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.
1
2
.
3
.
1
.

meet
these
expectat
ions.
a.
Separat
e areas
need to
be
designe
d for the

(2) Vis
ual
ob

s
dm
e
ini
r
str
v
ati
a
ve
ti
ce
o
nte
n
r,
.
nur
T
se
h
sta
e
tio
r
n,
e
or
s
sta
h
ffe
a
d
ll
ch
b
arti
e
ng
d
sta
ir
tio
e
ns
c
an
t
d
o
all
r
pat
r
ien
e
t
m
be
o
ds
t
in
e
the
v
crit
is
ica
u
l
a
car
l
e
o
uni
b
t.
s
e *(2)
r
Doc
v
ume
a
ntati
ti
on
o
and
n
infor
b
mati
e
on
t
revi
w
ew
e
spac
e
es.
n
Spac
t
e
h
shall
e
be
prov
a

ided
with
in
the
unit
to
acco
mmod
ate
the
reco
rdin
g of
patie
nt
infor
mati
on.

*(a)
T
h
e
d
o
c
u
m
e
n
t
a
t
i
o
n
s
p
a
c
e
s
h
a
l
l
b
e
l
o
c

ate
d
wi
thi
n
or
adj
ac
ent
to
the
pat
ien
t
be
d
sp
ac
e.
It
sh
all
inc
lu
de
co
un
ter
to
p
tha
t
wi
ll
pr
ov
ide
for
a
lar
ge
flo
w
sh
eet
ty
pic
al
of
cri
tic
al
car
e
un
its
an
da

c
o
m
p
u
t
e
r

a
t
i
o
n
s
p
a
c
e

m
o
n
i
t
o
r

w
i
t
h

a
n
d

s
e
a
t
i
n
g

k
e
y
b
o
a
r
d
.

f
o
r
e
a
c
h

T
h
e
r
e

p
a
t
i
e
n
t

s
h
a
l
l

b
e
d
.

b
e
o
n
e
d
o
c
u
m
e
n
t

*(b)
T
h
e
r
e
s
h
a
l
l

and

be translate
a that to
sp adequate
eci
charting
fic
surfaces.
all
y 2.
T
de
sig he
na secretarial
te area should
d be
ar
accessible
ea
wi to all.
thi However,
n the charting
th areas may
e be
un
somewhat
it
for isolated to
inf facilitate
or concentrati
m on.
ati
on 3.
S
re torage for
chart
vi forms
ew and
supplies
lo should be
cat readily
accessibl
ed e.
to
fa 4.
cil Space for
ita computer
te terminals
co
and
nc
printer
en
tra and
tio conduit
n. for com-

5.

atient
records
should
be
readily
accessibl
e
to
clerical,
nursing,
and
physician
staff.
A3.4.2.4
(2)(a).
Documen
tation
space.
The
counterto
p area
should be
a
minimum
of 8
square
feet (0.74
square
meters).
If a
documen
tation
space is
to serve
two
patient
beds, it
should be
a
minimum
of 10

puter

square

hookup

feet (0.93

should be

square

staff

provided

meter).

(both

when

medical automate
and
nursing)
that
could be
present
at any

d
informati
on
systems
are in
use or
planned

one

for the

time

future.

A3.4.2
.4 (2)
(b).
Inform
ation
review
space.
There
should
be a

mini
mu
m of
8
squa
re
feet
(0.7
4
squa

re
meter
s) of
count
ertop
and
seatin
g
to
accom
modat

nes for
Design
2006 and
Guideli

2.1 GEN
E R AL H O
S P I TA L S

*(3) Office
space.
Adequat
e office
space for
critical
care
medical
and
nursing
manage
ment/ad
ministrat
ive
personne
l shall be
available
immediat
ely
adjacent
to the
critical
care unit.
The
offices
shall be
linked
with the
unit by
telephon
e or an
intercom
munications
system.

(4)

Multip
urpose
room(s

e two
peopl
e for
every
five
patien
t beds
it
serves
.
Constr Health Care
uction Facilities
of

51

).
Multip
urpose
room(s
) shall
be
provid
ed for
staff,
patient
s, and
patient
s
familie
s for
patient
confere
nces,
reports,
education,
trainin
g
session
s, and
consult
ation.
These
rooms
shall
be
accessi
ble to
each
nursing
unit.

*(5)
Medication
station.
Provision
shall be
made for
24hou
r

distr
ibut
ion
of
med
icati
ons
in
acc
ordan
ce
with
Sect
ion
2.12.3.
4.

distraction of
those preparing
medica-tions,
the area should
be enclosed. A
glass wall or
walls may be
advisable to
permit
observation of
patients and
unit activities. A
self-contained
medicinedispensing unit
may be located
at the nurse

*(6) Patient
monitori
ng
equipme
nt. Each
unit
shall
contain
equipme
nt for
continuo
us
monitori
ng, with
visual
displays
for each
patient
at the
bedside

station, in the
clean
workroom, in
an alcove, or in
another area
directly under
visual control of
nursing or
pharmacy staff.

A3.4.2.4 (6).
The unit
should provide
the ability to
continuously
monitor the
physiological
parameters
appropriate for
the types of
patients the
unit is

APPEN
DIX
A3.4.2.4 (3).
The offices
should be
large
enough to
permit
consulting
with
members of
the critical
care team
and visitors.
A3.4.2.4 (5). To
minimize

expected to
care for.

A3.4.2.4 (12)
(b).
Equipment
storage room
or alcove

1.

T
he location
of
the
equipment
storage
room
or
alcove
should not
interfere
with
the
flow
of

traffic.

2.

Wor

k areas and
storage

of

critical

and at
the
nurse
station.
Monitor
s shall
be
located
to
permit
easy
viewing
and
access
but shall
not
interfere
with
access
to the
patient.

care

supplies
should

be

read-ily
accessible to
nursing

and

physician
staff.

3.

Sh
elving, file
cabinets,
and drawers
should
be
accessible
to
all
requiring
use.

4.

El

ectrical

(7) X-ray

outlets
should

be

provided

viewing
facility.
The unit
shall
have an
x-ray
viewing
facility,
which
may be
shared
by more
than one
critical
care unit
provided
direct
access is
availabl
e from
each.

in

sufficient
numbers

to

permit
recharging
stored
batteryoperated
equipment.

5.

Alco

ves should be
provided for the
storage

and

rapid retrieval of
crash carts and
portable
monitor/defibrill
ator units.

(8)

Nourishm
ent area.
This area
shall be
provided
in
accordanc
e with
Section

2.1-2.3.5.

b
e
p
r
o
v
i
d
e
d
i
n
a
c
c
o
r
d
a
n
c
e
w
it
h
S
e
c
ti
o
n
2
.
1
2
.
3
.
7
.

It shall be
immediately
available
within
each
critical
care suite.
More than
one
critical
care unit
shall be
permitted
to share
this area
provided
direct
access is
available
from
each.

(9) Ice
machin
e. This
equipm
ent
shall be
provide
d
in
accorda
nce
with
Section
2.12.3.6.

(10)

Cle
an
workroo
m
or
clean
supply
room.

(1) T
h
i
s
r
o
o
m
s
h
a
ll

(2)

This
roo
m
shal
l be
im
med
iatel
y
avai
labl
e in
eac
h
criti
cal
care
suit
e.

Mor
e
than
one
criti
cal
care
unit
shal
l be
per
mitt
ed
to
shar
ea
clea
n
wor
kro
om
or
clea
n
sup
ply
roo
m
pro
vide
d
dire
ct
acce
ss is
avai
labl
e
fro
m
eac
h.

(11)

Soil
ed
workroo
m
or
soiled
holding
room.

(1) T
h
i
s
r
o
o
m

s
h
a
ll
b
e
p
r
o
v
i
d
e
d
i
n
a
c
c
o
r
d
a
n
c
e
w
it
h
S
e
c
ti
o
n
2
.
1
2
.
3
.
8
.

(2)

It
shal
l be
im
med
iatel
y
avai
labl
e in
eac
h
criti
-cal
care

suit
e,
but
mor
e
than
one
criti
cal
care
unit
shal
l be
per
mitt
ed
to
shar
e
the
roo
m
pro
vide
d
dire
ct
acce
ss is
avai
labl
e
fro
m
eac
h.

(12)

Equ
ipment
and
supply
storage

(1)

Cle
an
line
n
stor
age
.
Thi
s
sha
ll
be
pro
vid
ed

in
acc
ord
anc
e
wit
h
Sec
tion
2.1
2.3.
9.1.
Thi
s
are
a
sha
ll
be
im
me
diat
ely
ava
ilab
le
wit
hin
eac
h
crit
ical
car
e
suit
e.
Mo
re
tha
n
one
crit
ical
car
e
unit
sha
ll
be
per
mit
ted
to
sha
re
the
roo

m
pro
vid
ed
dire
ct
acc
ess
is
ava
ilab

le
fro
m
eac
h.

*(b)
Equipm
ent
storage
room or
alcove
Guidelin Construction of
es for
Health Care
Design Facilities
and

52
2006

(1) A
p
p
r
o
p
ri
at
e
r
o
o
m
(s
)
o
r
al
c
o
v
e(
s)
s
h
al
l
b
e
p
r
o
vi
d
e
d
in
a
c
c

o
r
d
a
n
c
e
w
it
h
S
e
ct
io
n
2.
1
2.
3.
9.
2.

(2) Ea
ch
crit
ical
car
e
uni
t
sha
ll
hav
e
suf
ficie
nt
sto
rag
e
are
a(s
)

loc
ate
d
on
the
pat
ien
t
flo
or
to
kee
p
the
req
uir
ed
cor
ridor
wi
dth
fre
e
of
all
equ
ip
me
nt
and
sup
pli
es.
No
les
s
tha
n
20
squ
are
fee
t
(1.
86
squ
are
me
ters
)
per
pat
ien
t
bed
sha

ll
be
pro
vid
ed
for
equ
ip
me
nt
sto
rag
e.

(3)

W
he
elc
hai
r
an
d
str
etc
he
r
sto
ra
ge.
Sp
ac
e
to
sto
re
str
etc
he
rs
an
d
wh
eel
ch
air
s
sh
all
be
pr
ovi
de
d
in
ac
co
rd
an
ce

wi
th
Se
cti
on
2.1
2.3
.9.
3.

i
n
a
c
c
o
r
d
a
n
c
e

(4) E
m
e
r
g
e
n
c
y
e
q
u
i
p
m
e
n
t
s
t
o
r
a
g
e
.
S
p
a
c
e
s
h
a
l
l
b
e
p
r
o
v
i
d
e
d

w
i
t
h
S
e
c
t
i
o
n
2
.
1
2
.
3
.
9
.
4
.

(13)

Hou
sekeepin
g room.
A
houseke
eping
room
shall be
provided
within
or
immedia
tely
adjacent
to the
critical
care
unit.

following
shall be
provided
for all
types of
critical
care units
unless
otherwise
noted.

(1) Thi
s
roo
m
shal
l
not
be
shar
ed
wit
h
oth
er
nur
sing
unit
s or
dep
art
me
nts.

(1)

(2) It
shal
l
con
tain
a
serv
ice
sink
or
floo
r
rece
ptor
and
pro
visi
ons
for
stor
age
of
sup
plie
s
and
hou
sek
eepi
ng
equ
ipm
ent.
3.4.2.5
Support
areas for
staff. The

Staff
lounge(s
)
and
toilet(s).
The
followin
g may
be
located
outside
the unit
if
conveni
ently
accessib
le.

(1) Th
ese
sh
all
be
loc
ate
d
so
tha
t
sta
ff
ma
y
be
rec
all
ed
qui
ckl
y
to
the
pat
ien
t
are
a
in
em
erg

en
cie
s.

(2)

Th
e
lou
ng
e
sha
ll
ha
ve
tel
ep
ho
ne
or
int
erc
om
an
d
em
erg
en
cy
co
de
ala
rm
co
nn
ect
ion
s
to
the
crit
ica
l
car
e
uni
t it
ser
ves
.

(3) I
f
n
o
t
p
r
o
v
i

d
e
d
e
l
s
e
w
h
e
r
e
,
p
r
o
v
i
s
i
o
n
f
o
r
t
h
e
s
t
o
r
a
g
e
o
f
c
o
a
t
s
,
e
t
c
.,
s
h
a
l
l
b
e
m
a
d
e
i
n

t
h
i
s
a
r
e
a
.

2.1 GEN
E RAL H O
S P I TA L S

(4) Ade
qua
te
furn
ishi
ngs,
equ
ipm
ent,
and
spa
ce
for
co
mfo
rtab
le
seat
ing
and
the
pre
par
atio
n
and
con
sum
ptio
n of
sna
cks
and
bev
era
ges
shal
l be
pro
vid
ed
unl
ess
pro
visi
ons
hav
e
bee
n
ma
de

else
whe
re.

(5) On
e
lou
ng
e
sh
all
be
per
mi
tte
d
to
ser
ve
adj
ace
nt
cri
tic
al
car
e
are
as.

(2) Staff
storage
facilities
.
Facilitie
s
for
personal
use of
staff
shall be
provided
in
accorda
nce with
Section
2.12.4.3.

(3) Staff
accomm
odations
.
Sleeping
and
personal
care
accomm
odations
shall be

provide
d for
staff on
24-hour,
on-call
work
schedule
s.

3.4.2.6
Support areas
for visitors

The
following
shall be
provided
and may
be located
outside
the unit if
convenie
ntly
accessible
.

(1) Visitor
waiting
room

(1)

This
roo
m
shal
l be
desi
gne
d to
acc
om
mod
ate
the
long
stay
s
and
stre
ssfu
l
con
diti
ons
com
mon
to
suc
h

spac
es,
incl
udin
g
pro
visi
ons
for
priv
acy,
mea
ns
to
facil
itate
com
mun
icati
ons,
and
acce
ss
to
toile
ts.

(2) Th
e
lo
cat
io
ns
an
d
siz
e
sh
all
be
ap
pr
op
ria
te
for
th
e
nu
m
be
r
of
pa
tie
nts
an
d
un

its
ser
ve
d,
wi
th
a
se
ati
ng
ca
pa
cit
y
of
no
t
les
s
th
an
on
e
fa
mi
ly
m
e
m
be
r
pe
r
pa
tie
nt
be
d.
3.4.3
Coronary
Care Unit
Coronary
patients
have special
needs. They
are often
fully aware
of their
surrounding
s but still
need immediate and
critical
emergency
care. In
addition to
the
standards in

Section 2.13.4.2, the

following
standards
apply to the
coronary
critical care
unit:

3.4.3.1
Each
coronar
y patient
shall
have a
separate
room
for
acoustic
al and
visual
privacy.

h coronary
patient shall
have access
to a toi-let in
the room.
Portable
commodes
shall be
permitted in
lieu of
individual
toilets, but
provisions
must be made
for their
storage,
servicing,
and odor
control.
Guidelin Construction of
es for
Health Care
Design
Facilities
and

53

2006

2.1 GEN
E R AL H O
S P I TA L S

3.4.4

C
ombined
Medical/
Surgical
Critical
Care
and
Coronar
y Care
If
medical/sur
gical and
coronary
critical care
services are
combined
in one
critical care
unit, at least
50 per-cent
of the beds
shall be
located in
private
rooms or
cubicles.

3.4.5

3.4.3.2 Eac

Pe

diatric
Critica
l Care
Critically
ill
pediatric
patients
have
unique
physical
and
psycholo
gical
needs.
3.4.5.1
General

(1)

Applica
bility.
The
standar
ds
previou
sly set
forth
for
a
general
critical
care
unit
(Sectio
n 2.13.4.2)
shall

apply
to
a
pediatri
c
critical
care
unit.

(2) Functio
nal
progra
m. If a
facility
has a
specific
pediatri
c
critical
care
unit,
the
functio
nal program
shall
include
conside
ration
for
staffing
, isolation,
transpo
rtation,
life
support
, and
environ
mental
system
s.

A3.4.5.2
(1)(b)
Parent
sleeping
accomm
odations
should
be
provided
at the
patients
bedside.
A3.4.5.2 (3)
(a) Formula
storage may
be outside
the unit but
should be
available for
use at all
times. The
functional
program
should
determine the
location and
size of
formula
storage.

A3.4.5.2 (3)(c)
Space
allowances for
pediatric beds
and cribs are
greater than
those for adult
beds because
of the variation
in bed/crib
sizes and the

3.4.5.2
Patient care
areas. A
pediatric
critical care
unit shall
provide the
following:

potential for

(1) Space
requirements

pedi-atric

change. The
functional program may
determine that
general
storage be
provided in the
critical care
unit above the
minimum
required under

APPEN
DIX

Section 2.13.4.2.4 (12)(b).

A3.4.5.3
The
number
and
location of
examinatio
n/treatmen
t rooms
should be
based on
the
functional
program.

A3.4.6.1 (1)
(a) There
should be
efficient
access to
the unit
from the
labor and
delivery
area and
emergency
department
or other
referral
entry points.

(1)

Spa
ce
at
eac
h
bed
side
for
fam
ilies
and
visi
tors
in
add
itio
n to
the
spa
ce
pro
vid
ed
for
staf
f.
The
spa
ce
pro
vid
ed
for
pare
ntal
acc
om
mo
dati
ons
as
defi
ned
by
the
fun
ctio
nal
pro
gra
m
shal
l
not

limi
t or
enc
roa
ch
upo
n
the
min
imu
m
clea
ran
ce
req
uire
me
nts
for
staf
f
and
me
dic
al
equ
ipm
ent
aro
und
the
pati
ent
s
bed
stat
ion.

*(b)
Sle
epi
ng
spa
ce
for
par
ent
s
wh
o
ma
y
be
req
uire
d to
spe
nd

lon
g
hou
rs
wit
h
the
pati
ent.
If
the
slee
pin
g
are
a is
sep
arat
e
fro
m
the
pati
ent
are
a, it
shal
l be
in
co
mm
uni
cati
on
wit
h
the
criti
cal
car
e
unit
.

(2) Cons
ultati
on/de
monst
ration
room
withi
n, or
conve
nient
to, the
pediat
ric
critica
l care

unit
for
privat
e
discu
ssions

(3) Storage
facilities
*(a)
Provisio
ns for
formula
storage

(2) S
e
p
a
r
a
t
e
s
t
o
r
a
g
e
c
a
b
i
n
e
t
s
o
r
c
l
o
s
e
t
s
f
o
r
t
o
y
s
a
n
d
g
a
m

e
s
*(c)
Eq
uip
me
nt
sto
rag
e
spa
ce.
Sp
ace
for
eq
uip
me
nt
sto
rag
e
sha
ll
be
pro
vid
ed
in
acc
ord
anc
e
wit
h
Se
cti
on
2.1
2.3
.9.
2.
*3.4.5.3
Examination
and treatment
room(s)

3.4.6
Newborn
Intensive
Care Units
The
following
standards
apply to
the
newborn

inten-sive
care unit
(NICU):

d.
Th
e
rec
ept
io
n
are
a
sh
all
pe
rm
it
vis
ual
ob
ser
vat
io
n
an
d
co
nta
ct
wi
th
all
tra
ffi
c
ent
eri
ng
the
un
it.

3.4.6.1
Patient care
areas

(1) Safety
and security

*(a)
Al
l
en
tri
es
to
th
e
NI
C
U
sh
all
be
co
ntr
oll
ed
.
Th
e
fa
mi
ly
en
tra
nc
e
an
d
re
ce
pti
on
ar
ea
sh
all
be
cl
ea
rly
id
en
tif
ie

(2)

Th
e
NI
CU
sha
ll
be
des
ign
ed
as
par
t of
an
ove
rall
saf
ety
pro

gra
m
to
pro
tec
t
the
ph
ysi
cal
sec
urit
y
of
inf
ant
s,
par
ent

s,
and
staf
f
and
to
mi
ni
miz
e
the
risk
of
inf
ant
abd
ucti
on.
2006
and
Guidelin Construction of
es for Health Care
Design Facilities

54

(2) Space
require
ments

(1) E
a
c
h
p
a
t
i
e
n
t
c
a
r
e
s
p
a
c
e
s
h
a
l
l
c
o
n

t
a
i
n
a
m
i
n
i
m
u
m
o
f
1
2
0
s
q
u
a
r
e
f
e
e
t
(
1
1
.
1
5
s
q
u
a

r
e
m
e
t
e
r
s
)
o
f
c
l
e
a
r
f
l
o
o
r
a
r
e
a
p
e
r
b
a
s
s
i
n
e
t
e
x
c
l
u
d
i
n
g
s
i
n
k
s
a
n
d
a
i
s
l
e
s

(2) Th
ere
sha
ll
be
an
ais
le
adj
ace
nt
to
eac
h
inf
ant
car
e
spa
ce
wit
ha
mi
ni
mu
m
wi
dth
of
4
fee
t
(1.
22
me
ter
s)
in
mu
ltip
lebe
d
roo
ms
.
W
he
n
sin
gle
pat
ien
t
roo

ms
or
fix
ed
cu
bic
le
par
titi
on
s
are
util
ize
d
in
the
des
ign
,
the
re
sha
ll
be
an
adj
ace
nt
ais
le
of
not
les
s
tha
n8
fee
t
(2.
44
me
ter
s)
in
cle
ar
an
d
un
ob
str
uct
ed
wi
dth
to
per

mit
the
pas
sag
e
of
eq
uip
me
nt
an
d
per
so
nn
el.

(3) In
mul
tipl
ebed
roo
ms,
ther
e
shal
l be
a
min
imu
m
of 8
feet
(2.4
4
met
ers)
bet
wee
n
infa
nt
car
e
bed
s.

(3) Vie
wing
wind
ows.
Whe
n
view
ing
wind
ows

are
prov
ided,
prov
ision
shall
be
mad
e to
cont
rol
casu
al
view
ing
of
infa
nts.

(4)

s
h
a
ll
h
a
v
e
s
p
a
c
e
f
o
r
c
o
u
n
t
e
r
s
a
n
d
s
t
o
r
a
g
e
.

Privacy.
Each
patient
care
space
shall be
designe
d
to
allow
privacy
for the
infant
and
family.

(5) Con

(2) Thi

trol
stati
on.
A
cent
ral
area
shal
l
serv
e as
a
cont
rol
stati
on.

s
are
a
sha
ll
hav
e
con
ven
ien
t
acc
ess
to
han
dwa
shi
ng
stat
ion
s.

(1) T
h
i
s
a
r
e
a

(3) It
sha

ll
be
per
mit
ted
to
be
co
mb
ine
d
wit
h
or
to
incl
ude
cen
ters
for
rec
epti
on
and
co
m
mu
nic
atio
n
and
pati
ent
mo
nit
ori
ng.

(6) Handwashing
stations

(1) In
a
m
ul
ti
pl
ebe
d
ro
o
m,
ev
er
y
be

d
po
sit
io
n
sh
all
be
wi
thi
n
20
fe
et
(6
.1
0
m
et
er
s)
of
a
ha
nd
sfr
ee
ha
nd
w
as
hi
ng
st
ati
on
.
W
he
re
an
in
di
vi
du
al
ro
o
m
co
nc
ep
t
is
us
ed
,a

ha
nd
sfr
ee
ha
nd
w
as
hi
ng
st
ati
on
sh
all
be
pr
ov
id
ed
wi
th
in
ea
ch
in
fa
nt
ca
re
ro
o
m.

2.1 GEN
E RAL H O
S P I TA L S

(2) Al
l
ha
nd
w
as
hi
ng
sta
tio
ns
sh
all
be
lar
ge
en
ou
gh
to
co
nt
ai
n
sp
las
hi
ng
.

(7) Constru
ction
require
ments

(1) Noi
se
con
trol

(1) Inf
ant
be
d
are
as
an
d
the
sp
ac
es
op

en
in
g
on
to
th
e
m
sh
all
be
de
sig
ne
d
to
pr
od
uc
e
mi
ni
m
al
ba
ck
gr
ou
nd
no
ise
an
d
to
co
ntai
n
an
d
ab
so
rb
m
uc
h
of
th
e
tra
nsi
en
t
no
ise
th
at
ari

ses
wi
thi
n
the
NI
C
U.

(2) The
co
mbi
nati
on
of
con
tinu
ous
bac
kgro
und
sou
nd
and
tran
sien
t
sou
nd
in
any
pati
ent
car
e
are
a
shal
l
not
exc
eed
an
hou
rly
Leq
of
50
dB
and
an
hou
rly
L10
of
55
dB,

bot
h
Awei
ght
ed
slo
w
res
pon
se.
The
Lm
ax
(tra
nsie
nt
sou
nds
)
shal
l
not
exc
eed
70
dB,
Awei
ght
ed
slo
w
res
pon
se.

(2) D
o
o
r
s
.
A
t
l
e
a
s
t
o
n
e
d
o
o
r

t
o
e
a
c
h
p
a
t
i
e
n
t
r
o
o
m
i
n
t
h
e
u
n
i
t
m
u
s
t
b
e
l
a
r
g
e
e
n
o
u
g
h
i
n
b
o
t
h

w
i
d
t
h
a
n
d
h
e
i
g
h
t
t
o
a
c
c
o
m
m
o
d
a
t
e
p
o
r
t
a
b
l
e
x
r
a
y
a
n
d
u
l
t
r
a
s
o
u
n

d
e
q
u
i
p
m
e
n
t
.

(3) Cei
ling
s

(1) C
e
i
l
i
n
g
s
s
h
a
l
l
b
e
e
a
s
i
l
y
c
l
e
a
n
a
b
l
e
a
n
d
n
o
n
f
r
i

C
)

a
b
l
e
.

o
f
a
t

(2) C
e
i
l
i
n
g
s

l
e
a
s
t
0
.
9
0
.

s
h
a
l
l
h
a
v
e
a
n
o
i
s
e
r
e
d
u
c
t
i
o
n
c
o
e
f
f
i
c
i
e
n
t
(
N
R

(3)

Ce
ili
ng
co
nst
ruc
tio
n
sh
all
li
mi
t
pa
ssa
ge
of
par
ticl
es
fro
m
ab
ov
e
the
cei
lin
g
pla
ne
int
o
the
cli
nic
al

en
vir
on
me
nt.

ed
ov
er
in
di
vi
du
al
pat
ien
t
car
e
sp
ac
es.

(8) Lighting
(1)

Pro
visi
ons
sha
ll
be
ma
de
for
ind
irec
t
lig
hti
ng
and
hig
hinte
nsit
y
lig
hti
ng
in
the
NI
CU
.

(2) Co
ntr
ols
sh
all
be
pr
ov
ide
d
to
en
abl
e
lig
hti
ng
to
be
adj
ust

(3)

D
a
r
k
e
n
i
n
g
s
u
f
f
i
c
i
e
n
t
f
o
r
t
r
a
n
s
i
l
l
u
m
i
n
a
t
i
o
n
s
h

a
l
l
b
e
a
v
a
i
l
a
b
l
e

w
h
e
n
n
e
c
e
s
s
a
r
y
.
2006
and
Guidelin Construction of
es for
Health Care
Design
Facilities

55

2.1 GEN
E R AL H O
S P I TA L S

nt
care
area
shall
be
locat

(4)

ed
No

or

dire

fram

ct

ed

amb

to

ient

avoi

light

da

ing

dire

shall

ct

be

line

per

of

mitt

sight

ed

from

in

any

the

infa

infa

nt to

nt

the

care

fixtu

spac

re.

e,

This

and

does

any

not

dire

excl

ct

ude

amb

the

ient

use

light

of

ing

dire

used

ct

outs

proc

ide

edur

the

infa

light

ing.

(5) Lig
htin
g
fixt
ure
s
shal
l be
eas
y to
clea
n.

(6) At
leas
t
one
sou
rce
of
day
ligh
t
shal
l be
visi
ble
fro
m
ne
wb
orn
car
e
are
as.

(1) E
xt
er
n
al
w
in
d
o
w
s
in
in
fa
nt
c
ar
e
ro
o
m
s
s

h
al
l
b
e
gl
a
z
e
d
w
it
h
in
s
ul
at
in
g
gl
as
s
to
m
in
i
m
iz
e
h
e
at
g
ai
n
or
lo
ss
.

(2) Ext
ern
al
wi
nd
ow
s in
inf
ant
car
e
roo
ms
sha
ll
be
situ
ate
d

at
lea
st 2
fee
t
(60
.96
cen
tim
ete
rs)
aw
ay
fro
m
an
y
par
t of
a
ba
by
s
be
d
to
mi
ni
mi
ze
rad
ian
t
hea
t
los
s
fro
m
the
ba
by.

(3)

All
ext
ern
al
wi
nd
ow
s
sha
ll
be
eq
uip
pe
d

wit
h
eas
ily
cle
ane
d
sha
din
g
de
vic
es
tha
t
are
ne
utr
al
col
or
or
op
aq
ue
to
mi
ni
mi
ze
col
or
dis
tort
ion
fro
m
tra
ns
mit
ted
lig
ht.

3.4.6.2
Airborne
infection
isolation
room. An
airborne
infection
isolation
room shall be
required in at
least one
level of
nursery care.

possible,

(1)

The
room
shall be
enclosed
and
separate
d from
the
nursery
unit with
provisio
ns
for
observati
on of the
infant
from
adjacent
nurseries
or
control
area(s).

(2) All
airborn
e
infectio
n
isolatio
n
rooms
shall
comply
with
the
require
ments
of
Section
2.13.2.2,
except
the
require
ments
for
separat
e toilet,
bathtub, or
shower.

APPEN
DIX
A3.4.6.4 (6)
Whenever

supplies should
flow through
special supply
entrances from
external
corridors so that
penetration of
the semi-sterile
zone by nonnursery
personnel is
unnecessary.

A3.4.6.4 (7)
Soiled
materials
should be
sealed and
stored in a
soiled
holding area
until
removed.
This holding
area should
be located
where there
will be no
need to pass
back through
the semisterile zone
to remove
the soiled
materials.

ns may
chart
and have
simultan
eous
access to
informat
ion and
commun
ication
systems.

3.4.6.3 Dia
gnostic,
treatment,
and service
areas.
Support
space shall
be accessible
for
respiratory
therapy,
blood gas
lab,
development
al therapy,
social work,
laboratory,
pharmacy,
radiology,
and other
ancillary
services
when these
activities are
routinely
performed on
the unit.

3.4.6.4 Sup
port
areas
for
newb
orn
intens
ive
care
units

(1)

Docume
ntation
area.
Charting
facilities
shall
have
adequate
linear
surface
space to
ensure
that staff
and
physicia

(2)

Nurse/sup
ervisor
office or
station.
This shall
be
provided
in
accordanc
e with
Section
2.13.4.2.4
(3).

(3)

Multipu
rpose
room(s)
for
staff,
patients
, and
patients

families
for
patient
confere
nces,
reports,
educati
on,
training
session
s, and
consult
ation.

(1) T
he
se
ro
o
m
s

m
us
t
be
ac
ce
ss
ib
le
to
ea
ch
nu
rsi
ng
un
it.
T
he
y
m
ay
be
on
ot
he
r
fl
oo
rs
if
co
nv
en
ie
nt
fo
r
re
gu
la
r
us
e.

y
s
e
r
v
e
s
e
v
e
r
a
l
n
u
r
s
i
n
g
u
n
i
t
s
a
n
d
/
o
r
d
e
p
a
r
t
m
e
n
t
s
.

(2) O
n
e
s
u
c
h
r
o
o
m
m
a

(4)

Medica
tion
station.
A
medicat
ion
station
shall be
provide
d
in
accorda

nce
with
Section
2.12.3.4.

(5)

Lactatio
n
support
space.
Space
shall be
provided
for
lactation
support
and
consultat
ion in or
immedia
tely
adjacent
to the
NICU.
Provisio
n shall
be made,
either
within
the room
or
convenie
ntly
located
nearby,
for handwashing
station,
counter,
refrigerat
ion and
freezing,
storage
for pump
and
attachme
nts, and
educatio
nal
materials
.

*(6)
Cl
ea
n
wo
rkr

oo
m
or
cle
an
su
pp
ly
ro
o
m.
Th
is
ro
o
m
sh
all
be
pr
ov
ide
d
in
ac
co
rd
an
ce
wi
th
Se
cti
on
2.1
3.4
.2.
4
(1
0).
*(7)
Soile
d
work
room
or
soile
d
holdi
ng
room
.
This
room
shall
be
provi
ded

in
acco
rdan
ce
with
Secti
on
2.13.4.2
.4
(11).

(8)

Emerg
ency
equip
ment
storag
e.

Space
for
storage
of
emerg
ency
equip
ment
shall
be
provid
ed in
accord
ance
with
Sectio
n 2.12.3.9.4
.
Guidelin Construction of
es for
Health Care
Design Facilities
and

56
2006

(9) House
keepin
g
room.
A
housek
eeping
room
shall
be
provid
ed for
the
unit.

(1) T
hi
s
r
o
o
m
s
h
al
l
b
e
di
re
ct
ly
a

c
c
e
ss
ib
le
fr
o
m
th
e
u
ni
t
a
n
d
d
e
di
c
at
e
d
f
o
r
th
e
e
x
cl
u
si
v
e
u
s

e
o
f
th
e
N
I
C
U
.

o
v
is
i
o
n
s
f
o
r
st
o
r
a
g
e
o
f
s
u
p
p
li
e
s
a
n
d
h
o
u
s
e
k
e
e
p
i
n
g
e
q
u
i
p
m
e
n
t.

(2) T
h
is
r
o
o
m
s
h
a
ll
c
o
n
t
a
i
n
a
s
e
r
v
i
c
e
si
n
k
o
r
fl
o
o
r
r
e
c
e
p
t
o
r
a
n
d
p
r

3.4.6.5
Support areas
for staff

(1)

Staff
lounge,
storage
facilitie
s, and
toilet.

A
lounge,
locker
room,
and
staff
toilet
shall be
provided
within
or
adjacen
t to the
unit for
staff
use.

(2)

Staff
accommo
dations.
Physician
sleeping
facilities
with
access to
a toilet
and
shower. If
not
contained
within the
unit itself,
the area
shall have
a
telephone
or
intercom
connectio
n to the
patient
care area.

3.4.6.6
Support areas
for patients
and visitors

(1) Visitor
waiting
room.
See
Section
2.13.4.2.6.

(2) Parent/i

nfant
room(s).
A
room(s)
shall be
provided
within
the
NICU
that
allow(s)
parents
and
infants
extende
d private
time
together.

(1)

Th
e
roo
m(
s)
sha
ll
hav
e
dir
ect,
pri
vat
e
acc
ess
to
sin
k
and
toil
et
fac
iliti
es,
co
m
mu
nic
ati
on
lin
kag
e
wit
h
the
NI
CU

staf
f,
ele
ctri
cal
and
me
dic
al
gas
out
lets
as
spe
cifi
ed
for
oth
er
NI
CU
bed
s,
sle
epi
ng
fac
iliti
es
for
at
lea
st
one
par
ent,
and
suf
fici
ent
spa
ce
for
the
inf
ant
s
bed
and
equ
ip
me
nt.

(2)

The
roo
m(s
)

ma
y
be
use
d
for
oth
er
pur
pos
es
wh
en
the
y
are
not
req
uire
d
for
fam
ily
use
.

3.5 Postpar
tum
Units
See Section
2.1-4.2.

3.6 Nurseri
es
3.6.1
General
Infants
shall be
housed in
nurseries
that
comply
with the
standards
in this
section.

2.1 GEN
E RAL H O
S P I TA L S

3.6.1.1
Location
. All
nurserie
s other
than
pediatric
nurserie
s shall
be
conveni
ent to
the
postpart
um
nursing
unit and
obstetric
al
facilities
.

3.6.1.2 Lay
out

(1)

The
nurserie
s shall
be
located
and
arrange
d to
preclude
the need
for
unrelate
d
pedestri
an
traffic.

(2) No
nu
rse
ry
sh
all
op
en
dir
ect
ly

ont
o
an
oth
er
nu
rse
ry.
3.6.2
Patient
Care Areas
(General)
The
following
standards
shall apply to
nurseries:

3.6.2.1
Space
require
ments.
Enough
space
shall be
provide
d
for
parents
to stay
24
hours.

3.6.2.2 V
iewing
windows.
Glazed
observati
on windows to
permit the
viewing
of infants
from
public
areas,
workroo
ms, and
adjacent
nurseries
shall be
provided.

3.6.2.3 Han
d-washing
station(s). At
least one
lavatory,
equipped
with a hands-

free handwashing
facility, shall
be provided
for each
eight or
fewer infant
stations.

3.6.2.4 Stor
age
for
infant
supplies.
Convenient,
accessible
storage for
linens and
infant
supplies
shall
be
provided at
each nursery
room.
3.6.3
Airborne
Infection
Isolation
Room
An airborne
infection
isolation
room shall
be provided
in or near at
least one
level of
nursery care.

3.6.3.1 The
room shall be
enclosed and
separated
from
the
nursery unit
with
provisions
for
observation

2006

2.1 GEN
E R AL H O
S P I TA L S

of the infant
from adjacent
nurseries or
control
area(s).

3.6.3.2 A
ll
airborne
infection
isolation
rooms
shall
comply
with the
requirem
ents
of
Section
2.1-3.2.2,
except
for
separate
toilet,
bathtub,
or
shower.
3.6.4
Neonate
Examination
and
Treatment
Areas

Such areas,
when
required by
the
functional
program,
shall
contain a
work
counter,
storage
facilities,
and a
hands-free
handwashing
station.
Guidelin Construction of
es for
Health Care
Design
Facilities
and

57

3.6.5
Support
Areas for
Nurseries
The
following
standards
shall apply

to nurseries:
3.6.5.1
Document
ation area.
Charting
facilities
shall have
linear
surface
space to
ensure that
staff and
physicians
may chart
and have
simultaneo
us access
to
informatio
n and
communic
ation
systems.
*3.6.5.2
Workroo
m(s).
Each
nursery
room
shall be
served
by a
connecti
ng
workroo
m.

(1) The
workro
om
shall
contain
scrubbi
ng and
gownin
g
facilitie
s at the
entranc
e for
staff
and
housek
eeping
person
nel,
work

counter
,
refriger
a-tor,
storage
for
supplie
s, and a
handsfree
handwashin
g
station.

(2) One
workro
om may
serve
more
than
one
nursery
room
provide
d that
required
services
are
convenient to
each.

(3) The
workroo
m
serving
the fullterm and
continuing care
nurserie
s may
be
omitted
if
equivale
nt work
and
storage
areas
and
facilities
,
includin
g those
for
scrubbin

g and
gowning
, are
provide
d within
that
nursery.
Space
required
for work
areas
located
within
the
nursery
is in
addition
to the
area
required
for
infant
care.

(4) Provisi
on shall
be
made
for
storage
of
emerge
ncy
cart(s)
and
equipm
ent out
of
traffic.

provid
ed via
borro
wed
lights
and/or
view
panels
betwee
n the
staff
work
area
and
each
nurser
y.

3.6.5.3
Lactation
support
room. A
consultatio
n/
demonstrati
on/breastfe
eding or
pump room
shall be
provided
convenient
to the
nursery.

APPEN
DIX
A3.6.5.2

(5) Provi
sion
shall
be
made
for
the
sanita
ry
storag
e and
dispo
sal of
soiled
waste.

(6) Visual
control
shall
be

When the
functional
program
includes a
motherbaby
couplet
approach to
nursing
care, the
workroom
functions
described
above may
be
incorporate
d into the
nurse
station that

serves the
postpartum
patient
rooms.

(1) Provisi
on shall
be
made,
either
within
the
room or
conveni
ently
located
nearby,
for
handwashin
g
station,
counter,
refriger
ation
and
freezin
g, storage for
pump
and
attachm
ents,
and
educati
onal
materia
ls.

(2) If
conveni
ently
located,
this
ancillar
y area
shall be
permitte
d to be
shared
for
other
purpose
s.
3.6.5.4
Neonate
formula
facilities

ng
supplie
s.
Thi
s
area
shal
l
incl
ude
a
han
dwas
hin
g
stati
on,
faci
litie
s
for
bott
le
was
hin
g, a
wor
k
cou
nter
,
and
steri
lizat
ion
equi
pme
nt.

(1) Locatio
n.
Where
infant
formula
is
prepare
d onsite,
direct
access
from
the
formula
prepara
tion
room to
any
nursery
room is
prohibit
ed. The
room
may be
located
near the
nursery
or at
other
appropr
iate
location
s in the
hospital
.

(2) The
formul
a
prepar
ation
room
shall
includ
e the
follow
ing:

(1)

Cle
anu
p
area
for
was
hin
g
and
steri
lizi

(2)

Sep
arat
e
roo
m
for
pre
pari
ng
infa
nt
for
mul
a.
Thi
s
roo

m
shal
l
cont
ain
war
min
g
faci
litie
s,
refri
gera
tor,
wor
k
cou
nter
,
for
mul
a
steri
lize
r,
stor
age
faci
litie
s,
and
a
han
dwas
hin
g
stati
on.

(3) Ref
rig
era
ted
sto
rag
e
and
wa
rmi
ng
fac
iliti
es
for
inf
ant
for
mu

la
acc
ess
ibl
e
for
use
by
nur
sery
per
son
nel
at
all
tim
es.

(3) If a
commer
cial
infant
formula
is used,
the
separate
cleanup
and
preparat
ion
rooms
may be
omitted. The
storage
and
handling
may be
done in
the
nursery
workroo
m or in
another
appropri
ate room
that is
conveni
ently
accessib
le at all
hours.
The
preparat
ion area
shall
have a

work
counter,
a handwashing
station,
and
storage
facilities
.

room

(1)

3.6.5.5 So
iled
workroom
or
soiled
holding
room shall
be provided
in
accordance
with Section
2.1-2.3.8.

3.6.5.6 Hou
sekee
ping
2006
Guidelin
es for
Design

58

nurser
y unit.
It
shall
be
directl
y
access
ible
from
the
unit.

(2) This
room
shall
contai
na
servic
e sink
or
floor
recept
or and
provid
e for
storag

A
hous
ekee
ping/
envir
onm
ental
servi
ces
room
shall
be
provi
ded
for
the
excl
usive
use
of
the

and
Construction of
Health Care
Facilities

e of
suppli
es and
house
keepin
g
equip
ment.
3.6.6
Newborn
Nursery
*3.6.6.1
Capacity.
Each
newborn
nursery room
shall contain
no more than
16 infant
stations.
When a
room-ing-in
program is
used, the
total number
of bassinets
in these units
shall be
permitted to
be reduced,
but the

newborn
nursery shall
not be
omitted in its
entirety from
any facility
that includes
delivery
services.

3.6.6.2 Are
a. The
minimum
floor space
shall be 24
square feet
(2.23 square
meters) per
bassinet,
exclusive of
auxiliary
work areas.

3.6.6.3 B
abyholding
nursery. In
postpartu
m and
labordeliveryrecoverypostpartu
m (LDRP)
units, a
babyholding
nursery
shall be
permitted
instead of
a
traditional
nursery.

(1)

The
minimu
m floor
area per
bassinet,
ventilati
on,
electrica
l,
and
medical
vacuum
and
gases

shall be
the same
as that
required
for
a
full-term
nursery.

(2) These
holding
nurserie
s shall
be next
to the
nurse
station
on these
units.

(3) The
hold
ing
nurs
ery
shal
l be
size
d to
acco
mmod
ate
the
perc
enta
ge
of
new
born
s
who
do
not
rem
ain
with
their
mot
hers
duri
ng
the
post
part
um
stay.
3.6.7
Continuing
Care

Nursery

3.6.7.1 For
hospitals
that provide
continuing
care for
infants
requiring
close
observation
(for
example,
low birthweight
babies who
are not ill
but require
more hours
of nursing
than normal
neonates),
the minimum floor
space shall
be 50 square
feet (4.65
square
meters) per
bassinet,
exclusive of
auxiliary
work areas,
with
provisions
for at least 4
feet (1.22
meters)
between and
at all sides
of each
bassinet.

3.6.7.2 The
continuing
care
bassinets are
permitted to
be within the
hospitals
NICU in a
defined
location for
these infants.

2.1 GEN
E RAL H O
S P I TA L S

3.6.8
Pediatric
Nursery
3.6.8.1
Capacity. To
minimize the
possibility of
crossinfection,
each nursery
room serving
pediatric
patients shall
contain no
more than
eight
bassinets.
Note:
Limitation
on number
of patients in
a nursery
room does
not apply to
the pediatric
critical care
unit.

3.6.8.2 Spac
e requirements.
Each bassinet
shall have a
mini-mum
clear floor area
of 40 square
feet

(3.72

square meters).

3.6.8.3 Fac
ility
requirements
. Each room
shall contain
a hands-free
handwashing
station, a
nurse
emergency
call system,

and a glazed
viewing
window for
observ-ing
infants from
public areas
and
workrooms.

*3.7
Pediatric
and
Adolescent
Unit
The unit
shall meet
the
following
standards:
3.7.1
Patient
Rooms

3.7.1.1
Capacity
.
Maximu
m room
capacity
shall be
four
patients.

support
requirements
. Additional
provisions
for hygiene,
toilets,
sleeping, and
personal
belongings
shall be
made where
the program
indicates that
parents will
be allowed to
remain with
young children. (See
Section 2.13.4.5 for
pediatric
critical care
units and
Section 2.13.6.6 for
newborn
nurseries.)

APPEN
DIX

3.7.1.2 Spa

A3.6.6.1 For

ce
requirements.
The space
requirements
for pediatric
patient beds
shall be the
same as for
adult beds
due to the
size variation
and the need
to change
from cribs to
beds and
vice-versa.
See Section
2.1-

facilities that

3.1.1.2 for

development

requir
ement
s.

use

rooming-in
program
which

all

infants

are

returned
the
at

to

nursery
night,

reduction in
nursery size
may not be
practical.
A3.7 In view
of their
unique
physical and
al needs,
pediatric and
adolescent
patients, to

*3.7.1.3
Family

in

the extent
their

condition

including

permits,

family sleep

should be

rooms,

grouped

pantry,

together in

toilets,

distinct units

showers,

or distinct

washers and

areas of

dryers, and

general units

access to

separate

computers,

from adults.

phones, and

A3.7.1.3

copy

Family

machines,

support

should be

spaces,

provided.

2006
Guidelin

2.1 GEN
E R AL H O
S P I TA L S

3.7.1.
4
Wind
ow.
Each
patien
t
room
shall
have
a
windo
w in
accor
dance
with
Sectio
n 2.18.2.2.
5.

3.7.2
Airborne
Infection
Isolation
Room(s)

3.7.2.1 A
t
least
one such
room
shall be
provided
in each
pediatric

es for
Construction of
Design Health Care
and
Facilities

59

unit. The
total
number
of
infection
isolation
rooms
shall be
determin
ed by an
ICRA.

3.7.2.2 A
irborne
infection
isolation
room(s)
shall
comply
with the
requirem
ents of
Section
2.1-3.2.2.

3.7.3
Examinatio
n/Treatmen
t Rooms
An
examination
/treatment
room shall
be provided
for pediatric
and
adolescent
patients. A
separate
area for

infant
examination
and
treatment
shall be
permitted
within the
pediatric
nursery
workroom.

3.7.4.1
Multipurpose
or individual
room(s)

(1)

These
shall be
provided
within
or
adjacent
to areas
serving
pediatric
and
adolesce
nt
patrons
for
dining,
educatio
n, and
develop
mentally
appropri
-ate play
and
recreatio
n, with
access
and
equipment for
patients
with
physical
restrictio
ns.

(2)

If the
functio
nal
progra
m
require
s, an
individ
ual
room
shall
be
provid
ed to
allow
for
confid
ential

3.7.3.1 Sp
ace
requirement
s.
Examinatio
n/treatment
rooms shall
have a
minimum
floor area of
120 square
feet (11.15
square
meters).

3.7.3.2 Fac
ility
requirements
. The room
shall contain
a handwashing
station;
storage
facilities;
and a desk,
counter, or
shelf space
for writing.
3.7.4
Support
Areas for
Pediatric/Ad
olescent
Units
The staff
support areas
in the pediatric
and adolescent
nursing units
shall conform
to Sections 2.13.1.4 through
2.1-3.1.6 and
shall also meet
the following
standards:

APPEN
DIX
A3.8.1.3 The

parent/fa
mily
comfort,
consultat
ion, and
teaching.

facility should
provide a
therapeutic
environment
appropriate for
the planned
treatment

(3) Insulat
ion,
isolati
on,
and
structu
ral
provis
ions
shall
minim
ize the
transm
ission
of
impact
noise
throug
h the
floor,
walls,
or
ceiling
of the
multipurpos
e
room(
s).

programs. The
environment
should be
characterized by
a feeling of
openness with
emphasis on
natural light. In
every aspect of
building design
and
maintenance it
is essential to
make
determinations
based on the
potential risk to
the specific
patient
population
served.

3.7.4.2 For
mula facilities.
Space for
preparation and
stor-age of
infant formula
shall be
provided
within the unit
or other
convenient
location.
Provisions
shall be made
for
continuation of
special formula

that may have

been prescribed for the
infant prior to
admission or
readmission.

