing. 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.

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

1224.18.5.3 Patient toilet(s). A patient toilet shall be directly accessible to the ultrasound procedure room. The patient toilet may be permitted to serve more than one ultrasound procedure room.

1224.18.6 Mammography. When provided, the mammog- raphy 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 sta- tion shall be provided within the procedure room.

1224.18.7 Support spaces. The following spaces are com- mon 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 PHARMACEUTICAL SERVICE SPACE¶

1224.19.1 General. Facilities shall be provided to accom- modate 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 pro- vide a drug room, and the supporting spaces, in compli- ance 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 premises 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 Pharmacy, associated with Business and Professions Code Section 4056, shall provide all basic pharmaceutical services in compliance with Sec- tion 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-wash- ing station shall be provided in the area where med- ication(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.

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.

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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 receiv- ing, breakout and inventory control of materials used in the pharmacy.

1224.19.2.1.1.1 Size. A minimum of 120 square feet (11.15 m ² ) shall be provided.

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, with a minimum area of 120 square feet (11.15 m ² ) per station.

1224.19.2.1.3.2 Handwashing station. Hand- washing 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 electronic workstation(s).

1224.19.2.1.5 Temporary storage. An area for tem- porary 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.

1224.19.2.3 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 sup- port 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.

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1224.19.2.3.5 Secured storage. Secured lockable storage shall be provided for narcotics and con- trolled drugs.

1224.19.2.3.6 Equipment and supplies. Equipment and supply storage for general supplies and equip- ment not in use.

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 hazard- ous 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 sys- tem shall be used in a cleanroom suite to continuously monitor the pressure differential between the ante- room(s) and buffer room(s) and between the ante-room and the general pharmacy 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 Cal- ifornia 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 prepa- ration 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 work- station designed for product protection shall be pro- vided in accordance with Title 16, Section 1735, and USP Chapter 797, and include the following.

1224.19.3.2.1 Workstation. The Primary Engineer- ing Control (PEC) shall be a laminar airflow work bench or isolator (CAI) as required. The worksta- tion shall have a visible pressure gauge for detec- tion 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, 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:

1224.19.3.2.2.1 Size. The minimum size for a nonhazardous buffer room is 120 square feet (11.15 m ² ) for a single workstation, and 75 square feet (6.97 m ² ) for each additional work- station.

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1224.19.3.2.2.2 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.

1224.19.3.2.2.3 Finishes. The buffer room is con- sidered 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, counters, and cab- inets shall be smooth, seamless, impervious, free from cracks and crevices, and be non-shedding. Ceilings shall be monolithic or utilize cleanroom style scrubbable and gasketed panels, able to with- stand cleaning with chemicals. 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, eas- ily cleanable, and of a type suitable for a clean- room environment. Wall finishes shall be 2-coat epoxy-covered gypsum board, seamless vinyl, or other impervious covering. Work surfaces, shelv- ing 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.

1224.19.3.2.2.4 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.

1224.19.3.2.2.5 Sealed tight room. Room perim- eter 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 pheno- lic material, self-closing, and with hands-free door operation. Normal operation may include automatic door controls sequencing such that only the buffer room door or the anteroom door is open at one time. Egress provisions shall not be impeded.

1224.19.3.2.2.6. 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 buf- fer 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 rooms shall be under negative pressure relative to the buffer room and positive pressure relative to nonrestricted areas. Refer to Califor- nia Mechanical Code Table 4A, Title 16 Section 1735, and USP Chapter 797 for additional requirements.

1224.19.3.2.3.3 Handwashing station. A hand- washing station, with hands-free controls and nonrefillable closed soap dispensing system, pro- viding support for scrubbing up to the elbows, shall be located in 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 envi- ronmental 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, 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 and gasketed panels, able to withstand cleaning with chemi- cals. 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, easily cleanable, and of a type suitable for a cleanroom environment. Wall fin- ishes shall be 2-coat epoxy-covered gypsum board, seamless vinyl, or other impervious cover- ing. 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 perim- eter 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 pheno- lic 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

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and anteroom, a segregated compounding area, with a limitation on permitted compounded sterile preparations and allowable time of use, shall com- ply 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 mini- mum clearance of 3.281 feet (1 meter) between the PEC and the line of demarcation.

1224.19.3.2.4.1 Air quality. Nonhazardous Seg- regated Compounding Areas shall provide air- flow from clean to less clean areas. Refer to California Mechanical Code Table 4A, Title 16 Section 1735, and USP Chapter 797 for addi- tional requirements.

1224.19.3.2.4.2 Handwashing station. A hand- washing station, with hands-free controls and nonrefillable closed soap dispensing system, pro- viding 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.

1224.19.3.2.4.3 Finishes. The segregated com- pounding area is considered a semi-restricted area with nonporous and cleanable surfaces, ceilings, walls, and floors subject to wet clean- ing. The surfaces of ceilings, walls, floors, fix- tures, shelving, 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 scrubba- ble and gasketed panels, able to withstand clean- ing with chemicals. 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, 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 pervi- ous substrate is not permitted.

1224.19.3.3 Hazardous 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, Sec- tions 1735 and 1751, and USP Chapters 797 and 800.

1224.19.3.3.1 Workstation. The Primary Engineer- ing Control (PEC) shall be a negative pressure bio- logical safety cabinet or isolator (CACI) as required. The workstation shall have an exhaust to the outside with a visible pressure gauge for detec- tion 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

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unit shall be sealed to prevent intrusion of moisture, contaminants and bacteria growth.

1224.19.3.3.2 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:

1224.19.3.3.2.1 Size. The minimum size for a non-hazardous buffer room is 130 square feet (12.08 m ² ) for a single workstation, and a mini- mum of 75 square feet (6.97 m ² ) for each addi- tional workstation.

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, ceilings, walls, and floors subject to wet cleaning. The surfaces of ceilings, walls, floors, fixtures, shelving, count- ers, and cabinets shall be smooth, seamless, and impervious, free from cracks and crevices, and be nonshedding. Ceilings shall be monolithic or uti- lize cleanroom style scrubbable and gasketed panels, able to withstand cleaning with chemi- cals. 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, easily cleanable, and of a type suitable for a cleanroom environment. Wall fin- ishes shall be 2-coat epoxy covered gypsum board, seamless vinyl, or other impervious cover- ing. 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 stor- age 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 doff- ing 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 perim- eter walls, ceiling, floors, doors and penetrations shall be sealed tightly to minimize air infiltration from the outside or from other rooms. Buffer

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room doors shall be glass, metal or other pheno- lic material, self-closing, and with hands-free door operation. Normal operation may include automatic door controls sequencing 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 pass-through is not permitted between the haz- ardous drug buffer room and any unclassified area.

1224.19.3.3.2.9 Housekeeping. Dedicated envi- ronmental 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 fol- lowing 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. 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. 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 Mechan- ical Code Table 4A, Title 16 Section 1751, and USP Chapter 800 for additional requirements.