3.7.4.3 Cle
an and
soiled
workrooms.
Separate
clean and
soiled
workrooms
or holding
rooms shall
be pro-vided
as described
in Sections
2.1-2.3.7
and 2.12.3.8.

3.7.4.4 Equ
ipmen
t and
suppl
y
storag
e

(1)

Storag
e
closet
s or
cabine
ts
shall
be
provid
ed for
toys,
educat
ional,
and
recrea
tional
equip
ment.

(2) S
t
o
r
a
g
e

s
p
a
c
e
s
h
a
l
l
b
e
p
r
o
v
i
d
e
d
t
o
p
e
r
m
i
t
e
x
c
h
a
n
g
e
o
f
c
r
i
b
s
a
n
d
a
d
u
l
t
b

e
d
s
.

(3)

Provision
s shall

3.8
Psychiatric
Nursing
Unit
3.8.1
General

also be

3.8.1.1 Ps

made for

ychiatric
care in a
medical
unit.
See
Section
2.1-3.2.4
for
psychiatric
care in a
medical
unit.

storage of
equipmen
t and
supplies
(including
cots or
recliners,
extra
linen,
etc.) for
parents
who stay
with the
patient
overnight.

3.7.5
Support
Areas for
Patients
3.7.5.1
Patient
toilet
room(s).
Toilet
room(s)
with handwashing
station(s) in
each room,
in addition
to those
serving bed
areas, shall
be
convenient
to multipurpose
room(s) and
to each
central
bathing
facility.

60
2006
Guidelin
es for
Design
and

3.8.1.2 Fun
ctional
program.
Provisions
shall be
made in the
design for
adapting the
area for
various
types of
medical and
psychiatric
therapies as
described in
the
functional
program.

*3.8.1.3
Environment
of care. The
facility shall
provide a
therapeutic
environment
appropriate
for the
planned
treatment
programs.
Constru
ction of
Health
Care
Facilities

and
Visitor
s
See Section
2.3-2.6.
*3.8.1.4
Security.
Security
appropriate
for the
planned
treatment
programs
shall be
provided.

3.8.1.5
Shared
facilities. In
no case shall
adult and
pediatric
clients be
mixed. This
does not
exclude sharing of
nursing
stations or
support
areas, as
long as the
separation
and safety of
the units can
be
maintained.

3.9 InHospital
Skilled
Nursing
Units
Many
facilities
have
incorporated
extended stay
units for the
medical/surgi
cal
department;
these are
often referred
to as inhospital
skilled
nursing units
or facili-ties.
These units
should not be
confused
with longterm

APPEN
DIX
A3.8.1.4 A safe
environment is
critical; however,

*3.8.2
Patient
Rooms
See Section
2.3-2.1.1.

3.8.3

Sec
lusion
Treat
ment
Room
s
See Section
2.3-2.2.1.

no environment
can be entirely
safe and free of
risk. The majority
of persons who
attempt suicide
suffer from a
treatable mental
disorder or a
sub-stance
abuse disorder
or both. Patients
of inpatient
psychiatric

3.8.4

Sup
port
Areas
for
Staff

treatment
facilities are
considered at
high risk for
suicide; the envi-

ronment should

or blind corners

avoid physical

or areas should

hazards while

be avoided.

maintaining a
thera-peutic

2.

environment.

he

The built

openness

environment, no

of

matter how well

nurse

designed and

station will

constructed,

be

cannot be relied

determine

upon as an

absolute

planned

preventive

treatment

measure. Staff

program.

awareness of

Considerat

their

ion should

environment,

be given to

latent risks of

patient

that

privacy

environment,

and also to

and the behavior

staff

risks and needs

safety.

the

by the

of

the patients
served in the
environment
are absolute
necessities.
Different
organization
s and
different
patient
populations
will require
greater or
lesser
tolerance for
risk.

1.

Cons

ideration should
be given to
visual control
(including electronic
surveillance) on
nursing units of
corridors, dining
areas, and
social areas
such as
dayrooms and
activity areas.
Hidden alcoves

A3.8.2
Patient
Rooms.
The
guideline
s noted in
Sections
2.3-1
through
2.3-2.3.3
and
Section
2.3-2.6
should
apply,
with the
following
exception
s:

2.1 GEN
E RAL H O
S P I TA L S

skilled
nursing units
found in
Chapter 4.1
of these
Guidelines.
These
extended stay
unit beds are
licensed
hospital beds
for patients
requiring
skilled
nursing care
as part of
their
recovery
process.
Many of
these
facilities are
intended for
elderly
patients
undergoing
various
levels of
rehabilitation
and
recuperating
stroke
victims or
brain trauma
victims
requiring
rehabilitation
.

3.9.1
General
3.9.1.1
Location

(1) The
location
of the
unit
shall
provide
conveni

ent
access
to the
Physical
and
Rehabili
tation
Medicin
e
departm
ents.

(2) Whe
reve
r
poss
ible,
the
unit
shall
be
loca
ted
to
prov
ide
acce
ss to
outd
oor
spac
es
that
can
be
utili
zed
for
ther
apeu
tic
purp
oses
.
3.9.1.2
Layout. The
unit shall be
located to
exclude
unrelated
traffic going
through the
unit to access
other areas of
the hospital.

1.
The
patie
nt
room
size
shoul
d
meet
the
requi
reme
nts in
Secti
on
2.13.1.1.
2.

provided
in each
room,
but this
is
not
required.

4.

A
quiet room is
not required
on units of
12 beds or
fewer unless
required by
the
functional
program.

5.

The

2.

functional needs

Ad
eq
ua
te
st
or
ag
e
sh
ou
ld
m
ee
t
th
e
re
qu
ire
m
en
ts
in
Se
cti
on
2.
12.
2.
2.

of the program

3.

A
desk or
writing
surface
for
patient
use may
be

should
determine

the

need for a nurse

call system. If a
nurse

call

system

is

provided,

it

should meet the

requirements of
Section

2.1-

10.3.8. However,
provisions
should be made
for easy removal
or

covering

of

the call system.

6.

Vi
sual privacy
in multi-bed
rooms
(e.g.,
cubicle
curtains) is
not
required.

7.

The

functional
needs of the
program will
determine the
need for
medical gas
and/or
vacuum
systems. If a

medical gas/

However,

vacuum

provisions

system is

should be

provided, it

made for easy

should meet

removal

the

and/or

requirements

covering of

of Sections

the medical

2.1-10.1.4.1

gas/vacuum

and 2.1-

system.

10.1.2.1 (2).
2006
Guidelin
es for
Design
and
Construc
tion of
Health
Care
Facilities

61

2.1 GEN
E R AL H O
S P I TA L S

3.9.2
Patient
Rooms
The basic
requirement
s contained
in Section
2.1-3.1.1
apply.
3.9.3
Treatment
Areas
3.9.3.1
Physical
rehabilitation
room. When
required by
the functional
program, a
physical
rehabilitation
room shall be
provided for
the use of the
skilled
nursing unit if
the unit is not
located
conveniently
to the facilitys physical
and
rehabilitation
therapy
departments.
The room
size and the
equipment
provided
shall be
adequate to
provide the
therapeutic
milieu
required by
the facilitys
functional
program.

.
9
.
4
S
u
p
p
o
r
t
A
r
e
a
s
f
o
r
I
n
H
o
s
p
i
t
a
l
S
k
i
l
l
e
d
N
u
r
s
i
n
g
U
n
i
t
s
In
addition
to the
support

areas
required
under
Sections
2.1-3.1.4
through
2.13.1.6,
the
followin
g rooms
and
support
elements
shall be
provided
:
3.9.4.1
Storage for
wheelchairs
and walking
aids.
Additional
storage
spaces to
accommodat
e the
increase in
wheelchair
and walking
aids used by
this patient
population
shall be
included in
the design of
the unit, with
an additional
square
footage of 7
square feet
(0.65 square
meters) per
bed.

3.9.5
Support
Areas for
Patients
3.9.5.1
Dining and
recreation
spaces

(1)

Factors
for
determ
ining

space
require
ments.
The
space
needed
for
dining
and
recreati
on
shall
be
determ
ined by
consid
ering
the
followi
ng:

(1)

The
nee
ds
of
pati
ents
wh
o
use
ada
ptiv
e
equ
ipm
ent
and
mo
bilit
y
aids
and
rece
ive
assi
stan
ce
fro
m
sup
port
and
serv
ice
staf
f

(2) T
he

ex
te
nt
to
w
hi
ch
su
pp
or
t
pr
og
ra
m
s
sh
all
be
ce
nt
ral
iz
ed
or
de
ce
nt
ral
iz
ed

(3) Th
e
nu
mb
er
of
pati
ent
s to
be
sea
ted
for
din
ing
at
one
tim
e,
as
req
uir
ed
by
the
fun
ctio
nal

pro
gra
m

(2)

Space
require
ments.
Nothin
g
in
these
Guideli
nes is
intende
d
to
restrict
a
facility
from
providi
ng

additio
nal
square
footage
per
resident
beyond
what is
require
d
herein
for
dining
rooms,
activity
areas,
and
similar
spaces.

(1) In
ne
w
co
nst
ruc
tio
n,
the
tot
al
are
a
set
asi
de
for
din
ing
,
pat
ien
t
lou
ng
es,
an
d
rec
rea
tio
n
sh

all
be
at
lea
st
25
sq
uar
e
fee
t
(2.
32
sq
uar
e
me
ter
s)
per
be
d
wit
ha
mi
ni
mu
m
tot
al
are
a
of
at
lea
st
22
5
sq
uar
e
fee
t
(2
0.9
0
sq
uar
e
me
ter
s).
At
lea
st
20
sq
uar

(2)

at
lea
st
14
squ
are
fee
t
(1.
30
squ
are
me
ters
)
per
bed
sha
ll
be
ava
ila
ble
for
din
ing
.
Ad
diti
ona
l
spa
ce
ma
y
be
req
uir
ed
for
out
pat
ien
t
day
car
e
pro
gra
ms.

e
fee
t
(1.
86
sq
uar
e
me
ter
s)
per
be
d
sh
all
be
av
ail
abl
e
for
din
ing
.
Ad
dit
ion
al
sp
ac
e
ma
y
be
req
uir
ed
for
out
patie
nt
da
y
car
e
pr
og
ra
ms
.

3.9.5.2 Pri

For
ren
ova
tio
ns,

vate space.
When
required by
the functional program,
the unit shall

contain
private
space for the
use of
individual
patients,
family, and
caregivers to
discuss the
specific
patients
needs or
private
family
matters.

room
for
patient
grooming
shall
be
provided.

(1)

(1) This
space
shall
have a
minimu
m clear
area of
250
square
feet
(23.23
square
meters).

(2) This
space
is
permi
tted
to be
consi
dered
part
of the
squar
e
foota
ge per
bed
outlin
ed in
Sectio
n 2.13.9.5.
2.
3.9.5.3
Patient
grooming
room. When
required by
the functional
program,
a

The
minimu
m area
shall not
be part
of
the
aggregate
area
under
Section
2.13.9.5.2
and
shall be
as
determin
ed
by
the
function
al
program
.

(2) This
room
shall
provid
e
spaces
for
hairwashi
ng
station
(s),
hair
clippi
ng and
hair
stylin
g, and
other
groom
ing
needs.

(3)

A handwashing
station,
mirror,
work
counter(

s),
storage
shelving
, and
sitting
area(s)
for

patients
shall be
provide
d as part
of the
room.
Design and
Construction of
2006
Health Care
Guidelin Facilities
es for

62

3.9.6
Constructio
n
Requireme
nts
3.9.6.1
Handrails

(1) Handrai
ls
located
in
accorda
nce
with
ADA
and all
local,
state,
and
federal
require
ments
shall be
installed
on both
sides of
the
patient
use
corridor
. Where
corridor
s are
defined
by
walls,
handrail
s shall
be
provide
d on
both

sides of
all
corridor
s
normall
y used
by
patients.

(2) A
minim
um
clearan
ce of
1-1/2
inches
(3.81
centimeter
s) shall
be
provid
ed
betwee
n the
handra
il and
the
wall.

(3) Rail
ends
shall be
returned
to
the
wall or
floor.

4
Obstetric
al
Facilities
*4.1
General
4.1.1
Location

and Layout

treated as the

The obstetrical

moving part.

unit shall be

She is moved

located and

through these

designed to

functional areas

pro-hibit

depending on

nonrelated

the status of the

traffic through

birth process.

the unit. When

delivery and
operating
rooms are in
the same suite,
access and
service
arrangements

The
functional
areas

are

separate
rooms
consisting of
the

labor

shall be such

room,

that neither

delivery

staff nor

room,

patients need

recovery

to travel

room,

through one

postpartum

area to reach

bedroom,

the other.

and

infant

nurseries
(levels

APPEN
DIX
A4.1 Obstetrical
program models
vary widely in
their delivery
methodologies.
The models are

determined
by acuity).

b. LaborDeliveryRecovery
Model
All labordeliveryrecovery

essentially of

rooms (LDRs)

three types. The

are designed

follow-ing

to accom-

narrative

modate the

describes the

birthing

organizational

process from

framework of

labor through

each model.

delivery and

a. Traditional
Model

recovery of
mother and
baby. They

Under the

are equipped

traditional

to handle

model, labor,

most

delivery,

complications,

recovery, and

with the

postpar-tum

exception of

occur in

cesarean

separate areas.

sections.

The birthing
woman is

2.1 GEN
E RAL H O
S P I TA L S

4.1.2
Newborn
Nursery
A
newbor
n
nursery
shall be
provide
d. See
Section
2.13.6.6.
4.1.3
Renovation
Except
as
permitted
otherwise
herein,
existing
facilities
being
renovated
shall, as far
as
practicable,
provide all
the required
support
services.

infection
isolation
room
is
not
required
for
the
obstetrical
unit.
Provisions
for
the
care of the
perinatal
patient
with
an
airborne
infection
shall
be
determined
by
an
ICRA.
4
.
2
.
3
E
x
a
m
i
n
a
ti
o
n
/

4.2
Postpartum
Unit

T
r
e
a

4.2.1

Pos
tpartu
m
Bedro
oms
See Section
2.1-3.1.1.

t
m
e
n
t
R
o

4.2.2

Airb
orne
Infecti
on
Isolati
on
Room(
s)

An
airborne

o
m
a
n
d
/
o
r

M
u
lt
i
p
u
r
p
o
s
e
D
i
a
g
n
o
s
ti
c
T
e

The
birthing
woman
moves
only as a
postpartu
m patient
to her
bedroom
or to a
cesarean
section
delivery
room
(surgical
operative
room) if
delivery
complicati
ons occur.

After the

ti

mother

and baby

are

recovered

o
o
m

4.2.3.1 Space
requirements.
This room
shall have a
min-imum
clear floor
area of 120
square feet
(11.15 square
meters).
When used as
a multipatient
diagnostic
test-ing
room, a
minimum
clear floor
area of 80
square feet
(7.43 square
meters) per
patient shall
be provided.

in the
LDR, they
are
transferred
to a
motherbaby care
unit for
postpartu
m stay.

c. LaborDeliveryRecoveryPostpartum
Model
Single-room
maternity care
in labordeliveryrecoverypostpartum
rooms (LDRPs)
adds a "P" to
the LDR
model. Room
design and
capability to
handle most

emergencies

moved into

remain the

the room as

same as the

needed,

LDRs.

rather than

However, the

moving the

LDRP model

patient to the

eliminates a

equipped

move to

room. Certain

postpartum

deliveries are

after delivery.

handled in a

LDRP uses

cesarean

one private

section

room for labor,

delivery room

delivery,

(surgical

recovery, and

operative

postpartum

room) should

stay.

delivery

Equipment is

complications
occur.
Guidelin Construction of
es for
Health Care
Design
Facilities
and

63

2006

2.1 GEN
E R AL H O
S P I TA L S

4.2.4.3 A
nurse
office

4.2.4.4 Con
4.2.3.2
Toilet room.
An
adjoining
toilet room
shall be
provided for
patient use.

4.2.4
Support
Areas for
the
Postpartum
Unit
The following
support areas
shall be
provided for
this unit.

4.2.4.1 A
nurse
statio
n

4.2.4.2 Doc
ument
ation
area

sultati
on/co
nfere
nce
room(
s)

4.2.4.5 Me
dication
station.
Provision
shall be
made for
storage and
distribution
of drugs and
routine
medications. This
may be done
from a
medicine
preparation
room or unit,
from a selfcontained
medicinedispens-ing
unit, or by
another
system.

(1) Medicin
e
preparat
ion
room or
unit

(1)

If
use
d, a
me
dici
ne
pre
par
atio
n
roo
m
or
unit
shal
l be
und
er
vis
ual
con
trol
of
nur
sin
g
staf
f.

(2) Thi
s
roo
m
or
uni
t
sha
ll
con
tain
a
wo
rk
cou
nter
,
sin
k,
refr
ige
rat
or,
and

dou
ble
loc
ked
stor
age
for
con
trol
led
sub
sta
nce
s.

(3) C
on
ve
ni
en
t
ac
ce
ss
to
ha
nd
w
as
hi
ng
sta
tio
ns
sh
all
be
pr
ov
id
ed
.
(S
ta
nd
ar
d
cu
psi
nk
s
pr
ovi
de
d

in
m
an
y
sel
fco
nt
ai
ne
d
un
its
ar
e
no
t
ad
eq
ua
te
fo
r
ha
nd
w
as
hi
ng
.)

4.2.4.6 No
urishment
area.
A
nourishment
station shall
be provided
in
accordance
with Section
2.1-2.3.5.

4.2.4.7 Cle
an
workroom or
clean supply
room. A
clean
workroom or
clean supply
room shall
be provided
in
accordance
with Section
2.1-2.3.7. A
clean
workroom is

required if
clean
materials are
assembled
within the
obstetrical
suite prior to
use.

4.2.4.8 Soi
led
workroom
or soiled
holding
room. A
soiled
workroom
or soiled
holding
room shall
be provided for
the
exclusive
use of the
obstetrical
suite in
accordance
with Section
2.1-2.3.8.

ment
and
supplie
s.
4.2.4.9
Equipment
and supply
storage

(1) Cle
an
line
n
stor
age
.
Thi
s
sha
ll
be
pro
vid
ed
in
acc
ord
anc
e
wit
h
Sec
tio
n
2.1
2.3.
9.1.

(2) Equipm
ent
storage
room.
Each
unit
shall
provide
sufficie
nt
storage
area(s)
on the
patient
floor to
keep its
require
d
corridor
width
free of
equip-

(1) Thi
s
stor
age
are
a
shal
l be
not
less
tha
n
10
squ
are
feet
(0.9
3
squ
are
met
er)
per
pos
tpart
um
roo
m
and
20
squ
are
feet
(1.8
6
squ
are
met
ers)
per
eac
h
lab
ordeli
ver
yrec
ove
ry
(L
DR
) or
LD

RP
roo
m.

(2) T
hi
s
st
or
ag
e
ar
ea
sh
al
l
be
in
ad
di
ti
o
n
to
an
y
st
or
ag
e
in
pa
ti
en
t
ro
o
m
s.

(3)

Stor
age
spac
e
for
stret
cher
s
and
whe
elch
airs.
Stor
age
spac
e
shal
l be
prov
ided
in

acco
rdan
ce
with
Sect
ion
2.12.3.
9.3.

(4) Emer
genc
y
equip
ment
stora
ge.
Stora
ge
shall
be
close
to the
nurse
statio
n.

4.2.4.10
Housekeepi
ng room. A
housekeepin
g room shall
be provided
for the
exclusive
use of the
obstetri-cal
suite in
accordance
with Section
2.1-2.3.10.

4.2.5
Support
Areas for
Staff
The following
support areas
shall be
provided for
this unit.

4.2.5.1 Staf
f
loung
e

4.2.5.2 Sta
ff
storage
facilities.

Lockable
closets
or
cabi-nets for
personal
articles
of
staff shall be
provided.

4.2.5.3 Staf
f
toilet
room
4.2.6
Support
Areas for
Patients
and Visitors
The following
support areas
shall be
provided for
this unit.

4.2.6.1

Patient
lounge.
The
patient
lounge
may be
omitted
if
all
rooms
are
singlebed
rooms.

4.2.6.2 Pati
ent
bathin
g
facilit
ies
(1) Where
bathing
facilities are
not provided
in
2006
Guidelin
es for
Design

64

and
Construction of
Health Care
Facilities

provided
within or
directly
accessible
to

bathing

patient
rooms
, there
shall
be at
least
one
showe
r
and/or
bathtu
b for
each
six
beds
or
fractio
n
thereo
f.

(2)

facility.

4.3
Cesarean/
Delivery
Suite
4.3.1 Labor
Rooms
4.3.1.1
General

(1)

toilet

and handwashing
station
shall

each

be

Number.
In
facilities
that have
only one
cesarean/
delivery
room,
two
labor
rooms
shall be
provided
.

per bed.

(2) Access.
Labor
rooms
shall
have
controll
ed
access
with
doors
that are
arranged
for
observat
ion from
a
nursing
station.

4.3.1.2 Cap
acity. Where
LDRs or
LDRPs are
not provided, a
minimum of
two labor
beds shall be
provided for
each
cesarean/deli
very room.

4.3.1.3 Spa
ce
requir
ement
s

(1) Each
room
shall be
designe
d for
either
one or
two
beds,
with a
minimu
m clear
area of
120
square
feet
(11.15
square
meters)

(2) In
reno
vatio
n
proje
cts,
labor
room
(s)
(LD
R or
LDR
P
room
s
may
be
subst
itute
d)
shall
have
a
mini
mum
clear
area
of
100
squa
re
feet
(9.29
squa
re
mete
rs)
per
bed.

4.3.1.4 Wi
ndows.
Windows in
labor rooms,
if provid-ed,
shall be
located,
draped, or
otherwise
arranged to
preserve
patient
privacy
from casual
observation
from outside
the labor

room.

4.3.1.5 H
andwashing
station.
Each labor
room shall
contain a
handwashing
station.

4.3.1.6 Toil
et
room

(1)

Each
labor
room
shall
have
access to
a toilet
room.

(2) One
toilet
room
may
serve
two
labor
rooms.
4.3.1.7
Bathing
facilities. At
least one
shower
(which

2.1 GEN
E RAL H O
S P I TA L S

may be
separate
from the
labor room
if under
staff
control) for
use of
patients in
labor shall
be provided.

4.3.2
Delivery
Room(s)

4.3.2.1 Spa
ce
requirements.
These shall
have a minimum clear
area of 300
square feet
(27.87 square
meters)
exclusive of
fixed
cabinets and
built-in
shelves.

4.3.2.2 E
mergency
communica
tion system.
An emergency
communica
tion system
shall
be
connected
with
the
obstetrical
suite
control
station.
4.3.3
Cesarean/D
elivery
Room(s)

4.3.3.1

Number
. There
shall be
a
minimu
m
of
one
such
room in
every
obstetri
cal unit.

(1)

Space
in
deliver
y
rooms.
A
minim
um
clear
floor
area of
40
square
feet
(3.72
square
meters
) shall
be
provid
ed for
the
infant
resusci
tation
space
in
additio
n
to
the
requir
ed
area of
each
deliver
y or
cesare
an/deli
very
room.

(2)

Space
in a
separate
room.
Infant
resuscit
ation
space
provide
d in a
separate
but
immedi
ately
accessi

4.3.3.2 Sp
ace
requirement
s. These
shall have a
mini-mum
clear floor
area of 360
square feet
(33.45
square
meters)
with a
minimum
dimension
of 16 feet
(4.88
meters)
exclusive of
built-in
shelves or
cabinets.

4.3.4 Infant
Resuscitati
on Space

4.3.4.1 Loc
ation. Infant
resuscitation
shall be
provided
within
cesarean/deli
very room(s)
and delivery
rooms or in a
separate but
immediately
accessible
room.

4.3.4.2 Spa
ce
requir
ement
s

ble
room
shall
have a
minimu
m clear
floor
area of
150
square
feet
(13.94
square
meters).
4.3.4.3
Electrica
l outlets.
Six
single or
three
duplex
electrical
outlets
shall be
provided
for the
infant in

4.3.5
Recovery
Room(s)
LDR or
LDRP rooms,
when located
within or
adjacent to
the
cesarean/deli
very suite,
may be
substituted.

4.3.5.1
Capacity.
Recovery
rooms shall
contain at
least two
beds.
Guidelin Construction of
es for
Health Care
Design
Facilities
and

65

2006

2.1 GEN
E R AL H O
S P I TA L S

4.3.5.2
Support areas
for recovery
rooms

(1)

addition
to
the
facilities
required
for the
mother.

Nurse
station
and
documen
tation
area.
Recover
y room
shall
have a
nurse
station
with
charting
facil-ities
located

to permit
visual
control
of all
beds.

(2) Handwashin
g
station.
Each
room
shall
include
a handwashin
g
station.

(3) Medic
ation
dispen
sing
faciliti
es.
Each
room
shall
include

faciliti
es for
dispens
ing
medici
ne.

(4) Clinical
sink. A
clinical
sink
with
bedpan
flushing
device
shall be
availabl
e.

(5) Equip
ment
and
suppl
y
storag
e.
Storag
e for
supplies
and
equip
ment
shall
be
availa
ble.
4.3.5.3
Support areas
for families

(1)

When
required
by the
function
al
program,
there
shall be
enough
space for
baby and
crib and
a chair
for the
support
person.
There
shall be

the
ability to
maintain
visual
privacy
for the
new
family.
4.3.6
Support
Areas for the
Cesarean/De
livery Suite

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

4.3.6.2 Ar
eas solely
for
the
cesarean/del
ivery suite.
The
following
support
areas shall
be provided:

(1) A
contr
ol/nu
rse
statio
n.
This
shall
be
locat
ed to
restri
ct
unaut
horiz
ed
traffi

c into
the
suite.

(2) Soile
d
work
room
or
soile
d
holdi
ng
room
.
This
room
shall
be
provi
ded
in
accor
danc
e
with
Secti
on
2.12.3.8
.

(3) Fluid
waste
disposal

APPEN
DIX
A4.3.6.3 (5)
High-speed
autoclaves
should only
be used in
an
emergency
situation
(e.g.,

dropped
instrument
and

no

sterile
replacemen
t

readily

available).

4.3.6.3 Areas
permitted to
be shared.
The
following
support areas
shall be
permitted to
be shared
with the
surgical
facilities in
accordance
with the
functional
program.
Where
shared, areas
shall be
arranged to
avoid direct
traffic
between the
delivery and
operating
rooms.

(1) A
supervis
ors
office or
station

(2)

Medicat
ion
station.
A drug
distribut
ion
station
with
handwashing
stations
and
provisio
ns for
controll
ed
storage,
preparat
ion, and
distribut
ion of

medicat
ion
shall be
provide
d. A
selfcontain
ed
medicat
ion
dispensi
ng unit
in
accorda
nce
with
Section
2.12.3.4
may be
utilized
instead.

(3) Scrub
facilities
for
cesarean
/delivery
rooms

(1) Tw
o
scru
b
posi
tion
s
shal
l be
pro
vid
ed
adja
cent
to
the
entr
anc
e to
eac
h
ces
area
n/d
eliv
ery
roo
m.

(2) Scr
ub
faci
litie
s
sha
ll
be
arra
nge
d to
min
imi
ze
any
spl
atte
r on
nea
rby
per
son
nel
or
sup
ply
cart
s.

(3) In
ne
w
co
ns
tr
uc
tio
n,
vi
e
w
wi
nd
o
w
s
sh
all
be
pr
ov
id
ed
at
sc
ru
b
st
ati

on
s
to
pe
rm
it
th
e
ob
se
rv
ati
on
of
ro
o
m
int
eri
or
s.

(4) Anesthe
sia
workroo
m. An
anesthes
ia
workroo
m for
cleaning
, testing,
and
storing
anesthes
ia equipment
shall be
provided
. It shall
contain
a work
counter,
sink, and
provisio
ns for
separatio
n of
clean
and
soiled
items.

*(5)
Steriliza
tion
facilities
.

Steriliza
tion
facilities
with
highspeed
sterilize
rs shall
be
located
conveni
ent to
all
cesarean
/deliver
y
rooms.
Steriliza
tion
facilities
shall be
separate
from the
delivery
area and
adjacent
to clean
assembl
y.

(6) Clean
workroo
m
or
clean
supply
room

(1)

Cle
an
wor
kro
om.
A
clea
n
wor
kro
om
shal
l be
pro
vid
ed
if
clea
n

mat
eria
ls
are
asse
mbl
ed
wit
hin
the
obst
etri
cal
suit
e
prio
r to
use.
It
shal
l
con
tain

a
wor
k
cou
nter
,
han
dwas
hin
g
stati
on,
and
spa
ce
for
stor
age
of
sup
plie
s.
2006
Guidelin
es for
Design

66

and
Construction of
Health Care
Facilities

al
prog
ram
defi
nes

(2)

Clea
n
sup
ply
roo
m.
Pro
visi
on
of a
clea
n
sup
ply
roo
m
shal
l be
per
mitt
ed
whe
n
the
func
tion

a
syst
em
for
the
stor
age
and
distr
ibuti
on
of
clea
n
and
steri
le
supp
lies.
See
(7)
(a)
just
belo
w
for
steri

le

om
.
Th
e
siz
e
sha
ll
be
bas
ed
on
lev
el
of
usa
ge,
fun
cti
on
s
pro
vid
ed,
an
d
su
ppl
ies
fro
m
the
ho
spi
tal
ce
ntr
al
dis
tri
butio
n
are
a.

stor
age.

(7) Equip
ment
and
supply
storag
e.
Storag
e
room(
s)
shall
be
provid
ed for
equip
ment
and
suppli
es
used
in the
obstetr
ical
suite.
These
shall
includ
e the
follow
ing:

(1) A
cle
an
ste
ril
e
sto
ra
ge
are
a
rea
dil
y
av
ail
abl
e
to
the
del
ive
ry
ro

(2) Me
dica
l
gas
stor
age
faci
litie
s.
See
Sect
ion
2.1-

5.3.
5.1
4
(3).

(3) An
are
a
for
sto
rin
g
stre
tch
ers
out
of
the
pat
h
of
nor
ma
l
traf
fic

(8)

Housek
eeping
room.
Housek
eeping
room
with a
floor
recepta
cle or
service
sink
and
storage
space
for
housek
eeping
supplie
s and
equipm
ent.

4.3.7
Support
Areas for
Staff
The
following
support
areas shall
be
permitted

to
be
shared
with
the
surgical
facilities in
accordance
with
the
functional
program.
Where
shared,
areas shall
be
arranged to
avoid
direct
traffic
between
the
delivery
and
operating
rooms.

4.3.7.1 L
ounge and
toilet
facilities.
Lounge
and toilet
facilities
for
obstetrical
staff
convenient
to delivery,
labor, and
recovery
areas. The
toilet room
shall contain handwashing
stations.

4.3.7.2 Staf
f
chang
e
areas

(1)

The
clothing
change
area(s)
shall be
laid out
to
encourag

e oneway
traffic
and
eliminat
e crosstraffic
between
clean
and
contami
nated
personne
l.

(2) The
area(s)
shall
contain
lockers,
shower
s,
toilets,
handwashin
g
stations
, and
space
for
donnin
g and
disposi
ng
scrub
suits
and
booties.

2.1 GEN
E RAL H O
S P I TA L S

4.3.7.3 S
upport
person
change
areas.
Change
areas,
designed
as
describe
d above,
shall be
provided
for male
and
female
support
persons.

4.3.7.4 S
taff
accomm
odations
. An oncall
room(s)
shall be
provided
for
physicia
n and/or
staff. It
may be
located
elsewher
e in the
facility.
4.3.8
Support
Areas for
Visitors
The
following
support
areas shall
be
permitted
to
be
shared
with the
surgical
facilities

in
accordanc
e with the
functional
program.
4.3.8.1
Waiting
room. A
waiting
room, with
toilets,
telephones,
and
provisions
for drinking
water shall
be
convenientl
y located.
The toilet
room shall
contain
handwashing
stations.

4.4 LDR
and LDRP
Rooms
When
required by
the
functional
program,
delivery
procedures
in
accordance
with
birthing
concepts
may be
performed
in the LDR
or LDRP
rooms.
4.4.1
Location
LDR
room(s)
may
be
located in
a separate
LDR suite
or as part
of
the
cesarean/d

elivery
suite. The
postpartum
unit
may
contain
LDRP
rooms.
4.4.2
Capacity
Each LDR or
LDRP room
shall be for
single
occupancy.

4.4.3 Space
Requireme
nts
*4.4.3.1
New
construction
. These
rooms shall
have a
minimum
clear floor
area of 300
square feet
(27.87
square
meters) with
a minimum
dimension
of 13 feet
(3.96
meters),
exclusive of
toilet room,
closet,
alcove, or
vestibules.

(1) Where
require
d by
the
functio
nal
progra
m,
there
shall
be
enoug
h
space

for a
crib
and
reclini
ng
chair
for a
suppor
t
person
.

(2) An area
within
the
room
but
distinct
from the

APPEN
DIX

A4.4.3.1 A
minimum
dimension
of 15 feet
(4.57
meters) is
preferable
to
accommod
ate the
equipment
and staff
needed for
complex
deliveries.
Guidelin Construction of
es for Health Care
Design
Facilities
and

67

2006

2.1 GEN
E R AL H O
S P I TA L S

moth
ers
area
shall
be
provi
ded
for
infant
stabilizati
on
and
resus
citati
on.
4.4.3.2
Renovation
. When
renovation
work is
undertaken,
every effort
shall be
made to
meet the
above
minimum
standards.

If it is not
possible to
meet the
above
square-foot
standards,
existing
LDR or
LDRP
rooms shall
be
permitted
to have a
minimum
clear area
of 200
square feet
(18.58
square
meters).

4.4.4
Patient
Privacy
Windows
or doors
within a
normal
sightline
that
would
permit
observatio
n into the
room
shall be

arranged
or draped
as
necessary
for patient
privacy.

current

4.4.5 HandWashing
Stations
Each room
shall
be
equipped
with handwashing
sta-tions.
(Handwashing
stations
with handsfree operation
are
acceptable
for
scrubbing.)

preparation

4.4.6
Patient
Bathroom
Each LDR
or LDRP
room shall
have direct
access to a
private
toilet with
shower or
tub.

emergency
department
capac-ity for
such patients.

1.

This

should include
the

provision

of

adjacent

space

for

triage

and

management
of

infectious

patients.

2.
Utility
upgrad
es for
these
areas
(oxygen
, water,
electric
al)
should
be
conside
red.

3.

The

area should
provide for
depressurization
to help control
aerosolized
infectious
particles with 100

APPEN
DIX

percent exhaust
capabili-ty. If 100

A5.1 Surge
Capacity

percent exhaust

In preparation

achieved,

for the

appropriate

emergence of

proven

highly

technology

infectious

should be utilized

patients, hos-

to reduce

pitals should

airborne particles

have the

by > 95 percent.

capacity to

If patient care

handle a surge

areas are to be

of up to ten or

utilized in the

a fourfold

hospital to house

increase

these patients,

above the

the route to the

cannot be

patient care unit

should minimize
the potential for
crosscontamination.
Existing smoke
control areas
could be utilized
to meet the
ventilation
requirements.
Air-handling
systems should
be designed to
provide required
pres-sure
differentials.
Written protocols
must be
developed to
ensure

4.4.7
Medical
Gas Outlets

4.4.
7.1
See
Tabl
e
2.1-5
for
medi
cal
gas
outle
t
requi
reme
nts.

4.4.7.2 T
hese
outlets
shall be
located in
the room
so
they
are
accessible
to
the
mothers
delivery
area and
infant
resuscitati
on area.
4.4.8
Finishes
Finishes
shall be
selected to
facilitate
cleaning
and to
resist
strong
detergents.
4.4.9
Lighting
Portable
examinati
on lights
shall be
permitted
, but must

be
immediat
ely
accessible
.

5
Diagnosti
c and
Treatmen
t
Locations
*5.1
Emergency
Service

emer
genc
y
depar
tment
s/
servi
ces/tr
auma
cente
rs
Basic aspects
of previous
Level I-IV
emergency
department/
services
classifications

5.1.1
General

are still

*5.1.1.1
Definition
Levels of
emergency
care range
from initial
emergency
management
to definitive
emergency
care.

current criteria

recognizable in
statements but
have evolved
substantially to
address
changes in
practice,
needs, and
technologies.
The following
publications
are especially
useful
references for

proper

understanding

performan

and listing

ce of the

current refined

means

and expanded

to

accomplis

requirements:

American

the

intended

College of

goals.

Surgeons.

DHHS, the

"Trauma

Office

Center

of

Emergenc
y
Preparedn
ess,

will

have more
up-to-date
informatio
n.

A5.1.
1.1
Class
ificati
on of

Descriptions
and Their
Roles in a
Trauma
System,"
chapter 2 in
Resources for
Optimal Care
of the Injured
Patient (ACS,
1999). This
reference
provides

detailed

Design (American

descriptions of

College

Level ILevel

Emergency

IV trauma

Physicians,

centers.

1993). The author

(www.facs.org
)

plan-

ning for various

Riggs,
M.,

discusses

of

Leonard
Jr.,

ed.

Emergency

levels

of

treatment

acuity.

(www.acep.org)

Department

2006
Guidelin
es for
Design

68

and
Construction of
Health Care
Facilities

definitiv
e
emergen
cy
manage
ment. In
those
cases, it
is
importa
nt that
the
hospital
be able
to assess
and
stabilize
emergent
illnesses
and
injuries
and
arrange
for
appropriate
transfer.

(1) Initial
emergen
cy
manage
ment is
care
provide
d to
stabilize
a
victims
conditio
n and to
minimiz
e
potential
for
further
injury
during
transpor
t to an
appropri
ate
service.
Patients
may be
brought
to the
nearest
hospital,
which
may or
may not
have all
required
services
for

(2)

Emergen
cy care
may
range
from the
suturing
of
laceratio
ns to
fullscale
emergen
cy
medical

procedures.
Facilities
that
include
personne
l and
equipment for
definitiv
e
emergen
cy care
provide
for 24hour
service
and
complete
emergen
cy care
leading
to
discharg
e to the
patients
home or
direct
admissio
n to the
appropri
ate
hospital.
5.1.1.2
Applicability.
The extent
and type of
emergency
service to be
provided
depends on
community
needs and the
availability of
other services
in the area.

(1)

Whil
e
initi
al
emer
genc
y
man
age
ment

shall
be
avail
able
at
ever
y
hosp
ital,
fullscale
defi
nitiv
e
emer
genc
y
servi
ces
may
be
impr
actic
al
and/
or
an
unne
cess
ary
dupl
icati
on.

(2)

All
services
need
adequate
equipme
nt
and
24-hour
staffing
to ensure
no delay
in
essential
treatment
.

5.1.1.3
Requirements

(1)

The
followi
ng
standar
ds are
intende
d only

as
minim
ums.
Additi
onal
faciliti
es, as
needed
, shall
be as
require
d to
satisfy
the
functio
nal
progra
m.

(2)

Provisio
ns for
facilities
to
provide
nonemergen
cy
treatmen
t of
outpatie
nts are
covered
in
Chapter
3.2.

5.1.2 Initial
Emergency
Manageme
nt
5.1.2.1
General

(1)

At a
minimu
m, each
hospital
shall
have
provisions
for
emerge
ncy
treatme
nt for
staff,
employ
-ees,

and
visitors,
as well
as for
persons
who
may be
unawar
e of or
unable
to
immedi
ately
reach
services
in other
facilitie
s. This
is not
only for
patients
with
minor
illnesse
s or
injuries
that
may

2.1 GEN
E RAL H O
S P I TA L S

requi
re
mini
mal
care
but
also
for
perso
ns
with
sever
e
illnes
s and
injuri
es
who
must
recei
ve
imme
diate
emer
genc
y
care
and
assist
ance
prior
to
trans
port
to
other
facili
ties.

(2) Pro
visi
ons
for
initi
al
eme
rge
ncy
ma
nag
eme
nt
shal

l
incl
ude
the
foll
owi
ng:

5.1.2.2 Entr
ance. A wellmarked,
illuminated,
and cov-ered
entrance shall
be provided
at grade
level. The
emer-gency
vehicle entry
cover shall
provide
shelter for
both the
patient and
the
emergency
medical crew
during
transfer from
an emergency
vehicle into
the building.

5.1.2.3 Rec
eption,
triage, and
control
station. This
shall be
located to
permit staff
observation
and control
of access to
treatment
area,
pedestrian
and
ambulance
entrances,
and public
waiting area.

5.1.2.4 C
ommunic
ation
system.
Communi

cation
hookups
to the
Poison
Control
Center
and
regional
emergenc
y medical
service
(EMS)
system.

5.1.2.5 A
treatm
ent
room

(1) Space
require
ments

(1)

Th
is
sha
ll
ha
ve
not
les
s
tha
n
12
0
sq
uar
e
fee
t
(11
.15
sq
uar
e
me
ter
s)
of
cle
ar
are
a,
ex
clu
siv
e
of

toil
ets,
wa
itin
g
are
a,
an
d
sto
rag
e.

(2) The
trea
tme
nt
roo
m
ma
y
hav
e
add
itio
nal
spa
ce
and
pro
visi
ons
for
sev
eral
pati
ent
s
wit
h
cub
icle
curt
ain
s
for
pri
vac
y.
Mu
ltip
lebed
trea
tme
nt
roo
ms
sha

ll
pro
vid
ea
min
imu
m
of
80
squ
are
feet
(7.4
3
squ
are
met
ers)
per
pati
ent
cub
icle
.

(2)

Facility
require
ments.
Each
treatmen
t room
shall
contain
an
examina
tion
light,
work
counter,
handwashing
stations,
medical
equipme
nt,
cabinets,

2006

2.1 GEN
E R AL H O
S P I TA L S

for
protectiv
e

medicati
on
storage,
adequate
electrica
l outlets
above
floor
level,
and
counter
space
for
writing.
5.1.2.6
Airborne
infection
control. At
least one
air-borne
infection
isolation
room shall
be
provided
as
described
in Table
2.1-2 and
Sections
2.13.2.2.2,
2.13.2.2.4 (2)
(a) and
(b), and
3.2.2.4
(4). The
need for
additional
airborne
infection
isolation
rooms or
Guidelin Construction of
es for
Health Care
Design
Facilities
and

69

environ
ment
rooms
as
describe
d in
Section
2.13.2.3
shall be

determin
ed by an
ICRA.

5.1.2.7 Equ
ipment and
supply
storage.
Storage for
gen-eral
medical/surg
ical
emergency
supplies,
medications,
and
equipment
such as
ventilator,
defibrillator,
splints, etc.
This shall be
located out
of traffic and
under staff
control.

room(s).
*5.1.3
Definitive
Emergency
Care

5.1.3.1 Gen
eral. Where
24-hour
emergency
service is to
be provided,
the type,
size, and
number of
the serv-ices
shall be as
defined in
the
functional
program. As
a minimum,
the following
shall be
provided:

5.1.3.2 E
5.1.2.8 W
aiting
room.
Provisions
for
reception,
con-trol,
and public
waiting.
These shall
include a
public
toilet with
handwashing
station(s)
and
a
telephone.

5.1.2.9 Pat
ient toilet. A
patient
toilet room
with handwashing
station(s).
This shall
be
convenient
to the
treatment

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

5.1.3.3 Ent
rance.
A
wellmarked,
illuminated,
and cov-ered
entrance
shall
be
provided at
grade level.

A5.1.3.4 The

APPEN
DIX

design of the
emergency
department is

A5.1.3 FastTrack Area

A separate fasttrack area when
annual

critical, particularly at the

main public
access point, to

emergency

ensure that

department visits

emergency

exceed 20,000

medical staff and

30,000 visits

hospital security

should be

personnel

considered. This

maintain control

area should

of

include space for

registration,
discharge, triage,
and waiting, as
well as a
physician/nurse
work station.
Storage areas
for supplies and
medication
should be
included. A
separate
treatment/
procedure room
of 120 square
feet (11.15
square meters)
of clear floor
space should be
provided.
Examination/trea
tment areas
should be 100
square feet (9.29
square meters)
of clear floor
space, with
hand-washing
stations,
vacuum, oxygen,
and air out-lets,
and examination
lights. At least
one
treatment/exami
nation room
should be
designated for
pelvic
examinations.

and
control
station
shall be
located
to
permit
staff
observat
ion and
control
of
access
to
treatmen
t area,
pedestri
an and
ambulance
entrance
s, and
public
waiting
area.
(See
Table
2.1-5.)

(1) This
shall
provide
direct
access
from
public
roads
for
ambula
nce and
vehicle
traffic.

(2) Entrance
and
drivewa
y shall
be
clearly
marked.

(3) If

a
raised
platfo
rm is
used
for
ambu
lance
discharg
e, a
ramp
shall
be
provi
ded
for
pedes
trian
and
wheel
chair
acces
s.

*5.1.3.4
Reception,
triage, and
control
station

(1) Recepti
on,
triage,

(2)

The
triage
area
requires
special
consider
ation. As
the point
of entry
and
assessme
nt for
patients
with
undiagno
sed and
untreated
airborne
infection
s, the
triage
area
shall be
designed
and
ventilate
d to
reduce
exposure

of staff,
patients,
and
families
to
airborne
infectiou
s
diseases.
(See
Table
2.1-2.)

continued
availability as
a resource.

1.

Effor

ts will be made
to separate
patients waiting
for triage in a
secure area
with appropriate
ventilation that
is clearly visible

5.1.3.5 Co

from the triage

mmunicatio
ns center.
The
communicat
ions center
shall be
convenient
to the
nursing
station and
have radio,
telephone,
and
intercommu
nication systems. (See
Section 2.18.1.3.)

station. This

5.1.3.6 Pub

permit

lic
waitin
g area

area will be
separate from
the post-triage
waiting area to
limit the spread
of
contamination
and/or
contagion.

2.

Altho

ugh the triage

station must
have
unobstructed
visibility of the
waiting area to
observation of
patients waiting
for treat-ment, a
reception and
control or
security
function must

access at all

be provid-ed to

times. In the

monitor the

event of a

main entrance

disaster,

to the

terrorist event,

department and

or infectious

all public areas.

disease

Public access

outbreak, the

points to the

emergency

treatment area

service must

shall be minimal

remain under

in number, and

the control of

under direct

the hospital
and limit
contamination
to ensure its

observation by
the reception
and con-trol or
security
function.

2006
Guidelin
es for
Design

70

and
Construction of
Health Care
Facilities

Guidelin
es for
Preventin
g the
Transmiss

(1) This
shall
have
toilet
facilitie
s,
drinking
fountain
s, and
telepho
nes.

(2)

If so
determine
d by the
hospital
ICRA, the
emergency
departme
nt waiting

ion of
Mycobact
erium
tuberculos
is in
Health
Care
Facilities.

5.1.3.7
Diagnostic,
treatment,
and service
areas

(1) Examina
tion and
treatmen
t
room(s)

area shall
require
special
measures
to reduce
the risk of
airborne
infection
transmissi
on. These
measures
may
include
enhanced
general
ventilatio
n and air
disinfecti
on similar
to
inpatient
requireme
nts for
airborne
infection
isolation
rooms.
See the
CDC

(1) Sp
ace
req
uir
em
ent
s.
Ea
ch
exa
mi
nat
ion
roo
m
sha
ll
hav
ea
mi
ni
mu
m
cle
ar
flo
or
are
a

of
12
0
squ
are
fee
t
(11
.15
squ
are
me
ter
s),
exc
lus
ive
of
fix
ed
cas
ew
ork
.

(2) Fa
cili
ty
req
uir
em
ent
s.
Ea
ch
exa
mi
nat
ion
roo
m
sha
ll
co
nta
in
wo
rk
co
unt
er(
s);
cab
inet
s;
ha
ndwa

shi
ng
stat
ion
s;
sup
ply
sto
rag
e
fac
iliti
es;
exa
mi
nat
ion
lig
hts;
a
des
k,
cou
nte
r,
or
she
lf
spa
ce
for
wri
tin
g;
and
a
visi
on
pan
el
adj
ace
nt
to
and
/or
in
the
do
or.

(3) Re
nov
atio
n.
Wh
ere
ren

ova
tio
n
wo
rk
is
und
erta
ken
,
eve
ry
eff
ort
sha
ll
be
ma
de
to
me
et
the
se
mi
ni
mu
m
sta
nda
rds.
In
suc
h
cas
es,
eac
h
roo
m
sha
ll
hav
ea
mi
ni
mu
m
cle
ar
are
a of
100
squ
are
feet
(9.
29

squ
are
met
ers)
,
exc
lusi
ve
of
fixe
d
or
wal
lmo
unt
ed
cab
inet
s
and
buil
t-in
she
lve
s.

(4) Tre
atm
ent
cub
icle
s

(1) W
he
re
tre
at
m
en
t
cu
bi
cl
es
ar
e
in
op
en
m
ult
ipl
ebe
d
ar
ea

s,
ea
ch
cu
bi
cl
e
sh
all
ha
ve
a
mi
ni
m
u
m
of
80
sq
ua
re
fe
et
(7.
43
sq
ua
re
m
et
er
s)
of
cl
ea
r
flo
or
sp
ac
e
an
d
sh
all
be
se
pa
rat
ed
fr
o
m
ad
joi
ni
ng
cu

bicl
es
by
cu
rta
in
s.

(2) H
a
n
d
w
a
s
h
i
n
g
s
t
a
t
i
o
n
s
s
h
a
l
l
b
e
p
r
o
v
i
d
e
d
f
o
r
e
a
c
h
f

o
u
r
t
r
e
a
t
m
e
n
t
c
u
b
i
c
l
e
s
o
r
m
a
j
o
r
f
r
a
c
t
i
o
n
t
h
e
r
e
o
f
i
n
m
u
l
t
i
p
l

e
b
e
d
a
r
e
a
s
.

2.1 GEN
E R AL H O
S P I TA L S

(5) For
oxy
gen
and
vac
uu
m,
see
Tab
le
2.15.

(6)

Tre
atm
ent/
exa
min
atio
n
roo
ms
use
d
for
pel
vic
exa
ms
shal
l
allo
w
for
the
foot
of
the
exa
min
ation
tabl
e to
face
awa
y
fro
m
the
doo
r.

*(2)
Trauma/
cardiac
rooms
for
emerge
ncy
procedu
res,
includin
g
emerge
ncy
surgery

(1) Spa
ce
req
uire
me
nts

(1)
Eac
h
r
o
o
m
s
h
a
l
l
h
a
v
e
a
t
l
e
a
s
t
2
5
0
s
q
u

a
r
e
f
e
e
t
(
2
3
.
2
3
s
q

d
i
t
i
o
n
a
l
s
p
a
c
e
w
i
t
h

u
a
r
e
m
e
t
e
r
s
)
o
f
c
l
e
a
r
f
l
o
o
r
s
p
a
c
e
.

(2) A
d

c
u
b
i
c
l
e
c
u
r
t
a
i
n
s
f
o
r
p
r
i
v
a
c
y
m
a
y
b
e
p
r
o

v
i
d
e
d

e
t
r
a
u
m
a

t
o
a
c
c
o
m
m
o
d
a
t
e
m
o
r
e
t
h
a
n
o
n
e
p
a
t
i
e
n
t
a
t
a
t
i
m
e
i
n
t
h

r
o
o
m
.

(2)

Fa
cil
it
y
re
qu
ir
e
m
en
ts.
T
he
ro
o
m
sh
all
co
ntai
n
ca
bi
ne
ts
an
d
e
m
er
ge
nc
y
su
pp
ly
sh
el
ve
s,
x-

ra
y
fil
m
ill
u
m
in
at
or
s,
ex
a
m
in
at
io
n
li
g
ht
s,
an
d
co
u
nt
er
sp
ac
e
fo
r
w
rit
in
g.

pat
ien
ts.

(4) Su
pp
ly
sto
ra
ge.
St
or
ag
e
sh
all
be
pr
ov
ide
d
for
im
me
dia
te
ac
ce
ss
to
att
ire
us
ed
for
un
ive
rsa
l
pr
ec
aut
io
ns.

(3) Pat
ien
t
mo
nit
ori
ng.
Pro
vis
ion
s
sha
ll
be
ma
de
for
mo
nit
ori
ng
the

(5)

D
o
o
r
w
i
d
t
h
.
D
o
o
r

w
a
y
s
l
e
a
d
i
n
g
f
r
o
m

s
h
a
ll
b
e
a
m
i
n
i
m
u
m

t
h
e
a
m
b
u
l
a
n
c
e
e
n
t
r
a
n
c
e
t
o
t
h
e
c
a
r
d
i
a
c
t
r
a
u
m
a
r
o
o
m

o
f
5
f
e
e
t
(
1
.
5
2
m
e
t
e
r
s
)
w
i
d
e
t
o
s
i
m
u
lt
a
n
e
o
u
s
l
y
a
c
c
o

m
m
o
d
a
t
e
s
t
r
e
t
c
h
e
r
s
,
e
q
u
i
p
m
e
n
t,
a
n
d
p
e
r
s
o
n
n
e
l.

(6)

de
to
hav
e
exis
ting
card
iac/t
rau
ma
roo
ms
mee
t
the
abo
ve
min
imu
m
stan
dar
ds.
If it
is
not
pos
sibl
e to
mee
t
the
abo
ve
squ
arefoot
stan
dar
ds,
the

Ren

auth

ova

oriti

tion

es

. In

havi

ren

ng

ova

juri

tion

sdic

proj

tion

ects

may

gra

eve

nt

ry

app

effo

rov

rt

al

shal

to

l be

devi

ma

ate

fro

m
this
req
uire
me
nt.
In
suc
h
cas
es,
thes
e
roo
ms
shal

APPEN
DIX

A5.1.3.7
(2)
Access
should
be
conveni
ent to
the
ambulan
ce
entrance
.
Guidelin Construction of
es for
Health Care
Design
Facilities
and

71

2006

2.1 GEN
E R AL H O
S P I TA L S

be
no
less
tha
na
cle
ar
are
a
of
240
squ
are
feet
(22
.30
squ
are
met
ers)
,
and
doo
rwa
ys
lea
din
g
fro
m
the
am

bul
anc
e
ent
ran
ce
to
the
roo
m
ma
y
be
4
feet
(1.
22
met
ers)
wid
e.

APPEN
DIX
A5.1.3.7 (4) When
advanced imaging
technologies such
as CT are
available, the
emergency
department
should have
convenient
access.

A5.1.3.7 (5)

Decontaminati
on area on the
exterior
perimeter

1.

Ideall

y 150 feet (45.72

meters) from the

ed by at least
6 feet (1.83
meters); a
separate
spigot for
attach-ment
of a hose.

ambulance
entrance (if

5.

required by the

ipermanent or

constraints of the

portable/collapsi

structures

ble structures

involved, this

(curtains, tents,

may be no less

etc.) that will

than 30 feet

provide shelter

(9.14 meters)

from the

from the

environment,

ambulance

privacy, and

entrance).

some

2.

At

location

where

no

windows

or

doors

abut

the

defined

area

or

where

all

doors

are

securable
from

the

outside

and

all

windows

are

capable

of

being

containment of
the
contaminant/inf
ectious agent.

6.
access

telephone
system and
a

duplex

electrical
outlet

for

each

two

shower

3.

no

At
least two
shower
heads,
temperaturecontrolled
and separat-

to

the hospital

heads

4.

Se

cured

shuttered.

Bou
ndaries shall
be defined
on the paved
ground
surface with
a yellow
paint line and
the word
DECON
painted
within these
boundaries.

Sem

and
closer

than 4 feet
(1.22
meters)

to

any shower.

7.
Exterior
lighting
to
maximiz
e
visibility;
appropri
ate for
wet/
shower
facilities
.

8.

Nega

tive airflow and

ventilation
system on the
hospital perimeter wall but
drawing air
within the
confines of the
decontamination
structure;
exhausted
directly to the
outdoors, no
less than 50 feet
(15.24 meters)
away from the
decontamination
site with no recirculation of air.
This system
shall be
defunctionalized
when the
decontamination
structure is not
in use.

9.

Wate

r runoff shall be
contained and
disposed of
safely to ensure
that it does not
enter community
drainage
systems. This
shall be
accomplished
either by graded
floor structures
leading to a drain
with a collection
system separate
from that of the
hospital or by the
use of plastic
pools or
specialized
decontamination
stretchers.

Decontamina
tion room
within the
facility
a. Separate,
independent,
secured
external
entrance
adjacent to

as the
ambulance
entrance; a
yellow painted

(3)

Provisio
ns for
orthoped
ic and
cast
work.
These
may be
in
separate
room(s)
or in the
trauma
room.

(1)

Spa
ce
req
uire
me
nts.
The
clea
r
floo
r
spa
ce
for
this
area
shal
l be
dep
end
ent
on
the
fun
ctio
nal

boundary line
3 feet (0.91
meter) from
each side of
the door and
extending 6
feet (1.83
meters) from
the hospital
wall; the word
DECON
painted within
these
boundaries.

2.

Inter
nal entrance
to a corridor
within
the
emergency
area.

3.

It

shall have spatial

requirements
and the medical
support servic-es
of a standard
emergency area
airborne infection
isolation room,
with air
externally
exhausted
separate from
the hospital
system. It shall
contain a work
counter, handwashing station
with hands-free
controls, an area
for personnel
gowning, and a
storage area for

the ambulance

supplies, as well

entrance, but

as equipment for

no less than 30

the

feet (9.14

decontamination

meters)

process.

distant; lighted
and protected

4.

from the

ng, wall, and

environment in

floor finishes

the same way

shall be smooth,

Ceili

nonporous,
scrubbable,
nonadsorptive,
nonperforated,
capable of
withstand-ing
cleaning with
and exposure to
harsh

door
and
very
high
relative
humidity.

8.

ater
drainage
must be
contained

chemicals,

and

nonslip, and
without crevices
or seams.
Floors shall be
self-coving to a
height of 6
inches (15.24

disposed of
safely to
ensure that
it does not
enter the
hospital or
community

centimeters).

drainage

The surface of

systems.

the floor shall

There

be self-finished

should be a

and require no

saddle at

protective

the floor of

coating for

the door

maintenance.

buck to

5.

Tw
o hospital
telephones;
two duplex
electrical
outlets,
secured
appropriatel
y for a wet
environmen
t.

prevent
efflux.

9.

certified
physicist or
other qualified
expert
representing
the owner or
the state
agency shall

6.

At

specify the

least two hand-

type, location,

held

and amount of

shower

radiation

heads,
temperaturecontrolled;
tains

or

curother

devices to allow
patient
to

the

privacy,
extent

possible.

7.

Ap
propriately
heated and
air-cooled
for a room
with
an
external

protection to be
installed in
accordance
with final
approved
department
layout and the
functional
program.
These
specifications
shall be
incorporated
into the plans.

10.

The

decontaminati

hygiene room

on area may

under

function as an

departmental

isolation room

function.

or

72

routine

patient
2006
Guidelin
es for
Design

and
Construction of
Health Care
Facilities

2 . 1 G E N E R A L H O S P I TA L S

p. If

d
ot
he
r
or
th
ope
di
c
su
pp
lie
s,
tr
ac
ti
on
ho
ok
s,
xra
y
fil
m
ill
u
m
in
at
or
s,
an
d
ex
a
m
in
ati
on
li
gh
ts.

a
sink
is
used

(2)

Pl
ast
er
tra

p
r
o
g
r
a
m

for

a
n
d
t
h
e
p
r
o
c
e
d(3)
u
r
e
s
a
n
d
e
q
u
i
p
m
e
n
t
a
c
c
o
m
m
o
d
at
e
d
h
e
r
e.

paris

the
disp
osal
of
plast
er of
,

plast
er
trap
shall
be
prov
ided.

E
qu
ip
m
en
t
an
d
su
pp
ly
st
or
ag
e.
T
he
y
sh
all
in
cl
ud
e
st
or
ag
e
fo
r
sp
li
nt
s
an

*(4)
Diag
nosti
c
servi
ce
areas
.
Conv
enien
t
acces
s to

rad
iolo
gy
and
lab
ora
tor
y
ser
vic
es
sha
ll
be
pro
vid
ed.

*(5)
Decont
aminati
on area

(1)

Lo
ca
tio
n.
In
ne
w
co
ns
tru
cti
on
,a
de
co
nt
a
mi
na
tio
n
ro
o
m
sh
all
be
pr
ov
id
ed
wi

th
an
outside
entr
y
doo
r as
far
as
prac
tical
fro
m
the
clos
est
othe
r
entr
anc
e.
The
inte
rnal
doo
r

o
r
r
i
d
o
r
o
f
t
h
e
e
m
e
r
g
e
n
c
y

o
f
t
h
i
s
r
o
o
m
s
h
a
l
l
o
p
e
n
i
n
t
o
a
c

d
e
p
a
r
t
m
e
n
t
,
s
w
i
n
g
i
n
t
o
t
h
e
r
o
o
m
,
a

n
d
b
e
l
o
c
k
a
b
le
a
g
ai
n
st
i
n
g
r
e
s
s
fr
o
m
t
h
e
c
o
rr
i
d
o
r.

(2) S
p
a
c
e
r
e
q
u
ir
e
m
e
n
ts
.
T
h
e
r
o
o

m
sha
ll
pro
vid
ea
mi
ni
mu
m
of
80
squ
are
fee
t
(7.
43
squ
are
me
ter
s)
cle
ar
flo
or
are
a.

s
h
a
l
l
b
e
e
q
u
i
p
p
e
d
w
i
t
h
t
w
o

(3) F
a
c
i
l
i
t
y

h
a
n
d
h
e
l
d

r
e
q
u
i
r
e
m
e
n
t
s

s
h
o
w
e
r

(1
) T

w
i
t
h

h
e
r
o
o

h
e
a
d
s

t
e
m
p

er
at
u
re

b
e
co
ntr
ols
an
d
de
dic
ate
d
hol
din
g
tan
k
wit
h
flo
or
dra
in.

p
r
o
v
i
d
e
d
.
P
o
r
t
a
b
l
e
s
u
c
t
i
o
n

(35
) P
o
r
t
a
b
l
e

s
h
a
l
l

o
r

a
l
s
o

h
a
r
d
p
i
p
e
d

b
e
a
v
a
i
l
a
b
l
e
.

o
x
y
g
e
n
s
h
a
l
l

(4) Co
nst
ruc

ti
o
n
r
e
q
u
ir
e
m
e
n
ts
.
T
h
e
r
o
o
m
s
h
a
ll
h
a
v
e
a
ll
s
m
o
o
t
h
,
n
o
n
p
o
r
o
u
s,
s
c
r
u
b
b
a
b
l
e

,
no
na
ds
or
pti
ve,
no
np
erf
ora
ted
sur
fac
es.
Fi
xtu
res
sh
all
be
aci
d
res
ist
ant
.
Th
e
flo
or
of
the
de
co
nta
mi
nat
ion
ro
om
sh
all
be
sel
fco
vin
g
to
a
hei
ght
of
6
inc
he
s

(1
5.2
4
ce
nti
me
ter
s).

(5) T
h
i
s
s
e
c
t
i
o
n
d
o
e
s
n
o
t
p
r
e
c
l
u
d
e
d
e
c
o
n
t
a
m
i
n
a
t
i
o
n
c
a

pa
bil
ity
at
ot
he
r
loc
ati
on
s
or
ent
ra
nc
es
im
me
dia
tel
y
adj
ac
ent
to
the
em
erg
en
cy
de
pa
rt
me
nt.
*(6)
Pediatri
c care
5.1.3.8
Special
patient
care
areas

(1) Ai
rb
or
ne

infe
ctio
n
isol
atio
n
roo
m.
At
leas
t
one
airb
orne
infe
ctio
n
isol
atio
n
roo
m
shal
l be
pro
vided
as
desc
ribe
d in
Tabl
e
2.12
and
Sect
ions
2.13.2.
2.2,
3.2.
2.4
(2)
(a)
and
(b),
and
3.2.

2.4
(4).
The
nee
d
for
addi
tion
al
airb
orne
infe
ctio
n
isol
atio
n
roo
ms
or
for
prot
ecti
ve
envi
ron
men
t
roo
ms
as
desc
ribe
d in
Sect
ion
2.13.2.
3
shal
l be
dete
rmi
ned
by
an
ICR
A.

APPENDIX

A5.1.3.7 (6) Pediatric treatment r

ment of pediatric cases in dedica
unit should be provided. The qua
depend on the census of the p

a. This area should include space f

waiting, and a playroom. Pediatr
adjacent to a family waiting area a
station and physician station, stora
and one to two isolation rooms

b. Each examination/treatment roo

(9.29 square meters) of clear floo
dure/trauma room of 120 square

200
6
Gui
deli
nes
for
Des
ign
and
Co
nstr
ucti
on
of
He
alth
Car
e
Fac
ilitie
s

7
3

2.1 GEN
E R AL H O
S P I TA L S

*(2)
Observation
units

(1) Eac
h
pati
ent
bed
area
shal
l
hav
e
spa
ce
at
eac
h
bed
side
for
visi
tors
,
and
pro
visi
on
for
visu
al
priv
acy
fro
m
cas
ual
obs
erv
atio
n
by
oth
er
pati
ents
and
visi
tors
.

(2)

Ha
ndwa
shi
ng
sta
tio
ns.
Ha
ndwa
shi
ng
sta
tio
ns
sha
ll
be
pro
vid
ed
for
eac
h
fou
r
tre
at
me
nt
cu
bic
les
or
ma
jor
fra
cti
on
the
reo
f.
Ha
ndwa
shi
ng
sta
tio
ns
sha
ll
be
co
nv
eni

shal

ent
to
nur
se
sta
tio
ns
an
d
pat
ien
t
be
d
are
as.

l be
provide
d
for
each
sixt
een
treat
men
t
cubi
cles
or
maj
or

(3) Toil
et
roo
m.
On
e
toil
et
roo
m
shal
l be
pro
vided
for
eac
h
eig
ht
trea
tme
nt
cub
icle
s or
maj
or
frac
tion
ther
eof.

(4)

Sho
wer
roo
m.
One
sho
wer
roo
m

fract
ion
ther
eof;
the
sho
wer
roo
m
and
toilet
roo
m
may
be
com
bine
d
into
the
sam
e
roo
m.

(5)

No
uri
sh
me
nt
are
a.
A
no
uri
sh
me
nt
sta

tio
n
tha
t
ma
y
be
sha
red
sha
ll
be
pro
vid
ed.
It
sha
ll
inc
lud
ea
sin
k,
wo
rk
co
unt
er,
ref
rig
era
tor,
sto
rag
e
ca
bin
ets,
an
d
eq
uip
me
nt
for
hot
an
d
col
d
no
uri
sh
me
nt
bet
we
en

sch
ed
ule
d
me
als
.

(3)

Secure
holding
room.
When
required
by the
functional
program,
there
shall be
a secure
holding
APPEN
DIX

A5.1.3.8 (2)
Observation/ho
lding units for
patients
requiring
observation up
to 23 hours or
admission to
an inpatient
unit should be
located
separately but
near the main
emergency
department.
The size will
depend upon
the function
(observation
and/or
holding),
patient acuity
mix, and
projected
utilization.

1.

As

defined by the
functional plan,
this area should
consist of a
centralized
nurse station;

100 square feet

(9.29 square
meters) of clear
floor space for
each cubicle,

roo
m.
This
roo
m
shal
l be
desi
gne
d to
prev
ent
inju
ry
to
pati
ents
.

with vacuum,
oxygen, and air
outlets,
monitoring
space, and
nurse call
buttons.

2.

A
patient
bathroom
should be
provided.

3.
Storage
space
for
medical
and
dietary
supplies
should
be
included
.

(1)

4.

Xray
illuminators
should be
available.

(2)

Th
ere
sha
ll
not
be
an
y
ele

All
fini
shes
,
ligh
t
fixt
ures
,
vent
s
and
diff
user
s,
and
spri
nkle
rs
shal
l be
tam
per
resi
stan
t.

ctri
cal
out
let
s,
me
dic
al
gas
out
let
s,
or
si
mil
ar
de
vic
es.

(3)

o
r
p
r
o
t
r
u
s
i
o
n
s
,
a
n
d
T
h
e
r
e
s
h
a
l
l
b
e
n
o
s
h
a
r
p
c
o
r
n
e
r
s
,
e
d
g
e
s
,

t
h
e
w
a
l
l
s
s
h
a
l
l
b
e
f
r
e
e
o
f
o
b
j
e
c
t
s
o
r

a
c
c
e
s
s
o
r
i
e
s
o
f
a
n
y
k
i
n
d
.

(4) Pat
ient
roo
m
doo
rs
sha
ll
swi
ng
out
and
sha
ll
hav
e
har
dw
are
on
the
ext
eri
or
sid
e
onl
y.
Do
ors
sha
ll
hav

e
an
ele
ctri
c
stri
ke
tha
t is
tie
d
int
o
the
fire
ala
rm.
5.1.3.9
Support
areas for
definitive
emergency
management
facilities

(1) Adm
inistr
ative
cente
r or
nurse
statio
n for
staff
work
and
chart
ing.

(1) Th
ese
are
as
sh
all
ha
ve
sp
ac
e
for
co
unt
ers
,
ca
bin
ets

,
an
d
me
dic
ati
on
sto
rag
e,
an
d
sh
all
ha
ve
co
nv
eni
ent
ac
ces
s
to
ha
nd
wa
shi
ng
sta
tio
ns.

(2) The
y
are
per
mitt
ed
to
be
co
mbi
ned
wit
h or

the
treatment
areas,
waiting
areas, and
key
entrance
sites.

1.

Th

system

should
include
visual
monitoring
devices
installed
both
internally

in

the
emergency
department
as

well

as

externally at
entrance
sites

and

parking lots.

2.

pecial
requiremen
ts for a
security
station
should
include
accommod
ation for
hospital
security
staff, local
police
officers,
and
monitoring
equipment.

3.

De

sign

A5.1.3.9 (2)
A security
station
and/or
system
should be
located to
maximize
visibility of

consideration
should
include
installation of
silent alarms,
panic
buttons, and
intercom
systems, and
physical

barri-ers
such as
doors to
patient entry
areas.

4.

Th
e
security
monitoring

system
should
be
included on
the
hospitals
emergency
power
backup
system.
2006
Guidelin
es for
Design

74

in
cl
ud
e
ce
nt
ers
for
re
ce
pti
on
an
d
co
m
m
un
icat
io
n
or
po
iso
n
co
ntr
ol.

(3) N
ur
si
n
g
st
at
io
n
s
d
e
c
e
nt

and
Construction of
Health Care
Facilities

ra
li
ze
d
n
ea
r
cl
us
te
rs
of
tr
ea
t
m
e
nt
ro
o
m
s
ar
e
p
er
m
itt
e
d.

(4) W
her
e
fea
sib
le,
vis
ual
obs
erv
ati
on
of
all
traf
-fic
int
o
the

uni
t
an
d
of
all
pat
ien
ts
sha
ll
be
pro
vid
ed
fro
m
the
nur
sin
g
sta
tio
n.

If
provide
d, they
shall
be
permitt
ed to
be part
of the
staff
work
and
chartin
g area.

(4)

Scrub
stations.
Scrub
stations
located in
or
adjacent
and
convenien

*(2)
Securit
y
station.
Where
dictate
d by
local
needs,
a
securit
y
system
shall
be
located
near
the
emergency
entranc
es and
triage/r
eceptio
n area.

(3)

Poison
control
center
and
EMS
commu
nicatio
ns
center.

t to each
trauma
and/or
orthopedi
c room.

(5) Provis
ions
for
dispos
al of
solid
and
liquid
waste.
This
may
be a
clinica
l sink
with
bedpa
n
flushin
g
device
within
the
soiled
workr
oom.

(6)

Clean
workroo

m or
clean
supply
room. A
clean
workroo
m or
clean
supply
room
shall be
provided
in
accordan
ce with
Section
2.12.3.7. If
the area
serves
children,
additiona
l storage
shall be
provided to
accomm
odate
supplies
and
equipme
nt in the
range of
sizes
required
for
pediatric
s.

*(7) Soiled
workroo
m or
soiled
holding
room. A
soiled
workroo
m or
soiled
holding
room
shall be
provided in
accorda
nce with
Section
2.1-2.3.8

for the
exclusiv
e use of
the
emergen
cy
service.

(8) Equipme
nt and
supply
storage

(1)

Wh
eelc
hair
and
stre
tche
r
stor
age.
Stor
age
for
whe
elch
airs
and
stre
tche
rs
for
arri
vin
g
pati
ents
shal
l be
loca
ted
out
of
traf
fic
wit
h
con
ven
ient
acc
ess
fro
m
eme
rge
ncy

entr
anc
es.

Sect
ion
2.12.3.

(2)

Eme
rgen
cy
equi
pme
nt
stor
age.
Suff
icie
nt
spac
e
shal
l be
prov
ided
for
eme
rgen
cy
equi
pme
nt
(e.g.
,a
CP
R
cart,
pum
ps,
vent
ilato
rs,
pati
ent
mon
itori
ng
equi
pme
nt,
and
port
able
xray
unit
) in
acco
rdan
ce
with

9.4.

2.1 G
ENE
RAL
HOS
P I TA
LS

(9) Housek
eeping
room. A
houseke
eping
room
shall be
directly
accessib
le from
the unit
and
shall
con-tain
a
service
sink or
floor
receptor
and
provisio
ns for
storage
of
supplies
and
houseke
eping
equipment.
5.1.3.10
Support areas
for staff

(1)

Staff
lounge.
Conveni
ent and
private
access
to staff
toilets,
lounge,
and
lockers
shall be
provide
d.

(2) Staff
storage
facilitie
s.
Securab
le
closets
or
cabinet
compart
ments
shall be
provide
d for
the
persona
l effects
of
emerge
ncy
service
personn
el in
accordance
with
Section
2.12.4.3.
*5.1.3.11
Support areas
for patients

*(1)
Bereavement
room

(2) Patient
toilet
room.
A
minimu
m of
one
patient
toilet
room
per
eight
treatme
nt
rooms
or
fraction
thereof
shall be
provide
d, with

handwashin
g station(s)
in each
toilet
room.

5.2
Freestandi
ng
Emergency
Service

Disposal
space for
regulated
medical waste

(e.g.,
gauzes/line
ns soaked
with body
fluids)
should be
separate
from routine
disposal
space.
A5.1.3.11 Other
space

5.2.1
Definition
Freestanding
emergency
service shall
mean an
extension of
an existing
hospital
emergency
department
that is
physically
separate
from the
main hospital
emergency
department
and that is
intended to
provide
comprehensive
emergency
service. A
service that
does not
provide 24hour-a-day,
seven-day-aweek
operation

considerations.
Provision of a
patient hygiene
room with
shower and toilet
facilities should
be considered.
A5.1.3.11 (1) At
least one
bereavement
room should be
provided. This
room should be
accessible from
both the
emergency treatment corridor
and the
emergency
waiting area.
This room should
be comfortable
enough to
provide respite to
the bereaved
family and
should be
equipped with a
sound
transmission
coefficient
equivalent to 65

APPEN
DIX

A5.1.3.9 (7)
2006
Guidelin

2.1 GEN
E R AL H O

for the walls and

45 for the floors
and ceiling.
es for
Construction of
Design Health Care
and
Facilities

75

S P I TA L S

Section 2.15.1.
or that is not
capable of
providing
basic
services as
defined for
hospital
emergency
departments
shall not be
classified as
a
freestanding
emergency
service and
shall be
described
under other
portions of
this
document.

5.2.1.1
Physical
ly
separate
from the
main
hospital
means
not
located
on the
same
campus.

5.2.2
Facility
Requiremen
ts
Except as
noted in the
following
sections, the
requirements
for
freestanding
emergency
service shall
be the same
as
for
hospital
emergency
service as
described in

5.2.2.1 Gen
eral.
See
Sectio
n 2.15.1.1.

5.2.2.2 I
nitial
emergen
cy
manage
ment.
See
Section
2.15.1.2.

5.2.2.3 Defi
nitive
emerg
ency
care.
See
Sectio
n 2.15.1.3.

5.2.2.4 Su
pport areas.
See
Sections
2.1-5.1.3.9
through 2.15.1.3.11.

APPEN
DIX

A5.3
Surgery
a.

The

size

and location of
the

surgical

procedure
rooms shall be
determined by
the

level

of

care

to

be

provided. The
levels of care
as defined by
the

American

College

of

Surgeons are

as follows:

pulmonary

Class

A:

Provides

for

minor

surgical

procedures

these
procedures
should not be
performed in

performed
under

topical,

local,

or

regional

the operating
suite. They
should be
performed in a

anesthesia
without

tuberculosis,

pre-

operative sedation. Excluded

are

room meeting
airborne
infection
isolation room
ventilation

intravenous,

requirements

spinal,

or in a space

and

epidural routes;

using local

these methods

exhaust

are appropriate

ventila-tion. If

for Class B and

the procedure

Class

must be

facilities.

Class B:
Provides for
minor or
major surgical
procedures
per-formed in
conjunction
with oral,
parenteral, or
intravenous
seda-tion or
under
analgesic or
dissociative
drugs.
Class C:
Provides for
major surgical
procedures that
require general
or regional block
anesthesia and
support of vital
bodily functions.

b. When
invasive
procedures
are performed
on patients
known or
suspected to
have

performed in
the operating
suite, see the
CDC
Guidelines for
Preventing the
Transmission
of
Mycobacteriu
m
Tuberculosis
in Health Care
Facilities.

those
functi
ons
descr
ibed
in
Secti
on
2.15.11.

5.2.3
Additional
Requiremen
ts
The
freestanding
emergency
service shall
have the following
capabilities
and/or
functions
within the
facility:

5.2.3.2
Service areas

(1) Pharmac
y

(2) Provisio
n
for
serving
patient
and
staff
meals
shall be
provide
d.
A
kitchen
or
a
satellite
serving
facili-ty
shall be
permitte
d.

5.2.3.1
Diagnostic
and treatment
areas

(1) Diagno
stic
imagin
g. This
shall
include
radiogr
a-phy
and
fluoros
copy.

(2) Observ
ation
beds.
At least
one of
these
shall
have
full
cardiac
monitor
ing.

(3)

Labor
atory.
These
facilit
ies
shall
acco
mmo
date

(3)

Supp
ort
servi
ces
and
funct
ions
shall
inclu
de
hous
ekee
ping,
laund
ry,
gener
al
store
s,
main
tenanc
e and

plant
opera
tions,
and
secur
ity.

(1) The
surgical
suite
shall be
located
and
arranged
to
prevent
nonrelat
ed traffic
through
the suite.

*5.3
Surgery
5.3.1
Surgical
Suites
Note:
Additions to,
and
adaptations
of, the
following
elements
shall be
made for the
special
procedure
oper-ating
rooms found
in larger
facilities.

(2) The
clinical
practice
setting
shall be
designe
d to
facilitat
e
movem
ent of
patients
and
personn
el into,
through,
and out
of
defined
areas
within
the
surgical
suite.
Signs
shall
clearly
indicate
the surgical
attire
required
.

5.3.1.1 Si
ze. The
number of
operating
rooms and
recovery
beds and
the sizes of
the support
areas shall
be based
on the
expected
surgical
workload.

5.3.1.2 Lay
out
2006
Guidelin
es for
Design

76

(3)

An
operatin
g room

and
Construction of
Health Care
Facilities

suite
design
with a
sterile
core
shall
provide
for no

crosstraffic of
staff and
sup-plies
from the
soiled/de
contami
nated
areas to
the
sterile/cl
ean
areas.
The use
of
facilities
outside
the
operatin
g room
for
soiled/de
contami
nated
processing
and
clean
assembl
y and
sterile
processi
ng shall
be
designed
to move
the flow
of goods
and
personne
l from
dirty to
clean/ste
rile
without
compro
mising
universa
l
precauti
ons or
aseptic
techniqu
es in
both
departm
ents.

(4) The
surgical
suite
shall be
divided
into
three
designated
areas
unrestri
cted,
semires
tricted,
and
restrict
ed
defined
by the
physica
l
activiti
es performed
in each
area.

(1) Unr
estr
icte
d
are
a

(1) Th
e
unr
est
rict
ed
are
a
inc
lud
es
a
ce
ntr
al
co
ntr
ol
poi
nt
est
abl
ish
ed
to

mo
nit
or
the
ent
ran
ce
of
pat
ien
ts,
per
so
nn
el,
an
d
ma
teri
als
.

(2) S
tr
e
et
cl
o
t
h
e
s
a
r
e
p
e
r
m
it
te
d
i
n
t
h
is
a
r
e
a
a
n
d
tr
a
ff
ic
is
n
o
t

li
m
it
e
d.

(2) Se
mir
estr
icte
d
are
a

(1) Th
e
se
mi
res
tric
ted
are
a
inc
lud
es
the
per
iph
era
l
su
pp
ort
are
as
of
the
sur
gic
al
sui
te.
It
has
sto
rag
e
are
as
for
cle
an
an
d
ste
rile
su
ppl

ies
,
wo
rk
are
as
for
sto
rag
e
an
d
pro
ces
sin
g
of
ins
tru
me
nts
,
an
d
cor
rid
ors
lea
din
g
to
the
res
tric
ted
are
as
of
the
sur
gic
al
sui
te.

(2) T
r
a
ff
i
c
i
n
t
h
is
a

r
e
a
is
li
m
it
e
d
t
o
a
u
t
h
o
ri
z
e
d
p
e
r
s
o
n
n
e
l
a
n
d
p
a
ti
e
n
ts
.
P
e
r
s
o
n
n
e
l
a
r
e
r
e
q
u
ir
e
d

t
o
w
e
a
r
s
u
r
g
i
c
a
l
a
tt
ir
e
a
n
d
c
o
v
e
r
a
ll
h
e
a
d
a
n
d
f
a
c
i
a
l
h
a
ir
.

t
r
i
c
t
e
d
a
r
e
a
i
n
c
l
u
d
e
s
o
p
e
r
a
t
i
n
g
a
n
d
p
r
o
c
e
d
u
r
e

(3) Res
trict
ed
are
a

(1) T
h
e
r
e
s

r
o
o
m
s
,
t
h
e
c
l
e

a
n

2.1 GEN
E RAL H O
S P I TA L S

c
o
r
e
,

s
t
e
r
i
l
e

a
n
d
s
c
r
u
b

s
u
p
p
l
i
e
s

s
i
n
k

o
r

a
r
e
a
s
.

s
c
r
u
b
b
e
d

(2) Sur
gic
al
atti
re
and
hai
r
cov
eri
ngs
are
req
uir
ed.
Ma
sks
are
req
uir
ed
wh
ere
ope
n

p
e
r
s
o
n
s
m
a
y
b
e
l
o
c
a
t
e
d
.
5.3.1.3
Provision of
outpatient

surgery. In
the functional
program, the
size,
location, and
configuration
of the
surgical suite
and support
areas shall
reflect the
projected
volume of
outpatients.
This may be
achieved by
designing
either an
outpatient
surgery
facility or a
combined
inpatient/out
patient
surgical
suite.

(1) Hospit
al
surgica
l suite.
Where
outpati
ent
surger
y is
provid
ed in
the
surgica
l suite
of the
hospita
l
facility
, it
shall
compl
y with
the
require
ments
for
outpati
ent
surger
y in

Chapte
r 3.7,
Outpat
ient
Surgic
al
Facilit
y.

(2)

Separate
hospital
unit or
outpatie
nt
surgical
facil-ity.
Where
outpatie
nt
surgery
and
postanesthet
ic care
is
provide
d in a
separate
unit of
the
hospital
facility
or in a
separate
outpatie
nt
surgical
facility,
it shall
comply
with the
require
ments
for
outpatient
surgery
in
Chapter
3.7.

5.3.2
Operating
and
Procedure
Rooms
5.3.2.1

General
operating
room(s)

(1) New
construc
tion

(1) S
p
ac
e
re
q
ui
re
m
e
nt
s.
E
ac
h
ro
o
m
sh
al
l
h
a
v
e
a
m
in
i
m
u
m
cl
ea
r
ar
ea
of
4
0
0
sq
u
ar
e
fe
et
(3
7.
1

6
sq
ua
re
m
et
er
s)
ex
cl
us
iv
e
of
fi
xe
d
or
w
al
lm
o
u
nt
ed
ca
bi
ne
ts
an
d
b
ui
ltin
sh
el
ve
s,
w
it
h
a
m
in
i
m
u
m
of
2
0
fe
et
(6
.1
0

m
et
er
s)
cl
ea
r
di
m
e
ns
io
n
b
et
w
ee
n
fi
x
e
d
ca
bi
n
et
s
a
n
d
b
ui
ltin
sh
el
v
es
.

(2)

Co
m
mu
nic
atio
n
sys
tem
.
Eac
h
roo
m
sha
ll
hav
ea
sys

tem
for
em
erg
enc
y
co
m
mu
nic
atio
n
wit
h
the
sur
gic
al
suit
e
con
trol
stat
ion.

(3)

X
r
a
y
v
i
e
w
e
r
s
.
X
r
a
y
f
i
l
m
v
i
e
w
e
r
s
f

o
r
h
a
n
d
l
i
n
g
a
t
l
e
a
s
t
f
o
u
r
f
i
l
m
s
s
i
m
u
l
t
a
n
e
o
u
s
l
y
o
r
d
i
g
i
t
a
l

i
m
a
g
e
v
i
e
w
e
r
s
s
h
a
l
l
b
e
p
r
o
v
i
d
e
d
.

(4) C
o
n
s
t
r
u
c
t
i
o
n
r
e
q
u
i
r
e
m
e
n
t
s
.
O

p
e
r
a
t
i
n
g
r
o
o
m
p
e
r
i
m
e
t
e
r
w
a
l
l
s
,
c
e
i
l
i
n
g
,
a
n
d
f
l
o
o
r
s
,

c
l
u
d
i
n
g
p
e
n
e
t
r
a
t
i
o
n
s
,
s
h
a
l
l
b
e
s
e
a
l
e
d
.
(
S
e
e
G
l
o
s
s
a
r
y
.
)

i
n
2006
and
Guidelin Construction of
es for
Health Care
Design
Facilities

77

2.1 GEN
E R AL H O
S P I TA L S

*(2)
Renova
tion.
Where
renovati
on
work is
underta
k-en,
every
effort
shall be
made to
meet
the
above
minimu
m
standar
ds. If it
is not
possible
to meet
the
above
squarefootage
standar
ds, each
room
shall
have a
minimu
m clear
area of
360
square
feet
(33.45
square
meters),
exclusi
ve of
fixed or
wallmounte
d
cabinets
and
built-in
shelves,
with a
minimu
m of 18
feet
(5.49

meters)
clear
dimension
between
fixed
cabinets
and
built-in
shelves.
5.3.2.2
Room(s) for
cardiovascula
r, orthopedic,
neuro-logical,
and
other
special
procedures
that require
addi-tional
personnel
and/or large
equipment

(1) Space
require
ments.
When
included
, these
room(s)
shall
have, in
addition
to the
above
require
ments
for
general
operatin
g rooms,
a minimum
clear
area of
600
square
feet
(55.74
square
meters),
with a
minimu
m of 20
feet
(6.10

nt
storage
rooms.
Where
complex
orthopedic
and
neurosur
gical
surgery
is
performe
d,
additiona
l rooms
shall be
in the
restricted
area of
the
surgical
suite,
preferabl
y
adjoinin
g the
specialty
operatin
g rooms,
which
shall be
designat
ed as
equipme
nt
storage
rooms
for the
large
equipme
nt used
to
support
these
procedur
es.

meters)
clear
dimensi
on
exclusiv
e of
fixed or
wallmounted
cabinets
and
built-in
shelves.

(2)

(3)

Pump
room.
Where
openheart
surgery
is performed,
an
addition
al room
in the
restricte
d area
of the
surgical
suite,
prefera
bly
adjoinin
g this
operatin
g room,
shall be
designa
ted as a
pump
room
where
extra
corpore
al
pump(s
),
supplies
, and
accesso
ries are
stored
and
service
d.
Equipme

(4)

Plumbin
g
and
electrica
l
connecti
ons.
Appropr
iate
plumbin

g
and
electrica
l
connecti
ons shall
be

APPEN
DIX
A5.3.2.1 (2)
The functional
program may
require
additional clear
space,
plumbing, and
mechanical
facilities to
accommodate
special
functions in one
or more of
these rooms.
When existing
functioning
operating
rooms are
modified, and it
is impractical

to
increase
the
square
footage
because
of walls
or
structur
al
member
s, the
operatin
g room
may
continue
in use
when
request
ed by
the
hospital.

p
r
o
v
i
d
e
d
i
n
t
h
e
c
a
r
d
i
o
v
a
s
c
u
l
a
r,
o
rt
h
o
p
e
d
i
c,
n
e
u
r
o
s
u
r
g
i
c
a
l,
p
u
m
p
,
a
n

d
st
o
r
a
g
e
r
o
o
m
s.

(5) Renova
tion.
Where
renovat
ion
work is
underta
k-en,
every
effort
shall be
made to
meet
the
above
minimu
m
standar
ds. If it
is not
possibl
e to
meet
the
above
squarefootage
standar
ds, the
followi
ng
standar
ds shall
be met:

(1) Ort
hop
edi
c
sur
gic
al
roo
ms
sha
ll

hav
ea
min
imu
m
cle
ar
are
a of
360
squ
are
feet
(33
.45
squ
are
met
ers)
,
wit
ha
min
imu
m
dim
ens
ion
of
18
feet
(5.
49
met
ers)
.

(2) R
oo
m
s
fo
r
ca
rd
io
va
sc
ul
ar,
ne
ur
ol
og
ic
al,
an
d

ot
he
r
sp
ec
ial
pr
oc
ed
ur
es
sh
all
ha
ve
a
m
in
im
u
m
cl
ea
r
ar
ea
of
40
0
sq
ua
re
fe
et
(3
7.
16
sq
ua
re
m
et
er
s).
5.3.2.3
Additional
requirements
for
orthopedic
surgery

(1)

Equipm
ent
storage.
Where
include
d, this

room
shall, in
addition
to the
above
require
ments,
have
enclose
d
storage
space
for
splints
and
traction
equipm
ent.
Storage
may be
outside
the
operatin
g room
but
must be
conveni
ently
located.

(2)

Plaste
r trap.
If a
sink is
used
for
the
dispos
al of
plaste
r of
paris,
a
plaste
r trap
shall
be
provi
ded.

5.3.2.4
Room(s)
for
surgical
cystosco
pic and
other
endourol
ogic

procedur
es

(1) Space
require
ments

(1)

T
hi
s
ro
o
m
s
h
al
l
h
a
v
e
a
m
in
i
m
u
m
cl
e
ar
ar
e
a
of
3
5
0
s
q
u
ar
e
fe
et
(3
2.
5
2
s
q
u
ar
e
m
et
er
s)

e
x
cl
us
iv
e
of
fi
x
e
d
or
w
al
lm
o
u
nt
e
d
ca
bi
n
et
s
a
n
d
b
ui
ltin
sh
el
v
es
,
w
it
h
a
m
in
i
m
u
m
of
1
5
fe
et
(4
.5
7
m
et

er
s)
cl
e
ar
di
m
e
n
si
o
n
b
et
w
e
e
n
fi
x
e
d
c
a
bi
n
et
s
a
n
d
b
ui
lt
in
s
h
el
v
es
.

sur
gic
al
cys
tos
cop
y
sha
ll
be
per
mit
ted
to
hav
ea
mi
ni
mu
m
cle
ar
are
a
of
25
0
squ
are
fee
t
(23
.23
squ
are
me
ters
).

(2)

viewer.
X-ray
viewing

(2) In

capability

ren
ov
ati
on
pro
jec
ts,
roo
ms
for

78

X-ray

to
accommo
date

at

least four
films
simultane
ously
shall

be

provided.
2006
Guidelin
es for
Design

and
Construction of
Health Care
Facilities

5
.
3
.
2
.
5
E
n
d
o
s
c
o
p
y
s
u
i
t
e
.
S
e
e
C
h
a
p
t
e
r
3
.
9
,
G
a
s
t
r
o
i
n
t
e
s
t
i
n
a
l

E
n
d
o
s
c
o
p
y
F
a
c
i
l
i
t
i
e
s
.

5.3.3 Preand
Postoperati
ve Holding
Areas
5.3.3.1
Preoperative
patient
holding
area(s). In
facili-ties
with two or
more
operating
rooms, areas
shall
be
provided to
accommodat
e stretcher
patients as
well
as
sitting space
for
ambulatory
patients.

(1) Location
. These
areas
shall be
under
the
direct
visual
control
of the
nursing

staff and
may be
part of
the
recovery
suite to
achieve
maximu
m
flexibility in
managin
g
surgical
caseload
s.

(2)

Space
requir
ement
s.
Each
stretc
her
statio
n
shall
be a
minim
um of
80
square
feet
(7.43
square
meter
s)
exclus
ive of
gener
al
circul
ation
space
throug
h the
ward
and
shall
have a
minim
um
cleara
nce of
4 feet
(1.22
meter
s) on

the
sides
of the
stretc
hers
and
the
foot
of the
stretc
hers.

(3) Patient
privacy.
Provisio
ns such
as
cubicle
curtains
shall be
made
for
patient
privacy.

(4) Pr
ov
isi
on
s
sh
all
be
m
ad
e
fo
r
th
e
is
ol
ati
on
of
inf
ec
tio
us
pa
tie
nt
s.

(5) An
airborne
infectio
n
isolation
room is
not

required
in a
preoper
ative
holding
area.
Provisio
ns for
the
recover
y of a
potentia
lly
infectio
us
patient
with an
airborne
infectio
n shall
be
determi
ned by
an
ICRA.
*5.3.3.2 Postanesthetic
care units
(PACUs)

(1) Space
require
ments.
The
design
shall
provide
a
minimu
m of 80
square
feet
(7.43
square
meters)
for each
patient
bed,
exclusiv
e of
general
circulation
space
within
the
PACU,
with a

space
for
addition
al
equipme
nt
describe
d in the
function
-al
program
and for
clearanc
e of at
least 5
feet
(1.52
meters)
between
patient
beds
and 4
feet
(1.22
meters)
between
patient
bedsides
and
adjacent
walls.

(2) Layout
. In
new
constru
ction,
at least
one
door to
the
recover
y room
shall
provid
e
access
directl
y from
the
surgica
l suite
withou
t
crossin
g
public
hospita
l

2.1
GEN
ERA
L HO
SPI
TA L S

corrido
rs.

(3)

Pati
ent
priv
acy.
Pro
visi
ons
for
pati
ent
priv
acy
suc
h as
cub
icle
curt
ains
shal
l be
ma
de.

(4)

Facility
require
ments.
Each
PACU
shall
contain
a
medicati
on
station;
handwashing
stations;
nurse
station
with
charting
facilities
; clinical
sink;
provisions for
bedpan
cleaning
; and
storage

space
for
stretcher
s,
supplies,
and
equipme
nt.

(1)

Ha
nd
wa
shi
ng
sta
tio
n(s
).
At
lea
st
on
e
ha
nd
wa
shi
ng
sta
tio
n
wi
th
ha
nd
sfre
e
or
wr
ist
bla
de
op
era
ble
co
ntr
ols
sh
all
be
av
ail
abl

e
for
ev
ery
fo
ur
be
ds,
uni
for
ml
y
dis
tri
but
ed
to
pr
ovi
de
eq
ual
ac
ces
s
fro
m
ea
ch
be
d.

(2) Staf
f
toil
et.
A
staf
f
toil
et
shal
l be
loca
ted
wit
hin
the
wor
kin
g
area
to
mai
ntai
n
staf
f
avai

labi
lity
to
pati
ents
.

(5) Pr
o
vi
si
o
ns
sh
al
l
be
m
ad
e
fo
r
th
e
is
ol
at
io
n
of
in
fe
ct
io
us
pa
ti
en
ts.

(6)

An
airborn
e
infectio
n
isolatio
n room
(AIIR)
is not
require
d in a
PACU.
Provisi
ons for
the
recovery of a
potentia
lly
infectio

us
patient
with an
airborne
infectio
n shall
be
determi
ned by
an
ICRA.
5.3.3.3 Phase
II recovery.
Where
outpatient
surgeries are
to be part of
the surgical
suite, and
where
outpatients
receive Class
B or Class C
sedation, a
separate
Phase II or
step-down
recovery
room shall be
provided.

(1) Layout.
In new
construc
tion, at
least
one
door
shall
access
the
PACU
without
crossing
unrestric
t-ed
corridor
s of the
hospital.

(2) Space
requirem
ents

(1)

The
desi

gn
shal
l
pro
vid
ea
min
imu
m
of
50
squ
are
feet
(4.6
5
squ
are
met
ers)
for
eac
h
pati
ent
in a
lou
nge
chai
r,
wit
h
spa
ce
for
add
ition

al
equ
ipm
ent
des
crib
ed
in
the
fun
ctio
nal

APPEN
DIX
A5.3.3.2
Separate and
additional
recovery space
may be
necessary to
accommodate
patients. If
children receive
care, recovery
space should be
provided for
pediatric patients
and the layout of
the surgical suite
should facilitate
the presence of
parents in the
PACU.

es for
Construction of
Design Health Care
and
Facilities

2006
Guidelin

79

2.1 GEN
E R AL H O
S P I TA L S

pro
gra
m
and
for
cle
ara
nce
of
4
feet

(1.
22
met
ers)
on
the
sid
es
of
the
lou
nge
cha
irs
and
the
foo
t of

the
lou
nge
cha
irs.

(2) A
mi
ni
mu
m
cle
ar
flo
or
are
a of
100
squ
are
feet
(9.
29
squ
are
met
ers)
sha
ll
be
pro
vid
ed
in
sin
gle
bed
roo
ms.

(3)

Pati
ent
priv
acy.
Pro
visi
ons
for
pati
ent
priv
acy
suc
h as
cubi
cle
curt
ains
shal

l be
mad
e.

(4) Facility
require
ments.
The
room
shall
contain
handwashing
stations,
a nurse
station
with
charting
facilities
, clinical
sink,
provisio
n for
bedpan
cleaning
, and
storage
space
for
supplies
and
equipme
nt.