1224.19.3.3.3.3 Handwashing station. A hand- washing station with hands-free controls and nonrefillable closed soap dispensing system, pro- viding 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 envi- ronmental services, materials and supplies shall be located in the anteroom.

1224.19.3.3.3.6 Finishes. The anteroom is con- sidered 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, count- ers, and cabinets shall be smooth, seamless, and impervious, free from cracks and crevices, and be nonshedding. Ceilings shall be monolithic or uti-

lize cleanroom style scrubbable and gasketed panels, able to withstand cleaning with chemi- cals. 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, easily cleanable, and of a type suitable for a cleanroom environment. Wall fin- ishes shall be 2-coat epoxy-covered gypsum board, seamless vinyl, or other impervious cover- ing. 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 perim- eter 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 pheno- lic material, self-closing, and with hands-free door operation.

1224.19.3.3.4 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 com- ply 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 Segre- gated Compounding Areas shall be under nega- tive 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 hand- washing station, with hands-free controls and nonrefillable closed soap dispensing system, pro- viding 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 com- pounding area is considered a semi-restricted area with nonporous and cleanable surfaces, ceilings, walls, and floors subject to wet clean- ing. The surfaces of ceilings, walls, floors, fix- tures, shelving, counters, and cabinets shall be smooth, seamless, impervious, free from cracks and crevices, and be nonshedding. Ceilings shall be monolithic or utilize cleanroom style scrubba- ble and gasketed panels, able to withstand clean- ing with chemicals. 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-

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covered gypsum board, seamless vinyl, or other impervious covering. Work surfaces shall be con- structed 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. Provi- sions 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 educa- tion 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. Pro- vide for immediate accessibility to pharmacy staff toilet rooms and lockers.

1224.20 DIETETIC SERVICE SPACE¶

1224.20.1 General. Food and nutrition facilities shall be provided to support food services provided for staff, visi- tors, 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 sup- plies. Food service facilities and equipment shall conform to these standards, the standards of the National Sanita- tion 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 ser- vice 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, inte- rior transportation, storage, etc., without traversing patient or public circulation. Food preparation, service and storage shall be inaccessible to nondietetic service staff.

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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, refriger- ated, 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 perishable foods shall be main- tained 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 sched-

e: Licensed Bed Capacity	Storage Space
Licensed Bed Capacity	Storage Space
1 to 99 beds	2 square feet (0.19 m2) per bed
100 to 199 beds	200 square feet (18.58 m2) plus 1 square foot 0.0929 m2) per bed in excess of 100 beds
200 beds and over	300 square feet (27.99 m2), plus 1/2 square foot (0.0465 m2) 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 sup- plies, 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 pro- vided.

4. Waste storage and recycling facilities (per local requirements) shall be located in a separate room immediately accessible to the outside for direct pickup or disposal.

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1224.20.2.4 Cleaning supplies storage. Provide a sepa- rate 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 sys- tem shall be provided with spaces for storage, loading, distribution, receiving, and sanitizing of the food ser- vice carts. The cart traffic shall be designed to elimi- nate 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, staff, and visitors. These spaces shall be sepa- rate 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 trans- ferred for storage or use in the dining room area with- out 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 multi-compartmented sinks.

1224.20.2.12 Waste storage room. A food waste stor- age room shall be readily accessible to the food prepa- ration and ware washing areas but not within the food preparation area. It shall have direct access to the hos- pital’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 ser- vice 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 prepara- tion 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 pro- vided for dietetic service employee’s clothing and per- sonal 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.

SUPPORT SERVICES

1224.21 ADMINISTRATIVE SPACE.¶

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 toi- let room facilities, telephones 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 elec- tronic media.

1224.22 CENTRAL STERILE SUPPLY.¶

1224.22.1 Minimum requirements. A central supply and sterilizing area shall be provided. Rooms and spaces shall accommodate 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.

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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 hos- pitals 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 STORAGE.¶

1224.23.1 General storage. Hospitals shall provide gen- eral 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 the hospital building and readily accessible to the connecting corridor required under Section 1224.4.7.5.

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 mini- mum area of 10 square feet (0.93 m ² ) and may be within the clean utility room. The soiled linen collec- tion 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 hav- ing 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.

1224.23.2.3 Wheelchairs. A room or space shall be provided in each nursing unit for wheelchairs and gur- neys. 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 Sec- tion 1224.20.

1224.24 MORGUE AND AUTOPSY FACILITIES.¶

1224.24.1 General acute-care hospitals with a licensed bed capacity of 50 or more 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 Minimum requirements. The morgue and autopsy space shall have a minimum of 250 square feet

INTERIOR ENVIRONMENT

(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.

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 EMPLOYEE DRESSING ROOMS AND LOCKERS.¶

1224.25.1 Minimum facilities. Hospitals shall provide the following:

1. Separate dressing rooms for male and female per- sonnel with lockers, lavatory and toilet.

2. Additional dressing rooms for the surgical service and as required within any of the supplemental ser- vices.

1224.26 HOUSEKEEPING ROOMS.¶

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 LAUNDRY.¶

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 sort- ing 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

1224.28 SUPPLEMENTAL SURGERY AND SPECIAL PROCEDURE SERVICES.¶

PROCEDURE 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 mini- mum 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 procedure 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 desig- nated as a pump room where extra corporeal pump(s), sup- plies and accessories are stored and serviced. Appropriate plumbing and electrical connections shall be provided in the cardiovascular, pump, and storage rooms.

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1224.28.1.1 Service areas. Shall be provided in accor- dance with Section 1224.15.3.

Exception: Where renovation work is undertaken in facilities built under the 2001 or prior Califor- nia Building Code, existing rooms for cardiovascu- lar, 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 mini- mum 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 con- trol, monitoring and recording equipment, and x-ray 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 x-ray transformers, power modules, and associated electronics and electri- cal gear shall be provided.

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

1224.28.2.5 Staff clothing change areas. Appropriate areas shall be provided for male and female staff work- ing 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 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 stor- age and holding of clean and sterile supply materials, the work counter and handwashing station shall be per- mitted 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 util- ity 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 stor- age of supplies and housekeeping equipment. This may be shared with an adjacent surgical unit.

1224.28.3 Freestanding cardiac catheterization labora- tory service space. A general acute care hospital refer- enced 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.

acute care hospital refer-_ enced 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 sup- port areas shall include outpatient waiting rooms in com- pliance with Section 1224.4.5. A separate space shall be provided where outpatients change from street clothing and are prepared for a procedure. 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 ser- vice 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 sys- tem 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 cor- ridors and/or passageways.

1224.28.3.4 Essential electrical system. Cardiac cathe- terization 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: nor- mal power; emergency power; nurse call; communica- tion 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 build- ing, any alteration to the system shall be subject to

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review by the Office of Statewide Health Planning and Development.