(1) Ha
ndwas
hin
g
stat
ion
s

(1) A
h
a
n
d
w
a
s
h
i
n
g
s

t
a
t
i
o
n
s
h
a
l
l
b
e
p
r
o
v
i
d
e
d
i
n
e
a
c
h
r
o
o
m
.

(2) A
t
l
e
a
st
o
n
e
h
a
n
d
w
a
s
h
i
n
g

st
a
ti
o
n
w
it
h
h
a
n
d
s
fr
e
e
o
p
e
r
a
b
l
e
c
o
n
tr
o
ls
s
h
a
ll
b
e
p
r
o
v
i
d
e
d
f
o
r
e
v
e
r
y
f
o
u
r
l

o
u
n
g
e
c
h
a
ir
s,
u
n
if
o
r
m
l
y
d
is
tr
i
b
u
t
e
d
t
o
p
r
o
v
i
d
e
e
q
u
a
l
a
c
c
e
s
s
fr
o
m
e
a
c
h
l
o
u

n
g
e
c
h
a
ir
.

(2) Toil
et
roo
ms

(1) S
t
a
f
f
t
o
i
l
e
t
.
A
s
t
a
f
f
t
o
i
l
e
t
s
h
a
l
l
b
e
p
r
o
v
i
d
e

a
v
a
i
l
a
b
i
l
i
t
y

w
i
t
h
d
i
r
e
c
t

t
o

a
c
c
e
s
s

p
a
t
i
e
n
t
s
.

t
o
t
h
e
w
o
r
k
i
n
g
a
r
e
a
t
o
m
a
i
n
t
a
i
n
s
t
a
f
f

(2) P
at
ie
nt
to
il
et
.
A
pa
ti
en
t
to
il
et
sh
al
l
be
pr
o
vi
de
d
w
it
h
di
re
ct
ac

ce
ss
to
th
e
P
h
as
e
II
re
c
o
v
er
y
u
ni
t
fo
r
th
e
e
x
cl
us
iv
e
us
e
of
p
at
ie
nt
s.

(5) Pr
ov
isi
on
s
sh
all
be
m
ad
e
fo
r
th
e
is
ol
ati
on
of
inf
ec
tio

us
pa
tie
nt
s.

(6) An
airborne
infectio
n
isolatio
n room
is not
required
in a
Phase II
recover
y area.
Provisio
ns for
the
recover
y of a
potentia
lly
infectio
us
patient
with an
airborne
infectio
n shall
be
determi
ned by
an
ICRA.

5.3.4
Diagnostic
and
Treatment
Locations

5.3.4.1 Exa
mination
provisions.
Provisions
shall be
made for
patient
examination,
interviews,
preparation,
testing, and
obtaining
vital signs of
patients for
outpa-tient
surgery.

5.3.4.2 Are
a for
preparation
and
examination
of frozen
sections. This
area may be
part of the
general
labora-tory if
immediate
results are
obtainable
without
unnecessary
delay in the
completion of
surgery.

5.3.5
Support
Areas for
the Surgical
Suite
Support
areas, except
for the
enclosed
soiled
workroom
mentioned in

Section 2.15.3.5.10 and

the
housekeeping
room in
Section 2.15.3.5.14, may
be shared
with the
obstetrical
facilities in
accordance
with the
functional
program.
Support
areas, where
shared with
delivery
rooms, shall
be designed
to avoid the
passing of
patients or
staff between
the operating
room and the
delivery room
areas. The
following
shall be
provided:

5.3.5.1 A
control
station.
This shall
be located
to per-mit
visual
observation
of all traffic
into
the
suite.

5.3.5.2 A
supervisor
office or
station. The
number of
offices,
stations, and
teaching
areas in the
surgical suite
shall depend
upon the
functional

anc
e of
eac
h
ope
rati
ng
roo
m.

program.

5.3.5.3 D
ocumentat
ion area.
The
dictation
and report
preparatio
n area
may be
accessible
from the
lounge
area.

(2) Scrub
faciliti
es
shall
be
arrang
ed to
minim
ize
incide
ntal
splatte
r on
nearb
y
perso
nnel,
medic
al
equip
ment,
or
suppl
y
carts.

5.3.5.4 S
crub
facilities.
Two scrub
positions
shall
be
provided
near the
entrance
to
each
operating
room.

(1)

Tw
o
scr
ub
pos
itio
ns
ma
y
ser
ve
two
ope
rati
ng
roo
ms
if
bot
h
pos
itio
ns
are
adj
ace
nt
to
the
entr

(3) In new
constr
uction,
view
windo
ws at
scrub
stations
permit
ting
observ
ation
of
room
interio
rs
shall
be
provid
ed.

(4)

The

scrub
sinks
shall
be
recess
ed
into
an
alcove

out of
the
main
traffic
areas.
The
alcove
shall
be
2006
Guidelin
es for
Design

80

located
off the
semirest
ricted or
restricte
d areas
of the
surgical
suite.

5.3.5.5 Me
dication
station.
Provision
shall
be
made
for
storage and
distribution
of drugs and
routine
medica-tions
in
accordance
with Section
2.1-2.3.4.

5.3.5.6 Ice
machine.
An
ice
machine
shall
be
provided in
accordance
with
Section 2.12.3.6.

5.3.5.7 Pa
tient
holding
area.
In
facilities
with two or

and
Construction of
Health Care
Facilities

more
operating
rooms, an
area shall
be
provided to
accommod
ate
stretcher
patients
waiting for
surgery.
This
holding
area shall
be under
the visual
control of
the nursing
staff.

5.3.5.8 A
substerile
service
areas(s). This
area acts as a
service area
between two
or more
operating or
proce-dure
rooms. Other
facilities for
processing
and sterilizing reusable
instruments,
etc., are
typically
located in
another
hospital
department,
such as
central
services.

(1)

(2)

(3)

It shall
be
equippe
d with a
flash
sterilize
r, warming
cabinet,
sterile
supply
storage
area,
and
handwashing
station
with
handsfree
controls
.
A
sterilizin
g
facility(i
es) with
highspeed
sterilizer(s) or
other
sterilizin
g
equipme
nt for
immedia
te or
emergen
cy use
shall be
grouped
to
service
sev-eral
operatin
g rooms
for
convenie
nt,
efficient
use.
A
work
space
and

handwashin
g
station
shall
be
provid
ed if
require
d by
the
functio
nal
progra
m.
5.3.5.9
Clean
workroom or
clean supply
room. Soiled
and clean
workrooms
or holding
rooms shall
be separated. The
clean
workroom or
supply room
shall not be
used for
food
preparation.

(1) Stora
ge
space
for
sterile
and
clean
suppli
es
shall
be
sized
to
meet
the
functi
onal
progr
am.
The
space
shall
be
moist

ure
and
tempe
rature
controlle
d and
free
from
crosstraffic
.

(2) Clean
workroo
m. A
clean
workroo
m shall
be provided
when
clean
material
s are
assembl
ed
within
the
surgical
suite
prior to
use or
followin
g the
deconta
minatio
n cycle.

2.1 GEN
E RAL H O
S P I TA L S

(1)

It
shal
l
cont
ain
a
wor
k
cou
nter,
a
han
dwas
hing
stati
on,
stor
age
facil
ities
for
clea
n
sup
plie
s,
and
a
spac
e to
pac
kag
e
reus
able
item
s.

(2) Th
e
sto
rag
e
for
ster
ile
sup
pli
es
mu

soiled
holding
room
that is
part of
a
system
for the
collecti
on and
disposa
l of
soiled
materia
l) shall
be
provide
d for
the
exclusi
ve use
of the
surgical
suite.

st
be
sep
arat
ed
fro
m
thi
s
spa
ce.

(3)

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

5.3.5.10
Soiled
workroom or
holding
room. Soiled
and clean
workrooms
or holding
rooms shall
be separated.

(1)

An
enclose
d soiled
workro
om (or

(2) The
room
shall be
located
in
the
restricte
d area.

(3)

The
soiled
workroo
m shall
contain
a
flushing
-rim
clinical
sink or
equivale
nt
flushing
-rim
fixture,
a handwashing
station,
a work
counter,
and
space
for
waste
receptac
les and

soiled
linen
receptac
les.
Rooms
used
only for
tempora
ry
holding
of soiled
material
may
omit the
flushing
-rim
clinical
sink and
work
counters
.
Howeve
r, if the
flushing
-rim
clinical
sink is
omitted,
other
provisio
ns for
disposal of
liquid
waste
shall be
provide
d.

(4)

The
room
shall
not
have
direct
conne
ction
with
operat
ing
rooms
or
other
sterile
activit
y
rooms
.

5.3.5.11
Anesthesi
a
workroom
. An
anesthesia
workroom for
cleaning,
testing,
and
storing
anesthesia
equipment
.

(1) Thi
s
roo
m
sha
ll
con
tai
n
wo
rk
cou
nte
r(s)
and
sin
k(s
)
and
rac
ks
for
cyl
ind
ers.

(2) Provi
sions
shall
be
made
for
separ
ate
stora
ge of
clean
and
soile
d
items
.

(3) In new

constru
ction,
dependi
ng on
the
function
al and
space
progra
ms, the
anesthe
sia
workro
om

shall
provide
space
for
anesthe
sia case
carts
and
other
anesthe
sia
equipm
ent.
Guidelin Construction of
es for
Health Care
Design
Facilities
and

81

2006

2.1 GEN
E R AL H O
S P I TA L S

5.3.5.12
Storage
for blood,
organs,
and
pathologic
al
specimens

(1) Provis
ions
for
refrig
erated
blood
bank
storag
e that
meets
the
standa
rds of
the
Ameri
can
Blood
Banki
ng
Assoc
iation
shall
be
provid
ed.

(2) Stora

ge for
harve
sted
organ
s.
Wher
e
applic
able,
refrig
eratio
n
facilit
ies for
harve
sted
organ
s shall
be
provi
ded.

5.3.5.13
Storage for
pathological
specimens.
Provisions for
storage
of
pathological
specimens
prior
to
transfer
to
pathology
section shall
be provided.

5.3.5.14
Equipment
and
supp
ly
stora
ge

*(1) Storage
room(s)
shall be
provided
for
equipmen
t and
supplies
used in
the
surgical
suite.
Each
surgical
suite shall
provide
sufficient
storage
area to
keep its
required
corridor
width free
of
equipmen
t and supplies, but
not less
than 150
square
feet
(13.94
square
meters) or
50 square
feet (4.65
square
meters)
per
operating
room,
whicheve
r is
greater.

(2) Storage
areas
shall be
provide
d for
portabl
e x-ray
equipm
ent,
stretche
rs,

fracture
tables,
warmin
g
devices
,
auxiliar
y
lamps,
etc.
These
areas
shall be
out of
corrido
rs and
traffic.

(3) Medi
cal
gas
stora
ge.
Main
stora
ge of
medi
cal
gases
may
be
outsi
de or
insid
e the
facilit
y in
accor
dance
with
NFP
A 99.
Provi
sion
shall
be
made
for
additi
onal
separ
ate
stora
ge of
reser
ve
gas
cylin
ders

neces
sary
to
comp
lete
at
least
one
days
proce
dures
.
5.3.5.15
Housekeeping
facilities.
Housekeeping
facilities shall
be provided
for the
exclusive use
of the surgical
suite. They
shall be
directly
accessible
from the suite
and shall
contain a
service sink or
floor receptor
and

APPEN
DIX

5.3.5.14 (1)
Equipment
storage
room(s) for
equipment
and supplies
used in the
surgical suite
should be
strategically
located and
sized for
convenient
access and
utilization. In
larger
surgical
suites,
storage
spaces
should be

located for
ready access
to specialty
rooms.

provision
s for
storage of
supplies
and
housekee
ping
equipmen
t.
5.3.6
Support
Areas for
Staff
5.3.6.1 Staff
lounge and
toilet
facilities

(1) Separ
ate or
combi
ned
loung
es
shall
be
provid
ed for
male
and
femal
e
staff.

(2) Lounge(
s) shall
be
designe
d
to
minimiz
e
the
need to
leave
the suite
and to
provide
conveni
ent
access
to the
recover
y room.
5.3.6.2
Staff

clothing
change
areas.
Appropriat
e areas
shall be
provided
for male
and female
personnel
(orderlies,
technicians
, nurses,
and
doctors)
working
within the
surgical
suite.

(1) The
areas
shall
conta
in
locke
rs,
show
ers,
toilet
s,
handwashi
ng
statio
ns,
and
space
for
donni
ng
surgi
cal
attire.

(2) These
areas
shall be
arrange
d to
encoura
ge a
oneway
traffic
pattern
so that
personn
el

enterin
g from
outside
the
surgical
suite
can
change
and
move
directly
into the
surgical
suite.

toilet(s),
and
clothing
change
or
gowning
area.

(2)

5.3.7
Support
Areas for
Patients
5.3.7.1
Patient
clothing
change
areas. If the
functional
program
defines
outpatient
surgery as
part of the
sur-gical
suite, a
separate area
shall be
provided
where
outpatients
and sameday
admission
patients may
change from
street
clothing into
hospital
gowns and
be prepared
for surgery.

(1) It shall
include
a
waiting
room,
locker(s
),

82

Where
private
holdin
g
room(s
)
or
cubicle
(s) are
provid
ed, a
separat
e
change
area is
not
require
d.

5.4
Interventio
nal
Imaging
Facilities
5.4.1
Cardiac
Catheteriza
tion Lab
(Cardiology
)
5.4.1.1
Location.
The cardiac
catheterizati
on lab is
normally a
separate
suite, but
location in
the imaging
suite shall
be permitted
provided the
appropriate
sterile
environment
is provided.
See Section
2.1-5.5.7.
2006
Guidelin
es for
Design

and
Construction of
Health Care
Facilities

p
e
c
t
e
d

5.4.1.2 Space
requirements

u
t
i
l
i
z
a
t
i
o
n
.

(1) Procedu
re
rooms

(1) T
h
e
n
u
m
b
e
r
o
f
p
r
o
c
e
d
u
r
e
r
o
o
m
s
s
h
a
l
l
b
e

(2)

T
h
e
p
r
o
c
e
d
u
r
e
r
o
o
m
s
h
a
l
l
b
e
a

b
a
s
e
d
o
n
e
x

m
i
n
i
m
u
m
o

f
4
0
0
s
q
u
a
r
e
f
e
e
t
(
3
7
.
1
6
s
q
u
a
r
e
m
e
t
e
r
s
)
e
x
c
l
u
s
i
v
e
o
f
f
i
x
e
d

c
a
b
i
n
e
t
s
a
n
d
s
h
e
l
v
e
s
.

(2) Prep,
holding,
and
recovery
rooms.
The size
of the
prep,
holding,
and
recovery
areas
shall be
based on
expected
utilizatio
n.

5.4.1.3 Ele
ctrophysiolog
y labs. If
electrophysio
logy labs are
also provided
in accordance
with the
approved
func-tional
program,
these labs
may be
located
within and
integral to the
catheterizatio
n suite or

located in a
sepa-rate
functional
area
proximate to
the cardiac
care unit.

prep,
holding
, and
recover
y area
or
room. A
patient
preparat
ion,
holding
, and
recover
y area
or room
shall be
provide
d and
arrange
d to
provide
visual
observa
tion
before
and
after
the
procedu
re.

5.4.1.4 Sup
port
areas
for the
cardia
c
cathet
erizati
on lab

(1) Scrub
facilitie
s. Scrub
facilitie
s with
handsfree
operabl
e
controls
shall be
provide
d
adjacen
t to the
entranc
e of
procedu
re
rooms,
and
shall be
arrange
d to
minimi
ze
incident
al
splatter
on nearby
personn
el,
medical
equipm
ent, or
supplies
.

(2) Patient

(3)

Control
room
or area.
A
control
room
or area
shall be
provide
d and
shall be
large
enough
to
contain
and
provide
for the
efficien
t
functio
ning of
the xray and
image
recordi
ng

equipm
ent. A
view
windo
w
permitt
ing full
view of
the
patient
from
the
control
console
shall
be
provide
d.

(4) Electric
al
equipme
nt room.
An
equipme
nt room
or
enclosur
e large
enough
to
contain
x-ray
transformers,
power
modules
,
and
associat
ed
electroni
cs and
electrica
l
gear
shall be
provide
d.

(5)

Viewin
g room.
A
viewing
room
shall be
availabl
e
for
use by
the
cardiac

catheter
ization
suite.

2.1 G
ENE
R AL
HOS
P I TA
LS

for
use
by
the
cardi
ac
cathet
erizat
ion
suite.

(6) Clean
workroo
m or
clean
supply
room. A
clean
workroo
m or
clean
supply
room
shall be
provide
d in
accorda
nce with
Section
2.12.3.7.

(7) Soiled
workroo
m or
soiled
holding
room. A
soiled
workroo
m shall
be
provide
d in
accorda
nce with
Section
2.12.3.8.

(8)

Film
file
room
.
Film
file
room
shall
be
avail
able

(9)

Housek
eeping
closet.
A
houseke
eping
closet
shall be
provide
d in
accorda
nce with
Section
2.12.3.10.

5.4.1.5
Support areas
for staff

(1)

Staff
clothing
change
area(s).
Staff
change
area(s)
shall be
provide
d and
arrange
d to
ensure a
traffic
pattern
so that
personn
el can
enter
from
outside
the
suite,
change
their
clothing
, and
move

directly
into the
cardiac
catheter
ization
suite.

A5.5.1.1 Space
layouts should
be developed
in compliance
with
manufacturer's

5.5
Imaging
Suite
5.5.1
General
*5.5.1.1
Functional
program.
Equipment
and space
shall be as
necessary to
accommodat
e the
functional
program.
The imaging
department
provides
diagnostic
procedures.
An imaging
department
commonly
includes
fluoroscopy,
radiography,
mammograp
hy,
tomography,
computerize
d
tomography
scanning,
ultrasound,
mag-netic
resonance,
angiography,
and similar
techniques.

recommendatio
ns because
area
requirements
may vary from
machine to
machine. Since
technology
changes frequently and
from
manufacturer to
manufacturer,
rooms can be
sized larger to
allow upgrading
of equipment
over time.
A5.5.1.2
Particular
attention should
be paid to the
management of
outpatients for
preparation,
holding, and
observation. The
emer-gency,
surgery,
cystoscopy, and
outpatient clinics
should be
accessi-ble to
the imaging
suite. Imaging
should be
located on the
ground floor, if
practical,
because of

*5.5.1.2
Layout. Beds
and stretchers
shall have
ready

equipment
ceiling height
requirements,
close proximity
to electrical
services, and

APPEN
DIX

expansion
considerations.

Guidelin Construction of
es for
Health Care
Design
Facilities
and

83

2006

2.1 GEN
E R AL H O
S P I TA L S

access to and
from other
departments
of the
institution.
5.5.1.3
Radiation
protection.
Most
imaging
requires
radiation
protection. A
certified
physicist or
other
qualified
expert
representing
the owner or
appropriate
state agency
shall specify
the type,
location, and
amount of
radiation
protection to
be installed
in
accordance
with the final
approved
department
layout and
equipment
selections.

(1)

Where
protect
ed
alcove
s with
view
windo
ws are
requir
ed, a

minim
um of
1 foot
6
inches
(45.72
centim
eters)
shall
be
provid
ed
betwe
en the
view
windo
w and
the
outsid
e
partiti
on
edge.

(2) Radiati
on
protecti
on
require
ments
shall be
incorporated
into the
specific
ations
and the
buildin
g plans.
5.5.1.4
Construction
requirements

(1) F
l
o
o
r.
F
l
o
o
r
s
h
a

ll
b
e
a
d
e
q
u
a
t
e
t
o
m
e
e
t
l
o
a
d
r
e
q
u
i
r
e
m
e
n
t
s
.

(2) Ceiling.
A lay-in
type
ceiling
shall be
permitt
ed to be
conside
red for
ease of
installat
ion,
service,
and
remode
ling.
5.5.2
Angiograph
y
5.5.2.1
General

shall be
provided
as
necessar
y to
accomm
odate
the
function
al
program
.

APPEN
DIX

A5.5.2.1
(1) The
procedure
room
should be
a
minimum
of 400
square
feet (37.16
square
meters).
A5.5.2.3
Viewing
areas
should be
a
minimum
of 10 feet
(3.05
meters) in
length.
A5.5.2.6 A
patient
holding area
should be
provided to
accommodate two
stretchers
with
additional
spaces for
additional
proce-dure
rooms.
A5.5.4.1

*(1) Space
requirem
ents.
Space

Radiography
rooms should be
a minimum of

180 square feet

(16.72 square
meters).
(Dedicated chest
X-ray may be
smaller.)
A5.5.4.2
Tomography
and
radiography/flu

(2)

Provision
shall be
made
within the
facility
for
extended

oroscopy (R&F)

post-

rooms should

procedure

be a minimum

observati

of 250 square

on of

feet (23.23

outpatient

square meters).

s.

5.5.2.2
Control
room. A
control room
shall be
provid-ed as
necessary to
accommodat
e the
functional
pro-gram. A
view
window shall
be provided
to permit full
view of the
patient.
*5.5.2.3
Viewing area.
A viewing
area shall be
provided.

5.5.2.4 Scru
b facilities. A
scrub
sink
located
outside the
staff entry to
the
procedure
room shall
be provided
for use by
staff.

5.5.2.5 Equ
ipment
storage.

Storage for
portable
equip-ment
and catheters
shall
be
provided.
*5.5.2.6
Patient
holding
area. A
patient
holding
area shall
be
provided.

5.5.3
Computeriz
ed
Tomograph
y (CT)
Scanning

5.5.3.1 Sp
ace
requirement
s. CT scan
rooms shall
be
as
required to
accommoda
te
the
equipment.

5.5.3.2 Co
ntrol room.
A
control
room shall
be provid-ed
that
is
designed to
accommodat
e
the
computer
and
other
controls for
the
equipment.

(1) A
view
wind
ow
shall
be
provi
ded
to
permi
t full
view

of the
patie
nt.

(2) The
angle
betwe
en the
contro
l and
equip
ment
centro
id
shall
permit
the
contro
l
operat
or to
see
the
patient
s
head.

(3) The
contr
ol
room
shall
be
locate
d to
allow
convenie
nt
film
proce
ssing.
5.5.3.4
Patient toilet.
A patient
toilet shall be
provided. It
shall be
convenient to
the procedure
room and, if
directly
accessible to
the scan
room,
arranged so a
patient can
leave the
toilet without

having to
reenter the
scan room.

5.5.4
Diagnostic
X-Ray
*5.5.4.1
Space
requirements
.
Radiography

rooms shall
be of a size
to
accommodat
e the
functional
program.
*5.5.4.2
Tomography,
radiography/fl
uoroscopy
rooms
Guidelin Construction of
es for
Health Care
Design Facilities
and

84
2006

y for
fluor
osco
pic
proce
dures
shall
be
perm
itted
to
use
nearb
y
patie
nt
toilet
s if
they
are
locat
ed
for
imme
diate
acces
s.

(1) Separate
toilets
with
handwashin
g
stations
shall be
provide
d with
direct
access
from
each
fluoroscopic
room so
that a
patient
can
leave
the
toilet
without
having
to
reenter
the
fluoros
copic
room.

(2) Room
s
used
only
occas
ionall

*5.5.4.3
Mammograph
y rooms
5.5.4.4
Shielded
control
alcoves

(1)

Each
x-ray
room
shall
include
a
shielde

d
control
alcove.
This
area
shall
be
provid
ed
with a
view
windo
w
design
ed to
provid
e full
view
of the
examin
ation
table
and the
patient
at all
times,
includi
ng full
view
of the
patient
when
the
table is
in the
tilt
positio
n or
the
chest
x-ray
is in
use.

(2)

For
mammog
raphy
machines
with
built-in
shielding for
the
operator,
the
alcove
shall be
permitte

d to be
omitted
when
approved
by the
certified
physicist
or state
radiation
protectio
n agency.

5.5.5
Magnetic
Resonance
Imaging
(MRI)
5.5.5.1 Space
requirements

(1) Space
shall be
provide
d
as
necessar
y
to
accomm
o-date
the
function
al
program
.

(2) The
MRI
room
shall
be
permit
ted to
range
from
325
square
feet
(30.19
square
meters
) to
620
square
feet
(57.60
square
meters
),
depen
ding
on the

vendor
and
magne
t
strengt
h.
5.5.5.2
Layout.
When
spectroscopy
is provided,
caution shall
be exercised
in locating it
in relation to
the mag-netic
fringe fields.
*5.5.
5.3
Contr
ol
room.
A
contr
ol
room
shall
be
provi
ded
with
full
view
of the
MRI.
*5.5.5.4
Patient
holding
area. A
patient
holding
area shall
be
provided.
*5.5.5.5
Computer
room. A
computer
room shall
be
provided.

2.1 GEN
E RAL H O
S P I TA L S

*5.5.5.6
Darkroom. A
darkroom
shall be
provided.
*5.5.5.7
Cryogen
storage.
Cryogen
storage
shall be
provided
.
5.5.5.8
Equipment
installation
requirements

*(1) Power
conditioning
shall be
provided.
*(2)
Magnetic
shielding
shall be
provided.

(3) For
superconducti
ng MRI,
cryogen
venting
and
emergen
cy
exhaust
must be
provided
in accordance
with the
original
equipme
nt
manufac
turers
specifica
tions.

5.5.6
Ultrasound

5.5.6.1 Sp
ace
requirements
. Space shall
be provided
as necessary
to
accommodat
e
the
functional
program.

5.5.6.2 P
atient
toilet. A
patient
toilet,
accessible
from the
procedure
room,
shall be
provided.

A5.5.5.4
When patient
holding
areas are
provided,
they should
be located
near the MRI
unit and
should be
large enough
to accommodate
stretcher(s).
A5.5.5.5 A
computer room
may range
from 150
square feet
(13.94 square
meters) to 380
square feet
(35.30 square
meters)
depending on
the vendor and
magnet

APPEN
DIX

strength. Selfcontained air

A5.5.4.3

conditioning

Mammog

supplement is

raphy

normally

rooms

required.

should be
a
minimum
of 100
square
feet (9.29
square
meters).

A5.5.5.3
Control
rooms
should be a
minimum of
100 square
feet
(9.29
square
meters), but
may
be
larger
depending
on
the
vendor and
magnet size.

A5.5.5.6 A
darkroom
may be
required for
loading
cassettes
and shall be
located
near the
control
room. This
darkroom
shall be
outside the
10-gauss
field.
A5.5.5.7
Cryogen
storage may
be required in
areas where
service to
replenish

supplies is not
readily
available.
When
provided,
space should
be a minimum
of 50 square

cryogen.
A5.5.5.8 (1)
Power
conditioning
and voltage
regulation
equip-ment

feet (4.65

as well as

square meters)

direct

to

current (DC)

accommodate

may be

two large

required.

dewars of

2006
Guidelin

2.1 GEN
E R AL H O
S P I TA L S

5.5.7
Cardiac
Catheteriza
tion Lab
(Cardiology
)
The cardiac
catheterizatio
n lab is
normally a
separate suite
(see Section
2.1-5.4.1) but
location
within the
imaging suite
shall be
permitted
provided the
appropri-ate
sterile
environment
is provided.
Combination
with
angiography
shall be
permitted in
low usage
situations.

5.5.8
Support
Areas for
the Imaging

es for
Construction of
Design Health Care
and
Facilities

85

Suite
The
following
spaces
are
common
to the
imaging
departme
nt and are
minimum
requirem
ents
unless
stated
otherwise
:

5.5.8.1 Con
trol
desk
and
recept
ion
area

5.5.8.2 Offi
ces for
radiologist(s
) and
assistant(s).
Offices shall
include
provisions
for viewing,
individual
consultation,
and charting
of film.

5.5.8.3 Han
d-

washi
ng
statio
ns

(1)

Handwashing
stations
shall be
provided
within
each
procedur
e room
unless
the room
is used
only for
routine
screenin
g such
as chest
x-rays
where
the
patient
is not
physicall
y
handled
by the
staff.

(2) Handwashin
g
stations
shall be
provide
d convenient
to the
MRI
room,
but
need
not be
with-in
the
room.

referring
clinicians
shall be
provided.

APPEN
DIX
A5.5.5.8 (2)
Magnetic
shielding may be
required to
restrict the
magnetic field
plot. Radio
frequency
shielding may be
required to
attenuate stray
radio
frequencies. The
area around,
above and below
the MRI suite
shall be
reviewed and
evaluated for the
following:

Po

ssible
occupancy
by
person(s)
who could
have
pacemaker
s or other
metal
implants.

Equi

pment that
can be
disrupted by a
magnetic field.
Examples
include but are
not limited to

5.5.8.4
Consultatio
n area. An
appropriate
area for
individual
consultatio
n with

personal
computers,
monitors, CT
scanners, and
nuclear
cameras.

After

reviewing
and
evaluating
the
surrounding
space,
appropriate
magnetic
shielding
should be
provided
based upon
the type of
MRI scanner
to be
installed.

5.5.8.5 Pati
ent holding
area.
A
convenient
holding area
under staff
control shall
be provided
to
accommodat
e inpatients
on stretchers
or beds.

5.5.8.6
Clerical
offices/sp
aces.
Office
space
shall

be

provided
as
necessary
for

the

functional
program.

5.5.8.7 Fil
m
proce
ssing
room

(1)

If film
systems
are used,
a
darkroo
m shall
be provided for
processi
ng film
unless
the
processi
ng
equipme
nt
normally
used
does not

require a
darkroo
m for
loading
and
transfer.
When
daylight
processi
ng is
used, the
darkroo
m shall
be
permitted to be
minimal
for
emergen
cy and
special
uses.

(2)

Film
processi
ng shall
be
located
conveni
ent to
the
procedu
re
rooms
and to
the
quality
control
area.

5.5.8.8 Qu
ality control
area. An
area or room
shall be
provided
near the
processor
for viewing
film
immediately
after it is
processed.
All view
boxes shall
be
illuminated
to provide

light of the
same color
value and
intensity for
appropriate
comparison
of several
adjacent
films.

5.5.8.9 Con
trast
media
prepar
ation

(1) If
contrast
media
are
used,
this
area
shall
include
a sink,
counter,
and
storage
to allow
for
mixing
of
contrast
media.

(2)

One
preparat
ion
room, if
conveni
ently
located,
shall be
permitte
d to
serve
any
number
of
rooms.

(3) Where
preprepare
d media
are
used,
this

area
shall be
permitt
ed to be
omitted
, but
storage
shall be
provide
d for
the
media.
5.5.8.10
Cleanup
facilities.
Provisions for
cleanup shall
be located
within the
suite for
convenient
access and
use.

recept
acle as
well as
storag
e
space
for
equip
ment
and
suppli
es.

(2)

(1) The
faciliti
es
shall
includ
e
service
sink or
floor

86

2006
Guidelin
es for
Design

If
automat
ic film
process
ors are
used, a
receptac
le of
adequat
e size
with hot
and cold
water
for
cleaning
the
process
or racks
shall be
provide
d.

and
Construction of
Health Care
Facilities

5.5.8.12

5.5.8.11
Clean
storage.
Provision
shall be
made for the
storage of
clean
supplies and
linens. If
convenientl
y located,
storage shall
be permitted
to be shared
with another
department.

Soiled
holding.
Provision
shall be
made for
soiled
holding.
Separate
provisions
for
contaminat
ed handling
and
holding
shall be
made.
Handwashing
stations
shall be

provided.

5.5.8.13
Film storage

(1) Fil
m
stor
age
(act
ive)
.A
roo
m
wit
h
cab
inet
or
shel
ves
for
fili
ng
pati
ent
fil
m
for
im
me
diat
e
retr
iev
al
shal
l be
pro
vid
ed.

(2)

Film
storage
(inactive
). A
room or
area for
inactive
film
storage
shall be
provided
. It shall
be
permitte
d to be
outside
the

imaging
suite, but
must be
under
imaging
s
administ
rative
control
and
properly
secured
to
protect
films
against
loss or
damage.

(3) Storag
e for
unexp
osed
film.
If film
syste
ms
are
used,
storag
e
faciliti
es for
unexp
osed
film
shall
includ
e
protec
tion
of
film
agains
t
expos
ure or
dama
ge
and
shall
not be
warm
er
than
the air
of
adjace

nt
occup
ied
space
s.
5.5.8.14
Medication
storage.
Provision
shall be
made for
locked
storage of
medication
s and
drugs.

5.5.9
Support
Areas for
Staff
The
following
spaces
are
common
to the
imaging
departme
nt and are
minimum
requirem
ents
unless
stated
otherwise
:

5.5.9.1 St
aff lounge.
Staff
lounge with
lockers
shall
be
permitted to
be outside
the
suite
but shall be
conven-ient
for
staff
use.

5.5.9.2 St
aff toilets.
Toilets
shall be
permitted
to be

outside the
suite but
shall be
convenient
for staff
use. In
suites of
three or
more
procedure
rooms,
toilets
internal to
the suite
shall be
provided.
5.5.10
Support
Areas for
Patients
The
following
spaces
are
common
to the
imaging
departme
nt and are
minimum
requirem
ents
unless
stated
otherwise
:

2.1 GEN
E R AL H O
S P I TA L S

5.5.10.1
Patient
waiting area

(1) The
area
shall be
out of
traffic,
under
staff
control,
and
shall
have
seating
capacit
y in
accorda
nce
with
the
functio
nal
progra
m.

(2) If the
suite is
routinel
y used
for
outpatie
nts and
inpatien
ts at the
same
time,
separate
waiting
areas
shall be
provide
d with
screenin
g for
visual
privacy
between
them.

(3)

If so
determin
ed by an
ICRA,
the
diagnosti
c
imaging
waiting
area
shall
require
special
measures to
reduce
the risk
of
airborne
infection
transmission.
These
measures
shall
include
enhance
d general
ventilati
on and
air
disinfect
ion
techniqu
es
similar
to
inpatient
requirem
ents for
airborne
infection
isolation
rooms
(see
Table
2.1-2).

See
the
C
DC
Gui
deli
nes
for
Pre
ven
ting

the
Tra
ns
mis
sio
n
of
My
cob
act
eriu
m
Tu
ber
cul
osis
in
He
alth
Car
e
Fac
iliti
es.

5.5.10.2
Patient
toilet
rooms.
Toilet
rooms with
handwashing
stations
convenient
to the
waiting
rooms and
equipped
with an
emergency
call system
shall be
provided.

5.5.10.3
Patient
dressing
rooms.
Dressing
rooms shall
be provided
convenient
to
the
waiting
areas and
x-ray
rooms.
Each room

shall
include a
seat
or
bench, mirror,
and
provisions
for hanging
patients
clothing
and
securing
valuables.

5.6
Nuclear
Medicine
5.6.1
General
*5.6.1.1
Space
requirements.
Space shall
be provided
as necessary
to
accommodate
the functional
program.
Where the
functional
program calls
for it, nuclear
medicine
procedure
room(s) shall
accommodate
the
equipment
specified in
the functional
program, a
stretcher,
exercise
equipment
(treadmill
and/or
bicycle), and
staff work
space.

APPEN
DIX
A5.6.1.1
Nuclear
medicine

may

most

include

facilities. It

positron

requires

emission

specialized

tomograph

planning

y, which is

for

not

equipment.

common to

2006

2.1 GEN
E R AL H O
S P I TA L S

5.6.1.2 R
adiation
protection
requireme
nts. A
certified
physicist
or other
qualified
expert
representing the
owner or
state
agency
shall
specify the
type,
location,
and
amount of
radiation
protection
to be
installed in
accordance
with final
approved
department
layout and
equipment
selec-tion.
These
specificatio
ns shall be
incorporate
d into the
plans.

5.6.1.3 Con
struction

Guidelin Construction of
es for Health Care
Design
Facilities
and

87

requirements
. Provision
for wiring
raceways,
ducts, or
conduits
shall be
made in
floors, walls,
and ceilings.
Ceilingmounted
equipment
shall have
properly
designed
rigid support
structures
located
above the
finished
ceiling.
5.6.2
Radiophar
macy
If
radiopharm
aceutical
preparation
is
performed
on-site, an
area
adequate to
house
a
radiopharm
acy shall be
provided
with
appropriate
shielding.
5.6.2.1 Space
requirements
(1) This area
shall include
adequate

square

space for
storage

meters) with a
16-square-foot

APPEN
DIX

meters) space
safe for

A5.6.3
Positr
on
Emissi
on
Tomog
raphy
(PET)
Faciliti
es
Space
requir
ement
s

1.

(1.47 square

storage of
parts that may
need to cool
down for a
year or more.

Laboratory
facilities

1.

oth a hot
(radioactiv
e) lab and
a cold
(nonradioa
Spa

ctive) lab

ce should be

may be

provided as

required,

necessary to

each a

accommodate

minimum

the functional

of 250

program. PET

square

scanning is

feet (23.23

generally used
in experimen-tal

square
meters).

settings and

2.

requires space

A blood
lab of a
minimu
m of 80
square
feet
(7.43
square
meters)
should
be
provide
d.

for a scanner
and for a
cyclotron.

2.

Sc
anner room.
The scanner
room should
be
a
minimum of
300 square
feet (27.87
square
meters).

3.

Cy

clotron room.
Where a
cyclotron
room is
required, it
should be a
minimum of
225 square
feet (20.90

Facility
requirements
a. Patient
holding
area. A
patient
holding
area to
accommod
ate two
stretchers
should be
provided.

5.6.2.2 R
of
radion
uclides
,
chemic
als for
prepar
ation,
dose
calibra
tors,
and
recordkeepin
g.

(2) If preprepare
d
material
s are
used,
storage
and
calculat
ion area
may be
conside
rably
smaller
than
that for
on-site
preparat
ion.

(3)

Space
shall
provi
de
adequ
ately
for
dose
calibr
ation,
qualit
y
assur
ance,
and
recor
dkeepi
ng.

adiation
protection
requiremen
ts. The area
may still
require
shielding
from other
portions of
the
facilities.

5.6.2.3 Con
structi
on
requir
ement
s

(1) Flo
ors
and
wal
ls
shal
l be
con
stru
cte
d of
easi
ly
dec
ont
ami
nat
ed
mat
eria
ls.

(2) Ve
nts
an
d
tra
ps
for
ra
di
oa
cti
ve
ga
ses
sh
all
be
pr

water circulation

ov
ide
d
if
su
ch
are
us
ed.

system.

2.

Spe

cial ventilation
systems
together with
monitors,
sensors, and
alarm systems
may be required
to vent gases
and chemicals.

b. Gas storage
area. A gas

3.

The

heating,

storage area

ventilating,

large enough

air

to accom-

and

conditioning

system

will

modate bottles

require particular

of gas should

attention; highest

be provided.

pressures should

Each gas will

be

be piped

(radia-tion) areas

individually

and

exhaust

and may go to

should

be

the cyclotron

hottest

or to the lab.

(radiation) areas.

Construction
requirements

Redundancy
may
be
important.

Radiation

in

coldest

Plumbing
requirements

protection.
Significant

The cyclotron is

radiation

water cooled

protection

with de-ionized

may be

water. A heat

required,

exchanger and

since the

connection to a

cyclotron

compressor or
connection to

may

chilled water

generate

may be

high

required. A

radiation.

redundant

Ventilation
requirements

1.

Vent

ilation adequate
for
occupancy

in

the
is

required.
Compressed air
may be required
to pressurize a

plumbing
system connected to a
holding tank
may be required
to prevent
accidental
leakage of
contaminated
water into the
regular

plumbing

system.
Guidelin Construction of
es for
Health Care
Design Facilities
and

88
2006

consoles, and
if
present,
computer
terminals.

(3) Hoods
for
pharma
ceutical
prepara
tion
shall
meet
applica
ble
standar
ds.
*5.6.3
Positron
Emission
Tomograph
y (PET)
5.6.4
Nuclear
Medicine
Area
The
nuclear
medicine
area, when
operated
separately
from the
imaging
department
, shall
include the
following:

5.6.4.1 Spa
ce
requirements
. Space shall
be adequate
to
permit
entry
of
stretchers
and beds and
able
to
accommodate
imaging
equipment,
electronic

5.6.4.2 A
contro
l desk
and
recept
ion
area

5.6.4.3 Han
d-washing
stations.
These shall
be provided
within each
procedure
room.
*5.6.4.4
Dose
administrati
on area. A
dose
administration area as
specified by
the
functional
program
shall be
provided,
located near
the
preparation
area. Since
as much as
several
hours may
elapse for a
dose to take
effect, the
area shall
provide for
visual
privacy from
other areas.
5.6.4.5
Support areas
for the
nuclear
medicine area

(1) Consult
ation
area. A
consulta
tion
area
with
view
boxes
illumina
ted to
provide
light of
the
same
color
value
and
intensit
y for
appropri
ate
comparison
of
several
adjacent
films
shall be
provided.
Space
shall be
provide
d for
comput
er
access
and
display
terminal
s if such
are
include
d in the
program
.

(2) Patient
holding
area

(1) A
h
o
l
d

i
n
g
a
r
e
a
f
o
r
p
a
ti
e
n
ts
o
n
st
r
e
t
c
h
e
r
s
o
r
b
e
d
s
s
h
a
ll
b
e
p
r
o
v
i
d
e
d
o
u
t
o
f
tr
a
ff
i
c
a
n
d

u
n
d
e
r
c
o
n
tr
o
l
o
f
st
a
ff
.

(2)

(3)

Co
mbi
nati
on
of
this
area
with
the
dos
e
adm
inist
rati
on
area
shal
l be
per
mitt
ed
pro
vided
ther
e is
visu
al
priv
acy
bet
wee
n
the
area
s.

Offi
ces

2.1 GEN
E RAL H O
S P I TA L S

(1) M
e
di
ca
l
st
af
f
of
fi
ce
s.
O
ff
ic
es
fo
r
p
h
ys
ic
ia
ns
a
n
d
as
si
st
a
nt
s
sh
al
l
b
e
pr
o
vi
d
e
d
a
n
d
e
q
ui
p
p

e
d
fo
r
in
di
vi
d
u
al
c
o
ns
ul
ta
ti
o
n,
vi
e
w
in
g,
a
n
d
c
h
ar
ti
n
g
of
fil
m
.

(2) Ot
her
sta
ff
off
ice
s.
Cle
ric
al
off
ice
s
an
d
spa
ces
sha
ll
be
pro

vid
ed
as
nec
ess
ary
for
the
pro
gra
m
to
fun
cti
on.
*(4)
Darkr
oom.
If film
proces
sing is
used,
an onsite
darkro
om
shall
be
provid
ed for
film
proces
sing.

(5) Compu
ter
room.
When
the
functio
nal
progra
m
require
sa
centrali
zed
comput
er area,
it shall
be a
separat
e room
with
access
termin
als
availab

the
roo
m
is
use
d
for
te
mp
ora
ry
hol
din
g
of
soil
ed
ma
teri
als,
om
issio
n
of
the
cli
nic
al
sin
k
sha
ll
be
per
mit
ted.

le
within
the
imagin
g
rooms.

(6) A soiled
workroo
m
or
holding
room

(1) Soi
led
wo
rkr
oo
m.
It
sha
ll
con
tain
a
han
dwa
shi
ng
stat
ion
and
a
clin
ical
sin
k
(or
equ
ivale
nt
flus
hin
grim
fixt
ure
s).

(2)

Soi
led
hol
din
g
roo
m.
If

(7) Equipm
ent and
supply
storage

(1) Fil
m
stor
age.
Inac
tive
film
stor
age
und
er
dep
art
men
tal
adm

inist
rati
ve
cont
rol
and
pro
perl
y
secu
red
to
prot
ect
film
agai
nst
loss
or
dam
age
shal
l be
pro
vide
d
and
can
be
off
site.

wi
th
a
ha
nd
w
as
hi
ng
st
ati
on
.

APPEN
DIX
A5.6.4.4
Because
patients in this
area may be
held for long
peri-ods of
time, the
design of the
area should
incorporate
such fea-tures
as comfortable

(2) Cl
ea
n
li
ne
n
st
or
ag
e.
A
st
or
ag
e
ar
ea
fo
r
cl
ea
n
li
ne
n

2006

2.1 GEN

seating, varied
lighting, an
entertainment
center, music
headphones,
and availability
of reading
materials.

A5.6.4.5
(4) The
darkroom
should
contain
protective
storage
facilities for
unexposed
film that
guard the
film against
exposure
or damage.
Guidelin Construction of
es for
Health Care
Design
Facilities
and

89

E R AL H O

S P I TA L S

for patients

(1) Patient
(8)

Houseke
eping
rooms.
Provisio
ns for
cleanup
shall be
located
within
the suite
for
convenie
nt access
and use.
Cleanup
facilities
shall
include
service
sink or
floor
receptacl
e as well
as
storage
space
for
houseke
eping
equipme
nt and
supplies.

5.6.4.6
Support areas
for staff

(1) Staff
toilet(s)
. These
shall be
provide
d
conveni
ent to
the
nuclear
medicin
e
laborat
ory.
5.6.4.7
Support areas

waiting
areas.
Waiting
areas
shall be
provided
out of
traffic,
under
staff
control,
and with
seating
capacity
in
accorda
nce with
the
function
al
program
. If the
departm
ent is
routinely
used for
outpatie
nts and
inpatient
s at the
same
time,
separate
waiting
areas
shall be
provided
with
screenin
g or
visual
privacy
between
the
waiting
areas.

(2) Patient
dressing
rooms

(1) Th

pa
tie
nt
s
cl
ot
hi
ng
an
d
se
cu
ri
ng
va
lu
ab
le
s.

ese
sha
ll
be
con
ven
ien
t to
the
wai
tin
g
are
a
and
pro
ced
ure
roo
ms.

(2)

Ea
ch
dr
es
si
ng
ro
o
m
sh
all
in
cl
ud
e
a
se
at
or
be
nc
h,
a
mi
rr
or,
an
d
pr
ov
isi
on
s
fo
r
ha
ng
in
g

(3) Patient
toilet
rooms.
Toilet
rooms
reserved
for

APPEN
DIX
A5.6.5.1
Equipment
manufacturers
recommendatio
ns

should

sought

be
and

followed, since
space
requirements
may vary from
one machine to
another

and

one
manufacturer to
another.

1.

T
he
radiothera
py
suite
may
contain
electron
beam
therapy or
radiation
therapy or

both.

2.

Alth
ough
not
recommende
d,
a
simulation
room may be
omitted
in
small linear
accelerator
facilities
where other
positioning
geom-etry is
provided.

nu
cle
ar
me
dic
ine
pat
ien
ts
sh
all
be
pr
ovi
de
d
co
nv
eni
ent
to
wa
iti
ng
an
d
pr
oc
ed
ure
ro
om
s.

A5.6.5.1 (2)
Minimum
size should
be 260
square feet
(24.15
square
meters) for
the simulator
room; 680
square feet
(63.17
square
meters),
including the
maze, for
accelerator
rooms; and
450 square
feet (41.81
square
meters) for
cobalt
rooms.

5.6.5
Radiothera
py Suite
*5.6.5.1
Space
requirements

(1)

Rooms
and
spaces
shall be
provide
d
as
necessa
ry to
accom
modate
the
functio
nal
progra
m.

*(2)
Simulat
or,
accelera
tor, and
cobalt
rooms
shall be
sized to
accomm
odate
the
equipme
nt and
patient
access
on a
stretcher
,
medical
staff
access
to the
equipme
nt and
patient,
and
service
access.
5.6.5.2
Radiation
protection
requirements.
Cobalt, linear
accelerators,
and
simulation
rooms
require radiation
protection.

(1) Layouts
shall be
designe
d
to
prevent
the
escape
of
radioact
ive
particle
s.

(2) Openin

gs into
the
room,
includin
g doors,
ductwork,
vents,
and
electric
al
raceway
s and
conduit
s, shall
be
baffled
to
prevent
direct
exposur
e to
other
areas of
the
facility.

(3) A
certified
physicis
t
represen
ting the
owner
or
appropri
ate state
agency
shall
specify
the type,
location,
and
amount
of
protecti
on to be
installed
in
accorda
nce with
final
approve
d
departm
ent
layout
and

equipme
nt
selectio
n. The
architect
shall
incorpor
ate these
specific
ations
into the
hos-pital
building
plans.

it
shall
be
made
in
floors
and
ceilin
gs.

(3) Ceilin
gmount
ed
equip
ment
shall
have
proper
ly
design
ed
rigid
suppor
t
structu
res
locate
d
above
the
finishe
d
ceiling
.

5.6.5.3
Construction
requirements

(1)

Floori
ng
shall
be
adequa
te to
meet
load
require
-ments
for
equip
ment,
patient
s, and
person
nel.

(2) Provis
ion
for
wiring
racew
ays,
ducts,
or
condu

90

5.6.5.4
Support areas
for the
radiotherapy
suite. The
following
areas shall be
provided.
Sharing of
these areas
2006
Guidelin
es for
Design

and
Construction of
Health Care
Facilities

required by
the
functional
program:
between the
radiotherap
y suite and
other areas
shall be
permitted if

(1) Exam
rooms
for each
treatmen
t room.
These

shall be
as
specifie
d by the
function
al
program
.

e
q
u
i
p
p
e
d

(1) Ea
ch
ex
am
ro
om
sh
all
be
a
mi
ni
mu
m
of
10
0
sq
uar
e
fee
t
(9.
29
sq
uar
e
me
ter
s).

(2) E
a
c
h
e
x
a
m
r
o
o
m
s
h
a
l
l
b
e

w
i
t
h
a
h
a
n
d
w
a
s
h
i
n
g
s
t
a
t
i
o
n
.

(2) A
stretcher
hold
area

(1)

Th
is
sh
all
be
loc
ate
d
adj
ac
ent
to
the
tre
atme
nt

ro
o
ms
,
scr
ee
ne
d
for
pri
va
cy,
an
d
co
mbi
ne
d
wi
th
a
se
ati
ng
are
a
for
ou
tpa
tie
nts
.

(2) Th
e
siz
e
of
the
are
a
wil
l
be
de
pe
nd
ent
on
the
pro
gra
m
for
out
pat
ien
ts
an
d

inp
ati
ent
s.

(3) Patient
gowning
area

(1) S
af
e
st
or
a
g
e
fo
r
v
al
u
a
bl
es
a
n
d
cl
ot
hi
n
g
sh
al
l
b
e
pr
o
vi
d
e
d.

(2) At
leas
t
one
spa
ce
sho
uld
be
larg
e
eno
ugh
for
staf
fassi

en
cy
us
e.

ste
d
dre
ssin
g.

(4) Business

(2)

office
and/or
receptio
n/contro
l area

(5) Darkr
oom.
This
shall
be
conve
nient
to the
treatment
room(
s) and
the
quality
contro
l area.

(1)

W
he
re
da
yli
gh
t
pr
oc
ess
in
g
is
us
ed,
the
da
rkro
o
m
ma
y
be
mi
ni
ma
l
for
em
erg

If
auto
mati
c
film
proc
esso
rs
are
use
d, a
rece
ptacl
e of
ade
quat
e
size
with
hot
and
cold
wat
er
for
clea
ning
the
proc
esso
r
rack
s
shal
l be
pro
vide
d
eith
er
in
the
dark
roo
m
or
near
by.

(6) Film file

area

(7) Film
storage
area for
unproce
ssed
film.

(8) Houseke
eping
room.
This
shall be
equippe
d with
service
sink or
floor
receptor
and
large
enough
for
equipme
nt or
supplies
storage.

2.1 GEN
E RAL H O
S P I TA L S

5.6.5.5
Optional
support
areas for
the
radiother
apy suite.
The
following
areas
may be
required
by the
functiona
l
program:

(1) Offices
(1) O
n
c
o
l
o
g
i
s
t
s
o
f
f
i
c
e
(
m
a
y
b
e
c
o
m
b
i
n
e
d
w
it
h
c

o
n
s
u
lt
a
ti
o
n
r
o
o
m
)

(2) Ph
ysi
cist
s
offi
ce
(m
ay
be
co
mb
ine
d
wit
h
trea
tme
nt
pla
nni
ng)

(2) Treatme
nt
planning
and
record
room

(3) Consulta
tion
room

(4) Quali
ty
contr
ol
area.
This
shall
have
view
boxes
illumi
nated
to

provi
de
light
of
consi
stent
color
value
and
intens
ity.

(5)

Comp
uter
control
area.
This is
normal
ly
locate
d just
outsid
e the
entry
to the
treatm
ent
room(s
).

(6) Dosimet
ry
equipme
nt area

(7) Hypo
therm
ia
room
(may
be
comb
ined
with
an
exam
room
)

(8) Workstat
ion/nutri
tion
station
5.6.5.6
Additional
support areas
for linear
accelerator

(1) Mold
room
with
exhaust
hood
and
handwashing
station

(2) Block
room
with
storage.
The
block
room
may be
combin
ed with
the
mold
room.
5.6.5.7
Additional
support areas
for cobalt
2006

room

(1) Hot lab

5.7
Rehabilitati
on Therapy
Departmen
t
5.7.1
General
Rehabilitat
ion
therapy is
primarily
for
restoration
of
body
functions
and may
contain
one
or
several
cate-gories
of
services.
Guidelin Construction of
es for
Health Care
Design
Facilities
and

91

2.1 GEN
E R AL H O
S P I TA L S

and
equipment
may be
shared as
appropriate
.

5.7.1.1 If a

5.7.2
Physical
Therapy
If
physical
therapy
is part of
the
service,
at least
the
followin
g shall be
provided:

formal
rehabilitation
therapy service
is included in a
project, the
facilities and
equipment
shall be as
necessary to
accommodate
the functional
program.

5.7.1.2 W
here two or
more
rehabilitati
on services
are
included,
facilities

5.7.2.1 Indi
vidual
treatment
area(s) with
privacy
screens or
curtains. Each
such space

shall have not

less than 70
square feet
(6.51 square
meters) of
clear floor
area.

shall
have at
least one
handwashing
station.

5.7.2.2 Exe

5.7.2.5
Support areas
for physical
therapy

rcise
area
and
faciliti
es

5.7.2.3 Pro
vision for
additional
therapies. If
required by
the functional
program,
provisions for
thermotherap
y, diathermy,
ultrasonics,
and
hydrotherapy
shall be
made.

5.7.2.4 Han
dwashi
ng
statio
ns

(1)

Handwashi
ng
statio
ns for
staff
shall
be
locate
d
either
within
or at
each
treatm
ent
space.

(2) Each
treatmen
t room

(1)

Soiled
material
storage.
Separate
storage
for
soiled
linen,
towels,
and
supplies
shall be
provided
.

(2) Equipm
ent and
supply
storage

(1) Cle
an
line
n
and
tow
el
stor
age

(2) Stor
age
for
equ
ipm
ent
and
sup
plie
s
5.7.2.6
Support
areas for
patients. If
required by
the
functional

program,
patient
dressing
areas,
showers,
and lockers
shall be
provided.
They shall
be
accessible
and usable
by the
disabled.

APPEN
DIX
A5.7.3.2 The
facilities should
be similar to a
residential
environment.

5.7.3
Occupation
al Therapy
If
occupatio
nal
therapy is
part of the
service, at
least the
following
shall be
provided:
5.7.3.1
Work areas
and
counters.
These shall
be suitable for
wheelchair
access.
*5.7.3.2
Teaching
area. An area
for teaching
daily living
activities
shall be
provided. It
shall contain
an area for a
bed, kitchen
counter with
appliances
and sink, a
bathroom,
and a table
and chair.

5.7.3.3 Han
dwashi
ng
statio
ns

5.7.3.4 Equ
ipmen
t and
suppl
y
storag
e

5.7.4
Prosthetics
and
Orthotics
If
prosthetics
and
orthotics
are part of
the
service, at
least the
following
shall be
provided:

5.7.4.1 Wor
kspac
e for
techni
cians

5.7.4.2 Spa
ce
for
evaluation
and fitting.
This
shall
have
provision for
privacy.

5.7.4.3 Spa
ce for
equip
ment,
suppli
es,
and
storag
e
5.7.5
Speech and
Hearing
Services
If speech
and hearing
services are
offered, at
least the
following
shall be
provided:

5.7.5.1 Spa
ce for
evalua
tion
and
treatm
ent

5.7.5.2 Spa
ce for
equip
ment
and
storag
e
5
.
7
.
6
S
u
p
p
o
r
t
A
r
e
a
s
f
o
r
t
h
e
R
e
h
a
b
i
l
i
t
a
t
i
o
n
T
h
e
r
a
p
y

D
e
p
a
r
t
m
e
n
t
Each
rehabilitati
on therapy
department
shall
include the
following,
which may
be shared
or
provided
as separate
units for
each
service:

waiting
and
activities
areas and
may
be
combined
with office
and
clerical
space.

5.7.6.1 R

5.7.6.3 Mul

eception
and control
station(s).
This shall
permit
visual
control of

92
2006
Guidelin

5.7.6.4 Wh
eelchair and
stretcher
storage.
Space(s)
shall be
provided for
storing
wheelchairs
and
stretchers
out of traffic
while
patients are
using the
services.

5.7.6.2
Office
and
clerical
space.
Provisio
n shall
be made
for filing
and
retrieval
of
patient
records.

tipurpose
room.
Access to a
demonstratio
n/
conference
room shall
be provided.
es for
Construction of
Design Health Care
and
Facilities

These spaces
may be
separate
from the
service area
but must be
conveniently
located.

5.7.6.5 Ho
usekeeping
room.
A
convenientl
y accessible
housekeepin
g room and
service sink
for
housekeepin
g use shall
be provided.

5.7.7
Support
Areas for
Staff
Each
rehabilitati
on therapy
department
shall
include the
following,
which may
be shared
or
provided
as separate
units for
each
service:

5.7.7.1 Con
venie
nt
access
to
toilets

5.7.7.2 Lo
cking
closets or
cabinets
shall be
provided
within the
vicinity of
each work
area for
securing
staff
personal
effects.
5.7.8
Support
Areas for
Patients
Each
rehabilitati
on therapy
department
shall
include the
following,
which may
be shared
or
provided
as separate
units for
each

service:

5.7.8.1 P
atient
waiting
area(s).
These shall
be located
out
of
traffic with
provision
for
wheelchair
s.

5.7.8.
2
P
atient
toilets
with
handwashin
g
station
s
accessi
ble to
wheelc
hair
patient
s.

5.8
Respiratory
Therapy
Service
The type and
extent of
respiratory
therapy
service in
different
institutions
vary greatly.
In some,
therapy is
delivered in
large
sophisticated
units,
centralized in
a specific
area; in
others, basic
services are
provided only
at patients
bedsides. If
respiratory

service is
provided, the
following
elements
shall be
provided as a
minimum, in
addition to
those
elements
stipulated in
Sections 2.15.7.6.1 and
5.7.6.2 and
2.1-5.7.7.1
and 5.7.7.2:

r
o
s
o
l
G
e
n
e
r
a
t
i
n
g

5
.
8
.
1

P
r
o
c
e
d
u
r
e
s
5.8.1.1 All
coughinducing
procedures
performed
on patients
who may
have
infectious
Mycobacte
rium
tuberculosi
s shall be
performed
in rooms
using local
exhaust
ventilation
devices
(e.g.,
booths or
special

L
o
c
a
t
i
o
n
s
f
o
r
C
o
u
g
h
I
n
d
u
c
i
n
g
a
n
d
A
e

2.1 GEN
E RAL H O
S P I TA L S

enclo
sures
that
have
disch
arge
HEPA
filters
and
exhau
st
direct
ly to
the
outsid
e).

5.8.1.2 If a
ventilated
booth is
used, the air
exchange
rate within
the booth
shall be at
least 12 air
changes per
hour, with a
minimum
exhaust flow
rate of 50
cfm and
differential
pressure of
0.0l" w.c.
(2.5 Pa).

5.8.1.3 Th
ese
procedures
may also be
performed
in a room
that meets
the
ventilation
requiremen
ts for airborne
infection
control. See
Table 2.1-2
for airborne

infection
isolation
room
ventilation
requiremen
ts.
5.8.2
Outpatient
Testing and
Demonstrati
on
If
respiratory
services
such as
testing and
demonstration for
outpatients
are part of
the program,
addition-al
facilities and
equipment
shall be
provided as
necessary
for the
appropriate
function of
the service,
including
but not
limited to
the
following:

5.8.2.1 A
recept
ion
and
contro
l
statio
n

5.8.2.2 Roo
m(s)
for
patient
educati
on and
demon
stratio
n

5.8.2.3 Patie
nt
waiting
area

with
provisio
n
for
wheelc
hairs

5.8.2.4 Pati
ent
toilets
and
handwashi
ng
statio
ns
5
.
8
.
3
S
p
a
c
e
a
n
d
U
t
i
l
i
t
i
e
s
f
o
r
C
l
e
a
n
i
n
g
a
n
d
D

i
s
i
n
f
e
c
t
i
n
g
E
q
u
i
p
m
e
n
t

5.8.3.1 T
he space
for
receiving
and
cleaning
soiled
materials
shall be
physically
separated
from the
space for
storage of
clean
equipment
and
supplies.

5.8.3.2 A
ppropriate
local
exhaust
ventilation
shall
be
provided if
glutaraldeh
yde
or
other
noxious
disinfectants are
used in the
cleaning
process.
5.8.4
Storage for

Equipment
and
Supplies

5.9 Renal
Dialysis
Unit (Acute
and
Chronic)
5.9.1
General
5.9.1.1
Functional
program.
Equipment
and space
shall be

provided as
necessary
to meet the
functional
program,
which may
include
treatment
for acute
(inpatient)
and chronic
cases,
home
treatment,
and kidney
dialyzer
reuse
facilities.
2006
and
Guidelin Construction of
es for
Health Care
Design
Facilities

93

2.1 GEN
E R AL H O
S P I TA L S

5.9.1.2
Location

(1)

The
location
shall
offer
convenie
nt access
for outpatients.
Accessib
ility to
the unit
from
parking
and
public
transport
ation
shall be
a
consider
ation.

(2) Inpat
ient
servi
ces
are
perm

itted
in
critic
al
care
units
and
desi
gnat
ed
areas
in
the
hosp
ital
with
appr
opria
te
utilit
ies.
5.9.2
Treatment
Area

5.9.2.1 Lay
out. The
treatment
area shall be
permitted to
be an open
area and
shall be
separate
from
administrative and
waiting

areas.

5.9.2.2 Spa
ce
requir
ement
s

(1) Are
a.
Indi
vidu
al
pati
ent
treat
men
t
area
s
shall
cont
ain
at
least
80
squa
re
feet
(7.4
3
squa
re
met
ers),
excl
usiv
e of
gene
ral
circ
ulati
on
spac
e
with
in
the
war
d.

(2)

Clearan
ce.
There
shall be
at least
a 4-foot
(1.22
meters)

space
between
beds
and/or
lounge
chairs.

5.9.2.3
Privacy.
The
open
unit
shall be
designe
d
to
provide
privacy
for each
patient.

5.9.2.4 N
urse
station(s).
These shall
be located
within the
dialysis
treatment
area and
designed to
provide
visual
observation
of all
patient
stations.

5.9.2.5 Han
dwashi
ng
statio
ns

(1) Handwashin
g
stations
shall be
conven
ient to
the
nurse
station
and
patient
treatme
nt
areas.

(2) There
shall
be at
least
one
handwashi
ng
station
servin
g no
more
than
four
station
s.

(1) If a stat
laborato
ry for
blood
and
urinalysi
s is provided,
the stat
laborato
ry shall
contain
a handwashing
station,
work
counters
, storage
spaces,
an
underco
unter
refrigera
tor for
specime
ns, and a
cup
sink.

(3) The
handwashing
stations
shall be
uniforml
y
distributed
to
provide
equal
access
from
each
patient
station.

5.9.2.6 Pat
ient toilet.
A patient
toilet with
hand-washing stations
shall
be
provided.

(2) An
area
for
the
phleb
otomi
sts
use
shall
be
provided
adjac
ent to
the
labor
atory.

5.9.2.7 Stat
labora
tory

(3)

A passthrough
for
specime
ns shall
be
provided

between
the
patient
toilet
room
and the
laborator
y.

5.9.2.8
Private
treatment
area. If home
training is
pro-vided in
the unit, a
private
treatment
area shall be
provided.

(1) A
private
treatmen
t area of
at least
120
square
feet
(11.15
square
meters)
shall be
provide
d for
patients
who are
being
trained
to use
dialysis
equipme
nt at
home.

(2)

This
room
shall
contain
a
counter,
handwashin
g
stations
, and a
separat
e drain

for
fluid
disposa
l.
5.9.2.9
Airborne
infection
isolation
room(s). The
num-ber of
and need for
required
airborne
infection
isola-tion
rooms shall
be
determined
by an ICRA.
When
required, the
airborne
infection
isolation
room(s) shall
comply with
the
requirements
of Section
2.1-3.2.2.

5.9.3
Examinatio
n Room
An
examination
room with
handwashing
stations and
writing
surface shall
be provided
with at least
100 square
feet (9.29
square
meters).
5.9.4
Support
Areas for
the Renal
Dialysis
Unit

5.9.4.1 Ad
ministrative
space. Office

and clinical
work-space
shall
be
available for
administrati
ve services.

counte
r and
handwashi
ng
station
s shall
be
includ
ed in
this
area.

5.9.4.2 M
edication
dispensing
station. If
required
by
the
functional
program,
there shall
be
a
medication
dispensing
station for
the
dialysis
center.

(2) Provisio
ns shall
be made
for the
controll
ed storage,
preparat
ion,
distribut
ion, and
refrigera
tion of
medicati
ons.

(1) A
work

94

5.9.4.3 Nou
rishment
station. If a
nourishment
station for
the dialysis
service is
provided, it
shall contain
a handwashing
station, a
work
counter, a
refrigerator,
storage
cabinets, a
waterdispensing
unit separate
from the
handwashing

2006
Guidelin
es for
Design

and
Construction of
Health Care
Facilities

station, and
equipment
for serving
nourishments
as required.
The
nourishment
station shall
be located
away from
the treatment
area to prevent the risk
of crosscontaminatio
n.

5.9.4.4 Dial
yzer
reprocessing
room. If
dialyzers are
reused, a
reprocessing
room sized
to perform
the functions
required

shall be
provided.

delivery
system. Each
facility using a
central batch

(1) This
room
shall
include
a oneway
flow of
materials from
soiled to
clean.

(2) This
room
shall
include
provisio
ns for
refriger
a-tion
for
tempora
ry
storage
of
dialyzer
s,
deconta
minatio
n/cleani
ng
areas,
sinks,
process
ors,
comput
er
process
ors and
label
printers
,a
packaging
area,
and
dialyzer
storage
cabinets
.

5.9.4.5 Mixi
ng room and

delivery system
shall provide,
either on the
premises or
through written
arrangements,
indi-vidual
delivery
systems for the
treatment of
any patient
requiring
special dialysis
solutions. The
mixing room
shall include a
sink, storage
space, and
holding tanks.

5.9.4.6 Wat
er

treatment

equipment
room.

The

water

treat-

ment
equipment
shall

be

located in an
enclosed room.

5.9.4.7 Equ
ipment repair
room. If
required by
the functional
program, an
equipment
repair and
breakdown
room shall be
equipped
with a handwashing
station, deep
service sink,
work
counter, and
storage
cabinet.

5.9.4.8 C

lean
workroom
or supply
room. A
clean
workroom
shall be
provided.
Soiled and
clean
workrooms or
holding
rooms
shall be
separated
and have
no direct
connection
.

(1) Clean
workro
om. If
the
room
is used
for
preparing
patient
care
items,
it shall
contain
a work
counter
,a
handwashin
g
station,
and
storage
faciliti
es for
clean
and
sterile
supplie
s.

(2)

Clean
supply
room.
If the
room
is used
only

for
storag
e and
holdin
g as
part of
a
system
for
distri-

2.1 GEN
E RAL H O
S P I TA L S

area
shall be
provide
d. It
may be
within
the
clean
workro
om, a
separate
closet,
or an
approve
d distributio
n
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.

bution of
clean
and
sterile
materials
,
the
work
counter
and
handwashing
station
may be
omitted.

5.9.4.9 S
oiled
workroom
. A soiled
workroom
shall be
provided
and
contain a
flushingrim sink,
hand-

washing
station,
work
counter,
storage
cabinets,
waste
receptacles,
and a soiled
linen
receptacle.

(2) Supp
ly
areas
/carts
.
Supp
ly
areas
or
suppl
y
carts
shall
be
provi
ded.

5.9.4.10
Equipment
and
supp
ly
stora
ge

(1)

Clean
linen
storage.
A clean
linen
storage

(3)

Stretche
r/wheelc
hair
storage.

If
stretcher
s are
provided,
storage
space
shall be
availabl
e for
wheelchairs
and
stretcher
s, out of
direct
line of
traffic.
5.9.4.11
Environm
ental
services
closet. An
environmental
services
closet
shall be
provided
adjacent
to and for
the
exclusive
use of the
unit.

ly
and
drai
n
con
nect
ion
for
testi
ng
mac
hine
s
shall
be
prov
ided
.
5.9.5
Support
Areas for
Staff
Appropriate
staff clothing
change areas
and lounge
shall be
available for
male and
female
personnel. The
areas shall
contain
lockers,
shower, toilet,
and handwashing

(1) The
closet
shall
contain
a floor
receptor
or
service
sink and
storage
space
for
houseke
eping
supplies
and
equipm
ent.

(2) Wat
er
supp

stations.

5.9.6
Support
Areas for
Patients

5.9.6.1 Pa
tient
support
provisions.
A waiting
room,
toilet room
with handwashing
stations,
source of
drinking
water,
public
telephone,
and seating

accommodations
for waiting
periods
shall be
available
or
accessible
to the

2006

2.1 GEN
E R AL H O
S P I TA L S

dialysis
unit.

5.9.6.2 Pati
ent storage.
Storage for
patients
belongings
shall
be
provided.
Guidelin Construction of
es for
Health Care
Design
Facilities
and

95

dialysis
solution
piping
should be
accessible.
A5.9.8.2 Due

5.9.7
Diagnostic
Areas

to the nature

5.9.7.1
Laboratory
space.
If
required by
the functional
program,
a
laboratory
space,
including
counters,
sinks,
cabinets,
label
machines,
computers,
and
handwashing
sinks, shall be
provided to
accommodate
processing of
blood draws
and
urine
samples.

process and

APPEN
DIX

A5.9.8.1 All
installed
reverse
osmosis
water and

of the
dialyzing
the nature of
the patients
illness, the
temperature
should be
main-tained
at 72 to
78F (22 to
26C) with a
relative
humidity
level of 30 to
60 percent.

A
5
.
1
0
H
y
p
e
r
b
a
r
i
c
S
u
i
t
e

and national

A
p
p
l
i
c
a
b
i
l
i
t
y
These
guidelines
should apply
to
hyperbaric
facilities
designated
for clinical
hyperbaric
oxygen
therapy,
including
hospitalaffiliated and
freestanding
facilities.
General
Facility
Requirement
s

construction
codes
governing the
type of occupancy (health
care,
commercial,
other)
housing the
hyperbaric
chamber(s).
When a
hyperbaric
suite/clinic is
provided, it
should meet the
requirements of
Chapter 20,
NFPA 99, and
Chapter 12,
NFPA 101.

Multiplace
(NFPA Class
A
Chamber)
Facilities
Emergency
exit
requirements

1.
e

Th
facility

Hyperbaric

housing

chambers

Class

should be

chamber

constructed in

should

be

conformance

designed

to

with applicable

allow rapid or

construction
codes (ASME
PVHO-1, Safety
Standard for

emergency
removal

of

patients and
staff.

Pressure
Vessels for

2.

Human

the case of

Occupancy) and

multiple Class

carry a U

A chambers

stamp.

installed in a

The facility
should be
constructed
to comply
with
applicable
local, state,

In

single setting
or a Class A
chamber that
contains
multiple
compartments, the

rapid or
emergency
removal of a
patient or
personnel from
one
chamber/comp
artment should
not restrict in
any way the
rapid and
simultaneous
removal of
patients or
personnel from
all other
chambers or
compartments.

3.

minimum of two
exits should be

5.9.8
Constructio
n
Requireme
nts
*5.9.8.1
Piping.
Design
consideratio
n shall be
given to the
disposal of
liquid waste
from
the
dialyzing
process
to
prevent odor
and
backflow.

provided for the

chamber

room

unless a single
exit

opens

directly

to

primary
evacuation

*5.9.8.2
Temperature/
humidity
control

*5.10
Hyperbaric
Suite

hallway.

Space
requirements
The space
required to
house Class
A chambers
and
supporting
equipment
should be
defined by
NFPA 99,
Chapter 20
and the
equipment
manufactur
er, but in
any case
should not
be less than
the
following:

1.

entry

hatchways

inimum
clearances
around a
(Class A)
hyperbaric
chamber
should be
as follows:

feet

(1.21
meters).

6.

The

chamber
should have
a minimum

2.

Cha
mber entry
should
be
designed for
gurney/stretc
her access:
10 feet (3.04
meters).

of 4 feet

3.

with regard

Ent

ries

designed

for

wheeled

(1.21 meters)
of clearance
all the way
around the
chamber,
except as
specified
to entry
areas.

gurneys

7.

should

the chamber

be

provided

with

access ramps
that are flush
with

the

chamber entry
doorway.

4.

If

control console
is immediately
adjacent to the
chamber, a
minimum
passageway of
4 feet (1.21

Cha

meters) should

mbers

that

be provided

utilize

fixed

between the
control console

internal

and any

stretcher
frames

and

trans-fer
gurneys
should

be

designed

to

allow
immediate

obstruction.

Monoplace
(Class B)
Facilities
Emergency
exit
requirements

removal of the

1.

patient

the case of

upon

chamber

multiple

depressurizati

Class B

on.

chambers
installed in a

5.

hamber
man

In

setting, the

lock

entries

single

or

rapid or
emergency

compartm

removal of a

ents

patient from

utilizing
circular

one chamber
should not

restrict in any

exit

opens

way the rapid

directly

to

and

primary

simultane-

evacuation

ous removal

hallway.

of patients
from all other
chambers.

2.

minimum of two
exits should be
provided for the
chamber

room

unless a single

96
2006
Guidelin
es for
Design
and
Construc
tion of
Health
Care
Facilities

3.

E
xit
doorways
should
have
a
minimum
opening of
46 inches.
(1.16
meters)

operatoradjustable
devices are
located on or
APPEN
DIX

under the
chamber

Space
requirements

adjacent to

The space

minimum

required to

clearance

house Class B

should be 36

chambers and

inches (91.44

supporting

centimeters).

equipment

the side wall,

2.

should be
defined by the
equipment
manufacturer,
but in any case
should not be
less than the
following:

The space
housing
Class B
chambers
should
conform to
NFPA 99,
Chapter 20
requirement
s.

Betw
een
control
side of two
chambers, 48
inches (1.21
meters).

3.

Betw
een back side
of
two
chambers, 24
inches (60.96
centimeters)

4.

minimum
passage of 14
inches (35.56
centimeters)
should be
provided at
the foot end
of each

Minimum
clearanc
es
between
individua
l (Class
B)
hyperbar
ic
chamber
s should
be as
follows:

chamber. An

1.

immediately

Cha

mber and
side wall, 18

oxygen shutoff valve

should be
provided for
each
chamber and
should be
unob-structed
by the
chamber and
located as to
be
acces-sible to
the chamber

inches (45.72

operator.

centimeters).

5.

Exception: If
any chamber
controls,
ventilation
valves, or
other

minimum
space of 102
inches

(2.59

meters)
should

be

avail-able

at

the head end

nt waiting area.

of

The waiting area

the

chamber

to

should be large

allow for the

enough to

safe insertion

accommodate

and

the clinical

removal

of the patient

program and

from

chamber mix if

the

also used as a

chamber.

holding area. The

6.

An
y electrical
service
outlets
located
within 10
feet of the
Class B
chamber
entrance
should be
sited no
less than 3
feet (0.91
meter)
above floor
level.

area should be
out of traffic,
under staff
control, and
should have
seating capacity
in accordance
with the
functional
program. When
the hyperbaric
suite is routinely
used for
outpatients and
inpatients at the
same time,
separate waiting

Support
Areas

areas should be

The following

provided with

support

screening for

areas should

visual privacy

be provided

between the

for the

waiting areas.

hyperbaric

Patient waiting

facility. If the

areas may be

hyperbaric

omitted for two or

facility is

fewer Class B

included as

hyperbaric

an integral

chamber units.

portion of

3.

another

service such

olding area.

as a wound

The area

care

should be out

department,
support
areas may
be shared:

of traffic flow
from the
chamber and
should not

Support
areas for the
hyperbaric
suite

1.

Rec
eption/cont
rol desk

2.

Patie

obstruct
access to the
exits. A
holding

2.1 GEN
E RAL H O
S P I TA L S

rol desk.

6.

Ha

nd-washing
stations.

lavatory

area under

equipped

staff control

hand-washing

should

with

accommodat

free operable

e inpatients

controls

on stretchers

should

or beds.

located in the

Stretcher

hands-

be

room

patients
should be out
of the direct
line of normal
traffic. The

for

where

the
hyperbaric
chambers are
located.

patient

7.

holding area

mpressor

may be

room. This

omitted for

area should be

two or less

large enough

individual

Co

to house the

hyperbaric

chamber

chamber

compressors,

units.

accumulator

4.

Cons

ultation/treatmen
t

rooms.

Appropriate

tanks, fire
suppression
system and
their ability to
meet the

room

for

requirements

individual

con-

of NFPA 99,

sultation

and

Chapter 20.

treatment

with

The reserve
breathing

referring
clinicians should

gases could
also be

be provided.

housed here if

5.

Pati

it is in close

ent

record

proximity to

storage area.

the chamber

An

room.

should

area
be

8.

Soil

is out of traffic

ed

holding

flow

and

area. A soiled

under

staff

holding

room

control.

This

should

be

provided that

can be in the

provided with

clini-cal

waste

area

or located at

receptacles

the

and

reception/cont

linen

soiled

housekeeping

receptacles.

9.

Equi
pment and
supply
storage

Clean supply
and linen
storage. A clean
storage space

supplies

and

equipment, and
should

be

located nearby.

Support
areas for
staff
Toilets with
hand-washing

should be

fixtures with

provided for
clean supplies

hands-free

and linens.

operable

Hand-washing

controls may be

fixtures should

outside the suite

be provided with

but should be

hands-free

convenient for

operable

staff use.

controls. When a
separate storage
room is
provided, it may
be shared with
another

Support
areas for
patients

1.

Pati

ent dressing
rooms.

department.

Dressing

Gas cylinder room.

rooms for

This room should

outpatients

be large enough to

should be

accommo-date the

provided and

storage of enough

should include

(H) cylinders and

a seat or

manifolds for the

bench, mirror,

reserve breathing

and provi-

gases required for

sions for

chamber

hanging

operations. The

patients
clothing and

minimum room

for securing

size should be

valuables. At

able to house
eight (H) cylinders
and two gas manifolds, consisting of
at least two (H)
cylinders on each
manifold.

The

should

contain a floor
receptor

or

service sink and

storage
for

should be
provided to
accommodate
wheelchair

2.

atient

housekeeping
room

dressing room

patients.

j. Housekeeping
room.

least one

space

toilet
rooms.
Toilet
rooms
should be
provided
with

hand-

controls

washing

with direct

fixtures

access

with

from

hands-

hyperbari

free

c suite.

the

operable
2006
Guidelin

2.1 GEN
E R AL H O
S P I TA L S

5.11
Laboratory
Suite
5.11.1
General

5.11.1.1
Type.
Laboratory
facilities
shall be
provided for
the
performance
of tests in
hematology,
clinical
chemistry,
urinalysis,
microbiolog
y, anatomic
pathology,
cytology,
and blood
banking to
meet the
workload
described in
the
functional
program.

5.11.1.2
Location.
Certain
procedure
s may be
performed
on-site or
provided
through a

es for
Design
and

Construction of
Health Care
Facilities

97

contractu
al
arrangem
ent with a
laborator
y service
acceptabl
e to the
authority
having
local
jurisdicti
on.

(1)

Provisio
ns shall
be made
for the
followin
g procedures to
be
performe
d onsite:
blood
counts,
urinalysis,
blood
glucose,
electroly
tes,
blood
urea and
nitrogen
(BUN),
coagulati
on,
transfusi
ons (type
and
crossmatch
capabilit
y), and
stat gram
stains.

(2) Provisi
ons
shall
be
includ
ed for
speci
men
collec
-tion
and
proces
sing.
5.11.1.3
Equipment
requirements.
The
functional
pro-gram
shall describe
the type and
location of all
special
equipment
that is to be
wired,
plumbed, or
plugged in,
and
the
utilities
required
to
operate each.
Note: Refer
to NFPA
code
requirements
applicable to
hospital
laboratories,
including
standards
clarifying
that hospital
units do not
necessarily
have the
same fire
safe-ty
requirements
as
commercial
chemical
laboratories.

5.11.2
Facility

Requireme
nts
The
followi
ng
physic
al
faciliti
es shall
be
provid
ed
within
the
hospita
l:
5.11.2.1 Work
areas

(1) Laborat
ory
work
counter(
s) with
space
for
microscopes,
appropri
ate
chemica
l
analyzer
(s),
incubator(s),
centrifu
ge(s),
biosafet
y hoods,
etc.
shall be
provide
d.

APPEN
DIX
A5.11.2.4 (3).
For example,
separate
facilities should
be provided for
such
incompatible
materials as
acids and

bases, and
vented storage
should be
provided for
volatile
solvents.

(2) Wor
k
area
s
shall
inclu
de
sink
s
with
wate
r
and
acce
ss to
vacu
um,
gase
s,
and
air,
and
elect
rical
servi
ces
as
need
ed.

5.11.2.2
Handwashing
stations.
These shall
be located
within 25
feet (7.62
meters) of
each
workstation
and within
each room
with a
workstation.

5.11.2.3
Design
consi
derat
ions

(1)

Chem
ical

safety
provis
ions.
These
shall
includ
e
emerg
ency
showe
r, eyeflushi
ng
devic
es,
and
appro
priate
storag
e for
flam
mable
liquid
s, etc.

(2) Termina
l
sterilizat
ion
provisio
ns.
Facilitie
s and
equipme
nt shall
be
provided
for
terminal
sterilization of
contami
nated
specime
ns
before
transport
(autocla
ve or
electric
oven).
(Termin
al
sterilizat
ion is
not
required
for

specime
ns that
are
incinerat
ed onsite.)

(3)

Radioact
ive
materialhandling
provisio
ns. If
radioacti
ve
materials
are
employe
d,
facilities
for longterm
storage
and
disposal
of these
materials
shall be
provided
. No
special
provisio
ns shall
normally be
required
for body
waste
products
from
most
patients
receivin
g lowlevel
isotope
diagnostic
material.
Require
ments of
authoriti
es
having
jurisdicti
on shall
be
verified.

5.11.2.4
Support areas
for the
laboratory
suite

(1) Adminis
trative
areas.
These
shall
include
offices
as well
as space
for
clerical
work,
filing,
and
record
maintena
nce.

(2)

Refriger
ated
blood
storage
facilities.
A
refrigerat
or to
store
blood for
transfusi
ons shall
be
equipped
with
temperat
uremonitori
ng and
alarm
signals.

*(3) Storage
facilitie
s for
reagents
,
standard
s,
supplies
, and
stained
specime
n
microsc
ope
slides,
etc.
These
shall
include
refriger
ation.
Such
facilitie
s shall
conform
to
applicab
le
NFPA
standard
s.

(4) A
specime
n
collectio
n
facility.
This
facility
may be
located
outside
the
laborato
ry suite.
2006
Guidelin
es for
Design

98

(1) Th
e
blo
od

and
Construction of
Health Care
Facilities

col
lec
tio
n
are
a
sha
ll
ha
ve

a
wo
rk
co
unt
er,
spa
ce
for
pat
ien
t
sea
tin
g,
an
d
ha
ndwa
shi
ng
sta
tio
ns.

(2) T
h
e
u
r
i
n
e
a
n
d
f
e
c
e
s
c
o
l
l
e
c
t
i
o
n
f
a
c
i
l
i
t
y

s
h
a
ll
b
e
e
q
u
i
p
p
e
d
w
it
h
a
w
a
t
e
r
c
l
o
s
e
t
a
n
d
h
a
n
d
w
a
s
h
i
n
g
s
t
a
ti
o
n
.

5.11.2.5
Support
areas for
staff.
Lounge,
locker, and
toilet
facilities

shall be
convenientl
y located for
male and
female
laboratory
staff.
Location of
these areas
outside the
laboratory
area and
sharing of
these areas
with other
departments
shall be
permitted.

5.12
Morgue
5.12.1
Location
These
facilities
shall be
accessible
through an
exterior
entrance
and shall
be located
to avoid the
need for
transportin
g bodies
through
public
areas.
*5.12.2
Autopsy
Facilities
If autopsies
are
performed
in the
hospital,
the following
elements
shall be
provided:

5.12.2.1
Refrigerated
facilities for
body

holding.
Bodyholding
refrigerators
shall
be
equipped
with
temperaturemonitoring
and alarm
signals.

5.12.
2.2
An
autops
y
room.
This
shall
contai
n the
follow
ing:

(1) A work
counter
with a
handwashing
station

(2) A
stor
age
spa
ce
for
sup
plie
s,
equ
ipm
ent,
and
spe
cim
ens

(3) An
autopsy
table

(4) A deep
sink for
washing
specime
ns

5.12.2.3
Housekeepin
g facilities.
A
housekeepin
g
serv-ice
sink
or
receptor
shall
be
provided for
cleanup and
housekeepin
g.

5.12.3
BodyHolding
Room
If autopsies
are
performed
outside the
facility, a
wellventilated,
temperaturecontrolled
bodyholding
room shall
be provided.

2.1 GEN
E RAL H O
S P I TA L S

6
Service
Areas
6.1
Pharmacy
6.1.1
General

6.1.1.1 Fun
ctional
program.
The size and
type of services to be
provided in
the
pharmacy
will depend
upon the
type of drug
distribution
system used,
number of
patients to
be served,
and extent
of shared or
purchased
services.
These
factors shall
be described
in the functional
program.

6.1.1.2 Loc
ation. The
pharmacy
room or suite
shall be
located for
convenient
access, staff
control, and
security.

6.1.1.3 Faci
lity
requir

ement
s

(1) Facilit
ies
and
equip
ment
shall
be as
necess
ary to
accom
modat
e the
functi
onal
progra
m.
(Satell
ite
faciliti
es, if
provid
ed,
shall
includ
e
those
items
requir
ed by
the
progra
m.)

(2) As a
mini
mum
, the
follo
wing
elem
ents
shall
be
provi
ded:
6.1.2
Dispensing
Facilities

6.1.2.1 A
room or
area for
receiving,
breakout,
and
inventory
control of

materials
used in the
pharmacy

6.1.2.2 W
ork
counters
and space
for
automate
d
and
manual
dispensin
g
activities

*6.1.2.3 An
extemporan
eous
compoundin
g area. This
shall
include a
sink and
sufficient
counter
space for
drug
preparation.

6.1.2.4 An
area
for
revie
wing
and
record
ing

6.1.2.5 A
n area for
temporary
storage,
exchange,
and
restocking
of carts

APPEN
DIX

A5.12.2
Autopsy
rooms
should be
equipped
with

downdraft
local
exhaust
ventilation.
A6.1.2.3
Floor
drainage
may also

be
required,
depending
on the
extent of
compoundi
ng
conducted.
Guidelin Construction of
es for
Health Care
Design
Facilities
and

99

2006

2.1 GEN
E R AL H O
S P I TA L S

separate
rooms or
closets
shall be
provided
.

6.1.2.6
Security
provisions
for drugs
and
personnel in
the
dispensing
counter area,
if one is
provided

6.1.4.1 Bul
k
storag
e

6.1.4.2 Acti
ve
storag
e

6.1.4.3 Refr
igerat
ed
storag
e

6.1.3
Manufacturi
ng Facilities

6.1.3.1 A
bulk
comp
oundi
ng
area

6.1.3.2 Pro
vision
s for
packa
ging
and
labeli
ng

6.1.3.3 A
qualit
ycontro
l area
6.1.4
Storage
Cabinets
,
shelves,
and/or

6.1.4.4 Sto
rage for
volatile
fluids and
alcohol.
This shall
be
constructed
according to
applicable
fire safety
codes for
the
substances
involved.

6.1.4.5 Stor
age for
narcotics and
controlled
drugs. Secure
storage shall be
provided for
narcotics and
controlled

drugs

6.1.4.6 Equi
pment and
supply
storage.
Storage shall
be provided
for general
supplies and
equipment
not in use.

filing
capabilities,
communication
equipment,
and reference
materials.

APPEN
DIX
A6.2.1.1

6.1.5
Support
Areas for
the
Pharmacy

6.1.5.1 P
atient
informati
on.
Provision
shall be
made for
crosschecking
medicatio
n and
drug
profiles of
individual
patients.

Considerati
on may also
be required
for meals to
VIP suites
and for
cafeterias
for staff,
ambulatory
patients,
and visitors, as well
as providing
for
nourishment
s and
snacks
between
scheduled
meal

6.1.5.2 P
harmacolo
gical
informatio
n. Poison
control,
reaction
data, and
drug
informatio
n centers

6.1.5.3 Offi
ce. A
separate
room or area
shall be
provid-ed for
office
functions.
This room
shall include
space to
accommodat
e a desk,

service.

6.1.5.4 Pro
visions for
patient
counseling
and instruction. A room
separate
from the
pharmacy
shall be permitted to
meet this
requirement.

6.1.5.5 A
room for
education
and training.
A multipurpose
room shared
with other
departments
shall be
permitted to
serve this
purpose.

6.1.5.6 Out
patient
consultation/
education
area. If the
functional
program
requires
dispensing
of
medication
to
outpatients,
an area for
consultation
and patient
education
shall be
provided.

6.1.5.7 Han
d-washing
stations.
Handwashing
stations shall

be provided
within each
separate
room where
open
medication is
prepared for
administratio
n.

6.1.5.8 Ster
ile work
area. If
intravenous
(IV)
solutions are
prepared in
the
pharmacy, a
sterile work
area with a
laminar-flow
workstation
designed for
product protection shall
be provided.
The laminarflow
workstation
shall include
a
nonhydrosco
pic filter
rated at
99.97
percent
(HEPA), as
tested by
dioctylphtalate
(DOP) tests,
and have a
visible
pressure
gauge for
detection of
filter leaks or
defects.

6.1.5.9 A
dditional
equipmen
t and
supply
storage.
If unit
dose

procedure
is used,
additional
space and
equipmen
t for
supplies,
packagin
g,
labeling,
and
storage,
as well as
for the
carts.

provided.

6.2 Dietary
Facilities
6.2.1
General
*6.2.1.1
Applicability.
Food service
facilities shall
pro-vide food
service
for
staff, visitors,
inpatients,
and
outpatients
in
accordance
with
the
functional
program.

6.1.6
Support
Areas for
Staff

6.1.6.1 Sta
ff
toilet.
Convenient
access
to
toilet shall
be
provided.

6.2.1.2
Location.
Patient food
preparation
areas shall be
located
adjacent to
delivery,
interior
transportation
, and storage
facilities.

6.1.6.2 Sta
ff storage.
Convenient
access
to
locker shall
be

100

2006
Guidelin
es for
Design

and
Construction of
Health Care
Facilities

6.2.1.4 C

6.2.1.3 Stan
dards. Food
service
facilities and
equip-ment
shall
conform to
these
standards
and to the
stan-dards of
the National
Sanitation
Foundation
and other
applicable
codes.

onstruction
requirement
s. Finishes
in the
dietary
facility
shall be
selected to
ensure
cleanability
and the
maintenanc
e of
sanitary
conditions.

6.2.2
Functional
Elements
If on-site

conventional
food service
preparation
is used, the
following
shall be
provided, in
size and
num-ber
appropriate
for the
functional
program:
6.2.2.1
Receiving/
control
stations. An
area
for
receiv-ing
and control
of
incoming
dietary
supplies
shall
be
provided.

(1) Th
is
are
a
sh
all
be
se
par
ate
d
fro
m
the
ge
ner
al
rec
eiv
ing
are
a

(2)

It shall
contain a
control
station
and a
breakout
area for
loading,
uncratin

g, and
weighin
g
supplies.

6.2.2.2 Ha
nd-washing
stations.
Hands-free
operable
handwashing
stations
shall be
convenientl
y accessible
at locations
throughout
the unit.

6.2.2.3 Foo
d
prepar
ation
work
space
s

(1) Work
spaces
shall
be
provid
ed for
food
prepara
-tion,
cookin
g, and
baking.
These
areas
shall
be as
close
as
possibl
e to the
user
(i.e.,
tray
assemb
ly and
dining)
.

(2) Addit
ional
space

s
shall
be
provi
ded
for
thawi
ng
and
portio
ning.

6.2.2.4 A
ssembly
and
distributi
on. A
patient
tray
assembly
area shall
be close
to the
food
preparati
on and
distributi
on areas.

6.2.2.5 Foo
d
servic
e carts

(1)

A cart
distributi
on
system
shall be
provided
,
with
spaces
for
storage,
loading,
distributi
on,
receivin
g,
and
sanitizin
g of the
food
service
carts.

2.1 GEN
E RAL H O
S P I TA L S

(2)

The cart
traffic
shall be
designe
d to
eliminat
e any
danger
of
crosscirculati
on
between
outgoin
g food
carts
and
incomin
g,
soiled
carts,
and the
cleanin
g and
sanitizi
ng
process.
Cart
circulati
on shall
not be
through
food
processi
ng
areas.

6.2.2.6 Din
ing area.
Dining
space(s)
shall be
provided for
ambulatory
patients,
staff, and
visitors.
These
spaces shall
be separate
from the

food
preparation
and
distribution
areas.

6.2.2.7 Ar
ea
for
receiving,
scraping,
and sorting
soiled
tableware.
This shall
be adjacent
to
warewashing
and
separate
from food
preparation
areas.

6.2.2.8 War
ewashi
ng
facilit
ies

(1)

6.2.2.9 Potwashing
facilities

(1) These
shall
include
multicompart
mented
sinks of
adequate
size for
the
intended
use,
conveni
ent to
the
using
service.

(2) Supple

These
shall

having
to pass
through
food
preparat
ion
areas.

be

designed
to
prevent
contamin
ation

of

clean
wares
with
soiled
wares
through
crosstraffic.

(2) The
clean
wares
shall be
transferr
ed for
storage
or use
in the
dining
area
without

mental
heat for
hot
water to
clean
pots and
pans
shall be
by
booster
heater,
steam
jet, or
other
appropri
ate
means.

(3) Mobile
carts or
other
provisio
ns shall
be made
for
drying
and
storing
pots and

pans.
6.2.2.10
Facilities
for
commissary
or contract
services
from other
areas

(1)

Provisio
n shall
be made
to
protect
food
delivered
to ensure
freshness
, retain
hot and
cold, and
avoid
contamin
ation. If
delivery
is from
outside
sources,
protectio
n against
weather

shall be
provided
.

(2) Prov
ision
shall
be
mad
e for
thor
ough
clea
ning
and
sanit
izing
of
equi
pme
nt to
avoi
d
mixi
ng
soile
d
and
clea
n
equi
pme
nt.
2006
Construction of
Guidelin Health Care
es for
Facilities
Design
and

101

2.1 GEN
E R AL H O
S P I TA L S

main dining
area.

(1) The

6.2.2.11
Vending
services. If
vending
devices are
used for
unscheduled
meals, a
separate
room shall
be pro-vided
that can be
accessed
without
having to
enter the

vendin
g
room
shall
contai
n
coinoperat
ed
machi
nes,
bill
chang
ers, a
handwashi
ng
station
, and a

sitting
area.

intend
ed,
and
easily
cleane
d.

(2) Facilitie
s for
servicin
g and
sanitizin
g the
machine
s shall
be
provided
as part
of the
facilitys
food
service
program
.

(2) Where
equipm
ent is
movabl
e,
heavyduty
locking
casters
shall be
provide
d.
If
equipm
ent is to
have
fixed
utility
connect
ions,
the
equipm
ent
shall
not be
equippe
d with
casters.

6.2.3
Support
Areas for
Dietary
Facilities

6.2.3.1 Off
ice spaces.
Offices for
the use of
the food
service
manager
shall be
provided. In
smaller
facilities,
this space
may be
located in an
area that is
part of the
food
preparation
area.

(3)

Walkin
coole
rs,
refrig
erator
s, and
freeze
rs
shall
be
insula
ted at
floor
as
well
as at
walls
and
top.

(4)

Coolers,
refrigera
tors, and

6.2.3.2 Equ
ipmen
t

(1) Mech
anical
device
s shall
be
heavy
-duty,
suitab
le for
use

freezers
shall be
thermostatically
controlle
d to
maintain
desired
temperature
settings
in
increme
nts of 2
degrees
or less.

(1)

Co
oler
s
and
refr
iger
ator
s
sha
ll
be
cap
abl
e of
mai
ntai
nin
g a
tem
per
atur
e
do
wn
to
free
zin
g.

(2) F
r
e
e
z
e
r
s
s
h
a
l
l

b
e
c
a
p
a
b
l
e
o
f
m
a
i
n
t
a
i
n
i
n
g
a
t
e
m
p
e
r
a
t
u
r
e
o
f
2
0
d
e
g
r
e
e
s
b
e
l
o
w
0

F
.

(3)

Inte
rior
tem
per
atur
es
sha
ll
be
indi
cate
d
digi
tall
y
so
as
to
be
visi
ble
fro
m
the
ext
erio
r.
Co
ntr
ols
sha
ll
incl
ude
aud
ible
and
visi
ble
hig
h
and
low
tem
per
atur
e
alar
m.
Ti
me
of

alar
m
sha
ll
be
aut
om
atic
ally
rec
ord
ed.