1224.28.4 Interventional imaging. Image-guided inter- ventional procedures shall be performed in procedure rooms in compliance with this section. Cardiac catheter- ization operating rooms shall be in compliance with Sec- tion 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 require- ments 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-proce- dure and recovery areas shall be immediately accessi- ble to procedure rooms and separate from corridors. The pre-procedure and recovery areas shall comply with the requirements of Section 1224.16 Anesthesia/ recovery Service Space.

1224.28.4.3 Interventional MRI facilities. Interven- tional 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 obser- vation 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.

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/pro- cedure room and other adjacent space.

5. Where control functions for ionizing radiation exposures take place in the procedure room, stor- age for personal radiation 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 interven- tional 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.

INTERIOR ENVIRONMENT

1224.28.4.7 Reading room. A reading room for review- ing images shall be available for use by the interven- tional imaging suite.

1224.28.4.8 Electrical equipment room. Electronic equipment or enclosures large enough to contain x-ray transformers, power modules, and associated electron- ics and electrical gear shall be provided. Sharing of electronics 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 require- ments of Section 1224.4.15.

1224.28.4.12 Staff changing areas. Staff changing areas shall be provided and arranged to ensure a traf- fic pattern so that personnel can enter from outside the suite, change their clothing, and move directly into the semi-restricted corridor within the interventional imag- ing 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 operat- ing 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 spe- cific imaging equipment require a greater dis- tance.

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 imag- ing system control equipment 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 pro- vide for a full view of the patient and the surgical team.

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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) sys- tems shall have control rooms that comply with Sec- tion 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 Sec- tion 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 1224.18.4.2.

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 1224.28.4.4.

1224.28.5.6 Pre-procedure and recovery. Pre-proce- dure and recovery areas shall be immediately accessi- ble to procedure rooms and separate from corridors. The pre-procedure and recovery areas shall comply with the requirements of Section 1224.16 (Anesthesia/ recovery Service Space).

1224.28.6 Electroconvulsive Therapy. If electroconvul- sive 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 operating room in a surgical suite that meets the require- ments 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 equipment such as a CPR cart. A sepa- rate 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 INTENSIVE CARE UNITS.¶

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 mini- mum 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 minimum 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 California 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

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1224.29.1.11 Emergency equipment storage. Space that is easily accessible to the staff shall be provided for emergency equipment 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.

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 mod- ular 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 hospitals.

1224.29.1.14 Additional service spaces. The following additional service spaces shall be immediately accessi- ble within each intensive care service space. These may be shared by more than one intensive care unit pro- vided that direct access is available from each.

1224.29.1.14.1 Clean utility/workroom. Clean util- ity/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 utility room or a separate closet.

1224.29.1.14.3 Soiled utility/workroom. Soiled work- room 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 nour- ishment. Ice-making equipment 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. Appropri- ate room(s) shall be provided for storage of large items of equipment necessary 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 consul- tation.

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’s station or work area to permit, enable or allow maximum obser- vance 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 cubicles 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 combi- nation units located within a privacy curtain may be used within each patient space or private room. The toilet fixture shall be completely contained within cabi- netry when not in use. This fixture shall not be equipped with a bedpan washing attachment. Exhaust ventilation requirements shall comply with the Califor- nia 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 observa- tion 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 pan- els.

1224.29.1.7 Handwashing stations. Handwashing sta- tions shall be directly accessible to nurse stations and patient bed areas. There shall be at least one hand- washing station for every three beds in open plan areas, and one in each patient room. The handwashing 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 dis- tributed nurse station or work station and the heads of all patient beds in the intensive care unit.

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.

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5. Housekeeping room. Provide within or immedi- ately adjacent to the intensive care unit. It shall not be shared with other nursing units or departments.

6. Gurney and wheelchair storage. Provide a mini- mum 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. Additionally each NICU shall include or com- ply with the following:

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 con- cept 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 transillumination 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 sta- tion. It may be combined with or include centers for reception, communication and patient monitoring.

1224.29.2.6 Area. Each patient care space shall con- tain a minimum of 120 square feet (11.15 m ² ) of clear floor area per bassinet excluding handwashing fixtures and aisles. There shall be an aisle for circulation adja- cent to each patient care space with a minimum width of 4 feet (1219 mm).

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.

1224.29.2.6.1 Treatment area/room. A treatment area/room, with temperature control, shall be pro- vided immediately accessible 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 lac- tation support and consultation in or immediately adja- cent to the NICU.

1224.29.2.10 Infant formula facilities.

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 prepa- ration room may be located at another location as approved by the Licensing Agency.

1224.29.2.10.2 Formula preparation room. The for- mula preparation room shall be securable, facilitate workflow that supports aseptic technique, and include the following:

1. A separate cleanup area for washing and san- itizing. 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 exclu- sive use of the neonatal intensive care unit.

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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 eas- ily cleaned shading devices that are neutral color or opaque to minimize color distortion from transmitted light.

1224.30 PEDIATRIC AND ADOLESCENT UNIT.¶

A pedi- atric nursing unit shall be provided if the hospital has eight or more licensed pediatric beds. The unit shall meet the fol- lowing standards:

1224.30.1 Patient rooms. 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 or treatment rooms. This room shall be provided for pediatric and adolescent patients. A separate area for infant examination and treatment may be provided within the pediatric nursery workroom.

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

1224.30.3.1 Play area. A play area shall be provided.

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, edu- cational, 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 pediatric 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 PSYCHIATRIC NURSING UNIT.¶

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

INTERIOR ENVIRONMENT

1224.31.1.1 General. A psychiatric nursing unit shall meet the requirements of Section 1224.14 or 1228.14, in addition to the requirements of Section 1228.4, based on the functional program. Specific application shall respond to the patient injury and suicide preven- tion 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 med- ical care, the unit shall comply with Section 1224.14 and be located in a building that is compliant with Cal- ifornia 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 interview- ing patients.

1224.31.1.6 Dining and recreation. Provide spaces for dining and recreation. The total area for these pur- poses 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. Indoor and outdoor space for therapeutic activities.

1224.31.1.10 Occupational therapy. Facilities for occu- pational therapy shall comply with Section 1224.35.3.

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 appurtenances 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 fol- lowing 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 construc- tion and the air distribution devices, lighting fix- tures, 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

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compromise compliance with the hot and cold water supply controls, laminar flow, and sink requirements 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.

1224.31.2 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 OBSTETRICAL FACILITIES (PERINATAL¶

UNIT SPACE)

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 post- partum bedrooms shall comply with Section 1224.14.1.

1224.32.2.2 Service areas. Shall be provided in accor- dance with Section 1224.14.2 with the following addi- tions:

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 obstetri- cal 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 obstet- rical unit, unless a surgical operating room is designated specifically for cesarean delivery procedures. The cesar- ean 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 sta- tion shall be provided in accordance with Section 1224.15.3.1 and shall be located to restrict unautho- rized 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 deliv- ery suite.