(5) Walk-in
units

(1) T
h
es
e
m
a
y
b
e
lo
c
k
a
bl
e
fr
o
m
o
ut
si
d
e
b
ut
m
us
t
h
a
v
e
re
le
as
e
m
ec
h
a
ni
s
m
fo
r
e
xi
t
fr
o
m
in
si
d
e
at

al
l
ti
m
es
.

(2) Inte
rior
shal
l be
ligh
ted.

(3) All
shel
vin
g
shal
l be
corr
osio
n
resi
stan
t,
easi
ly
clea
ned
,
and
con
stru
cted
and
anc
hor
ed
to
sup
port
a
loa
din
g of
at
leas
t
100
pou
nds
per
line
ar
foot
.

(6) Cookin

g
equipm
ent. All
cooking
equipm
ent shall
be
equippe
d with
automat
ic
shutoff
devices
to
prevent
excessiv
e heat
buildup.

(7) Icemaking
equipme
nt

(1) Thi
s
equ
ipm
ent
shal
l be
con
ven
ient
for
ser
vice
and
easi
ly
clea
ned
.

(2)

It
shal
l be
pro
vide
d
for
both
drin
ks
and
foo
d
pro
duct

s
(sel
fdisp
ensi
ng
equi
pme
nt)
and
for
gen
eral
use
(sto
rage
-bin
type
equi
pme
nt).

(8) Constru
ction
require
ments.
Undercounter
conduits,
piping,
and
drains
shall be
arranged
to
not
interfere
with
cleaning
of
the
equipme
nt or of
the floor
below.
6.2.3.3
Equipment
and supply
storage

(1) General
.
Storage
spaces
shall be
conveni
ent to
the
receivin

g area
and
accessib
le
without
travelin
g
through
the food
preparat
ion
area.

(2) Food
storage

(1) S
to
ra
g
e
s
p
a
c
e
s
f
o
r
b
ul
k,
re
fr
ig
er
at
e
d,
a
n
d
fr
o
z
e
n
f
o
o
d
s
s
h
al
l
b
e

p
r
o
v
i
d
e
d.
P
r
o
v
is
i
o
n
s
h
al
l
b
e
m
a
d
e
f
o
r
st
o
r
a
g
e
o
f
a
m
i
n
i
m
u
m
o
f
f
o
u
r
d
a
y
s
s
u
p

pl
ie
s.

pr
e
p
ar
at
io
n
ar
e
as
.

(2) F
o
o
d
st
or
a
g
e
c
o
m
p
o
n
e
nt
s
sh
al
l
b
e
gr
o
u
p
e
d
fo
r
c
o
n
v
e
ni
e
nt
ac
ce
ss
to
th
e
re
ce
iv
in
g
a
n
d
fo
o
d

(3)

Al
l
fo
od
sh
all
be
sto
re
d
cle
ar
of
the
flo
or.
Lo
we
st
sh
elf
sh
all
be
no
t
les
s
tha
n
12
inc
he
s
(3
0.
48
ce
nti
me
ter
s)
ab
ov
e
the
flo

or
or

sh
all
2006
Guidelin
es for
Design

102

and
Construction of
Health Care
Facilities

(3) Additio
nal
storage
rooms.
These
shall be
provide
d as
necessar
y for the
storage
of
cooking
wares,
extra
trays,
flatware
, plastic
and
paper
products
, and
portable
equipme
nt.

b
e
c
l
o
s
e
d
i
n
a
n
d
s
e
a
l
e
d

(4) Cleaning
supplies
storage.
A
separate
storage
room
shall be
provided
for the
storage
of
nonfood
items
such as
cleaning
supplies
that
might
contaminate
edibles.

t
i
g
h
t
f
o
r
e
a
s
e
o
f
c
l
e
a
n
i
n
g
.

6.2.3.4
Housekeepin
g rooms

(1)

These

shall
be
provid
ed for
the
exclusi
ve use
of the
dietary
depart
ment
and
shall
contai
na
floor
sink
and
space
for
mops,
pails,
and
suppli
es.

(2)

Where
hot
water
or
steam
is used
for
general
cleanin
g,
additio
nal
space
within
the
room
shall
be
provide
d for
the
storage
of
hoses
and
nozzles
.

6.2.4
Support
Areas for
Staff
6.2.4.1

Toilets,
lockers, and
lounges.
Toilets,
lockers and
lounge
facilities
shall be
convenient
to the
dietary
department.
These
facilities
shall be
permitted to

be
shared
with
adjacent
services
provide
d they
are
adequat
ely
sized.

6.3 Central
Services
The
following
shall be
provided:
6.3.1 Soiled
and Clean
Work Areas
The
soiled
and
clean
work
areas
shall be
physicall
y
separate
d.
6.3.1.1 Soiled
workroom

(1) This
room
shall
be
physic
ally
separa

2.1 G
ENE
R AL
HOS
P I TA
LS

ted
from
all
other
areas
of the
depart
ment.

(2)

Work
space
shall be
provided
to
handle
the
cleaning and
initial
sterilizat
ion/disin
fection
of all
medical/
surgical
instrume
nts and
equipme
nt. Work
tables,
sinks,
flushtype
devices,
and
washer/sterili
zer
deconta
minators
shall be
provided
.

(3)

Passthrough
doors
and
washer/st
erilizer
deconta-

m
i
n
a
t
o
r
s
s
h
a
ll
d
e
li
v
e
r
i
n
t
o
c
l
e
a
n
p
r
o
c
e
s
si
n
g
a
r
e
a
/
w
o
r
k
r
o
o
m
s.
*6.3.1.2
Clean
assembly/w

orkroom.
This
workroom
shall
contain
handwashing
stations,
work space,
and
equipment
for terminal
sterilizing
of medical
and
surgical
equipment
and
supplies.

6.3.2
Equipment
and Supply
Storage
Areas
6.3.2.1
Clean/sterile
medical/surgi
cal supplies

(1) A
room
for
breakd
own
shall
be
provid
ed for
manuf
acturer
s
clean/s
terile
supplie
s. The
clean
proces
sing
area
shall
not be
in this
area
but in
an
adjace
nt
space.

(2)

Storage
for
packs,
etc.,
shall
include
provisio
ns
for
ventilati
on,
humidity
,
and
temperat
ure
control.

6.3.2.2
Storage room
for patient
care and
distribution
carts. This
area shall be
adjacent and
easily
available to
clean and
sterile
storage and
close to the
main distribution point
to keep
traffic to a
minimum
and ease
work flow.

6.3.3
Support
Areas for
Staff

6.3.3.1 A
dministrati
ve/changin
g room. If
required by
the
functional
program,
this room
shall be
separate
from all
other areas
and
provide for
staff to

change
from street
clothes
into work
attire.

room

should

contain

Hi-

Vacuum

or

gravity

steam

sterilizers and
sterilization

6.3.3.2 Staf
f
accom
modat
ions.
Locke
rs,
handwashi
ng

equipment

to

accommodate
heat-sensitive
equip-ment
(ETO sterilizer)
and

ETO

aerators.

3.

It

should contain
worktables,
APPEN
DIX

counters, a
hand-washing
station,

A6.3.1.2
Sterilization
room. This
room is used
exclusively
for the
inspection,
assembly,
and

ultrasonic
storage
facilities for
backup
supplies and
instrumentation, and a
drying cabinet

packaging of

or equipment.

medical/surgi

4.

Th

area

cal supplies
and
equipment for
sterilization.

1.

Acc
ess to the
sterilization
room
should be
restricted.

2.

This

2006
Guidelin

2.1 GEN
E R AL H O
S P I TA L S

should

be

spacious
enough

to

hold sterilizer
carts
loading

for
of

prepared
supplies

for

sterilization.
es for
tion of Health
Design Care Facilities
and
Construc

103

vicinity of
the
department.

6.4 Linen
Services
station, and
showers
shall be
made
available
within the
immediate

6.4.1
General
Each facility
shall have
provisions
for storing

and
processing of
clean and
soiled linen
for
appropriate
patient care.
Processing
may be done
within the
facility, in a
separate
building onor off-site, or
in a commercial or shared
laundry.
6.4.2
Internal
Linen
Processing
Facilities
and
equipment
shall be as
required for
costeffective
operation as
described in
the
functional
pro-gram.
At
a
minimum,
the
following
elements
shall
be
provided:

6.4.2.1 S
oiled
linen
holding
room. A
separate
room
shall be
provided
for
receiving
and
holding
soiled
linen
until
ready for

pickup or
processin
g.

6.4.2.2 C
lean linen
storage. A
central
clean linen
storage
and
issuing
room(s)
shall be
provided
in addition
to the
linen
storage
required at
individual
patient
units.

6.4.2.3 C
art
storage
area(s).
These
shall be
provided
for
separate
parking
of cleanand
soiledlinen
carts out
of traffic.

6.4.2.4 A
clean linen
inspection
and mending
room or
area. If not
provided
elsewhere, a
clean linen
inspec-tion,
delinting,
folding,
assembly,
and
packaging
area shall be
provided as

part of the
linen
services.

(1) Mendin
g shall
be
provide
d for in
the linen
services
departm
ent.

(2) A
space
for
tables
,
shelvi
ng,
and
storag
e
shall
be
provi
ded.
6.4.2.5 Handwashing
stations.
These shall
be provided
in each area
where
unbagged,
soiled linen is
handled.

APPEN
DIX

A6.4.4.3
This may
require a
capacity for
processing
a sevenday supply
in a 40hour week.

6.4.3
Additional
Areas for
Outside
Laundry
Services

If linen is
processed
outside the
building,
provisions
shall also
be made
for:

6.4.3.1 Ser
vice
entrance. A
service
entrance,
protected
from
inclement
weather,
shall
be
provided for
loading and
unloading of
linen.

6.4.3.2 Co
ntrol
station. A
control
station shall
be
provided
for
pickup and
receiving.
6.4.4 OnSite
Laundry
Facility
If linen is
processed in a
laundry
facility that is
part of the
project
(within or as
a separate
building), the
follow-ing
shall be
provided in

addition to
the
requirements
for internal
processing
facilities in
Section 2.16.4.2.

6.4.4.1 Lay
out.
Equipment
shall be
arranged to
permit an
orderly work
flow and
minimize
cross-traffic
that might
mix clean
and soiled
operations.

6.4.4.2 Con
trol and
distribution
room. A
receiving,
holding, and
sorting room
shall be
provided for
con-trol and
distribution
of soiled
linen.
Discharge
from soiled
linen chutes
shall be
received in a
separate
room
adjacent to it.
*6.4.4.3
Laundry
processing
room. This
shall have
commercial
or
industrialtype
equipment
that can
process at

least a
seven-day
supply
within the
regular
scheduled
work week.

6.4.4.4 Ha
nd-washing
stations.
Employee
hand-washing stations
shall be
provided in
each room
where clean
or soiled
linen is
processed
and handled.

6.4.4.5 Stor
age
for
laundr
y
suppli
es

6.4.4.6 Staf
f
support
locations.
Conveniently
accessible
staff lockers,
showers, and
lounge shall
be provided.

6.4.5 Linen
Chutes
If
provided,
these shall
meet or
exceed the
following
standards:
6.4.5.1
Standards

(1) Ser
vic
e
ope
nin

gs
to
chu
tes
sha
ll
co
mp

104

ly
wit
h
NF
PA
10
1.
2006
Guidelin
es for
Design

and
Construction of
Health Care
Facilities

rs).

(2) Chu
tes
shal
l
mee
t
the
pro
visi
ons
des
crib
ed
in
NF
PA
82.

(3) Chute
dischar
ge into
collecti
on
rooms
shall
comply
with
NFPA
101.
6.4.5.2
Dimensio
ns. The
minimum
crosssectional
dimensio
n of
gravity
chutes
shall be 2
feet
(60.96
centimete

6.5
Materials
Manageme
nt
6.5.1
Receiving
The
following
shall be
provided:

6.5.1.1 Off
street
unloa
ding
facilit
ies

6.5.1.2 Rec
eivin
g area
Adequate
receiving
areas shall
be provided
to accommodate
delivery
trucks and
other
vehicles.

*(1)
Location

1.

D
oc
k
ar
ea
s
sh
all
be
se

gr
eg
ag
ed
fr
o
m
ot
he
r
oc
cu
pi
ed
b
ui
ld
in
g
ar
ea
s
an
d
lo
ca
te
d
so
th
at
n
oi
se
an
d
o
d
or
s
fr
o
m
o
pe
ra
ti
o
n
w
ill
n
ot
ad
ve
rs
el
y
af

fe
ct
bu
il
di
ng
oc
cu
pa
nt
s.

2. Th
e
rec
eiv
ing
are
a
sh
all
be
co
nv
eni
ent
to
ser
vic
e
ele
vat
ors
an
d
oth
er
int
ern
al
cor
rid
or
sys
te
ms
.

3. Re
cei
vi
ng
ar
ea
s
sh
all
be
se

gr
eg
at
ed
fr
o
m
w
as
te
st
ag
in
g
an
d
ot
he
r
ou
tg
oi
ng
m
at
eri
al
sha
nd
lin
g
fu
nc
tio
ns
.

(2) Space
require
ments

(1) Ad
equ
ate
spa
ce
sha
ll
be
pro
vid
ed
to
ena
ble
bre
akd
ow
n,

sort
ing,
and
sta
gin
g of
inc
omi
ng
mat
eria
ls
and
sup
plie
s.

(2) Ba
ler
s
an
d
ot
he
r
de
vi
ce
s
sh
all
be
lo
cat
ed
to
ca
pt
ur
e
pa
ck
ag
in
g
for
re
cy
cli
ng
or
ret
ur
n
to
m
an
uf
act
ur

er
or
de
liv
er
er.

(3)

In
faci
litie
s
wit
h
cen
tral
ize
d
war
eho
usi
ng,
ade
qua
te
spa
ce
sha
ll
be
pro
vid
ed
at
rec
eivi
ng
poi
nts
to
per
mit
the
sta
gin
g of
reu
sab
le

2.1 GEN
E RAL H O
S P I TA L S

tra
nsp
ort
con
tai
ner
s
for
sup
pli
es
mo
vin
g
fro
m
cen
tral
wa
reh
ous
es
to
ind
ivi
dua
l
rec
eiv
ing
site
s.
6.5.2
General
Stores
In
addition
to supply
facilities
in
individual
departments, a
central
storage
area shall
be
provided.
6.5.2.1

General

General
stores may
be located in
a separate
building on
site with
provisions
for
protection
against
inclement
weather
during
transfer of
supplies.
The
following
shall be
provided:

ed.

(2)

6.5.2.2
General
storage
room(s)

(1) Locatio
n.
Locatio
n of
storage
in
separate
,
concentrated
areas
within
the
instituti
on or in
one or
more
individ
ual
buildin
gs on
site
shall be
permitt
ed. Offsite
location
for a
portion
of this
storage
shall be
permitt

Space
require
ments.
General
storage
room(s)
with a
total
area of
not less
than 20
square
feet
(1.86
square
meters)
per
inpatien
t bed
shall be
provide
d.

6.5.2.3
Additional
storage areas
for outpatient
facilities

(1)

Location
.
Location
of
addition
al
storage
areas in
combina
tion
with and
in
addition
to the
general
stores,
or in a
central
area
within
the
outpatie
nt
departm
ent,
shall be
permitte

d. Offsite
location
for a
portion
of this
storage
shall
also be
permitte
d.

(2) Spac
e
requi
reme
nts.
Addit
ional
stora
ge
areas
for
outpa
tient
facili
ties
shall
be
provi
ded
in an
amou
nt not
less
than
5
perce
nt of
the
total
area

of
those
facilit
ies.
6.5.3 Waste
Manageme
nt
*6.5.3.1
Collection
and storage.
Waste
collection
and storage
locations
shall be
determined
by the
facility as a
component
of the
functional
program.

APPEN
DIX

A6.5.1.2 (1)
The
receiving
area should
be located to
promote the
safe, secure,
and efficient
movement of
arriving
materials
without
compromisin
g

patient

areas.
es for ction of Health
Design Care Facilities
and
Constru

105

2006
Guidelin

2.1 GEN
E R AL H O
S P I TA L S

(1) Location
(1) Th
e
loc
ati

on
of
co
mp
act
ors
,
bal
ers
,
sh
arp
s,

an
d
rec
ycl
ing
co
nta
ine
r
sta
gin
g
at
do
ck
s
or
oth
er
wa
ste
re
mo
val
are
as
sh
all
be
sti
pul
ate
d
by
the
fu
nct
ion
al
pr
og
ra
m.

(2)

Re
d
bag
was
te
sha
ll
be
sta
ged
in
enc
los
ed
and

sec
ure
d
are
as.
Bio
haz
ard
ous
and
env
iro
nm
entall
y
haz
ard
ous
mat
eria
ls,
incl
udi
ng
mer
cur
y,
nuc
lear
rea
gen
t
was
te,
and
oth
er
reg
ulat
ed
was
te
typ
es,
sha
ll
be
seg
reg
ate
d
and
sec
ure
d.

(2) Space

udi
ng
cen
tral
ize
d
was
te
coll
ecti
on
and
stor
age
spa
ces.
Siz
e of
spa
ces
sha
ll
be
bas
ed
upo
n
the
vol
um
e of
pro
ject
ed
was
te
and
len
gth
of
anti
cip
ate
d
stor
age
.

requirem
ents

(1)

The
func
tiona
l
prog
ram
shall
stipu
late
the
categori
es
and
volu
mes
of
wast
e for
disp
osal
and
the
meth
ods
of
hand
ling
and
disp
osal
of
wast
e.

(2)

The
fun
ctio
nal
pro
gra
m
sha
ll
outl
ine
the
spa
ce
req
uire
me
nts,
incl

(3) Regulate
d waste
storage
spaces

(1)

If
pr
o
vi

de

tion. Facilities

d,

should seek

re

both to

minimize all

ul

components of

at

each waste

ed

stream and to

separate

ed

different

ic

components of

al

the total waste

stream. At a

as

minimum, the

te

functional

or

program should

in

include

fe

consideration of

c-

regular trash,

ti

medical/infectio

us waste,

us

hazardous

waste, and low-

as

level

te

radioactive

st

waste.

or

The program

ag

should

address the

sp

development

ac

of effective

es

collec-tion,

sh

transport, pest

al

control, and

storage

ha

systems;

ve

waste

manage-ment

fl

and

contingency

or

planning;
protection of
the health and

APPEN
DIX

safety of
workers; and
proper siting

A6.5.3.1

of all on-site

Collection and

waste

storage. The

treatment

underlying

technologies.

framework of
waste
management
comprises
waste
minimization
and segrega-

Optimizing waste
management
has
programmatic
and space
impacts
throughout the

facility at points
where waste is
generated,
collected, and
staged for

drai

disposal. For

n,

facilities or

clea

municipalities

nabl

with recycling

programs in

floo

place, particular

consideration

and

should

wall
surf
aces
,
light
-ing,
and
exh
aust
vent
ilati
on,
and
sho
uld
be
safe
fro
m
wea
ther,
ani
mal
s
and
una
utho
rize
d
entr
y.

(2) Re
fri
ger
ati
on
req
uir
em
ent
s
for
suc

h
sto
rag
e
fac
iliti
es
sha
ll
co
mp
ly
wit
h
stat
e
an
d/o
r
loc
al
reg
ula
tio
ns.

chu
tes
sha
ll
co
mp
ly
wit
h
NF
PA
10
1.

3. C
h
ut
e
di
sc
ha
rg
e
in
to
co
ll
ec
ti
o
n
ro
o
m
s
sh
al
l
co
m
pl
y
w
it
h
N
F
P
A
1
0
1.

6.5.3.2 Re
fuse
chutes. If
provided,
these shall
meet
or
exceed the
following
standards:

1. Chu
tes
shal
l
mee
t
the
pro
visi
ons
des
crib
ed
in
NF
PA
82.

2. Ser
vic
e
ope
nin
gs
to

4.

The
minimu
m
crosssection
al
dimensi
on of
gravity

chutes
shall be
2 feet
(60.96
centime
ters).
Note: See
Section 2.19.3 for text on
waste
processing.

6.6
Environme
ntal
Services
6.6.1
Facilities for
Cleaning
and
Sanitizing
Carts
Facilities
shall be
provided to
clean and
sanitize carts

systems should
be designed to
achieve an
efficient
movement

of
waste
from points
of
generation
to storage
or
treatment
while
minimizing
the risk to
personnel.

2.

Dedi

cated storage
and flow space
and
cleaning/sanitati
on facilities
should facilitate
reuse of items
such as medical
products, food
service items,
and the like to
eliminate
disposables

be given to
sorting and
staging
areas. The
following
elements
are
examples
that may be
considered:

and reduce
waste.

1.

processing

Build

3.

Spa

ce should be
included for
autoclaves,
shredders,
and other
technologies
for

ing should

medical

include

waste prior to

adequate space

removals to

to accommodate

landfill.

bins/carts for

Secure

appropriate

storage

waste

should be

segregation

provided for

such as

staging

recyclables,

fluorescent

infectious waste,

lamps for

sharps, etc.

recycling.

Corridors and
materials
handling

106
2006

Guidelin Construction of
es for Health Care
Design Facilities
and

6.6.2.2 Fac

serving the
central
service
department,
dietary
facilities,
and
linen
services.
These
facilities
shall
be
permitted to
be
centralized
or
departmenta
lized.
6.6.2
Housekeepi
ng Rooms
In addition
to the
housekeepin
g rooms
required in
certain
departments,
sufficient
housekeepin
g rooms
shall be
provided
throughout
the facility
to maintain
a clean and
sanitary
environment
.

6.6.2.1
Number.
There
shall not
be fewer
than one
houseke
eping
room
for each
floor.

ility
requirements
. Each shall
contain a
floor
receptor or
service sink
and storage
space for
housekeeping
equipment
and supplies.

6.7
Engineerin
g Services
and
Maintenan
ce
6.7.1
General
Sufficient
space shall
be included
in all
mechanical
and electrical
equipment
rooms for
proper
maintenance
of
equipment.
Provisions
shall also be
made for
removal and
replacement
of
equipment.
The
following
shall be
provided:
6.7.2
Equipment
Locations
Room(s) or
separate
building(s)
shall be
provided for

boilers,
mechanical,
and
electrical
equipment,
except:

6.7.2
.1
Rooft
op air
condit
ioning
and
ventila
tion
equip
ment
install
ed in
weath
erproo
f
housin
gs

lectrical
transforme
rs
and
switchgear
where
required to
serve the
facility
and where
installed
in
a
weatherpr
oof
housing

6.7.2.5 Me
dical
gas
parks
and
equip
ment

6.7.2.6 Air-

6.7.2.2 S
tandby
generator
s where
the
engine
and
appropria
te
accessori
es (i.e.,
batteries)
are
properly
heated
and
enclosed
in a
weatherpr
oof
housing

6.7.2.3 Coo
ling
tower
s and
heat
rejecti
on
equip
ment

6.7.2.4 E

cooled
chillers
where
installed in a
weatherproof
housing

6.7.2.7 Tras
h
comp
actors
and
incine
rators

2.1 GEN
E RAL H O
S P I TA L S

6.7.2.8
Site
lighting,
post
indicator
valves,
and other
equipment
normally
installed
on
the
exterior of
the
building

6.7.3
Engineers
Office
This shall
have file
space and
provisions
for
protected
storage of
facility
drawings,
records,
manuals,
etc.

6.7.4
General
Maintenanc
e Shop(s)
These
shall be
provided
to
accommo
date
repair and
maintenan
ce
requireme
nts.
6.7.5
Medical
Equipment
Shop
A separate
area
or
room shall

be provided
specifically
for storage,
repair, and
testing
of
electronic
and
other
medical
equipment.
The amount
of space and
type
of
utilities will
vary
with
the type of
equipment
involved
and types of
outside
contracts
used,
as
specified in
the
functional
program.
6.7.6
Equipment
and Supply
Storage
6.7.6.1
Supply
storage

(1) A
stor
age
roo
m
shal
l be
pro
vide
d
for
buil
ding
mai
nten
anc
e
sup
plie
s.

(2) Stora
ge for
solve
nts
and

flam
mable
liquid
s shall
compl
y with
applic
able
NFPA
codes.
6.7.6.2
Outdoor
equipment
storage. Yard
equipment
and supply
storage areas
shall be
provided.
These shall
be located so
that
equipment
may be
moved
directly to
the exterior
without
interference
with other
work.

Administ
rative
and
Public
Areas
7.1 Public
Areas
The
following
shall be
provided:
7.1.1
Entrance
This shall
be at grade
level,
sheltered
from
inclement
weather,
and
accessible
to the
disabled.
7.1.2 Lobby
This shall
include:
7.1.2.1 A
counter or
desk for
reception and
information
es for
tion of Health
Design Care Facilities
and
Construc

107

2006
Guidelin

2.1 GEN
E R AL H O
S P I TA L S

lic
teleph
ones

7.1.2.5 Pro
7.1.2.2 Pub
lic
waitin
g
area(s
)

vision
s for
drinki
ng
water
7.1.3 Public
Waiting
Areas

7.1.2.3 Pub
lic
toilet
facilit
ies

7.1.2.4 Pub

All public
waiting areas
serving more
than 15
people shall
include toilet

room(s)
equipped
with handwash-ing
stations.
These toilet
rooms shall
be located
near the
waiting areas
and may
serve more
than one such
area.

7.2
Administrat
ive and
Related
Support
Areas
The
following
shall be
provided:
7.2.1
Admissions
Area
If
requir
ed by
the
functi
onal
progra
m for
initial
admiss
ion of
inpatie
nts,
the
area
shall
includ
e:

desk
for
staff

7.2.1.3 Whe
elchair storage.
A storage area
for
wheelchairs
shall

be

provided out of
the

path

of

normal traffic.

7.2.2
Interview
Space(s)
These
shall
include
provisions
for private
interviews
relating to
social
service,
credit, and
admissions
.

7.2.3
General or
Individual
Office(s)
These shall
be provided
for business
transactions
, medical
and
financial
records, and
administrati
ve and
professional
staff.

7.2.1.1 A
separate
waiting area
for patients
and accompanying
persons

7.2.1.2 A
work
count
er or

7.2.4
Multipurpos
e Room(s)
These shall
be provided
for
conferences,
meetings,
and health
education
purposes, and
shall include
provi-

APPEN
DIX
A8.1.2.1 NFPA
101 generally
covers
fire/safety
requirements
only, whereas
the building
codes also
apply to
structural
elements. The
fire/safety
items of NFPA
101 would
take
precedence
over other
codes in case
of conflict.
Appropriate
application of
each would
minimize
problems.

sions for the

use of visual
aids. Several
services
shall be
permitted to
share one
multipurpose
room.
7.2.5
Medical
Records
Rooms,
areas, or
offices
for the
following
personnel
and/or
functions
shall be
provided:

7.2.5.1 Me
dical
recor
ds
admin
istrato
r/tech
nician

7.2.5.2 Rev
iew
and
dictati
on

7.2.5.3 Sort
ing,
recor
ding,
or
micro
filmin
g
recor
ds

7.2.5.4 Rec
ord
storag
e
7.2.6
Equipment
and Supply

Storage
Storage
shall be
provided
for office
equipme
nt and
supplies.

Codes

8.1.1.1 Ge

7.2.7
Support
Areas for
Employees
and
Volunteers
Lockers,
lounges,
toilets,

etc.

shall

be

provided

for

employ-ees
and volunteers.
These shall be
in addition to,
and

sepa-rate

from,

those

required

for

medical

staff

and the public.

8
Construc
tion
Standard
s
8.1
Des
ign
and
Con
stru
ctio
n,
incl
udi
ng
Fire
Res
ista
nt
Sta
nda
rds
8.1.1
Building

neral. Every
building
and portion
thereof shall
be designed
and
constructed
to sustain
all live and
dead loads,
including
seismic and
other
environmental
forces, in
accordance
with
accepted
engineering
practices
and
standards as
prescribed
by local
jurisdiction
or the
Internationa
l Building
Code or
NFPA 5000,
Building
Constructio
n and Safety
Code. (See
Sections
1.1-1.3.2
through 1.11.3.4.)

8.1.1.2 Fre
estanding
buildings.
Separate
freestanding
buildings
for the
boiler plant,
laundry,
shops,
general
storage, or
other
nonpatient
contact

areas shall
be built in
accordance
with
applicable
building
codes for
such
occupancy.

8.1.2
Constructio
n

108

contained
herein, and
the
requirement
s of
authorities
having
jurisdiction.
If there are
no
applicable
local codes,
the
Internationa
l Building
Code or
NFPA 5000
shall be
used (see
Section 1.17).
8.1.2.2 Fire
prevention/pr
otection
measures.
Compartmen
tation, exits,
fire alarms,
automatic
extinguishin
g systems,
and other fire
prevention
and fire
protection
measures,
including

Requireme
nts
*8.1.2.1
General.
Constructio
n shall
comply
with the
applicable
requiremen
ts of NFPA
101, the
standards
2006
and
Guidelin Construction of
es for Health Care
Design Facilities

those within
existing
facilities,
shall comply
with NFPA
101, with the
following
stipulation.
The FireSafety
Evaluation
System
(FSES) is
permitted,
subject to
AHJ
approval, in
new
construction
and
renovation.
(The FSES is
intended as
an evaluation
tool for fire
safety only.)
See Section
1.1-7 for
exceptions.

Note: For
most
projects it
is essential
that thirdparty
reimburse
ment
requiremen
ts also be
followed.
Verify

where
these may
be in
excess of
standards
in these
Guidelines.

8.1.2.3 Inte
rior finishes.
Interior
finishing
materials
shall comply
with the
flame-spread
limitations
and the
smokeproduction
limitations
indicated in
NFPA 101.
This
requirement
does not
apply to
minor
quantities of
wood or
other trim
(see NFPA
101) or to
wall covering less
than 4 mil
thick applied
over a
noncombustible
base.

8.1.2.4 Ins
ulation
materials.
Building
insulation
mate-rials,
unless sealed
on all sides
and edges
with noncombustible
material,
shall have a
flame-spread
rating of 25
or less and a

smokedeveloped
rating of 150
or less when
tested in
accordance
with NFPA
255.

8.1.3
Provisions
for
Disasters
See also
Section 1.15.
8.1.3.1
General

(1) Unless
specifica
lly
approve
d,
hospitals
shall not
be built
in areas
subject
to
damage
or
inaccess
ibility
due to
natural
floods.

(2) Where
faciliti
es
may
be
subjec
t
to
wind
or
water
hazard
s,
provis
ion
shall
be
made
to
ensure
continuou

s
operat
ion.
8.1.3.2
Emergency
communicati
on system.
An emer-

2.1 GEN
E RAL H O
S P I TA L S

gency-radio
communica
tion system
shall be
provided in
each
facility.

(1) This
syste
m
shall
operat
e
indep
enden
tly of
the
buildi
ngs
servic
e and
emerg
ency
power
syste
ms
during
emerg
encies
.

(2) The
system
shall
have
freque
ncy
capabil
ities to
comm
unicate
with
state
emerge
ncy
comm
unication
networ
ks.

(3)

Additio

nal
commu
nication
capabili
ties are
required
of
facilitie
s
containi
ng a
formal
community
emerge
ncytrauma
service
or other
specialt
y
services
(such as
regional
pediatri
c
critical
care
units)
that
utilize
staffed
patient
transpor
t units.
8.2 General
Standards
for Details
and
Finishes

8.2.1
General
8.2.1.1 New
construction
. Details and
finishes in
new
construction
projects,
including
additions
and alterations, shall
comply with
the
following
standards

(see Section
1.1-3
concerning
existing
facilities
where total
compliance
is
structurally
impractical).
*8.2.1.2
Renovation.
If approved
by the
authorities
having
jurisdiction,
retained
portions of
existing
facili-ties that
are not
required to
be totally
modernized
due to
financial or
other
hardships
shall be
permitted, as
a minimum,
to comply
with
applicable
requirements
of the
Existing
Health Care
Occupancies
Section of
NFPA 101.

8.2.2
Details
8.2.2.1
Corridor
width

(1) In
outpat
ient
suites
and in
areas
not
comm

only
used
for
patien
t bed
or
stretc
her
transp
ortatio
n,
reduct
ion of
corrid
or
width
to 5
feet
(1.52
meter
s)
shall
be
permit
ted.

ng
founta
ins,
telephone
booths
,
vendin
g
machi
nes,
and
portab
le

APPEN
DIX
A8.2.1.2 A
plan of
correction
for these
portions of
existing

(2)

Locati

facili-ties

on of

should be

items

developed

such

and

as

implemented

drinki
2006
Guidelin

2.1 GEN
E R AL H O
S P I TA L S

equipment

.
es for ction of Health
Design Care Facilities
and
Constru

109

ceiling height
shall be 7
feet 10 inches
(2.39
meters), with
the following
exceptions:

shall not
restrict
corridor
traffic or
reduce the
corridor
width
below the
minimum
standard.

8.2.2.2
Ceiling
height. The
minimum

(1)

Corridors
, storage
rooms,
toilet
rooms,
etc.
Ceilings
in these
spaces
shall be
not less
than 7
feet 8
inches

(2.34

normal
movem
ent.

meters)
in height.
Ceiling
heights in
small,
normally
unoccupi
ed spaces
may be
reduced.

(2) Rooms
with
ceilingmounte
d
equipm
ent/light
fixtures.
Ceilings
in
radiogra
phic,
operatin
g, and
delivery
rooms,
and
other
rooms
containi
ng ceilingmounte
d
equipm
ent or
ceilingmounte
d surgical
light
fixtures,
shall be
of
sufficie
nt
height
to
accomm
odate
the
equipm
ent or
fixtures
and
their

(3)

Seclusio
n
treatmen
t rooms.
These
rooms
shall
have a
minimu
m
ceiling
height of
9
feet
(2.74
meters).

(4) Boil
er
roo
ms.
Boil
er
roo
ms
shall
have
ceili
ng
clear
ance
s not
less
than
2
feet
6
inch
es
(76.2
0
centi
mete
rs)
abov
e the
main
boile
r
head
er
and
conn
ectin
g
pipin

the
floo
r.
Cle
aran
ces
in
othe
r
area
s
may
be 6
feet
8
inch
es
(2.0
3
met
ers).

g.

(5) Clearanc
es

(1)

Sus
pen
ded
trac
ks,
rails
,
and
pipe
s
loca
ted
in
the
traff
ic
path
for
pati
ents
in
bed
s
and/
or
on
stret
cher
s,
incl
udin
g
thos
e in
inpa
tient
serv
ice
area
s,
shal
l be
not
less
than
7
feet
(2.1
3
met
ers)
abo
ve

(2)

Wh
ere
exi
stin
g
str
uct
ure
s
ma
ke
the
abo
ve
ceil
ing
cle
ara
nce
im
pra
ctic
al,
cle
ara
nce
s
sha
ll
be
as
req
uir
ed
to
avo

id
inj
ury
to
ind
ivi
dua
ls
up
to
6
fee
t4
inc
hes
(1.
93
me
ters
)
tall
.
8.2.2.3 Doors

(1) Door
type

(1) Al
l
do
or
s
be
tw
ee
n
co
rri
do
rs,
ro
o
m
s,
or
sp
ac
es
su
bj
ec
t
to
oc
cu
pa
nc
y,

ex
ce
pt
el
ev
at
or
do
or
s,
sh
all
be
of
th
e
s
wi
ng
ty
pe
.

(2)

M
a
n
u
a
l
o
r
a
u
t
o
m
a
ti
c
s
li
d
i
n
g
d
o
o
r
s
m
a
y
b
e
e
x
e
m
p
t
f
r
o
m
t
h
i
s
s
t
a
n
d
a
r

d
w
h
e
r
e
fi
r
e
a
n
d
o
t
h
e
r
e
m
e
r
g
e
n
c
y
e
x
it
i
n
g
r
e
q
u
ir
e
m
e
n
t
s
a
r
e
n
o
t
c
o
m
p
r
o
m
i
s

e
d
a
n
d
w
h
e
r
e
c
l
e
a
n
li
n
e
s
s
o
f
s
u
r
f
a
c
e
s
c
a
n
b
e
m
a
i
n
t
a
i
n
e
d
.

(2) Door
size

(1) Ge
ne
ral
.
W
he
re
us

ed
in
th
es
e
G
ui
de
lin
es,
do
or
wi
dt
h
an
d
he
ig
ht
sh
all
be
th
e
no
mi
na
l
di
m
en
sio
n
of
th
e
do
or
lea
f,
ig
no
rin
g
pr
oj
ec
tio
ns
of
fra
m
e
an
d
sto

ps.
N
ot
e:
Al
th
ou
gh
th
es
e
sta
nd
ar
ds
ar
e
int
en
de
d
to
ac
co
m
m
oda
te
ac
ce
ss
by
pa
tie
nts
an
d
pa
tie
nt
eq
ui
pm
en
t,
siz
e
of
off
ice
fur
nit
ur
e,
etc
.,

sh
all
als
o
be
co
nsi
de
re
d.

(2) Inp
atie
nt
bed
roo
ms

(1) N
e
w
c
o
n
s
t
r
u
c
t
i
o
n
.
T
h
e
m
i
n
i
m
u
m
d
o
o
r
s
i
z
e
f

o
r
i
n
p
a
t
i
e
n
t
b
e
d
r
o
o
m
s
i
n
n
e
w
w
o
r
k
s
h
a
l
l
b
e

(
1
.
1
2
m
e
t
e
r
s
)
w
i
d
e
a
n
d
7
f
e
e
t
(
2
.
1
3
m
e
t
e
r
s
)

3
f
e
e
t
8
i
n
c
h
e
s

h
i
g
h
t
o
p
r
o
v
i
d
e

c
l
e
a
r
a
n
c
e
f
o
r
m
o
v
e
m
e
n
t
o
f
b
e
d
s
a
n
d
o
t
h
e
r
e
q
u
i
p
m
e
n
t
.

(2) Re
no
vat
io

n.
Ex
isti
ng
do
ors
of
no
t
les
s
tha
n2
fee
t
10
inc
he
s
(8
6.3
6
ce
nti
me
ter
s)
wi
de
ma
y
be
co
nsi
de
re
d
for
ac
ce
pta
nc
e
wh
ere
fu
nct
io
n
is
no
t
ad
ve
rse
ly
aff
ect

ed
an
d
re
pla
ce
me
nt
is
im
pr
act
ica
l.

(3)

R
o
o
m
s
fo
r
st
re
tc
he
rs
/
w
he
el
ch
ai
rs
.
D
o
or
s
to
ot
he
r
ro
o
m
s
us
ed
fo
r
st
re
tc
he
rs
(i
nc

lu
di
n
g
h
os
pi
ta
l
w
he
el
ed
be
d
st
re
tc
he
rs
)
an
d/
or
w
he
el
ch
ai
rs
sh
al
l
ha
ve
a
m
in
i
m
u
m
w
id
th
of
2
fe
et
1
0
in
ch
es
(8
6.
3

6
ce
nt
i
m
et
er
s)
.

obstruct
traffic
flow or
reduce
the
required
corridor
width.
(Large
walk-intype
closets
are
considered
inhabita
ble
spaces.)

(3) Door
swing.
Doors,
except
those to
spaces
such as
small
closets
not
subject
to
occupan
cy, shall
|not
swing
into
corridor
s in a
manner
that
might

(4) Door
hardwar
e

(1) Pati
ent
bat
hin
g/to
ilet
faci
litie
s
2006
Guidelin
es for
Design

110

(1) Ro
om
s
tha
t
co
nta
in
bat
htu
bs,
sit
z
bat
hs,
sh
ow
ers

and
Construction of
Health Care
Facilities

,
an
d/o
r
wa
ter
clo
set
s
for
inp
atie
nt
use
sha
ll
be
eq
uip
pe
d
wit
h

do
ors
an
d
har
dw
are
per
mit
tin
g
em
erg
en
cy
acc
ess
fro
m
the
out
sid
e.

op
en
ou
tw
ar
d
or
in
a
m
an
ne
r
th
at
wi
ll
av
oi
d
pr
es
si
ng
a
pa
tie
nt
w
ho
m
ay
ha
ve
co
lla
ps
ed
wi
thi
n
th
e
ro
o
m.

(2) W
he
n
su
ch
ro
o
m
s
ha
ve
on
ly
on
e
op
en
in
g
or
ar
e
s
m
all
,
th
e
do
or
s
sh
all

(3)

Si
mi
lar
co
nsi
de
rat
io
ns
ma
y

be
de
sir
ab
le
for
ce
rta
in
ou
tp
ati
en
t
ser
vi
ce
s.

(2) Pa
tie
nt
to
ile
t
ro
o
m
s
in
ps
yc
hi
at
ri
c
un
its
.
If
re
qu
ir
ed
by
th
e
fu
nc
ti
on
al
pr
og
ra
m,
de
si
gn

of
do
or
ha
rd
w
ar
e
on
pa
tie
nt
toi
let
ro
o
m
s
in
ps
yc
hi
atr
ic
nu
rsi
ng
un
its
sh
all
be
pe
r
mi
tte
d
to
all
o
w
st
af
f
to
co
nt
ro
l
ac
ce
ss.
8.2.2.4
Thresholds
and
expansion
joints

(1) Thresh
olds
and
expansi
on joint
covers
shall be
flush
with
the
floor
surface
to
facilitat
e the
use of
wheelc
hairs
and
carts.

(2) Expansi
on and
seismic
joints
shall be
constru
cted to
restrict
the
passage
of
smoke.
8.2.2.5
Windows

(1) Operabl
e
window
s.
Operabl
e
window
s are not
required
in
patient
rooms.
If
operable
window
s are
provide
d in
patient
rooms
or
suites,

operatio
n of
such
window
s shall
be
restricte
d to
inhibit
possible
escape
or
suicide.

8.2.2.6 In
sect
screens.
Windows
and outer
doors that
frequently
may be left
open shall
be
equipped
with insect
screens.

8.2.2.7 Gla
zing
materi
als
Note:
Provisions
of this
section
concern
safety from
hazards of
breakage.
NFPA 101
contains
additional
requiremen
ts for
glazing in
exit
corridors,
etc., especially in
buildings
without
sprinkler
systems.

2.1 GEN
E R AL H O
S P I TA L S

(1)

Safety
glass;
wired
glass; or
plastic,
breakresistant
material
that
creates
no
dangero
us
cutting
edges
when
broken
shall be
used in
the
followin
g:

(1)

Gl
ass
do
ors
,
lig
hts
,
sid
eli
ght
s,
bor
ro
we
d
lig
hts
,
an
d
wi
nd
ow
s
loc
ate
d

wit
hin
12
inc
hes
(30
.48
cen
tim
ete
rs)
of
a
do
or
ja
mb
(wi
th
a
bot
to
mfra
me
hei
ght
of
les
s
tha
n5
fee
t or
1.5
2
me
ter
s
ab
ov
e
the
fini
she
d
flo
or)

(2) W
a
ll
o
p
e
n
i
n

g
s
i
n
a
c
ti
v
e
a
r
e
a
s
s
u
c
h
a
s
r
e
c
r
e
a
ti
o
n
a
n
d
e
x
e
r
c
i
s
e
r
o
o
m
s
,
u
n
l
e
s
s
o
t
h
e
r
w
i

s
e
r
e
q
u
ir
e
d
f
o
r
fi
r
e
s
a
f
e
t
y

(2) Safety
glass
temper
ed or
plastic
glazing
materia
ls shall
be used
for the
followi
ng:

(1) Sho
wer
doo
rs
and
bat
h
enc
los
ure
s

(2)

Int
eri
or
wi
nd
ow
s
an
d
do
ors
,
inc
lud

ing
tho
se
in
pe
dia
tri
c
an
d
ps
yc
hia
tri
c
uni
t
cor
rid
ors

(3) Flamespread
ratings.
Plastic
and
similar
material
s used
for
glazing
shall
comply
with the
flamespread
ratings
of NFPA
101.

(4)

Renov
ation.
In
renova
tion
project
s, only
glazin
g
within
1 foot
6
inches
(45.72
centim
eters)
of the
floor
must

be
change
d
to
safety
glass,
wire
glass,
or
plastic,
breakresista
nt
materi
al.
8.2.2.8 Handwashing
stations

(1) Fittings.
Locatio
n and
arrange
ment of
fittings
for
handwashing
stations
shall
permit
their
proper
use and
operatio
n.
Particul
ar care
shall be
given to
the
clearanc
es
required
for
bladetype
operatin
g
handles.

(2) Mirror
s.
Mirror
s shall
not be
installe
d at

handwashin
g
station
s in
food
prepar
ation
areas,
nurseries,
clean
and
sterile
supply
areas,
scrub
sinks,
or
other
areas
where
asepsis
control
would
be
lessene
d by
hair
combi
ng.

(3) Provisio
ns
for
hand
drying

(1)

Pro
visi
ons
for
han
d
dryi
ng
shal
l be
incl
ude
d at
all
han
dwas
hin
g
stat
ion
s
exc
ept
scr
ub
sin
ks.

es for ction of Health

Design Care Facilities
and
Constru

111

2006
Guidelin

2.1 GEN
E R AL H O
S P I TA L S

(2) The
se
pro
visi
ons
shal
l be
pap
er
or
clot
h
unit
s
encl
ose
d to

prot
ect
agai
nst
dust
or
soil
and
to
ens
ure
sing
leunit
disp
ensi
ng.
Hot
air
dry
ers
shal
l be
per

mitt
ed
pro
vid
ed
that
inst
alla
tion
pre
clu
des
pos
sibl
e
con
tam
inat
ion
by
reci
rculati
on
of
air.

bars shall be
provided in
all patient
toilets,
showers,
bathtubs, and
sitz baths at a
wall
clearance of
1-1/2 inches
(3.81
centimeters).
Bars,
including
those that are
part of such
fixtures as
soap dishes,
shall be
sufficiently
anchored to
sustain a
con-centrated
load of 250
pounds
(113.40
kilograms).

(4) Anchori
ng.
Lavator
ies and
handwashin
g
stations
shall be
securel
y
anchore
d to
withsta
nd an
applied
vertical
load of
not less
than
250
pounds
(113.4
kilogra
ms) on
the
fixture
front.

8.2.2.9 Gra
b bars. Grab

8.2.2.10
Radiation
prote
ction

(1)

Radiati
on
protect
ion
require
ments
for xray and
gamma
ray
installa
tions
shall
confor
m with
NCRP
Report
Nos.
33 and
49 and
all
applica
ble
local
require

ments.
Testing
is to be
coordin
ated
with
local
authori
ties to
prevent
duplica
tion of
test
observ
ations
or
constru
ction
inspect
ions.

(2) Provi
sion
shall
be
made
for
testin
g
comp
leted
instal
lation
s
befor
e use.
All
defec
ts
shall
be
correcte
d
befor
e
appro
val.

rooms,
and
similar
spaces
where
impact
noises
may be
generat
ed shall
not be
located
directly
over
patient
bed
areas or
delivery
and
operatin
g suites,
unless
special
provisio
ns are
made to
minimize
such
noise.

(2) The

(1) Recreati

noise
reducti
on
criteria
shown
in
Table
2.1-1
shall
apply
to
partitio
ns,
floors,
and
ceiling
constructio
n in
patient
areas.

on
rooms,
exercise
rooms,
equipm
ent

8.2.2.12
Temperature
control.
Rooms
containing

8.2.2.11
Noise control

heatproducing
equipment,
such as
boiler or
heater rooms
or laundries,
shall be
insulated and
ventilated to
pre-vent the
floor surface
above and/or
the adjacent
walls

of
occupied
areas
from
exceedin
ga
temperat
ure of
10oF
(6oC)
above
ambient
room
temperat
ure.
8.2.3
Finishes
8.2.3.1
Noncombusti
ble or flameretardant
materials

(1) Cubicle
curtains
and
draperie
s shall
be
noncom
bustible
or
flameretardan
t and
shall
pass
both the
largeand
smallscale
tests of
NFPA
701
when
applicab
le.

(2) Materia
ls and
certain
plastics

known
to
produc
e
noxious
gases
when
burned
shall
not be
used
for
mattres
ses,
upholst
ery, and
other
items
insofar
as
practica
l.
8.2.3.2 Floors

(1)

Flo
or
ma
teri
als
sha
ll
be
eas
ily
cle
ana
ble
and
app
rop
riat
ely
we
arresi
sta
nt
for
the
loc
ati
on.

s
us
ed
fo
r
fo
od
pr
ep
ar
ati
on
or
fo
od
as
se
m
bl
y
sh
all
be
w
at
er
re
sis
ta
nt.

(2) Fl

(1) Fl
oo
rs
in
ar
ea

o
or
s
ur
fa
c
es
,
in
cl
u
di
n
g
til
e
jo
in
ts
,
s
h
al
l
b
e
re
si
st
a

nt
to
fo
o
d
ac
id
s.

(3)

In
all
area
s
subj
ect
to
freq
uent
wetclea
ning
meth
ods,
floor
mate
rials
shall
not
be
phys
icall
y
affec
ted
by
ger
mici
dal
clea
ning
solut
ions.

(2) Floors
subject
to traffic
while
wet
(such as
shower
and bath
areas,
kitchens
,
and
similar
work
areas)
shall

have a
nonslip
surface.