1224.32.3.1.6 Perioperative support services. Pre- operative patient holding and post-anesthesia recovery shall be provided in accordance with Sec- tion 1224.16. Post-anesthesia care shall provide direct access to the cesarean surgical service space without 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 obstetrical 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 deliv- ery room in the postpartum bed ratio.

2. When approved by the licensing agency, the operating room of small or rural hospi- tals with a licensed bed capacity 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 mini- mum 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 pro- vided, 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 con- trolled access with doors that are arranged for observa- tion from a nursing station. At least one shower (which may be separate from the labor room if under staff con-

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trol) for use of patients in labor shall be provided. Win- dows in labor rooms, if provided, shall be located, draped, or otherwise arranged, to preserve patient pri- vacy 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 beds and have a nurse station, with chart- ing 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 pri- vacy of the new family.

1224.32.3.8 Service areas. Individual rooms shall be provided as indicated in the following standards; oth- erwise, alcoves or other open spaces that do not inter- fere 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 ser- vices 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 immediately accessible. The toilet rooms shall contain a lavatory.

1224.32.3.8.2.3 Drug distribution station. The drug distribution station shall have a handwash- ing 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 mini- mize any splatter on nearby personnel or supply carts. In new construction, provide view windows at scrub stations to permit the observation of room interiors.

INTERIOR ENVIRONMENT

1224.32.3.8.2.5 Clean utility room. A clean util- ity 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 accessi- ble 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 work- room 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 person- nel entering from unrestricted area outside the delivery service space enter, change their clothing, 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, hand- washing stations, and space for donning and dis- posing scrub suits and booties.

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

1224.32.3.8.2.10 On-call room. An on-call room(s) for physician and/or staff shall be pro- vided, but may be located elsewhere 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 cesar- ean/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 minimum dimension of 13 feet (3962 mm). There shall be space for crib and sleeping space for support person. An area within the room but distinct from the mother’s area shall be provided for infant stabi- lization and resuscitation. 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.

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

1224.32.5 Newborn/well baby nurseries

1224.32.5.1 General. Infants shall be housed in nurser- ies that comply with the standards below. All nurseries shall be immediately accessible to the postpartum unit and obstetrical facilities. The nurseries shall be located and arranged to preclude the need for unrelated pedes- trian traffic. No nursery shall open directly onto another nursery. Each nursery shall contain the follow- ing:

General._** Infants shall be housed in nurser- ies that comply with the standards below. All nurseries shall be immediately accessible to the postpartum unit and obstetrical facilities. The nurseries shall be located and arranged to preclude the need for unrelated pedes- trian traffic. No nursery shall open directly onto another nursery. Each nursery shall contain the follow- ing:

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/demonstra- tion/breast feeding or pump room shall be provided in a location that is readily accessible to the nurs- ery. 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 equip- ment 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 nurs- ery 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 EMERGENCY SERVICE.¶

1224.33.1 Definition. Levels of emergency care range from initial emergency management as Standby Emer- gency Medical Service, with a Physician on call; to defini- tive emergency care as Basic Emergency Medical Service,

with a Physician on duty; to a Comprehensive Emergency Medical Service as an Emergency Department.

1224.33.2 Standby Emergency Medical Service. If pro- vided, 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, illu- minated 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 substi- tuted for the required accessible entrance to the hos- pital, 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 bariat- ric stretchers, mobile patient lift devices, and accom- panying attendants. Reception shall be located to permit staff observation and control of access to treat- ment area, pedestrian and ambulance entrances, and public waiting area.

1224.33.2.2 Treatment room. Standby emergency ser- vice 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 examina- tion light, work counter, and handwashing sta- tion.

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 minimum 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 cubicles by curtains. Handwashing fixtures shall be provided for each four treatment stations and for each major frac- tion 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

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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/sur- gical emergency supplies, medications and equipment such as ventilator, defibrillator, splints, etc. This stor- age shall be located in an alcove or room, out of corri- dor 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.

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 connec- tions to the Poison Control Center and local EMS sys- tem shall be provided.

1224.33.2.7 Observation area. A patient cubicle with a minimum clear floor area of 100 square feet (9.29 m ² ) shall be provided under the visual control of an emer- gency service staff work area. The patient station shall have space at bedside for visitors and shall have provi- sion for visual privacy from casual observation by other patients and visitors. 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 obser- vation area need not be dedicated solely for that purpose.

1224.33.2.8 Airborne infection isolation exam/treat- ment room. If provided, the airborne infection isolation exam/treatment room shall comply with the require- ments 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 mini- mum , all the provisions of Standby Emergency Service under Section 1224.33.2 and the following shall be pro- vided:

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 jurisdic- tion. 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.

INTERIOR ENVIRONMENT

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 emer- gency entrances.

1224.33.3.5 Public waiting area. A public waiting area shall be provided in compliance with Section 1224.4.5 and include provision 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 sur- gery, 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 view- ing capability, examination 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 mini- mum 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 lead- ing 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 posi- tions is permitted to serve two trauma rooms if located adjacent to the entrance of each procedure room. The placement of scrub sinks shall not restrict the minimum required corridor width.

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 posi- tions is permitted to serve two trauma rooms if located adjacent to the entrance of each procedure room. The placement of scrub sinks shall not restrict the minimum required corridor width.

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 stor- age 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 commu- nications 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 emergency service space.

1224.33.3.12.2 Clean utility room. See Section 1224.4.4.6.

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

1224.33.3.14 Staff lounge. A staff lounge shall be located within the Emergency Department and include staff clothing change areas with lockers, showers, toi- lets and handwashing stations for male and female staff.

1224.33.3.15 Housekeeping room. A housekeeping room, compliant with Section 1224.4.15, shall be located within the unit and dedicated to the emergency service space.

1224.33.3.16 Airborne infection isolation exam/treat- ment room. If provided shall comply with the require- ments of Section 1224.4.4.1.3.

1224.33.3.17 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 monitor- ing 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 pro- trusions, 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 require- ments 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 compli- ance 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 station shall have a minimum 100 square feet (9.29 m ² ) of clear floor area.

2. Each station shall include a handwashing sta- tion, work/documentation counter, examination table light.

3. Storage areas for supplies and medication.

4. 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, documentation counter, and a storage cabinet. Pre-screening stations, whether private rooms or open bays, are considered a part of the waiting area and must meet the same venti- lation requirements.

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

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1224.33.4.5 On-call room(s). Provisions shall be made to accommodate on-call sleeping room(s) for physi- cians 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 Emer- gency 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 pro- vided as a distinct unit within, the emergency depart- ment. If provided the unit shall have the following:

1. Handwashing stations shall be provided in each patient room and for each four treatment sta- tions, 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 sta- tions and patient care areas.

2. Each patient station shall have a minimum of 120 square feet (11.15 m ² ) of clear floor area includ- ing space at each bedside for visitors and provi- sion for visual privacy from casual observation by other patients and visitors.

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 com- pliance 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 NUCLEAR MEDICINE¶

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. Radiation protection requirements shall be incorpo- rated into the construction documents and comply with Chapter 31C and the requirements of California Radia- tion Control Regulations, California Code of Regula- tions, 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:

INTERIOR ENVIRONMENT

1224.34.1.2.1 Scintigraphy (Gamma Camera) Facilities. Shall include the following:

1. Scanner room. The scanner room shall pro- vide 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 loca- tions 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 clear- ance 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 pro- vided. Cyclotron facilities shall be located in access-restricted areas. Shielding require- ments for cyclotron facilities shall comply with Section 1224.34.1.1.

3. Control room. A control room shall be pro- vided 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 radioactive waste, and lava- tory shall be provided.

5. Handwashing stations shall be provided throughout the PET suite at locations of patient contact and at locations where radio- pharmaceutical materials are handled, pre- pared, 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. Computer equipment room shall be provided in support of the equipment provided.

8. Contaminated (hot) soiled holding shall be provided and operationally integrated to mini- mize 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. Scanner room shall provide a minimum clearance of 4 feet (1218 mm) at each side and the foot of the table.

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2. Control room. A control room shall be pro- vided with a full direct view of the patient in the SPECT scanner.

3. Computer 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 radio- pharmaceutical materials are handled, pre- pared, or disposed.

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 considerably smaller than that for on-site prepara- tion. Space shall provide adequately for dose calibra- tion, 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. Nuclear medicine area when operated separately from the imaging department shall provide the following:

1224.34.2.1 Entrance. Space shall be adequate to per- mit 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 accessi- ble. They shall include a service sink or floor recepta- cle 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-proce- dure/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 proce- dure rooms.

1224.34.2.9 Staff toilet rooms. Staff toilet rooms shall be readily accessible to the nuclear medicine labora- tory.

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. Pro- visions with handwashing stations shall be made for holding soiled material. Separate provisions shall be made for holding contaminated material.

1224.34.2.14 Hot lab for scintigraphy (gamma cam- era), 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 multi- ple 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 ther- apy 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, includ- ing a calibration constancy instrument and access to a secondary standard dose meter.

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, California 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 Chapter 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

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the requirements of Chapter 31C and the California Radiation Control Regulations, California Code of Regulations, Title 17, Division 1, Chapter 5, Subchapter 4.

5.4. Shielding of the rooms shall meet the requirements of Chapter 31C and the Cali- fornia Radiation Control Regulations. Cali- fornia Code of Regulations, Title 17, Division 1, Chapter 5, Subchapter 4.

1224.34.3.2 Radiation protection. Cobalt, linear accel- erators, hot lab and high dose rate brachytherapy rooms and simulation rooms require radiation protec- tion. All rooms that provide radiation treatment shall be appropriately shielded. A certified physicist shall specify the type, location, and amount of protection to be installed in accordance with final approved depart- ment layout and equipment selection. Radiation protec- tion 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.

1224.34.3.3 Room sizes. Rooms shall be sized as fol- lows:

1. Cobalt rooms and linear accelerators shall be sized in accordance with equipment requirements and shall accommodate 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 elec- trical 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 accelera- tor 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 min-

INTERIOR ENVIRONMENT

imum dimension of 8 feet (2438 mm). Each exam room shall be equipped with a handwashing sta- tion.

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 accelera- tor.

1224.34.4.1 Mold room with exhaust hood and hand- washing 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 pro- vided:

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

lding Standards Commission) Order Number #100735044 on Jul 24, 2019 03:54 PM (PDT) pursuant to License Agreement with ICC. No further reproduction or distribution authorized. Single user only, copying and networking prohibited. ANY UNAUTHORIZED REPRODUCTION OR DISTRIBUTION IS A VIOLATION OF THE FEDERAL COPYRIGHT ACT AND THE LICENSE AGREEMENT, AND SUBJECT TO CIVIL AND CRIMINAL PENALTIES THEREUNDER.

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INTERIOR ENVIRONMENT

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 gur- neys or patient beds. Each bay shall have a mini- mum clearance of 4 feet (1218 mm) between sides of gurneys or patient beds.

4. Patient privacy. Provisions such as cubicle cur- tains 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.

1224.35 REHABILITATION THERAPY DEPARTMENT.¶

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, ward- robes, alcoves or vestibules, with greater space provided for special needs such as circ-o-electric 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. An examination and treatment room, adjacent or directly accessible to an office for the physician in charge of the outpatient service.

7. A patient waiting area with access to telephone, drinking fountain, and men’s and women’s toilet room facilities in or adjacent to the rehabilitation outpatient service area.

8. Access to an outside area to be used for therapeu- tic 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, pri- vacy curtains, and designed for ease of accessibil- ity. The floor shall be sloped to provide drainage.

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). Each indi- vidual 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 perma- nent 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 sta- tion shall be provided for every four patient care stations, and for every major fraction thereof, in an open treatment area. One handwashing 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 sup- plies.

Exception: When approved by the licensing agency small or rural hospitals are exempt from Sections 1224.35.2.1 through 1224.35.2.6.

1224.35.3 Occupational therapy service space. If this ser- vice 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 appliances 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, consulta- tions 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.

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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.

1224.36 RENAL DIALYSIS SERVICE SPACE (ACUTE¶

AND CHRONIC)

1224.36.1 General. If provided, renal dialysis service shall comply with the following:

1224.36.2 Treatment area.

1224.36.2.1 Location. The treatment area may be an open area and shall be separate from administrative and waiting areas.

1224.36.2.2 Nurses’ station(s). Shall be located within the dialysis treatment area and designed to provide visual observation of all patient stations.

1224.36.2.3 Individual patient treatment areas. Shall contain at least 80 square feet (7.44 m ² ). There shall be at least a 4-foot (1219 mm) space around and between beds and/or lounge chairs.

1224.36.2.4 Handwashing stations. Handwashing sta- tions shall be directly accessible to the nurses’ station and to patient treatment areas. Handwashing stations shall be provided for each four treatment stations, and for each major fraction thereof. These shall be uni- formly distributed to provide equal access from each patient station.

1224.36.2.5 Privacy. The open unit shall be designed to provide privacy for each patient.

1224.36.2.6 Bloodborne infection isolation room. A minimum of one bloodborne infection isolation room of at least 120 square feet (11.15 m ² ) of clear floor space shall be provided for patients. This room shall contain a counter and handwashing station.

1224.36.2.7 Medication dispensing. If provided, there shall be a medication dispensing station for the dialysis center. A work counter and handwashing stations shall be included in this area. Provisions shall be made for the controlled storage, preparation, distribution and refrigeration of medications.