(3) In new
construc
tion or
major
renovati
on
work,
the
floors
and wall
bases of
all
operatin
g rooms
and any
delivery
rooms
used for
cesarean
sections
shall be
monolit
hic and
joint
free.

(4) The
floors
and
wall
bases
of
kitche
ns,
soiled
workr
ooms,
and
other
areas
subjec
t to
freque
nt wet
cleani
ng
shall
also
be
homog
enous,
but
may
have
tightly

sealed
joints.

tic
agents
are
stored
or
adminis
tered
shall
comply
with
NFPA
99.

(5) Floors
in areas
and
rooms
in
which
flamma
ble
anesthe

112

8.2.3.3 Walls

(1) Wall
finish
es.
Wall
finish
es
shall
be
washa
ble.
In the
vicini
ty of
plum
bing
fixtur
es,
wall
finish
es
shall
be
smoot
h and
water
resist
ant.

(2)

Dietary
and food
preparati
on areas.
In these
areas,
wall
construc

2006
Guidelin
es for
Design

and
Construction of
Health Care
Facilities

tion,
finish,
and
trim,
includin
g the
joints
between
the
walls
and the
floors,
shall be
free of
insectand
rodentharborin
g
spaces.

(3) Operati
ng
rooms,
cesarea
n
delivery
rooms,
isolation
rooms,
and
sterile
processi
ng
rooms.
In these
rooms,
wall
finishes
shall be
free of
fissures,
open

joints,
or
crevices
that
may
retain or
permit
passage of
dirt
particles
.
8.2.3.4
Ceilings

(1) Ceilings
,
includin
g
exposed
structure
in areas
normall
y
occupie
d by
patients
or staff
in food
preparat
ion and
food
storage
areas,
shall be
cleanable
with
routine
houseke
eping
equipme
nt.
Acousti
c and
lay-in
ceiling,
where
used,
shall not
interfere
with
infectio
n
control.

(2) In

dietary
areas
and in
other
areas
where
dust fallout may
present a
problem,
suspend
ed
ceilings
shall be
provided
.

(3) Semirest
ricted
areas

(1) Ceil
ing
fini
she
s in
sem
ires
trict
ed
area
s
suc
h as
airb
orn
e
infe
ctio
n
isol
atio
n
roo
ms,
prot
ective
env
iron
me
nt
roo
ms,
clea
n
corr
idor
s,

cent
ral
ster
ile
sup
ply
spa
ces,
spe
cial
ized
radi
ogr
aph
ic
roo
ms,
and
min
or
sur
gica
l
pro
cedur
e
roo
ms
shal
l be
smo
oth,
scru
bba
ble,
non
abs
orpt
ive,
non
perf
orat
ed,
cap
able
of
wit
hsta
ndi
ng
clea
nin
g
wit
h
che

mic
als,
and
wit
hou
t
cre
vice
s
that
can
har
bor
mol
d
and
bact
eria
l
gro
wth
.

(2)

If
layin
ceil
ing
is
pro
vid
ed,
it
sha
ll
be
gas
ket
ed
or
clip
ped
do
wn
to
pre
ven
t
the
pas
sag
e of
part
icle
s
fro
m
the

cav
ity
abo
ve
the
ceil
ing
pla
ne
into
the
se
mir
estr
icte
d
env
iro
nm
ent.
Per
for
ate
d,
teg
ular
,
serr
ate
d
cut,
or
hig
hly
text
ure
d
tile
s
are
not
acc
ept
abl
e.

2.1 GEN
E RAL H O
S P I TA L S

(4)

Restricted
areas.
Ceiling
finishes
in
restricted
areas
such as
operating
rooms
shall be
monolithi
c, scrubbable, and
capable
of
withstand
ing
chemicals
. Cracks
or
perforatio
ns in
these
ceilings
are not
allowed.

8.2.3.5 Pen
etrations.
Floors and
walls
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.

8.2.3.6 Psy

chiatric
patient
locations. In
psychiatric
patient
rooms,
toilets, and
seclusion
rooms, the
ceiling and
air
distribution
devices,
lighting
fixtures,
sprinkler
heads, and
other
appurtenanc
es shall be
of a tamperresistant
type.

8.2.3.7 Pro
tective
isolation
locations.
Rooms used
for
protective
isolation
and
anterooms
adjacent to
rooms used
for
protective
isolation
shall have
seamless
floor-ing
with
integral
coved base.

9 Special
Systems
9.1
General
9.1.1
Testing

9.1.1.1 P
rior to

acceptance
of the
facility, all
special
systems
shall be
tested and
operated
to
demonstra
te to the
owner or
his
designated
representat
ive that
the
installatio
n and
performan
ce of these
systems
conform to
design
intent.

9
.
1
.
1
.
2
T
e
st
r
e
s
u
lt
s
s
h
a
ll
b
e
d
o
c
u
m
e
n
t
e
d
f
o

r
m
a
i
n
t
e
n
a
n
c
e
fi
l
e
s.
9.1.2
Documentat
ion

9.1.2.1 Up
on
completion
of the special
systems
equip-ment
installation
contract, the
owner shall
be furnished
with a
complete set
of
manufacturer
s operating,
2006
Guidelin

2.1 GEN
E R AL H O
S P I TA L S

9.1.3
Insulation
Insulation
shall
be
provided
surrounding
special system
equipment
to conserve
energy,
protect
personnel,
and reduce
noise.

maintenance, and
preventive
maintenance
instructions,
a parts lists,
and complete
procurement
information
including
equipment
numbers and
descriptions.

9.1.2.2 Op
erating staff
persons
shall also be
provided
with written
instructions
for proper
operation of
sys-tems
and
equipment.
Required
information
shall
include all
safety or
code ratings
as needed.
es for
tion of Health
Design Care Facilities
and
Construc

113

9.2
Elevators
9.2.1
General
All
hospitals
having
patient
facilities
(such as
bed-rooms,
dining
rooms, or
recreation
areas) or
critical
services
(such as
operating,
delivery,

diagnostic,
or
therap
eutic
areas)
locate
d on
other
than
the
gradelevel
entran
ce
floor
shall
have
electri
c or
hydra
ulic
elevat
ors.
9.2.2
Number
In the
absence of
an
engineered
traffic study,
the following
guidelines
for number
of elevators
shall apply:

9.2.2.1 At
least two
hospitaltype
elevators
shall be
installed
where 1 to
59 patient
beds are
located on
any floor
other than
the main
entrance
floor.

9.2.2.2 At
least two
hospitaltype

elevators
shall be
installed
where 60 to
200 patient
beds are
located on
floors other
than the
main
entrance
floor, or
where the
major
inpatient
services are
located on a
floor other
than those
containing
patient
beds.
(Reduction
in elevator
service
shall be
permitted
for those
floors
providing
only partial
inpatient
services.)

9.2.2.3 At
least three
hospital-type
elevators
shall be
installed
where 201 to
350 patient
beds are
located on
floors other
than the
main
entrance
floor, or
where the
major
inpatient
services are
located on a
floor other
than those
containing
patient beds.

(Reduction
in ele-vator
service shall
be permitted
for those
floors providing only
partial
inpatient
services.)

9.2.2.4 For
hospitals
with more
than 350
beds, the
number of
elevators
shall be
determined
from a study

APPEN
DIX

A9.2.3.2
Elevator
car doors
should
have a
clear
opening of
not less
than 4.5
feet (1.37
meters).
A9.2.5.2 This
is so the light
control
feature will
be
overridden or
disengaged
should it
encounter
smoke at any
landing.

of the
hospital
plan and
the
expected
vertical
transportation
requireme
nts.
9.2.3
Dimensions
and
Clearances
9.2.3.1
Hospitaltype
elevator
cars shall
have
inside
dimensio
ns that
accommo
date a
patient
bed with
attendants
. Cars
shall be at
least 5
feet 8
inches
(1.73
meters)
wide by 9
feet (2.74
meters)
deep.
*9.2.3.
2 Car
doors
shall
have a
clear
openin
g of not
less
than 4
feet
(1.22
meters)
wide

and 7
feet
(2.13
meters)
high.

9.2.3.3 In
renovations,
an increase
in the size of
exist-ing
elevators
shall not be
required if
the elevators
can
accommodat
e
patient
beds used in
the facility.

9.2.3.4 Ad
ditional
elevators
installed for
visitors and
material
handling
shall be
permitted to
be smaller
than noted
above,
within
restrictions
set by
standards
for disabled
access.
9.2.4
Leveling
Device
Elevators
shall be
equipped
with a twoway
automatic
levelmaintaining
device with
an accuracy
of 1/4 inch
( 6.35
millimeters).
9.2.5
Elevator

Controls
9.2.5.1
Each
elevator,
except
those for
material
han-dling,
shall
be
equipped
with
an
independe
nt keyed
switch for
staff use
for
bypassing
all landing
button
calls and
responding
to
car
button
calls only.
*9.2.5.2
Elevator call
buttons and
controls shall
not be
activated by
heat or
smoke. Light
beams, if
used for
operating
door
reopening
devices
without
touch, shall
be used in
combination
with dooredge safety
devices and
shall be
interconnecte
d with a
system of
smoke
detectors.

9.2.6
Installation
and Testing

9.2.6.1 Sta
ndards.

Installation
and testing
of elevators
shall comply
with
ANSI/ASM
E A17.1 for
new construction and
ANSI/ASM
E A17.3 for
existing
facilities.
(See
ASCE/SEI 7
for seismic
design and

114

control systems
requirements
for
elevators.)

9.2.6.2 D
ocumentati
on. Field
inspections
and tests
shall be
made and
the owner
shall be
furnished
with
2006
and
Guidelin Construction of
es for Health Care
Design Facilities

and
Disposal

written
certification
stating that
the
installation
meets the
requirement
s set forth in
this section
as well as
all
applicable
safety
regulations
and codes.

9.3 Waste
Processing
For
waste
collecti
on and
storage
and
refuse
chute
require
ments,
see
Section
2.16.5.3.
9.3.1 Waste
Treatment

*9.3.1.1
Incineration.
On-site
hospital
incinerators
shall comply
with federal,
state, and
local
regulatory
and
environmenta
l
requirements.
The design
and construction of
incinerators
shall comply
with NFPA
82.

9.3.1.2 Other
technologies.
Types of nonincineration
waste
treatment
technology(ie
s) shall be
determined
by the facility
in
conjunction
with
environmenta

l, eco-nomic,
and
regulatory
consideration
s. The
functional
program shall
describe
waste
treatment
technology
components.

(1) Location
(1)

Saf
e
tra
nsf
er
rou
tes,
dist
anc
es
fro
m
wa
ste
sou
rce
s,
te
mp
ora
ry
sto
rag
e
req
uir
em
ent
s,
and
spa
ce
req
uir
em
ent
s
for
tre
at
me
nt
equ

ipme
nt
sha
ll
be
con
sid
ere
d
in
det
er
mi
nin
g
the
loc
ati
on
for
a
no
ninc
ine
rati
on
tec
hn
olo
gy.

(2) Th
e
lo
cat
io
n
of
th
e
tec
hn
ol
og
y
sh
all
no
t
ca
us
e
tra
ffi
c
pr
ob

le
ms
as
wa
ste
is
br
ou
gh
t
in
an
d
ou
t.

(3)

ned by
the
equipm
ent
require
ments,
includin
g
associat
ed area
for
opening
waste
entry
doors,
access
to control
panels,
space
for
hydrauli
c lifts,
conveyo
rs, and
operatio
nal
clearanc
es.
Mobile
or
portable
units,
trailermounte
d units,
undergr
ound
installations,
or allweather
enclose
d
shelters
at an
outdoor
site may
also be
used,
subject
to local
regulato
ry
approva
ls.

Odo
r,
nois
e,
and
the
visu
al
imp
act
of
med
ical
was
te
oper
atio
ns
on
pati
ents
,
visit
ors,
publ
ic
acce
ss,
and
secu
rity
shal
l be
con
side
red.

(2) Space
require
ments.
These
shall be
determi

(3)

Ventil

ation.
Exhau
st
vents,
if any,
from
the
treatment
techno
logy
shall
be
locate
d
a
minim
um of

2.1 G
ENE
R AL
HOS
P I TA
LS

25 feet
(7.62
meters)
from
inlets to
HVAC
systems.
If the
technolo
gy
involves
heat
dissipati
on, sufficient
cooling
and
ventilati
on shall
be
provided
.

9.3.2
Nuclear
Waste
Disposal
See Code of
Federal
Regulations
, Title X,
parts 20 and
35,
concerning
the
handling
and
disposal of
nuclear
materials in
health care
facilities.

10
Building
Systems
10.1

Plumbing

significant
contributor to

10.1.1
General
Unless
otherwise
specified
herein, all
plumbing
sys-tems
shall be
designed
and
installed
in
accordan
ce with
the
Internatio
nal
Plumbing
Code.
10.1.2
Plumbing
and Other
Piping
Systems
10.1.2.1
General
piping and
valves

air pollution
worldwide.

1.

H
ealth care
facilities
should
seek
to
minimize
incineratio
n
of
medical
waste,
consistent
with local
and state
regulation
s
and
public
health
goals.

2.

Whe

n incinerators
are used,
consideration
should be given
to the recovery
of waste heat
from on-site

(1) All
pipi
ng,
exc
ept
cont
rolline
tubi
ng,
shal
l be
iden
tifie
d.

incinerators
used to dispose of large
amounts of
waste
materials.
Incinerators
should be
designed in a
manner fully
consistent with
protection of
public and
environmental
health, both onsite and off-site,

APPEN
DIX
A9.3.1.1 The
EPA has
identified
medical
waste

and in
compliance with
federal, state,
and local
statutes and
regulations.
Toward this
end, permit

incineration

applications for

as a

incinerators and

modifications

specifically

thereof should

those set forth

be supported by

in U.S. EPA

Environmental

guide-lines, and

Assessments

should be fully

and/or

consistent with

Environmental

U.S. EPA

Impact

guidelines for

Statements

health risk

(EISs) and/or

assessment.

Health Risk

Under some

Assessments

circumstances,

(HRAs) as may

however, reg-

be required by

ulatory

regulatory

agencies

agencies.

having

Except as noted

jurisdiction over

below, such

a particular

assessments

project may

should utilize

require use of

standard U.S.

alternative

EPA methods,

methods.

2006
Guidelin

2.1 GEN
E R AL H O
S P I TA L S

(2) All
valves
shall be
tagged,
and a
valve
schedul
e shall
be
provide
d to the
facility
owner
for
permanent
record
and
referen
ce.

(3)

No
plumbin
g piping
shall be
exposed
overhea

es for
tion of Health
Design Care Facilities
and
Construc

115

d or on
walls
where
possible
accumul
ation of
dust or
soil may
create a
cleaning
problem
or where
leaks
would
create a
potential
for food
contami
nation.
10.1.2.2
Hemodialysis
/hemoperfusi
on piping

(1) In new
construc
tion and
renovati
on in
any
hospital
where

hemodi
alysis or
hemope
rfusion
is routinely
perform
ed, a
separate
water
supply
and a
drainag
e
facility
that
does not
interfere
with
handwashing
shall be
provide
d.

(2) When
the
function
al
program
includes
hemodi
al-ysis,
continu
ously
circulat
ed
filtered
cold
water
shall be
provide
d.
Piping
shall be
in
accorda
nce
with
AAMI
RD6.2.

10.1.2.3
Potable water
supply
systems

(1)

Capacity.

Systems
shall be
designed
to supply
water at
sufficient
pressure
to
operate
all
fixtures
and
equipme
nt during
maximu
m
demand.
Supply
capacity
for hotand coldwater
piping
shall be
determin
ed on the
basis of
fixture
units,
using
recogniz
ed
engineeri
ng
standards
. When
the ratio
of
plumbin
g
fixtures
to
occupant
s is
proportionally
more
than
required
by the
building
occupancy
and is in
excess of
1,000
plumbin
g fixture

units, a
diversity
factor
shall be
permitte
d.

(2) Valves.
Each
water
service
main,
branch
main,
riser,
and
branch
to a
group
of
fixtures
shall
have
valves.

(1)

Sto
p
valv
es
shal
l be
pro
vide
d
for
eac
h
fixt
ure.

(2) Ap
pro
pria
te
pan
els
for
acc
ess
sha
ll
be
pro
vid
ed
at
all
val
ves
wh
ere
req

uire
d.

(3) Backflo
w
preventi
on

(1)

Sys
te
ms
sha
ll
be
pro
tect
ed
aga
inst
cro
sscon
nec
tio
n
in
acc
ord
anc
e
wit
h
A
me
ric
an
Wa
ter
Wo
rks
As
soc
iati
on
(A
W
W
A)
Re
co
m
me
nde
d

Pr
act
ice
for
Ba
ck
flo
w
Pr
ev
en
tio
n
an
d
Cr
os
sCo
nn
ect
io
n
Co
ntr
ol.

(2) Va
cu
u
m
br
ea
ke
rs
or
ba
ck
flo
w
pr
ev
en
tio
n
de
vi
ce
s
sh
all
be
ins
tal

le
d
on
ho
se
bi
bs
an
d
su
pp
ly
no
zzl
es
us
ed
for
co
nn
ect
io
n
of
ho
se
s
or
tu
bi
ng
in
la
bo
rat
ori
es,
ho
us
ek
ee
pi
ng
sin
ks,
be
dp
an
flu
shi
ng
att
ac
h
m
en
ts,
au

to
ps
y
ta
bl
es,
etc
.

shall
not be
installe
d.

(6) Eme
rgen
cy
eye
was
h
and
sho
wers
shall
com
ply
with
AN
SI
Z35
8.1.

(4) Bedpanflushing
devices.
Bedpanflushing
devices
(may be
cold
water)
shall be
provide
d in
each
inpatien
t toilet
room;
howeve
r,
installat
ion is
optional
in
psychiat
ric and
alcoholabuse
units
where
patients
are
ambulat
ory.

(5) Potable
water
storage
.
Potable
water
storage
vessels
(hot
and
cold)
not
intende
d for
consta
nt use

10.1.2.4
Hot

water
syste
ms.
See
Secti
on
1.62.1.2
.1.

10.1.2.5
Drainage
syste
ms

(1) Piping
(1) D
r
a
i
n
l
i
n
e
s
f
r
o
m
s

i
n
k
s
u
s
e
d
f
o
r
a
c
i
d
w
a
s
t
e
d
i
s
p
o
s
a
l
s
h
a
l
l
b
e
m
a
d
e
o
f
a
c
i
d
r
e
s
i
s
t

a
n
t
m
a
t
e
r
i
a
l
.

(2) Dra
in
line
s
ser
vin
g
so
me
typ
es
of
aut
om
atic
blo
odcell
cou
nte
rs
sha
ll
be
of
car
efu
lly
sel
ect
ed
mat
eria
l
that
wil
l
eli
mi
nat
e
pot
enti
al
for
und

esir
abl
e
che
mic
al
rea
ctio
ns
(an
d/o
r
exp
losi
ons
)
bet
we
en
sod
iu
m
azi
de
wa
stes
and
cop
per,
lea
d,
bra
ss,
sol
der,
etc.

(3)

Inso
far
as
poss
ible,
drai
nag
e
pipi
ng
shal
l
not
be
inst
alle
d
with
in
the
ceili

ng
or
exp
ose
d in
oper
atin
g
and
deli
very
roo
ms,
nurs
erie
s,
foo
d
prep
arati
on
cent
ers,
foo
dserv
ing
facil
ities
,
foo
d
stor
age
area
s,
cent
ral
serv
ices
,
elec
tron
ic
data
proc
essi
ng
area
s,
elec
tric
clos
ets,
and
othe
r
sens

itive
area
s.
Wh
ere
exp
ose
d
over
hea
d
drai
n
pipi
ng
in
thes

e
area
s is
una
void
able
,
spec
ial
pro
visi
ons
shal
l be
mad
e to
2006
Guidelin
es for
Design

116

and
Construction of
Health Care
Facilities

g
e
,

p
r
o
t
e
c
t
t
h
e
s
p
a
c
e
b
e
l
o
w
f
r
o
m
l
e
a
k
a

c
o
n
d
e
n
s
a
t
i
o
n
,
o
r
d
u
s
t
p
a
r
t
i
c
l
e
s
.

(2) Floor
drains

(1) Fl
oo
r
dr
ain
s
sh
all
no
t
be
ins
tal
led
in
op
era
tin
g
an
d
del
ive
ry
ro
o
ms
.
*(b)
I
f
a
f
l
o
o
r
d
r
a
i
n
i
s
i
n
s
t
a
ll
e
d
i
n
c
y
s
t

o
s
c
o
p
y
,
it
s
h
a
ll
c
o
n
t
a
i
n
a
n
o
n
s
p
l
a
s
h
,
h
o
r
i
z
o
n
t
a
l
f
l
o
w
f
l
u
s
h
i
n
g
b
o
w
l
b
e

n
e
a
t
h
t
h
e
d
r
a
i
n
p
l
a
t
e
.

t
y
p
e
t
h
a
t
c
a
n
b
e

(3) Die
tary
are
a
floo
r
drai
ns
and
/or
floo
r
sin
ks

(1) T
y
p
e
.
T
h
e
s
e
s
h
a
l
l
b
e
o
f
a

e
a
s
i
l
y
c
l
e
a
n
e
d
b
y
r
e
m
o
v
i
n
g
t
h
e
c
o
v
e
r
.
R
e

m
o
v
a
b
l
e
s
t
a
i
n
l
e
s
s
s
t
e
e
l
m
e
s
h
s
h
a
l
l
b
e
p
r
o
v
i
d
e
d
i
n
a
d
d
i
t
i
o
n

t
o
g
r
i
l
l
e
d
d
r
a
i
n
c
o
v
e
r
s
t
o
p
r
e
v
e
n
t
e
n
t
r
y
o
f
l
a
r
g
e
p
a
r
t
i
c

l
e
s

d
r
a
i

o
f

w
a
s
t
e

r
f
l
o

t
h
a
t

o
r
s
i

m
i
g
h
t
c
a
u
s
e
s
t
o
p
p
a
g
e
s
.

n
k
s
s
h
a
l
l
b
e
p
r
o
v
i
d
e
d
a

(2) L

t
i

F
l

i
p

m
e

o
o

c
a

i
n

s
)

f
l

r
a

u
i

d
f
f

o
r

w
e

i
n

e
a

m
c

r
d

t
e

e
m

v
a

v
o

d
c
c

n
s

c
l

n
g

l
o

l
t

f
e
q
u
i
p

(3)

Autopsy
table
drain
systems.

Drain
systems
for
autopsy
tables
shall be
designed
to
positivel
y avoid
splatter
or
overflow
onto
floors or
back
siphonag
e and for
easy
cleaning
and trap
flushing.

ase
trap
s
shal
l be
of
cap
acit
y
req
uire
d.

(2) Gr
eas
e
tra
ps
sha
ll
be
loc
ate
d
and
arr
ang
ed
to
per
mit
eas
y
acc
ess
wit
ho
ut
the
nee
d
to
ent
er
foo
d
pre
par
ati
on
or
sto
rag
e
are
as.

(4) Sewers.
Buildin
g
sewers
shall
dischar
ge into
community
sewera
ge.
Where
such a
system
is not
availabl
e, the
facility
shall
treat its
sewage
in
accorda
nce
with
local
and
state
regulati
ons.

(5) Kitchen
grease
traps

(1) Gre

(3)

Gre
ase
trap

2.1 G
ENE
R AL
HOS
P I TA
LS

s
shal
l be
acce
ssib
le
fro
m
outs
ide
the
buil
ding
with
out
nee
d to
inte
rrup
t
any
serv
ices.

(6)

Plaster
traps.
Where
plaster
traps are
used,
provision
s shall be
made for
appropria
te access
and
cleaning.

10.1.2.6
Condensate
drains. See
Section 1.62.1.2.2.

10.1.3
Plumbing
Fixtures
In
addition
to
the
requireme
nts
of
Section
1.6-2.1.3,
the
following
standards
shall
apply to
plumbing
fix-tures
in
a
general
hospital:
10.1.3.1
Clinical sinks

(1) Clinic
al
sinks
shall
be
trimm

ed
with
valves
that
can be
operat
ed
witho
ut
hands.
Single
-lever
or
wrist
blade
device
s shall
be
permit
ted.
Handl
es on
clinic
al
sinks
shall
be at
least 6
inches
(15.24
centi
meter
s)
long.

(2) Clinic
al
sinks
shall
have
an
integr
al trap
wherei
n the
upper
portio
n of
the
water
trap
provid
es a
visible
seal.

scrub sinks
and
lavatories
used for
scrubbing in
procedure
rooms shall
be trimmed
with foot,
knee, or
ultrasonic
controls;
single-lever
wrist blades
are not
permitted.

10.1.4
Medical
Gas and
Vacuum
Systems
10.1.4.1
Medical gas
systems. The
installation,
testing, and
certification
of
nonflammabl
e medical gas
and air
systems shall
comply with
the
requirements
of NFPA 99.
(See Table
2.1-5 for
rooms
requiring
station
outlets.)

APPEN
DIX
A10.1.2.5 (2)(b)
Floor drains in
cystoscopy
operating
rooms have
been shown to
disseminate a
heavily

10.1.3.2
Scrub sinks.
Freestanding

contaminated
spray during
flushing. Unless

flushed

nonsplash,

regularly with

horizontal-flow

large amounts

type of bowl,

of fluid, the trap

preferably with

tends to dry out

a closed

and permit

system of

passage of

drainage.

gases, vapors,

Alternative

odors, insects,

methods

and vermin

include (a) an

directly into the

aspirator/trap

operating room.

installed in a

For new
construction, if
the users insist
on a floor
drain, the drain
plate should be
located away
from the
operative site,
and should be
over a
frequently
flushed

2006
Guidelin

2.1 GEN
E R AL H O
S P I TA L S

10.1.4.2
Vacuum
systems

(1) Clini
cal
vacuu
m
syste
m
instal
lation
s
shall
be in
accor
dance
with
NFP
A 99.
(See
Table
2.1-5

wall connected to the

collecting
trough of the
operating table
by a closed,
disposable
tube system, or
(b) a closed
system using
portable
collecting
vessels. (See
NFPA 99.)
es for ction of Health
Design Care Facilities
and
Constru

117

for
room
s that
requi
re
statio
n
outlet
s.)

(2) The
vacuum
discharg
e shall
be
located
at least
25 feet
from all
outside
air
intakes,
doors,
and
operable
window
s.

10.2
Heating,
Ventilating,
and AirConditionin
g
(HVAC)
Systems

in
g
pr
oc
ed
ur
es
sh
all
be
fol
lo
we
d
for
the
m
ost
ec
on
o
mi
cal
an
d
eff
ec-

*10.2.1
General
*10.2.1.1
Mechanical
system design

(1)

Efficienc
y. The
mechani
cal
system
shall be
designed
for
overall
efficienc
y and
appropri
ate lifecycle
cost.
Details
for costeffective
impleme
n-tation
of design
features
are
interrelat
ed and
too
numerou
s (as
well as
too
basic) to
list
individu
ally.

APPEN
DIX
A10.2.1
Remodeling and
work in existing
facilities may
present special
problems. As
practicality and
funding permit,
existing insulation, weather
stripping, etc.,
should be
brought up to
standard for
maximum
economy and
efficiency.
Consideration

(1)

Re
co
gni
ze
d
en
gin
eer

should be given
to additional
work that may be
needed to
achieve this.
A10.2.1.1
Protection of
HVAC systems

against chemical,

Engineers,

biological, and

853-01, October

radiological

2001.

attack should be
considered.
System design
fea-tures that

A10.2.1.1 (2)(a)
It may be
practical in
many areas to

should be

reduce or shut

evaluated

down

include

mechanical

protection of

ventilation

outside air
intakes, location

under

of return air

appropriate

grilles, and types

climatic and

of filtration. The

patient care

follow-ing

conditions and

documents

to use open

provide

windows for

additional

ventilation.

information
regarding these
issues:

1.

uidance for
Protecting
Building
Environment
s from
Airborne
Chemical,
Biological, or
Radiological
Attacks,
Department
of Health
and Human
Services/Ce
nters for
Disease
Control and
Prevention/N
ational
Institute for
Occupational
Safety and
Health, May
2002.

2.
ecting

Prot
Buildings

and

their

Occupants from
Airborne
Hazards (draft),
Army Corps of

TI

tiv
e
res
ult
s.
A
we
lldes
ign
ed
sys
te
m
ca
n
ge
nera
lly
ac
hie
ve
en
erg
y
effi
cie
nc
y
at
mi
ni
ma
l
ad
diti
on
al
cos
t
an
d
si
mu
lta
ne
ou
sly
pro
vid
e
im
pro

ve
d
pat
ien
t
co
mf
ort
.

(2)

Diff
eren
t
geo
grap
hic
area
s
may
hav
e
clim
atic
and
use
con
ditio
ns
that
favo
r
one
syst
em
over
anot
her
in
term
s of
over
all
cost
and
effic
ienc
y.

(3) In
no
cas
e
sh
all
pat
ien
t

car
e
or
saf
ety
be
sac
rifi
ce
d
for
co
ns
erv
ati
on.

(4) Ins
ofar
as
pra
ctic
al,
the
faci
lity
shal
l
incl
ude
pro
visi
ons
for
rec
ove
ry
of
was
te
coo
ling
and
hea
ting
ene
rgy
(ve
ntil
atio
n,
exh
aust
,
wat
er
and
stea
m

dis
cha
rge,
coo
ling
tow
ers,
inci
ner
ator
s,
etc.
).

(5)

Use
of
reco
gniz
ed
ener
gysavi
ng
mec
hani
sms
such
as
vari
able
-airvolu
me
(VA
V)
syst
ems,
load
shed
ding
,
prog
ram
med
cont
rols
for
unoc
cupi
ed
peri
ods
(nig
hts
and

wee

atio
n,
fen
est
rati
on,
an
d
oth
er
fea
tur
es
rel
ati
ve
to
pas
siv
e
an
d
act
ive
en
erg
y
sys
te
ms
.

kend
s,
etc.),
and
use
of
natu
ral
venti
latio
n
shall
be
cons
idere
d,
site
and
clim
atic
cond
ition
s
per
mitti
ng.

(6)

Fa
cili
ty
des
ign
co
nsi
der
ati
on
s
sha
ll
inc
lud
e
sit
e,
bui
ldi
ng
ma
ss,
ori
ent
ati
on,
co
nfi
gur

(2) Airhandling
systems
*(a)
Th
es
e
sh
all
be
de
sig
ne
d
wi
th
an
ec
on
o
mi
zer
cy
cle

wh
ere
ap
pr
op
ria
te
to
us
e
out
sid
e
air.
(U
se
of
me
ch
ani
cal
ly
cir
cul
ate
d
out
sid
e
air
do
es
not
red
uc
e
ne
ed
for
filt
rat
ion
.)

(2) VA
V
syst
ems
.
The
ener
gysavi
ng
pot
enti
al
of

vari
able
airvol
um
e
syst
ems
is
rec
ogn
ized
,
and
the
stan
dar
ds
her
ein
are
inte
nde
d to
ma
xim
ize
app
ropr
iate
use
of
thos
e
syst
ems
.
An
y
syst
em
use
d
for
occ
upi
ed
area
s
shal
l
incl
ude
pro
visi
ons
to

avo
id
air
stag
nati
on
in
inte
rior
spa
ces
whe
re
ther
mos
tat
de
ma
nds
are
met
by
tem
per
atur
es
of
surr
oun
din

g
area
s.

(3)

Non
cent
ral
airhan
dlin
g
syst
ems
(i.e.,
indi
vidu
al
roo
m
unit
s
used
for
heat
ing
and
cool
ing

Guidelin Construction of
es for Health Care
Design Facilities
and

118
2006

pur
pos
es,
suc
h
as
fan
coil
uni
ts,
hea
t
pu
mp
uni
ts,
etc.
).
Th

ese
unit
s
ma
y
be
use
d
as
reci
rcul
atin
g
unit
s
onl
y.
All
out
doo
r
air
req
uire

me
nts
sha
ll
be
met
by
a
sep
arat
e
cen
tral
airhan
dli
ng
sys
tem
wit
h
pro
per
filtr
atio
n,
as
not
ed
in
Tab
le
2.1
-3.

ptable
structur
e-borne
vibratio
n.

(4)

System
valves.
Supply
and
return
mains
and
risers for
cooling,
heating,
and
steam
systems
shall be
equippe
d with
valves to
isolate
the
various
sec-tions
of each
system.
Each
piece of
equipme
nt shall
have
valves at
the
supply
and
return
ends.

(5)

Renovat
ion. If
system
modific
ations
affect
greater
than 10
percent
of the
system
capacity,
designer
s shall
utilize
prerenovati

(3) Vibrati
on
isolator
s.
Mechan
ical
equipm
ent,
ductwork,
and
piping
shall be
mounte
d on
vibratio
n
isolator
s as
require
d to
prevent
unacce

on
water/ai
r flow
rate
measure
ments to
verify
that
sufficien
t
capacity
is
availabl
e and
that
renovati
ons
have not
adversel
y
affected
flow
rates in
nonrenovate
d areas.

*10.2.1.2
Ventilation
and space
conditioning
requirements. All
rooms and
areas used
for patient
care
shall
have
provisions
for
ventilation.

(1) Ventilat
ion
rates.
The
ventilat
ion
systems
shall be
designe
d and
balance
d, as a
minimu
m,
accordi

ng to
the
require
ments
shown
in Table
2.1-2
and the
applica
ble
notes.
The
ventilat
ion
rates
shown
in Table
2.1-2
do not
preclud
e the
use of
higher,
more
appropr
iate
rates.

(2) Air
change
rates.
Air
supply
and
exhaust
in rooms
for
which
no
minimu
m total
air
change
rate is
noted
may
vary
down to
zero in
response
to room
load.
For
rooms
listed in
Table
2.1-2,
where

VAV
systems
are
used,
minimu
m total
air
change
shall be
within
limits
noted.

2.1 GEN
E RAL H O
S P I TA L S

controlle
d to
ensure
moveme
nt of air
from
clean
to less
clean
areas,
especiall
y in
critical
areas.

(3) Tem
perat
ure
and
humi
dity.
Spac
e
temp
eratu
re
and
relati
ve
humi
dity
shall
be as
indic
ated
in
Tabl
e
2.12.

(4)

Air
moveme
nt
directio
n.
To
maintain
asepsis
con-trol,
airflow
supply
and
exhaust
shall
generall
y be

(5)

Althoug
h natural
ventilati
on for
nonsensi
tive
areas
and
patient
rooms
(via
operable
windows
) shall
be
permitte
d,
mechani
cal
ventilati
on shall
be
consider
ed for all
rooms
and
areas in
the
facility.

10.2.1.3
Testing and
documentatio
n

(1) Upon

comple
tion of
the
equipm
ent
installa
tion
contrac
t, the
owner
shall
be
furnish
ed with
a
comple
te set
of
manufa
cturers
operati
ng,
maintenanc
e, and
prevent
ive
mainte
nance
instruc
-tions,
parts
lists,
and
comple
te
procur
ement
inform
ation,
includi
ng
equipm
ent
numbe
rs and
descrip
tions.
Requir
ed
inform
ation
shall
include
energy
ratings
as
needed

for
future
conser
vation
calcula
tions.

(2) Operat
ing
staff
person
s shall
also be
provid
ed
with
written
instruc
tions
for
proper
operati
on of
system
s and
equip
ment.
10.2.2
Requireme
nts for
Specific
Locations
10.2.2.1
Airborne
infection
isolation
rooms. The
infec-tious
disease
isolation
room is used
for isolating
the airborne
spread of
infectious
diseases,
such as
measles,
varicella, or
tuberculosis.

(6) The
design
of
airborn
e
infecti

on
isolati
on
rooms
(AIIRs
) shall
be
permitt
ed to
includ
e
provisi
ons for
normal
patient
care
during
period
s not
requiri
ng
isolati
on
precau
tions.

(7) Use of
supple
mental
recircul
ating
devices
shall be
permitt
ed in
the
patient
room to
increas
e the
equival
ent
room
air
exchan
ges;
howeve
2006
Guidelin

2.1 GEN
E R AL H O
S P I TA L S

require

r, such
recircul
ating
devices
do not
provide
outside
air

APPEN
DIX
A10.2.1.2
Owing to
potential
operational
problems for
the ultravi-olet
germicidal
irradiation
(UVGI) lamps,
and the fact
that the
effectiveness
of UVGI is
dependent on
the airflow
pattern in the
room, use of
UVGI may be
considered as
a supplement
to the ventilation system
design, rather
than the main
control
mechanism.
The ACH of
the room
should
therefore be
set as if no
UVGI system
is installed.
es for ction of Health
Design Care Facilities
and
Constru

119

ments.
Recircu
lation
of air
within
individual
isolatio
n rooms

shall be
permitt
ed if
HEPA
filters
are
used.

(3)

Rooms
with
reversib
le
airflow
provisio
ns for
the
purpose
of
switchin
g
between
protecti
ve
environment
and AII
function
s are not
accepta
ble.

10.2.2.2
Protective
environment
rooms. The
protective
environment
(PE) room is
used to
protect the
patient from
common
environment
al airborne
infectious
microbes
(i.e.,
Aspergillus
spores).

(1) These
specia
l
ventil
ation
areas
shall
be

desig
ned to
provi
de
direct
ed
airflo
w
from
the
cleane
st
patien
t care
area
to less
clean
areas.

(2) These
rooms
shall be
protecte
d with
HEPA
filters at
99.97
percent
efficien
cy for a
0.3 m
sized
par-ticle
in the
supply
airstrea
m.
These
interrup
ting
filters
protect
patient
rooms
from
mainten
ancederived
release
of
environ
mental
microbe
s from
the
ventilati
on
system

compon
ents.
Recircu
lation
HEPA
filters
can be
used to
increase
the
equivalent
room
air
exchang
es.

down. For
example,
airflow from a
less clean
space such as
the corridor
can occur, and
standing water
can
accumulate in
the ventilation
system

(near
humidifiers
or
cooling
coils).

2.

(3)

Constant
volume
airflow
is
required
for
consisten
t
ventilatio
n for the
protected
environ
ment.

Th

e
recommend
ed air
change rate
in an
operating
room is 20
to 25 air
changes per
hour (ACH)
for ceiling
heights
between 9

APPEN
DIX

A10.2.2.4 (3)
(a) Operating
and delivery
room
ventilation

1.

Th

e operating
and delivery
room
ventilation
systems
should operate
at all times to
maintain the air
movement

feet (2.74
meters) and
12 feet (3.66
meters).

3.

The
system
should
provide
a
single
directional
flow regime,
with
both
high and low
exhaust
locations.

4.

relationship to

face velocity of

adjacent areas.

around 25 to 35

The

fpm (0.13 to

cleanliness of

0.18 m/s) is

the spaces is

sufficient from

compromised

the non-

when the

aspirating

ventilation

diffuser array

system is shut

provided the

array size itself

is set correctly.
The nonaspirating
diffuser array
size

(4)

If the
facility
determ
ines
that
airborn
e
infecti
on
isolatio
n
is
necess
ary for
protect
ive
enviro
nment
patient
s, an
anteroo
m shall
be
provid
ed.

(5) Rooms
with
reversib
le
airflow
provisio
ns for
the
purpose
of
switchi
ng
betwee
n
protecti
ve
environ
-ment
and
airborn
e
infectio
n
isolatio
n
functio
ns are
not
accepta

ble.

10.2.2.3
Psychiatric
patient areas.
Special
consideration
shall be given
to the type of
heating and
cooling units,
ventilation
outlets, and
appurtenance
s installed in
patientoccupied
areas of
psychiatric
units. The
fol-lowing
shall apply:

expose
d in the
room
shall be
constru
cted
with
rounde
d
corners
and
shall
have
enclosu
res
fastene
d with
tamperresistan
t
screws.

(3)

(1) All air

grilles
and
diffuse
rs
shall
be of a
type
that
prohib
its the
inserti
on of
foreig
n
object
s. All
expose
d
fasten
ers
shall
be
tamper
resista
nt.

(2) All
convect
or or
HVAC
enclosu
res

HVAC
equipme
nt shall
be of a
type that
minimizes
the need
for
mainten
ance
within
the
room.

should be set
appropriately
such

that

it

covers

at

least the area

footprint of the
table plus a
reasonable
margin
around it. In
the
study,

cited
this

margin is 21
inches (53.34
centimeters)
on the short

side and 12

Geometr

inches (25.40

y and

centimeters)

Ventilatio

on

n System

the

long

Paramet

side.
Note: The above
conclusions were
derived from

er
Variation
s on the
Protectio

studies
conducted by the

n of the

National

Surgical

Institutes of

Site

Health: Farhad

(IAQ

Memarzadeh

2004).

and Andrew P.

e. If additional

Manning,

diffusers are

Comparison of

required, they

Operating Room

may be

Ventilation

located

Systems in the

outside this

Protection of the

central

Surgical Site

diffuser array.

(ASHRAE

Up to 30

Transactions

percent of the

2002, Vol. 108,

central

pt. 2) and Farhad

diffuser array

Memarzadeh

may be

and

allocated to

Zheng

non-diffuser

Jiang,

items

Effect of

(medical gas

Operatio

columns,

n Room

lights, etc.).
Guidelin Construction of
es for
Health Care
Design Facilities
and

120
2006

10.2.2.4
Operating
and delivery
rooms

(1) Air
supply

(1)

In
new
con
stru
ctio
n
and
maj

or
ren
ova
tion
wor
k,
air
sup
ply
for
ope
rati
ng
and
deli
ver
y
roo
ms
shal
l be
fro

m
non
aspi
rati
ng
ceil
ing
diff
user
s
wit
ha
face
vel
ocit
y in
the
ran
ge
of
25
to
35
fpm
(0.1
3 to
0.1
8
m/s
),
loca
ted
at
the
ceil
ing
abo
ve
the
cent
er
of
the
wor
k
area
.
Ret
urn
air
shal
l be
nea
r
the
floo
r

leve
l, at
a
min
imu
m.
Ret
urn
air
shal
l be
per
mitt
ed
hig
h
on
the
wal
ls,
in
add
itio
n to
the
low
retu
rns.

(2) Ea
ch
op
era
tin
g
an
d
del
ive
ry
ro
om
sh
all
ha
ve
at
lea
st
tw
o
ret
ur
nair
inl
ets
loc
ate

d
as
far
fro
m
ea
ch
oth
er
as
pra
cti
cal
.

(3) Tur
bul
enc
e
and
oth
er
fact
ors
of
air
mo
veme
nt
sha
ll
be
con
sid
ere
d
to
mi
ni
miz
e
the
fall
of
par
ticu
late
s
ont
o
ster
ile
sur
fac
es.

(2)

Temper
ature.
Temper

ature
shall be
individ
ually
controll
ed for
each
operati
ng and
deliver
y room.

(3) Ventilati
on rates
*(a)
Op
erat
ing
and
deli
ver
y
roo
m
ven
tilat
ion
sys
tem
s
sha
ll
ope
rate
at
all
tim
es,
exc
ept
dur
ing
mai
nte
nan
ce
and
con
diti
ons
req
uiri
ng
shu
tdo
wn

by
the
buil
din
gs
fire
alar
m
syst
em.

(2)

Dur
ing
uno
ccu
pie
d
hou
rs,
ope
rati
ng
and
deli
ver
y
roo
m
air
cha
nge
rate
s
ma
y
be
red
uce
d,
pro
vid
ed
the
posi
tive
roo
m
pres
sure
is
mai
ntai
ned
as
req
uire
d in
Tab

le
2.12.

(4)

Standar
ds for
special
proced
ures.
Where
extraordinary
proced
ures,
such as
organ
transpl
ants,
justify
special
designs
,
installa
tion
shall
properl
y meet
perfor
mance
needs
as
determi
ned by
applicable
standar
ds.
These
special
designs
should
be
review
ed on a
caseby-case
basis.

10.2.2.5
Coughinducing
procedure
rooms. Rooms
used for
sputum
induction,
aerosolized

pentamadine
treat-ments, or
other coughinducing
procedures
shall meet the
requirements
of Table 2.1-2
for airborne
infection
isola-tion
rooms. If
booths are
used, refer to
Section 2.15.8.1.

2.1 GEN
E RAL H O
S P I TA L S

10.2.2.6
Anesthesia
storage
rooms. The
ventilation
sys-tem for
anesthesia
storage
rooms shall
conform to
the
requirements
of NFPA 99,
including the
gravity
option.
Mechanicall
y operated
air systems
are optional
in these
rooms.

10.2.2.7
ETO
sterilizer
space. The
ventilation
system for
the space
that houses
ethylene
oxide (ETO)
sterilizers
shall be
designed as
follows:

(1)

A
dedi
cate
d
(not
con
nect
ed
to a
retu
rn
air
or
othe

r
exh
aust
syst
em)
exh
aust
syst
em
shal
l be
pro
vide
d.
Ref
er
to
29
CF
R
Part
191
0.10
47.

(2) All
source
areas
shall be
exhaust
ed,
includi
ng the
sterilize
r
equipm
ent
room,
service/
aeratio
n areas,
and the
space
above
the
sterilize
r door,
as well
as the
aerator.

(1) If
the
ET
O
cyli
nde
rs
are

not
loc
ate
d in
a
wel
lven
tilat
ed,
uno
ccu
pie
d
equ
ipm
ent
spa
ce,
an
exh
aus
t
hoo
d
sha
ll
be
pro
vid
ed
ove
r
the
cyli
nde
rs.

(2) Th
e
reli
ef
val
ve
sha
ll
be
ter
mi
nat
ed
in a
wel
lven
tila
ted,
uno
ccu

pie
d
equ
ip
me
nt
spa
ce
or
out
sid
e
the
bui
ldi
ng.

e,
an
ex
ha
ust
dra
in
ca
p
sh
all
be
pr
ovi
de
d
(co
or
din
ate
wit
h
loc
al
co
de
s).

(3) If
the
flo
or
dra
in
to
wh
ich
the
ste
rili
zer
(s)
dis
ch
arg
es
is
not
loc
ate
d
in
a
we
llve
nti
lat
ed,
un
oc
cu
pie
d
eq
uip
me
nt
sp
ac

(3) Gener
al
airflo
w
shall
be
away
from
the
sterili
zer
operat
or(s).

(4) A
dedicat
ed
exhaust
duct
system
for
ETO
shall be
provide
d. The
exhaust
outlet
to the
outside
shall be
at least

25 feet
(7.62
meters)
away
from
any air
intake.

(5)

An
audible
and
visual
alarm
shall
activate

2006
Guidelin

2.1 GEN
E R AL H O
S P I TA L S

10.2.2.8 Food
preparation
centers

(1)

Exhaust
hoods
handling
greaseladen
vapors in
food
preparatio
n centers
shall
comply
with
NFPA 96.

(2) All
hoods
over
cookin
g
ranges
shall be
equippe
d with
grease
filters,
fireextingu
ishing
systems
,
and

in the
sterilizer
work
area,
and in a
24-hour
staffed
location,
upon
loss of
airflow
in the
exhaust
system.
es for
tion of Health
Design Care Facilities
and
Construc

121

heatactuate
d fan
control
s.

(3) Cleanou
t
opening
s shall
be
provide
d every
20 feet
(6.10
meters)
and at
changes
in
directio
n in the
horizont
al
exhaust
duct
systems
serving
these
hoods.
Horizon
tal runs
of ducts
serving
range
hoods
shall be
kept to
a
minimu
m.

(4) Food
preparat
ion
centers
shall
have
ventilati
on
systems
whose
air
supply
mechani
sms are
interfaced
appropri
ately
with
exhaust
hood
controls
or relief
vents so
that
exfiltrati
on or
infiltrati
on to or
from
exit
corridor
s does
not
compro
mise the
exit
corridor
restricti
ons of
NFPA
90A or
the
pressure
require
ments of
NFPA
96.

10.2.2.9
Fuel-fired
equipment
rooms.
Rooms with
fuel-fired
equipment

shall be
provided
with
sufficient
outdoor air
to maintain
equipment
combustion
rates and to
limit
workstation
temperature
s.

10.2.3

The
rmal
Insula
tion
and
Acous
tical
Provis
ions

See Section
1.6-2.2.1.

10.2.4 HV
AC
Air
Distri
butio
n

10.2.4.
1
R
eturn air
systems
.
For
patient
care
areas,
return
air shall
be via
ducted
systems
.

10.2.4.2
HVAC
duct
work
. See
Secti
on
1.62.2.2
.1.

APPEN
DIX

A10.2.4.3 (2)
Acceptable
concentrations of
anesthetizing
agents are
unknown at this
time. The
absence of
specific data
makes it difficult
to set specific
standards.
However, any
scavenging
system should
be designed to
remove as much
of the gas as
possible from the
room
environment. It is
assumed that
anesthetizing
equipment will
be selected and
maintained to
minimize
leakage and
contamination of
room air. See
Industrial
Ventilation:

A
Manual
of
Recom
mended
Practice
,
publishe
d by the
America
n
Confere
nce of
Govern
mental
Industria
l
Hygienis
ts
(www.ac
gih.org),
for
addition
al
informati

on.