1224.36.2.8 Home training. If provided in the unit, a private treatment area of at least 120 square feet (11.15 m ² ) shall be provided for patients who are being trained to use dialysis equipment at home. This room shall contain a counter, handwashing station, and a separate drain for fluid disposal.

1224.36.2.9 Examination room. An examination room with a handwashing station shall be provided with at least 100 square feet (9.29 m ² ).

1224.36.2.10 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, a handwashing station, and storage facilities for clean and sterile supplies. If the room is used only for storage and holding as part of a system for distribution of clean

INTERIOR ENVIRONMENT

and sterile materials, the work counter and handwash- ing fixture may be omitted. Soiled and clean utility rooms or holding rooms shall be separated and have no direct connection.

1224.36.2.11 Soiled utility room. A soiled workroom shall be provided and contain a sink, handwashing sta- tion, work counter, storage cabinets, waste receptacles and a soiled linen receptacle.

1224.36.2.12 Reprocessing room. If dialyzers are reused, a reprocessing room is required and sized to perform the functions required and include one-way flow of materials from soiled to clean with provisions for a refrigerator (temporary storage or dialyzer), decontamination/cleaning areas, sinks, processors, computer processors and label printers, packaging area and dialyzer storage and disinfectants cabinets.

1224.36.2.13 Nourishment station. If a nourishment station for the dialysis service is provided, the nourish- ment station shall contain a sink, a work counter, a refrigerator, storage cabinets and equipment for serv- ing nourishments as required.

1224.36.2.14 Housekeeping room. Provide a house- keeping room that is immediately accessible to, and for the exclusive use of the unit

1224.36.2.15 Repair room. If required, an equipment repair and breakdown room shall be equipped with a handwashing fixture, deep service sink, work counter and storage cabinet. Needs water supply and drain connection for testing machines.

1224.36.2.16 Supplies. Supply areas or supply carts shall be provided.

1224.36.2.17 Storage. Storage space shall be available for wheelchairs and gurneys, if gurneys are provided, out of direct line of traffic.

1224.36.2.18 Clean linen storage. A clean linen stor- age area shall be provided. This may be within the clean utility room, a separate closet, or an approved distribution system. If a closed cart system is used, stor- age may be in an alcove. It must be out of the path of normal traffic and under staff control.

1224.36.2.19 Mixing room. Each facility using a cen- tral batch delivery system shall provide, either on the premises or through written arrangements, individual delivery systems for the treatment of any patient requir- ing special dialysis solutions. The mixing room shall also include a sink, storage space and holding tanks.

1224.36.2.20 Water treatment room. The water treat- ment equipment shall be located in an enclosed room.

1224.36.2.21 Patient toilet. A patient toilet room with a lavatory shall be provided.

1224.36.3 Ancillary facilities.

1224.36.3.1 Staff lounge, lockers and toilet(s). Space shall be available for male and female personnel for staff clothing change area and lounge. The areas shall con- tain lockers, shower, toilet(s), and handwashing sta- tions.

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of 48 square feet (4.5 m ² ), with no dimension less than 6 feet (1829 mm).

1224.39.2.3.2 Housekeeping. A housekeeping room shall be provided for the exclusive use of outpatient surgery. It shall be directly accessible from the ser- vice area.

1224.39.3 Gastrointestinal endoscopy. If gastrointestinal endoscopy is performed in the outpatient service area, the endoscopy suite shall be divided into a minimum of three major functional areas: the procedure room(s), instrument processing room(s), and patient holding/preparation and recovery room or area and the following shall be provided:

1224.39.3.1 Procedure room(s).

1224.39.3.1.1 Space requirements. Procedure room shall have a minimum clear floor area of 200 square feet (18.6 m ² ). Room arrangement shall permit a minimum clearance of 3 feet, 6 inches (1067 mm) at each side, head, and foot of the gurney/table.

1224.39.3.1.2 Handwashing stations. A separate dedicated handwashing station with hands-free con- trols shall be provided in the procedure room.

1224.39.3.2 Processing room.

1224.39.3.2.1 Dedicated processing room(s) for cleaning and decontaminating instruments shall be provided. The cleaning area shall allow for flow of instruments from the contaminated area to the clean assembly area and then to storage.

1224.39.3.2.2 The decontamination area shall be equipped with the following:

1. Utility sink(s) shall be provided as appropri- ate to the method of decontamination used.

2. One freestanding handwashing station.

3. Work counter space(s).

1224.39.3.3 Preoperative patient holding. A preopera- tive patient holding area shall be provided in accor- dance with Section 1224.16.2.

1224.39.3.4 Post-anesthesia recovery area. A post- anesthesia recovery area shall meet the requirements of Section 1224.16.3.

1224.39.3.5 Communication system. A system for emergency communication shall be provided.

1224.39.4 CANCER TREATMENT/INFUSION THER- APY SERVICE SPACE.

1224.39.4.1 General. If provided, cancer treatment/ infusion therapy service shall comply with the following:

1224.39.4.2 Treatment area.

1224.39.4.2.1 Location. The treatment area may be an open area and shall be separated from adminis- trative and waiting areas.

1224.39.4.2.2 Nurses’ station(s). Shall be located within the cancer treatment/infusion therapy area and designed to provide visual observation of all patient stations.

1224.39.4.2.3 Individual patient treatment areas. Shall contain at least 80 square feet (7.4 m ² ).

INTERIOR ENVIRONMENT

1224.36.3.2 Patient storage. Storage for patients’ belongings shall be provided.

1224.36.3.3 Waiting room. A waiting room, toilet room(s) with handwashing stations, drinking fountain, public telephone, and seating accommodations for waiting periods shall be available or accessible to the dialysis unit.

1224.36.3.4 Administrative services. Provide office and clinical work space.

1224.37 RESPIRATORY THERAPY SERVICE SPACE.¶

If respiratory service is provided, the following elements shall be included:

1. Storage for equipment and supplies.

2. Space and utilities for cleaning and disinfecting equipment. Provide physical separation of the space for receiving and cleaning soiled materials from the space for storage of clean equipment and supplies. Appropriate local exhaust ventila- tion shall be provided if gluteraldehyde or other noxious disinfectants are used in the cleaning process. This space may be co-located with other reprocessing functions within the hospital.

3. Additional facilities. If respiratory services such as testing and demonstration for outpatients are part of the program, additional facilities and equipment shall be provided including but not limited to:

3.1. Patient waiting.

3.2. A reception and control station.

1224.38 INTERMEDIATE-CARE SERVICE SPACE.¶

An intermediate-care service unit shall be housed in a separate and distinct nursing unit and shall comply with the applicable requirements of Section 1225.

1224.39 OUTPATIENT SERVICE SPACE.¶

1224.39.1 Waiting area(s). Provide with access to public toilet room facilities, a public telephone and a drinking fountain. These facilities may be shared with other services.

1224.39.2 Outpatient surgery. If outpatient surgery is per- formed in the out patient service space, the following shall be provided:

1224.39.2.1 Operating rooms. An operating room(s) with a minimum clear floor area of 270 square feet (25.08 m ² ), no dimension of which shall be less than 15 feet (4572 mm).

1224.39.2.2 Perioperative services. Preoperative patient holding and postanesthesia recovery area(s) shall be provided which meet the requirements of Sec- tion 1224.16.

1224.39.2.3 Service areas. Each surgical unit shall provide the service areas required under Section 1224.15.3 as modified by the following:

1224.39.2.3.1 Soiled workroom. A separate soiled workroom separated from any surgical sterilizing facilities. The soiled workroom shall provide 24 square feet (2.2 m ² ) per operating room up to eight operating rooms and shall have the minimum area

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There shall be at least a 4-foot (1219 mm) space around and between beds and/or lounge chairs used for chemotherapy treatment/infusion.

1224.39.4.2.4 Handwashing stations. Handwashing stations shall be directly accessible to the nurses’ station and patient treatment areas. Handwashing stations shall be provided for each four patient sta- tions, and for each major fraction thereof. These shall be uniformly distributed to provide equal access from each patient station.

1224.39.4.2.5 Privacy. The open unit shall be designed to provide privacy for each patient.

1224.39.4.2.6 Medication dispensing. If provided, there shall be a medication dispensing station for the cancer treatment/infusion therapy area. A work counter and handwashing station shall be included in the area. Provisions shall be made for the con- trolled storage, preparation, distribution and refrig- eration of medications.

1224.39.4.2.7 Examination room. An examination room with a handwashing station shall be provided with at least 100 square feet (9.29 m ² ) of clear floor area.

1224.39.4.2.8 Clean utility room. A clean utility room shall be provided. If the room is used for pre- paring patient care items, it shall contain a work counter, a handwashing station, and storage facili- ties for clean and sterile supplies. If the room is used for storage and holding as part of a system for dis- tribution of clean and sterile materials, the work counter and handwashing station may be omitted. Soiled and clean utility rooms or holding rooms shall be separated and have no direct connection.

1224.39.4.2.9 Soiled utility room. A soiled work- room shall be provided and contain a sink, hand- washing station, work counter, storage cabinets, waste receptacles and a soiled linen receptacle.

1224.39.4.2.10 Nourishment station. If nourishment station for the cancer treatment/infusion therapy service is provided, the nourishment station shall contain a sink, a work counter, a refrigerator, stor- age cabinets and equipment for serving nourishment as required.

1224.39.4.2.11 Housekeeping room. Provide a housekeeping room that is immediately accessible to and for the exclusive use of the unit.

1224.39.4.2.12 Supplies. Supply areas or supply carts shall be provided.

1224.39.4.2.13 Storage. Storage space shall be avail- able for wheelchairs and gurneys. If gurneys are pro- vided, they shall be out of the direct line of traffic.

1224.39.4.2.14 Clean linen storage. A clean linen storage area shall be provided. This may be within the clean utility room, a separate closet, or an approved distribution system. If a closed cart system

INTERIOR ENVIRONMENT

is used, storage may be in an alcove. It must be out of the path of normal traffic and under staff control.

1224.39.4.2.15 Patient toilet. A patient toilet room with a lavatory shall be provided.

1224.39.4.3 Ancillary facilities.

1224.39.4.3.1 Staff lounge, lockers and toilets. Space shall be available for male and female per- sonnel for staff clothing change area and lounge. The areas shall contain lockers, toilets, and hand- washing stations.

1224.39.4.3.2 Patient storage. Storage for patients’ belongings shall be provided.

1224.39.4.3.3 Administrative services. Office and clinical work space shall be provided.

1224.39.4.3.4 Special design elements. Decorative water features and fish tanks shall not be located inside cancer treatment/infusion therapy unit.

1224.39.5 HYPERBARIC THERAPY SERVICE SPACE.

1224.39.5.1 General. If provided, clinical hyperbaric oxygen therapy service space shall meet the require- ments of the “Hyperbaric Facilities” chapter in NFPA 99: Health Care Facilities Code and shall comply with the following:

1224.39.5.2 Hyperbaric chambers.

1224.39.5.2.1 Class A chamber (multi-place facili- ties).

1. Clearances. There shall be a minimum clear- ance of 3 feet (914 mm) around the chamber. The area in front of the chamber entry designed for gurney or bed access shall have a minimum clearance of 8 feet (2438 mm) for gurney or bed approach. The area in front of the chamber entry designed for ambulatory or wheelchair access only shall have a minimum clearance of 5 feet (1524 mm) for wheelchair approach.

2. Entries. Chamber entries shall be provided with access ramps that are flush with the chamber entry doorway. Chamber entries not designed for gurney/bed access shall be a minimum of 3 feet (914 mm).

1224.39.5.2.2 Class B chamber (mono-place facili- ties).

1. Clearances. There shall be a minimum clear- ance of 3 feet (914 mm) around the chamber. A minimum clearance of 44 inches (1118 mm) shall be provided between the control sides of two chambers. The area in front of the cham- ber entry shall be designed for gurney or bed access with a minimum clearance of 8 feet (2438 mm) for gurney or bed approach.

2. Oxygen. An oxygen service valve shall be pro- vided for each chamber.

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1224.39.5.3 Pre-procedure patient holding area(s). In facilities with a Class A hyperbaric chamber or with three or more Class B chambers, a pre-procedure/ patient holding area shall be provided to accommodate patients on gurneys or beds and sitting space for ambu- latory patients. The area shall permit visual observa- tion of the patient by nursing staff and be located out of traffic flow. Each gurney station shall be a minimum clear floor area of 80 square feet (7.43 m ² ) and shall have a minimum clearance of 3 feet (914 mm) on the sides of the gurneys and the foot of the gurney. There shall be provisions for privacy such as cubicle curtains.

1224.39.5.4 Medical gas station outlets. Refer to Table 1224.4.6.1 Station Outlets for Oxygen, Vacuum (Suc- tion) and Medical Air.

1224.39.5.5 Support areas for the hyperbaric suite.

1224.39.5.5.1 Reception/control desk. An adminis- trative center/nurse station shall be provided within the hyperbaric suite.

1224.39.5.5.2 Examination/treatment room(s). Room(s) for individual consultation and treatment shall be provided and meet the requirements of Sec- tion 1224.4.4.1.

1224.39.5.5.3 Clean linen storage. A clean linen storage area shall be provided. This may be within the clean utility room, a separate closet or an approved distribution system. If a closed cart system is used, storage may be in an alcove. It must be out of the path of normal traffic and under staff control.

1224.39.5.5.4 Clean supply room. A clean supply room shall be provided and meet the requirements of Section 1224.4.4.6.1. This room may be omitted if the suite is served by a cart system.

1224.39.5.5.5 Gas cylinder room. The gas cylinder room shall provide space to house eight (H) cylin- ders and two gas manifolds, consisting of at least two (H) cylinders on each manifold.

1224.39.5.5.6 Gurney and wheelchair storage. Space for gurney and wheelchair storage shall be provided.

1224.39.5.5.7 Housekeeping room. A housekeeping room shall be provided and shall be immediately accessible to the hyperbaric suite.

1224.39.5.5.8 Compressor room. A compressor room shall be provided to house the chamber compressors, accumulator tanks and fire suppression system.

1224.39.5.6 Support areas for staff. Toilet rooms with a handwashing stations shall be immediately accessible to the hyperbaric suite for staff use.

1224.39.5.7 Support areas for patients.

1224.39.5.7.1 Patient waiting area. The patient waiting area shall be provided and meet the require- ments of Section 1224.39.1.

1224.39.5.7.2 Patient changing areas. Changing area(s) for outpatients shall be provided for patient clothing and for securing valuables.

1224.39.5.7.3 Patient toilet room. A patient toilet room with a handwashing station shall be directly accessible to the hyperbaric suite.

1224.39.6 OUTPATIENT OBSERVATION UNITS.

1224.39.6.1 General. If provided, outpatient observa- tion unit(s) shall comply with the following:

1224.39.6.2 Location. The unit shall be located outside of any inpatient unit and not part of the Emergency Department. Location shall be in compliance with Sec- tion 1224.4.3. Corridor systems shall connect the unit to all Basic and applicable Supplemental Services.

1224.39.6.3 Signage. The unit shall be marked with a sign identifying the unit as an outpatient unit. The signage shall use the term “outpatient” in the title of the desig- nated area.

1224.39.6.4 Patient care stations. Each patient station shall provide minimum clear floor area that includes space at each bedside for visitors. Provisions for visual privacy from casual observation by other patients and visitors shall be provided. Patient care stations shall meet the following:

1224.39.6.4.1 Space requirements:

1. Single-station rooms: 110 square feet (10.2 m ² ). A minimum distance of 3 feet (914 mm) shall be provided between the sides and foot of bed and any wall or other fixed obstructions.

2. Multi-station rooms or areas: 80 square feet (7.4 m ² ) per patient station. A minimum dis- tance of 3 feet (914 mm) shall be provided between beds and 4 feet (1219 mm) between the foot of beds and walls or other fixed obstructions.

1224.39.6.4.2 Negative-pressure isolation room with anteroom. Negative pressure isolation is optional. If provided, signage shall be labeled with the words “Negative-Pressure Room” on or adja- cent to the anteroom side of the door between the isolation room and the anteroom. A separate ante- room shall be provided between the negative-pres- sure isolation room and the corridor, which shall constitute the primary entrance to the negative-pres- sure isolation room. This anteroom shall have a handwashing station, a 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 ante- room into the negative pressure isolation room. Doors shall be aligned to allow large equipment to be wheeled into the negative-pressure isolation room unless a second entry is provided. An adjoin- ing patient toilet room shall be provided which has an emergency nurse call system, a lavatory, and a toilet equipped with a bedpan flushing attachment with a vacuum breaker.

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1224.39.6.4.3 Handwashing station(s). A hand- washing station shall be provided at each nurse sta- tion.

1224.39.6.4.4 Patient toilet room(s). A minimum of one toilet room shall be provided for the use of patients. Patient toilet room(s) shall be equipped with a handwashing station and shall be immedi- ately accessible to the observation unit(s) from the corridor.

1224.39.6.5 Service areas. Unless otherwise indicated, provisions for the services listed below shall be in or immediately accessible to each outpatient observation unit.

1224.39.6.5.1 Nurse station. A minimum of one nurse station shall be provided, in compliance with Section 1224.4.4.2. The distance between the nurse station entrance and the most remote patient station or room shall not exceed 90 linear feet (27,432 lin- ear mm).

1224.39.6.5.2 Nurse or supervisor office.

1224.39.6.5.3 Staff toilet room(s). Readily accessi- ble toilet room(s) provided for staff use.

1224.39.6.5.4 Multipurpose room(s). A minimum of one multipurpose room shall be provided for staff, patients, and/or patients’ families for uses such as patient conferences, reports, education, training sessions, and consultation. Room(s) must be readily accessible to each outpatient observation unit. One such room may be shared and serve several units and/or departments.

1224.39.6.5.5 Examination or treatment room(s). Examination or treatment rooms are optional. If provided, examination and/or treatment rooms must be readily accessible, but may be shared with other units or compatible departments. Provisions shall be made to preserve patient privacy from observation from outside the exam room through an open door. The room shall have a minimum area of 80 square feet (7.4 m ² ), the least dimension of which 8 feet (2438 mm).

1224.39.6.5.6 Medication station(s). Medication station(s) shall be provided, and in conformance with Section 1224.4.4.4.

1224.39.6.5.7 Nourishment area. A nourishment area, in compliance with Section 1224.4.4.5, shall be provided within the unit.

1224.39.6.5.8 Clean utility room. A clean utility/ workroom shall be provided, and in conformance with Section 1224.4.4.6.

1224.39.6.5.9 Soiled workroom. A soiled workroom or soiled holding room shall be provided, and in conformance with Section 1224.4.4.7.

1224.39.6.5.10 Clean linen storage. Clean linen storage shall be provided. It may be within the clean utility room or a separate closet.

1224.39.6.5.11 Ice machine. An ice machine shall be provided for treatment and nourishment. Ice-

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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.

1224.39.6.5.12 Equipment storage. Appropriate room(s) shall be provided for storage of equipment necessary for patient care. Equipment storage must be readily accessible but may be shared with other units and/or departments.

1224.39.6.5.13 Gurneys and wheelchairs. A storage room or alcove for gurneys and wheelchairs shall be provided and shall be a minimum of 15 square feet (1.39 m ² ).

1224.39.6.5.14 Emergency equipment storage. Space shall be provided for emergency equipment that is under direct control of the nursing staff, such as a cardiopulmonary resuscitation crash cart. This space shall be directly accessible from the nursing station, but out of normal traffic.

1224.39.6.5.15 Portable oxygen storage. Space shall be provided for portable oxygen storage, and shall meet the requirements of Section 307 for allowable quantities and hazard group for fire sepa- rations. Portable oxygen storage may be omitted if station outlets per Table 1224.4.6.1 “observation unit” footnote 8 are provided.

1224.39.6.5.16 Housekeeping room. A housekeep- ing room must be readily accessible but may be shared with other units and/or departments.

1224.40 SKILLED NURSING SERVICE SPACE.¶

If pro- vided a skilled nursing service unit shall be housed in a sepa- rate and distinct nursing unit and shall comply with the applicable requirements of Section 1225.

1224.41 SOCIAL SERVICE SPACE.¶

If provided, the social service space shall include office or other space for privacy in interviewing, telephoning and conducting conferences.