10.2.4.3
Exhaust
systems

(1) General
(1)

To
enh
anc
e
the
effi
cie
ncy
of
rec
ove
ry
dev
ice
s
req
uir
ed
for
ene
rgy
con
ser
vat
ion
,
co
mb
ine
d
exh
aus
t
sys
te
ms
sha
ll
be
per
mit
ted.

(2) Loc
al
exh
aust
syst

ems
shal
l be
use
d
whe
nev
er
pos
sibl
e in
plac
e of
dilu
tion
ven
tilat
ion
to
red
uce
exp
osu
re
to
haz
ard
ous
gas
es,
vap
ors,
fum
es,
or
mis
ts.

(3) Fan
s
serv
ing
exh
aust
syst
ems
shal
l be
loca
ted
at
the
disc
har
ge
end
and
shal
l be

rea
dily
serv
icea
ble.

(4) Air
bor
ne
inf
ecti
on
isol
atio
n
roo
ms
sha
ll
not
be
ser
ved
by
exh
aus
t
sys
tem
s
inc
orp
ora
tin
g a
hea
t
wh
eel.
*(2)
Anesthesia
scavenging
systems

(1) Eac
h
spa
ce
rou
tine
ly
use
d
for
ad
min
iste
rin
g

inh
alat
ion
ane
sth
esia
and
inh
alat
ion
ana
lge
sia
sha
ll
be
ser
ved
by
a
sca
ven
gin
g
syst
em
to
ven
t
was
te
gas
es.

(2) W
h
e
n
a
n
e
st
h
e
si
a
s
c
a
v
e
n
gi
n
g
s
y
st
e

m
s
ar
e
re
q
ui
re
d,
ai
r
s
u
p
pl
y
s
h
al
l
b
e
at
o
r
n
e
ar
th
e
c
ei
li
n
g.
R
et
u
r
n
o
r
e
x
h
a
u
st
ai
r
in
le
ts
s
h
al
l
b
e

n
e
ar
th
e
fl
o
o
r
le
v
el
.

(3)

If a
vac
uu
m
syst
em
is
use
d,
the
gascoll
ecti
ng
syst
em
shal
l be
arra
nge
d so
it
doe
s
not
disturb
pati
ents

resp
irat
ory
syst
ems
.

(4)

G
as
es
fr
o
m
th

e
sc
av
en
gi
n
g
sy
st
e
m
sh
al
l
be
ex
ha
us
te
d
di
re
ct
ly
to
th
e
o
ut
si
de
.
T
he
an
es
th
es
ia
ev
ac
ua
ti
o
n
sy
st
e
m
m
ay
be
co
m
bi
ne
d

w
it
h
th
e
ro
o
m
ex
ha
us
t
sy
st
e
m
,
pr
o
vi
de
d
th
e
pa
rt
us
ed
fo
r
an
es
th
es
ia
ga
s
sc
av
en
gi
n
g
ex
ha
us
ts
di
re
ct
ly
to
th
e
o
ut
si
de

an
d
is
n
ot
pa
rt
of
th
e
re
ci
rc
ul
at
io
n
sy
st
e
m
.

(5)

Sca
ven
gin
g
syst
ems
are
not
req
uire
d
for
2006
Guidelin
es for
Design

122

10.2.4.4 Air
outlets and
inlets

*(1) Fresh
air intakes

(1)

area
s
whe
re
gas
es
are
use
d
onl
y
occ
asio
nall
y,
suc
h as
the
eme
rge
ncy
dep
art
me
nt,
offi
ces
for
rout
ine
den
tal
wor
k,
etc.

Fres
h
air
inta
kes
shal
l be
loca

and
Construction of
Health Care
Facilities

ted
at
leas
t 25
feet
(7.6
2
met
ers)
fro
m
exh
aust
outl
ets
of
ventilat
ing
syst

ems
,
com
bust
ion
vent
s
(inc
ludi
ng
thos
e
serv
ing
roof
top
air
han
dlin
g
equi
pmen
t),
med
icalsurg
ical
vac
uum
syst
ems
,
plu
mbi
ng
vent
s, or
area
s
that
may
coll
ect
vehi
cula
r
exh
aust
or
othe
r
noxi
ous
fum
es.
(Pre
vaili

ng
win
ds
and/
or
pro
xim
ity
to
othe
r
stru
ctur
es
may
requ
ire
grea
ter
clea
ranc
es.)

(2) Plu
mb
ing
ven
ts
that
ter
mi
nat
e at
a
lev
el
abo
ve
the
top
of
the
air
inta
ke
ma
y
be
loc
ate
d
as
clo
se
as
10
feet
(3.
05

met
ers)
.

44
cen
tim
eter
s)
abo
ve
roo
f
lev
el.

(3) The
bott
om
of
out
doo
r
air
inta
kes
ser
vin
g
cen
tral
syst
em
s
sha
ll
be
as
hig
h as
pra
ctic
al,
but
at
leas
t6
feet
(1.8
3
met
ers)
abo
ve
gro
und
lev
el,
or,
if
inst
alle
d
abo
ve
the
roo
f, 3
feet
(91.

(2)

Relief
air.
Relief
air is
exempt
from
the 25foot
(7.62meter)
separati
on
require
ment.
Relief
air is
defined
as air
that
otherwi
se
could
be
returne
d
(recircu
lated)
to an
air
handlin
g unit
from
the
occupie
d space,
but is
being
dischar
ged to
the
outdoor
s to
maintai
n
buildin
g

pressur
e, such
as
during
outside
air
econom
izer
operati
on.

(3) Gravity
exhaust.
Where
conditio
ns
permit,
gravity
exhaust
shall be
permitte
d for
nonpatie
nt areas
such as
boiler
rooms,
central
storage,
etc.

(4)

Construc
tion
requirem
ents. The
bottoms
of
air
distribution
devices
(supply/r
eturn/exh
aust)
shall be
at least 3
inches
(7.62
centimet
ers)
above
the floor.

10.2.4.5
Ventilation
hoods

(1) Exhaust
hoods

and
safety
cabinets

(1)

H
o
o
d
s
a
n
d
s
a
f
e
t
y
c
a
b
i
n
e
t
s
m
a
y
b
e
u
s
e
d
f
o
r
n
o
r
m
a
l
e
x
h
a
u
s
t
o
f
a
s
p
a
c
e

p
r
o
v
i
d
i
n
g
m
i
n
im
u
m
a
ir
c
h
a
n
g
e
r
a
t
e
s
a
r
e
m
a
i
n
t
a
i
n
e
d
.

(2)

If
air
cha
nge
sta
nda
rds
in
Ta
ble
2.1
-2
do
not

pro
vid
e
suf
fici
ent
air
for
pro
per
ope
rati
on
of

2.1 GEN
E RAL H O
S P I TA L S

exh
aust
hoo
ds
and
safe
ty
cabi
nets
(wh
en
in
use)
,
sup
ple
me
ntar
y
ma
keu
p
air
(filt
ere
d
and
pre
heat
ed)
shal
l be
pro
vid
ed
aro
und
thes
e
unit
s to
mai
ntai
n
the
req
uire
d
airfl
ow
dire

ction
and
exh
aust
vel
ocit
y.
Use
of
ma
keu
p
air
will
avo
id
dep
end
enc
e
upo
n
infil
trati
on
fro
m
out
doo
r
and
/or
fro
m
con
tam
inat
ed
area
s.

(3) Ma
keu
p
sys
tem
s
for
hoo
ds
sha
ll
be
arr
ang
ed
to

mi
ni
miz
e
sh
ort
circ
uiti
ng
of
air
and
to
avo
id
red
ucti
on
in
air
vel
ocit
y at
the
poi
nt
of
con
tam
ina
nt
cap
tur
e.

(2) Labora
tory
fume
hoods.
Labora
tory
fume
hoods
shall
meet
the
followi
ng
standar
ds:

(1) Gen
eral
stan
dar
ds

(1) An
ave
rag

e
fac
e
vel
ocit
y
of
at
leas
t 75
feet
per
min
ute
(0.
38
met
ers
per
sec
ond
)

(2) Co
nne
ctio
n to
an
exh
aus
t
syst
em
to
the
out
sid
e
that
is
sep
arat
e
fro
m
the
buil
din
g
exh
aus
t
syst
em

(3) L
o
c
a
t

i
o
n
o
f
a
n
e
x
h
a
u
s
t
f
a
n
a
t
t
h
e
d
i
s
c
h
a
r
g
e
e
n
d
o
f
t
h
e
s
y
s
t
e
m

(4) In
cl
us
io

n
of
a
n
e
x
h
a
us
t
d
u
ct
sy
st
e
m
of
n
o
n
c
o
m
b
us
ti
bl
e
c
or
ro
si
o
nre
si
st
a
nt
m
at
er
ia
l
as
n
ee
d
e
d
to
m
ee
t
th
e
pl
a

n
n
e
d
us
a
g
e
of
th
e
h
o
o
d

(2)

aci
d
and
oth
er
stro
ng
oxi
dan
ts
sha
ll
be
con
stru
cte
d
of
stai
nle
ss
ste
el
or
oth
er
mat
eria
l
con
sist
ent
wit
h
spe
cial
exp
osu
res.

Spe
cial
stan
dard
s
for
use
with
stro
ng
oxid
ants

(1) Fu
me
hoo
ds
and
thei
r
ass
oci
ate
d
equ
ipme
nt
in
the
air
stre
am
inte
nde
d
for
use
wit
h
per
chl
ori
c

APPEN
DIX
A10.2.4.4 (1)
Requirement
s to minimize
crosscontaminatio
n between
fresh air
intakes and
various
exhaust
outlets may
be
determined

by

with the

engineering

ASHRAE

modeling or

Handbook

calculations

Fundamental

performed in

s.

accordance
Design tion of Health
and
Care Facilities
Construc

2006
Guidelin
es for

123

2.1 GEN
E R AL H O
S P I TA L S

t
h
a

(2) T
h
e
s
e
h
o
o
d
s
a
n
d
e
q
u
i
p
m
e
n
t
s
h
a
l
l
b
e
p
r
o
v
i
d
e
d
w
i

w
a
t
e
r
w
a
s
h
a
n
d
d
r
a
i
n
s
y
s
t
e
m
t
o
p
e
r
m
i
t
p
e
r
i
o
d
i
c

f
l
u
s
h
i
n
g
o
f
d
u
c
t
a
n
d
h
o
o
d
.

(3) Ele
ctri
cal
equ
ipm
ent
inte
nde
d
for
inst
allati
on
wit
hin
suc
h
duc
ts
shal
l be
desi
gne
d
and
con
stru
cte
d to
resi
st
pen
e-

trat
ion
by
wat
er.
Lu
bric
ant
s
and
seal
s
sha
ll
not
con
tain
org
ani
c
mat
eria
ls.

(4) Wh
en
per
chl
ori
c
aci
d
or
oth
er
str
on
g
oxi
dan
ts
are
onl
y
tra
nsf
err
ed
fro
m
one
con
tai
ner
to
ano
the
r,

sta
nda
rd
lab
ora
tor
y
fu
me
hoo
ds
and
the
ass
oci
ate
d
equ
ipme
nt
ma
y
be
use
d
in
lieu
of
stai
nle
ss
ste
el
con
stru
ctio
n.

(3)

Sp
eci
al
sta
nd
ard
s
for
use
wit
h
inf
ect
iou
s
or
rad
ioa
cti

ve
ma
teri
als
. In
ne
w
co
nst
ruc
tio
n
an
d
ma
jor
ren
ov
ati
on
wo
rk,
eac
h
ho
od
use
d
to
pro
ces
s
inf
ect
iou
s
or
rad
ioa
cti
ve
ma
teri
als
sha
ll
me
et
the
fol
lo
wi
ng
req
uir
em
ent
s:

(1) Ea
ch
ho
od
sh
all
ha
ve
a
mi
ni
mu
m
fac
e
vel
oci
ty
of
90
to
11
0
fee
t
per
mi
nut
e
(0.
45
to
0.5
6
me
ter
s
per
sec
on
d)
wit
h
sui
tab
le
pre
ssu
reind
ep
en
de
nt
air
mo

dula
tin
g
de
vic
es
an
d
ala
rm
s
to
ale
rt
sta
ff
of
fa
n
sh
ut
do
wn
or
los
s
of
air
flo
w.

(2) Eac
h
sha
ll
als
o
hav
e
filt
ers
wit
ha
99.
97
per
cen
t
effi
cie
ncy
(ba
sed
on
the
DO
P

test
met
hod
) in
the
exh
aust
stre
am
and
be
desi
gne
d
and
equ
ipp
ed
to
per
mit
the
safe
rem
ova
l,
dis
pos
al,
and
repl
ace
me
nt
of
con
tam
inat
ed
filte
rs.
Filt
ers
shal
l be
as
clos
e to
the
hoo
d as
pra
ctic
al
to
min
imiz

e
duc
t
con
tam
inat
ion.

(3)

Fu
me
hoo
ds
inte
nde
d
for
use
wit
h
radi
oact
ive
isot
ope
s
shal
l be
con
stru
cted
of
stai
nles
s
stee
l or
othe
r
mat
eria
l
suit
able
for
the
part
icul
ar
exp
osur
e
and
shal
l
com
ply
wit

h
NFP
A
801,
Faci
litie
s
for
Han
dlin
g
Rad
ioac
tive
Mat
erial
s.
Not
e:
Rad
ioac
tive
isot
ope
s
use
d
for
inje
ctio
ns,
etc.,
with
out
pro
babi
lity
of
airb
orne
particul
ates
or
gase
s
may
be
proc
esse
d in
a

c
l
e
a
n
w
o
r
k
b
e
n
c
h
t
y
p
e
h
o
o
d
w
h
e
r
e
a
c
c
e
p
t
a
b
l
e
t
o
t
h
e
N
u
c
l
e
a

r
R
e
g
u
l
a
t
o
r
y
C
o
m
m
i
s
s
i
o
n
.
10.2.5
HVAC
Filters
10.2.5.1 Filter
efficiencies

(1)

All central
ventilatio
n or air
conditioni
ng
systems
shall be
equipped
with
filters
with
efficiencie
s equal to,
or greater
than,
those
specified
in Table
2.1-3.

(2) Noncent
ral airhandling
systems
shall be
equippe
d with

permane
nt
(cleanab
le) or
replaceable
filters
with a
minimu
m
efficienc
y of
MERV
3 (68
percent
weight
arrestan
ce).

(3) Fi
lt
er
ef
fi
ci
e
n
ci
es
,
te
st
e
d
in
a
c
c
or
d
a
n
c
e
w
it
h
A
S
H
R
A
E
5
2.
1,
s
h
al
l
b
e

a
v
er
a
g
e.

10.2.5.2
Filter bed
location.
Where two
filter beds
are
required,
filter bed
no. 1 shall
be located
upstream of
the air
conditionin
g
equipment
and filter
bed no. 2
shall be
downstream
of any fan
or blowers.

10.2.5.3
Filter
frames.
Filter frames
shall be
durable and
proportioned
to provide an
airtight fit
with the
enclosing
ductwork.
All joints
between
filter
segments
and
enclosing
ductwork
shall have
gaskets or
seals to
provide a
positive seal
against air
leakage.

10.2.5.4
Filter

housing
blank-off
panels.
Filter
housing
blank-off
panels shall
be
permanently
attached to
the frame,
constructed
of rigid
materials,
and have
sealing
surfaces
equal to or
greater than
the filter
media
installed in
the filter
frame.

10.2.5.5
Filter
manometers
.A
manometer
shall be
installed
across each
filter bed
having a
required
effi-ciency
of 75
percent or
more,
including
hoods
requir-ing
HEPA
filters.
Provisions
shall be
made to
allow access
to the
manometer
for field
testing.

10.2.6
Steam and
Hot Water
Systems

See Section
1.6-2.2.3.

10.3.1
General

10.3
Electrical
Systems

124

(1)

All
electric
al
materi
al and
equip
ment,
includi
ng
conduc
tors,
control
s, and
signali
ng
device
s, shall
be
installe
d in
compli
ance
with
applica
ble
sections
of
NFPA
70 and
NFPA
99.

10.3.1.1
Applicable
standards
2006
Guidelin
es for
Design

and
Construction of
Health Care
Facilities

availabl
e
standard
s of
listing
agencies
or other
similar
establish
ed
standard
s where
such
standard
s are
required
.

(3)

Field
labeling
of
equipmen
t and
materials
shall be
permitted
only
when
provided
by a
nationally
recognized
testing
laboratory
that has
been
certified

(2) All
electrica
l
material
and
equipme
nt shall
be listed
as
complyi
ng with

by the
Occupatio
nal Safety
and
Health
Administr
ation
(OSHA)
for that
reference
d

standard.

10.3.1.2
Testing and
documentatio
n. The
electrical
installations,
including
alarm, nurse
call, and
communication
systems, shall
be tested to
demonstrate
that
equipment
installation
and operation
is appropriate
and
functional. A
written
record of
performance
tests on
special
electrical
systems and
equipment
shall show
compliance
with
applicable
codes and
standards.

1
0
.
3
.
2
E
l
e
c
t
r
i
c
a
l
R
e
q

u
i
r
e
m
e
n
t
s
f
o
r
S
p
e
c
i
f
i
c
H
o
s
p
i
t
a
l
L
o
c
a
t
i
o
n
s
10.3.2.1
Inhalation
anesthetizing
locations. At
inhala-tion
anesthetizing
locations, all
electrical
equipment
and devices,
receptacles,
and wiring
shall comply
with
applicable
sections of
NFPA 99
and NFPA
70.

onl
y.

10.3.3 Ele

ctrica
l
Distri
butio
n and
Trans
missi
on

(2) S
wi
tch
bo
ar
ds
sh
all
be
co
nv
eni
ent
for
us
e,
rea
dil
y
ac
ce
ssi
ble
for
ma
int
en
an
ce,
an
d
aw
ay
fro
m
tra
ffi
c
lan
es.

10.3.3.1
Switchboards

(1) Locatio
n

(1) Mai
n
swi
tch
boa
rds
shal
l be
loc
ate
d in
an
are
a
sep
arat
e
fro
m
plu
mbi
ng
and
me
cha
nic
al
equ
ipm
ent
and
shal
l be
acc
essi
ble
to
aut
hor
ize
d
per
son
s

(3)

Sw
itc
hb
oar
ds
sha
ll
be
loc
ate
d
in
a
dry
,

ve
ntilat
ed
spa
ce
fre
e
of
cor
ros
ive
or
ex
plo
siv
e
fu
me
s,
gas
es,
or
an
y
fla
m
ma
ble
ma
teri
al.

2.1 GEN
E RAL H O
S P I TA L S

(2)

Overl
oad
protec
tive
device
s.
These
shall
operat
e
proper
ly in
ambie
nt
room
tempe
rature
s.

10.3.3.2
Panelboards

(1)

Panel
board
s
servin
g
critic
al
branc
h,
equip
ment
syste
m, or
norm
al
syste
m
loads
shall
be
locate
d on
the
same
floor
as the
loads
to be
serve

d.

A 70.

(2) Locatio

(2) When

n of
panelbo
ards
serving
life
safety
branch
loads
on the
floor
above
or the
floor
below
the
loads to
be
served
shall be
permitte
d.

groun
dfault
circuit
interr
upters
are
used
in
critica
l
areas,
provis
ions
shall
be
made
to
ensur
e that
other
essent
ial
equip
ment
is not
affect
ed by
activa
tion
of one
interr
upter.

(3) New
pane
lboar
ds
shall
not
be
locat
ed in
publi
c
acce
ss
corri
dors.
10.3.3.3
Ground-fault
circuit
interrupters

(1) Grou
ndfault
circu
it
interr
upter
s
(GF
CIs)
shall
comp
ly
with
NFP

10.3.4
Power
Generating
and Storing
Equipment
10.3.4.1
Emergency
electrical
service

(1)

Emerge
ncy
power
shall be
provide
d for in
accordance
with
NFPA
99,
NFPA
101,

and
NFPA
110.

(2)

Where
stored
fuel

is

r
e
a
d
i
n
g

required,
storage
capacity
shall
permit
continuou
s
operation
for

at

least

24

hours.

10.3.5
Lighting

10.3.5.1
General. See
Secti
on
1.62.3.1
.1.

10.3.5.2
Lighting for
speci
fic
locat
ions
in
the
hosp
ital

(1) Patie
nt
room
s.
Patie
nt
room
s
shall
have
gener
al
lighti
ng
and
night
lighti
ng.

(1) A

l
i
g
h
t
s
h
a
l
l
b
e
p
r
o
v
i
d
e
d
f
o
r
e
a
c
h
p
a
t
i
e
n
t
.

(1) Re
adi
ng
lig
ht
con
trol
s
sha
ll

be
acc
ess
ibl
e
to
the
pat
ien
t(s)
wit
ho
ut

the
pat
ien
t
hav
ing
to
get
out
of
bed
.
es for ction of Health
Design Care Facilities
and
Constru

125

2006
Guidelin

2.1 GEN
E R AL H O
S P I TA L S

(2) In
ca
nd
es
ce
nt
an
d
ha
lo
ge
n
lig
ht
so
ur
ce
s
th
at
pr
od
uc
e
he
at
sh
all
be
av
oi
de
d
to
pr
ev
en

t
bu
rn
s
to
th
e
pa
tie
nt
an
d/
or
be
d
lin
en.

(3) Un
les
s
spe
cifi
cal
ly
des
ign
ed
to
pro
tec
t
the
spa
ce
bel
ow
,
the
lig
ht
sou
rce
sha

ll
e
d
t
o
p
r
e
v
e
n
t
t
h
e
l
a
m
p
f
r
o
m

ll
be
co
ver
ed
by
a
dif
fus
er
or
len
s.

(4) F
l
e
x
i
b
l
e
li
g
h
t
a
r
m
s
,
if
u
s
e
d
,
s
h
a
ll
b
e
m
e
c
h
a
n
i
c
a
ll
y
c
o
n
tr
o

c
o
n
t
a
c
ti
n
g
t
h
e
b
e
d
li
n
e
n
.

(2)

At
leas
t
one
nig
ht
ligh
t
fixt
ure
in
eac
h
pati

ent
roo
m
shal
l be
con
troll
ed
at
the
roo
m
entr
anc
e.

(3) Li
ght
ing
for
cor
on
ary
an
d
int
en
siv
e
car
e
be
d
are
as
sh
all
per
mi
t
sta
ff
ob
ser
vat
ion
of
the
pat
ien
t
wh
ile
mi
ni
mi
zin
g
gla
re.

(2) Nursing
unit
corridor
s.
Corridor
s in
nursing
units
shall
have
general
illumina
tion with
provisio
ns for
reducing
light
levels at
night.

(3) Exa
m/tr
eat
men
t/tra
uma
roo
ms.
A
port
able
or
fixe
d
exa
min
atio
n
light
shall
be
prov
ided
for
exa
min
atio
n,
treat
men
t,
and
trau
ma
roo
ms.

(4) Operatin

g and
delivery
rooms.
Operatin
g and
delivery
rooms
shall
have
general
lighting
in addition to
special
lighting
units
provide
d at
surgical
and
obstetric
al
tables.
General
lighting
and
special
lighting
shall be
on
separate
circuits.

(1)

Eme
rgen
cy
light
ing.
See
Secti
on
1.62.3.1
.2.

(2)

Exit
signs
. See
Secti
on
1.62.3.1
.3.

10.3.6
Equipment
10.3.6.1 Xray
equipment

APPEN
DIX
A10.3.6.2
Special
attention
should

be

paid

to

safety
hazards
associated
with
equipment
cabling.
Every
attempt
should

be

made

to

minimize
these
hazards,
where
practical.

A10.3.6.
3 Refer
to NFPA
99 for a
descripti
on of the
essential
electrical
system.

(1)

(2)

Fixed
and
mobile
x-ray
equipme
nt
installati
ons shall
conform
to
articles
517 and
660 of
NFPA
70.
The xray film
illuminat
or unit
or units
for displaying
at least
two
films
simultan
eously
shall be
installed
in each
operatin
g room,
specified
emergency
treatmen
t rooms,
and xray
viewing
room of
the
radiolog
y
departm
ent. All
illuminat
or units
within
one
space or
room
shall

have
lighting
of
uniform
intensity
and
color
value.
*10.3.6.2
Special
electrical
equipment.
Special
equip-ment is
identified in
the sections
on critical
care units,
newborn
nurseries,
pediatric and
adolescent
unit, psychiatric
nursing unit,
obstetrical
suite, surgical
suites,
emergency
service,
imaging suite,
nuclear
medicine,
laboratory
suite,
rehabilitation
therapy
department,
renal dialysis
unit,
respiratory
therapy
service,
morgue,
pharmacy,
dietary
facilities,
administrativ
e and public
areas,
medical
records,
central
services,
general
stores, and
linen

services.
These
sections shall
be consulted
to ensure
compatibility
between
programmatic
ally defined
equipment
needs and
appropriate
power and
other
electrical
connection
needs.
*10.3.6.3
Handwashing
stations and
scrub sinks.
If operation
of a scrub
sink or a
handwashing
station in
critical care
areas,
emergency
departments,
labor and
delivery, and
surgical
suites is
dependent on
the build-ing
electrical
service, it
shall be
connected to
the essential
electrical
system.

10.3.7
Receptacle
s
10.3.7.1
Receptacles
in corridors

(1) Duplexgrounde
d
receptac

les for
general
use
shall be
installed
approxi
mately
50 feet
(15.24
meters)
apart in
all
corridor
s and
within
25 feet
(7.62
meters)
of
corridor
ends.

(2)

Rece
ptacl
es in
pedia
tric
and
psyc
hiatri
c
unit
corri
dors
shall
be of
the
tamp
erresist
ant
type.

(3)

Speci
al
recept
acles
marke
d for
x-ray
use
shall
be
install
ed in
corrid
ors of
patien
t

areas
so
that
mobile
equipm
ent
may be
used
anywhe
re
within
a
patient
room
using a
cord

126

areas,
receptac
les for
x-ray
use shall
permit
the use
of one
plug in
all
location
s. Where
capaciti
ve
discharg
e or
batterypowered
x-ray
units are
used,
special
x-ray
receptac
les are
not
required.
10.3.7.2
Receptacles
in patient care
areas

(1) Pa

length
of 50
feet
(15.24
meters)
or less.
If the
same
mobile
x-ray
unit is
used in
operati
ng
rooms
and in
nursing
2006
Guidelin
es for
Design

and
Construction of
Health Care
Facilities

tie
nt
ro
o
ms
.
Ea
ch
pa
tie
nt
ro
o
m
sh
all
ha
ve
du
pl
ex
gr
ou
nd
ed
re
ce
pt
acl
es.

(1) T
he
re
sh
all
be
on
e
at

ea
ch
si
de
of
th
e
he
ad
of
ea
ch
be
d;
on
e
fo
r
tel
ev
isi
on
,
if
us
ed
;
on
e
on
ev
er
y
ot
he
r
w
all
;
an
d
on
e
fo
r
ea
ch
m
ot
or
iz
ed
be
d.

(2)

Rec
ept
acl
es

ma
y
be
omi
tted
fro
m
ext
erio
r
wal
ls
wh
ere
con
stru
ctio
n
or
roo
m
con
fig
ura
tion
ma
kes
inst
alla
tion
imp
ract
ical
.

(2) Interme
diate
care
rooms.
These
shall
have at
least
four
duplex
outlets
per
bed.
The
outlets
shall be
arrange
d to
provide
two
duplex
outlets
on each

side of
the
head of
the bed.

(4)

Nurs
eries.
Nurs
eries
shall
have
at
least
two
duple
xgrou
nded
recep
tacles
for
each
bassi
net.

(5)

LDRP

(3) Critical
care
areas.
As
defined
by
NFPA
99 and
NFPA
70,
includin
g
pediatric
and
newborn
intensive
care
units,
critical
care
areas
shall
have at
least
seven
duplex
outlets
at the
head of
each
bed,
crib, or
bassinet.
Approxi
mately
50
percent
of
critical
care
outlets
shall be
connect
ed to
emergen
cy system
power
and be
so
labeled.

rooms.
LDRP
rooms
shall have
receptacle
s as
required
for patient
rooms
(Section
2.110.3.7.2
(1)); in
addition,
the
bassinet
shall have
receptacle
s as
required
for
nursery
bassinets
(Section
2.110.3.7.2
(4)).

(6) Trauma
and
resuscit
ation
rooms.
These
shall
have
eight

duplex
outlets
located
conveni
ent to
the head
of each
bed.

(7)

Emergen
cy
departm
ent.
Examina
tion and
treatment
rooms in
the
emergen
cy
departm
ent shall
have a
minimu
m of six
duplex
outlets
located
convenie
nt to the
head of
each
bed.
Approxi
mately
50
percent
of
emergen
cy care
outlets
shall be

2.1 GEN
E RAL H O
S P I TA L S

connec
ted to
emerg
ency
system
power
and be
so
labeled
.

(8) Each
general
care
examin
ation
and
treatme
nt table
and
each
work
table
shall
have
access
to two
duplex
recepta
cles.

(9) Operatin
g
and
delivery
rooms

(1) Eac
h
ope
rati
ng
and
deli
ver
y
roo
m
sha
ll
hav
e at
lea
st

ent
req
uiring
spe
cial
ele
ctri
cal
con
fig
urat
ion
s is
use
d,
add
itio
nal
rec
ept
acl
es
dist
inct
ivel
y
mar
ked
for
xray
or
lase
r
use
sha
ll
be
pro
vid
ed.

six
rec
ept
acl
es
con
ven
ient
to
the
hea
d
of
the
pro
ced
ure
tabl
e.

(2)

Eac
h
ope
rati
ng
roo
m
sha
ll
hav
e at
leas
t 16
sim
ple
x
or
eig
ht
dup
lex
rec
ept
acl
es.
Wh
ere
mo
bile
xray,
lase
r,
or
oth
er
equ
ipm

(10)

Ren
al
dialysis
units

(1) F
or
re
na
l
di
al
ys
is
un

its
,
tw
o
du
pl
ex
re
ce
pt
acl
es
sh
all
be
on
ea
ch
si
de
of
a
pa
tie
nt
be
d
or
lo
un
ge
ch
ai
r.

nn
ec
te
d
to
e
m
er
ge
nc
y
po
w
er.
10.3.7.3
Emergency
system
receptacles.
Electrical
receptacle
cover plates or
electrical
receptacles
supplied from
the emergency
systems shall
be distinctively
colored or
marked for
identification.
If color is used
for
identification
purposes, the

(2)

O
ne
du
pl
ex
re
ce
pt
ac
le
on
ea
ch
si
de
of
th
e
be
d
sh
all
be
co

same color
shall be used
throughout the
facility.

10.3.8 Call
Systems

10.3.8.1
General.
Alternate
technologie
s shall be
per-mitted
for
emergency
or nurse
call
systems. If
radio
frequency
systems are
utilized,
consideratio

n shall be
given to
electromag
netic
compatibilit
y between
inter-nal
and
external
sources.

10.3.8.2
Patient
room call
station. In
patient
areas, each
patient
room shall
be served
by at least
one calling station

for twoway voice

communica
tion.

(1) Each
bed
shall be
provide
d with a
call
device.
Two
call
devices
serving
adjacent
beds
may be
served
by one
calling
station.
es for
tion of Health
Design Care Facilities
and
Construc

127

2006
Guidelin

2.1 GEN
E R AL H O
S P I TA L S

(2) Signal
location

(1) Cal
ls
shal
l
acti
vat
ea
visi
ble
sig
nal
in
the
corrido
r at
the
pati
ent
s
doo
r, in
the

clea
n
wor
kroo
m,
in
the
soil
ed
wor
kro
om,
in
me
dic
atio
n,
cha
rtin
g,
clea
n
line
n
stor
age,
nou
rish
me
nt,
equ
ipm

ent
stor
age
,
and
exa
min
atio
n/tr
eatme
nt
roo
m(s
)
and
at
the
nur
sin
g
stat
ion
of
the
nur
sin
g
unit
.

(2) I
n
m
u
lt
ic
o
r
ri
d
o
r
n
u
r
s
i
n
g
u
n
it
s
,
a
d
d

it
i
o
n
a
l
v
i
s
i
b
l
e
s
i
g
n
a
l
s
s
h
a
ll
b
e
i
n
s
t
a
ll
e
d
a
t
c
o
r
ri
d
o
r
i
n
t
e
r
s
e
c
ti
o
n
s.

(3) In
roo
ms
con

tain
ing
two
or
mo
re
call
ing
statio
ns,
ind
icat
ing
lig
hts
sha
ll
be
pro
vid
ed
at
eac
h
stat
ion.

(3)

Nurse
call
system
s at
each
calling
station
shall be
equipp
ed with
an
indicati
ng light
that
remain
s
lighted
as long
as the
voice
circuit
is
operati
ng.

10.3.8.3
Emergency
call system

(1) The
emergen

cy call
shall be
designed
so that a
sig-nal
activate
d at a
patients
call
station
will
initiate a
visible
and
audible
signal
that can
be
turned
off only
at the
patient
call
station
and that
is
distinct
from the
regular
nurse
call
signal.

(2)

The
emerge
ncy
call
shall
activate
an
annunc
iator
panel
at the
nurse
station,
a
visible
signal
in the
corrido
r at the
patient
s door,
and at
other
areas
defined

by the
functio
nal
progra
m.

(3) Specific
location
s in the
hospital

(1) Pa
tie
nt
toi
let
an
d
bat
hi
ng
fac
ilit
ies
.A
nu
rse
em
er
ge
nc
y
cal
l
sy
ste
m
sh
all
be
pr
ov
ide
d
at
ea
ch
in
pat
ien
t
toi
let
,
bat
h,
sit
z

bat
h,
an
d
sh
ow
er
ro
o
m.
A
nu
rse
em
erg
en
cy
cal
l
sh
all
be
ac
ce
ssi
ble
to
a
col
lap
se
d
pat
ien
t
lyi
ng
on
the
flo
or.
In
clu
sio
n
of
a
pu
ll
co
rd
wi
ll
sat
isf
y
thi
s

sta
nd
ar
d.

(2) Ou
tpa
tie
nt
an
d
tre
at
me
nt
are
as.
Pr
ovi
sio
ns
for
em
erg
en
cy
cal
ls
sha
ll
be
pro
vid
ed
in
out
pat
ien
t
an
d
tre
at
me
nt
are
as
wh
ere
pat
ien
ts
ma
y
be
su
bje
ct

to
inc
ap
aci
tati
on.

ved
by
an
em
erg
enc
y
call
.
The
call
shal
l
acti
vat
ea
sig
nal
at
the
nur
ses
stat
ion.

(3) Ima
gin
g
suit
e.
Pati
ent
toil
et
roo
ms
wit
hin
the
ima
gin
g
suit
e
shal
l be
equ
ipp
ed
wit
h a
nur
se
em
erg
enc
y
call
.

(4) Ren
al
dial
ysis
unit
s.
Toil
et
roo
ms
in
ren
al
dial
ysis
unit
s
shal
l be
ser

10.3.8.4
Limited call
system. In
areas such
as critical
care,
recovery,
pre-op, and
emergency,
where
patients are
under
constant
visual
surveillance
, the nurse
call may be
limited to
the
following:

(1)

A
bedside
button
or
station
that
activate
sa
signal
readily
seen at
the

control
station
to
summo
n
addition
al
assistan
ce (see
Section
2.110.3.8.5
)

(2) An
emerge
ncy
code
resuscit
ation
alarm to
summo
n
medical
assistan
ce from
the
code
team

10.3.8.5 Staff
emergency
assistance
system

(1)

Location
of call
system.
An
emergen
cy
assistanc
e system
for staff
to
summon
addition
al
assistanc
e shall
be
provided
in each
operatin
g,
delivery,
recovery,
emergen

cy
examinat
ion,
treatmen
t, and
intermed
iate care
area, and
in
critical
care
units,
nurseries
, special
procedur
e rooms,
cardiac
catheteri
zation
rooms,
stresstest
areas,
triage,
outpatien
t surgery,
admissio
n and
discharg
e areas,
and areas
for
psychiatr
ic
patients,
includin
g seclusion and
security
rooms,
anteroo
ms and
toilet
rooms
serving
them,
commun
al toilet
and
bathing
facility
rooms,
and
dining,
activity,
therapy,
exam,
and

treatmen
t rooms.

(2)

Location
of
annuncia
tor. This
system
shall
annuncia
te
visibly
and
audibly
in the
clean
workroom, in
the
soiled
workroo
m, in
medicati
on,
charting,
clean
linen
storage,
nourish
ment,
equipment
storage,
and
examina
tion/treat
ment
room(s)
if
provided

128

2006
Guidelin

10.3.8.7
Alarm in
psychiatric
units. A
nurse call is
not required
in
psychiatric
nursing
units, but if

, and at
the
nursing
station
of the
nursing
unit,
with
backup
to
another
staffed
area
from
which
assistanc
e can be
summon
ed.

10.3.8.6
Emergency
resuscitation
alarm. In
critical care
units,
recovery, and
pre-op, the
call system
shall include
provisions for
an emergency
code
resuscitation
alarm to
summon
assistance
from outside
the unit.
es for Construction of
Design Health Care
and
Facilities

one is
included the
following
shall apply:

(1) Provis
ions
shall
be
made
for
easy
remov
al or
for
coveri

ng of
call
button
outlets
.

(2) In
psyc
hiatr
ic
nursi
ng
units
, all
hard
ware
shall
have
tamp
erresis
tant
faste
ners.
10.4
Telecommun
ications and
Information
Systems

10.4.1

Lo
cations for
terminating
telecommun
ications and
information
system
devices
shall
be
provided.

10.4.2 A
room shall
be provided
for central
equipment
locations.
Special air
conditioning
and voltage
regula-tion
shall be
provided
when
recommende
d by the
manufacturer
.

10.4.3 A
ll patient
carerelated
telecomm
unication
s
and
informati
on
systems
shall be
powered
from the
essential
electrical
system.

10.5
Electronic
Safety and
Security
10.5.1
Electronic
Surveillanc
e Systems
Electronic
surveillance
systems
include but
are not limited to patient
elopement
systems, door
access/contro
l systems,
video/audio
monitoring
systems,
patient location systems,
and infant
abduction
prevention
systems.

10.5.1.1
Electronic
surveillance
systems are
not required,
but if
provided for
the safety of
the patients,
any devices
in patient
areas need to

be mounted
so they are
unobtrusive
and in a
tamperresistant
enclosure.

10.5.1.
2
E
lectronic
surveilla
nce
system
monitori
ng
devices
need to
be
located
so they
are not
readily
observab
le by the
general
public or
patients.

10.5.1.3
If installed,
electronic
surveillance
systems shall
receive power

2.1 GEN
E RAL H O
S P I TA L S

Table 2.1-1
Sound
Transmission
Limitations in
General
Hospitals

Airborne sound
transmission class
(STC)1

Partitions

New construction2
Patient room to patient room
Public space to patient room
Service areas to patient room
Patient room access corrido
Exam room to exam room
Exam room to public space
Toilet room to public space
Consultation rooms/conference roo
to public space
Consultation rooms/conference roo
to patient rooms
Staff lounges to patient room

Existing construction2
Patient room to patient room
Public space to patient room
Service areas to patient room

from the
emergency
electrical
system in the
event of a
disruption of
normal
electrical
power.

11

Soun

d transmission
class (STC)
shall be
determined by
tests in accordance with
methods set

10.5.2 Fire
Alarm
System

forth in ASTM

All health care

parti-tions do not

facilities shall

extend to the

be provided

structure above,

with a fire

sound

alarm system

transmission

in accordance

through ceilings

with NFPA

and composite

101 and NFPA

STC

72.

performance

E90 and ASTM

E413. Where

must be
considered.
2

Treatment
rooms shall be
treated the
same as patient
rooms.

13
blic

Pu
space
includes
corridors
(except patient
room access
corridors),
lobbies, dining
rooms,
recreation
rooms,
and
similar space.

14
Servi
ce 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.

15
ient

Pat
room
access
corridors
contain
composite
walls
with
doors/windows and have
direct access
to
patient
rooms.

2006
Construction of
Guidelin Health Care
es for
Facilities
Design
and

129

2 . 1 G E N E R A L H O S P I TA L S

Table 2.1-2
Ventilation Requirements for Areas Affecting Patient Care in Hospitals and Outpatient Facilities1

Area designation

Air movement
relationship
to adjacent
area2

NURSING UNITS
Patient room

Toilet room
In
Newborn nursery suite

Protective environment room11

Out
Airborne infection isolation room11
In
Isolation alcove or anteroom
In/Out
Patient corridor

OBSTETRICAL FACILITIES
Delivery room13
Labor/delivery/recovery

Out

Labor/delivery/recovery/postpartum
EMERGENCY, SURGERY, AND CRITICAL CARE
Operating/surgical cystoscopic rooms11, 13 Out
Recovery room13

Critical and intensive care

Intermediate care

Newborn intensive care

Treatment room15

Trauma room15
Out
Bronchoscopy11
In
Triage
In
ER waiting rooms
In
Procedure room
Out
Laser eye room
Out
X-ray (surgical/critical care and
catheterization)
Out
Anesthesia gas storage
In
SUPPORT AREAS
Medication room
Clean workroom or clean holding
Soiled workroom or soiled holding
DIAGNOSTIC AND TREATMENT AREAS
Examination room
Treatment room
Physical therapy and hydrotherapy
Gastrointestinal endoscopy room
Endoscopic instrument processing room17
Imaging18
X-ray (diagnostic & treatment)
Darkroom
Imaging waiting rooms
Laboratory19
General18
Biochemistry18
Cytology
Glass washing

Minimum
Minimum
air changes
total air
of outdoor changes per
air per hour3
hour4, 5

610

70-75 (2124)

30-60

72-78 (22-26)
75 (24)
75 (24)

Yes

No
No
No
No

No

30-60

610

68-73 (2023)
70-75 (2124)

610

70-75 (2124)

3
2
2
2
2

15
6
6

No
No
No

30-60
30-60
30-60

3
2
2
2
3
3
3

15

610

6
6
15
12
12
12
15
15

4
4
10

6
6
6
6
10

In

In
In
In

Design
temperature9
(degrees F/C)

3
2

Out
Out
In

Relative
humidity8
(%)

2
2
2

15
8

In
In

Recirculated
by means of
room units7

10
6
12
12
10
2

In

All air
exhausted
directly to
outdoors6

Yes

Yes12

No
No

30-60
30-60

68-73 (2023)14
70-75 (21-24)
70-75 (2124)
70-75 (2124)
72-78 (22-26)
75 (24)
70-75 (2124)
68-73 (2023)
70-75 (21-24)
70-75 (21-24)
70-75 (21-24)
70-75 (21-24)

No

Yes

Yes16
Yes12, 16

30-60

No
No

30-60
30-60

No

30-60

70-75 (2124)

Yes

Yes

No

No
No

30-60

75 (24)
75 (24)
75 (24)
68-73 (2023)

75 (24)

Yes

Yes

No

6
10
12

Yes12, 16

6
6
6
10

Yes
Yes
Yes

No
No

130

70-75 (21-24)
75 (24)
75 (24)
75 (24)

2006 Guidelines for Design and

Construction of Health Care Facilities

2 . 1 G E N E R A L H O S P I TA L S

Table 2.1-2 (continued)

Ventilation Requirements for Areas Affecting Patient Care in Hospitals and Outpatient Facilities1

Area designation
Histology
Microbiology18
Nuclear medicine
Pathology
Serology
Sterilizing
Autopsy room11
Nonrefrigerated body-holding room
SERVICE AREAS
Pharmacy
Food preparation center
Warewashing
Dietary day storage
Laundry, general
Soiled linen (sorting and storage)
Clean linen storage
Soiled linen and trash chute room
Bedpan room
Bathroom
Housekeeping room
STERILIZING AND SUPPLY
ETO-sterilizer room
Sterilizer equipment room
Central medical and surgical supply
Soiled or decontamination room
Clean workroom
Sterile storage

Air movement
relationship
to adjacent
area2

Minimum
Minimum
air changes
total air
of outdoor changes per
air per hour3
hour4, 5

All air
exhausted
directly to
outdoors6

In
In
In
In
In
In
In
In

6
6
6
6
6
10
12
10

Yes

Out

4
10
10
2
10
10
2
10
10
10
10

In
Out
In
In
In
In

In
In

In
Out
Out

In
In

Recirculated
by means of
room units7

Relative
humidity8
(%)

Design
temperature9
(degrees F/C)

No
No
No
No
No

75 (24)
75 (24)
75 (24)
75 (24)
75 (24)

Yes
Yes
Yes
Yes
Yes

No

Yes
Yes

Yes

No

10
10

Yes
Yes

No

30-60

75 (24)

6
4
4

Yes

No
No

68-73 (2023)
75 (24)

No
No

Yes

Yes
Yes

No

Yes
Yes

No

Distribution

of

Ventilation for Acceptable Indoor Air Quality, and ASHRAE

HandbookHVAC Applications. Specialized patient care areas, including organ

transplant units, burn units, specialty procedure rooms, etc., shall have
additional ventilation provisions for air quality control as may be appropriate.
OSHA standards and/or NIOSH criteria require special ventilation requirements
for employee health and safety within health care facilities.

12
Design of the ventilation system shall provide air movement which is
generally from clean to less clean areas. If any form of variable air volume or
load shed-ding system is used for energy conservation, it must not compromise
the corri-dor-to-room pressure balancing relationships or the minimum air
changes required by the table.

13

exhaust, shall be as required by

good engineering practice. Minimum
outside air quantities shall remain

The ventilation rates in this table cover ventilation for comfort, as well

as for asepsis and odor control in areas of acute care hospitals that directly affect
patient care and are determined based on healthcare facilities being predominantly No Smoking facilities. Where smoking may be allowed, ventilation rates
will need adjustment. Areas where specific ventilation rates are not given in the
table shall be ventilated in accordance with ASHRAE Standard 62,

21

30-60
(Max) 70

75 (24)

the

outside air, added to the system to

balance required

11

70 (21)

23

To satisfy exhaust needs, replacement air from the outside is

necessary. Table 2.1-2 does not attempt to describe specific amounts of outside
air to be sup-plied to individual spaces except for certain areas such as those
listed.

constant while the system is in

operation. In vari-able volume
systems, the minimum outside air
setting on the air-handling unit shall
be calculated using the ASHRAE 62
method.

14
Number of air changes
may be reduced when the room is

unoccupied if provi-sions are made to

ensure that the number of air
changes indicated is reestab-lished
any time the space is being utilized.
Adjustments shall include provisions
so that the direction of air movement
shall remain the same when the
number of air changes is reduced.
Areas not indicated as having
continu-ous directional control may
have ventilation systems shut down
when space is unoccupied and
ventilation is not otherwise needed, if
the maximum infiltra-tion or
exfiltration permitted in Note 2 is not
exceeded and if adjacent pressure
balancing relationships are not
compromised. Air quantity
calculations must account for filter
loading such that the indicated air
change rates are provided up until
the time of filter change-out. The
minimum total air change requirements for Table 2.1-2 shall be based
on the supply air quantity in positive
pressure rooms, and the exhaust air
quantity in negative pressure rooms.

15
Air change
requirements indicated are

minimum values. Higher values

should be used when required to
maintain indicated room
conditions (temperature and
humidity), based on the cooling
load of the space (lights,
equipment, people, exterior walls
and windows, etc.).
2006 Guidelines for Design
and Construction of Health Care Facilities

131

2 . 1 G E N E R A L H O S P I TA L S

Table 2.1-2 (continued)

Ventilation Requirements for Areas Affecting Patient Care in Hospitals and Outpatient Facilities 1
allowances
exhaust (scavenging)
shall be
systems and general
made to
ventilation of the
prevent
areas in which the
16
Air from areas with contamination
respective gases are
nuisance
utilized.
alarms of
and/or odor problems shall be exhausted to the
monitoring
devices.

outside and not recirculated to other areas. Note

that individual circum-stances may require

12

If it is not
practical to
exhaust the
air from the
airborne
infection
isolation room
to the outside,
the air may be
returned
through HEPA
filters to the
air-handling
system
exclusively
serving the
isolation
room.

special consideration for air exhaust to the

outside, e.g., in intensive care units in which
patients with pulmonary infection are treated,
and rooms for burn patients.
*7

Recirculating room HVAC units refers to those

local units that are used prima-rily for heating
and cooling of air, and not disinfection of air.
Because of clean-ing difficulty and potential for
buildup of contamination, recirculating room
units shall not be used in areas marked No.
However, for airborne infection control, air may
be recirculated within individual isolation rooms
if HEPA filters are used. Isolation and intensive
care unit rooms may be ventilated by reheat
induction units in which only the primary air
supplied from a central system passes through

13onal InstituteNati

for
Occupational
Safety and
Health (NIOSH)
Criteria
Documents
regarding
Occupational
Exposure to
Waste
Anesthetic
Gases and
Vapors, and
Control of
Occupational
Exposure to
Nitrous Oxide
indicate a need
for both local

the reheat unit. Gravity-type heating or cooling

units such as radiators or convectors shall not
be used in operating rooms and other spe-cial

APPENDIX

care areas. See footnote A7 (at the bottom of

the page) for a description of recirculation units
to be used in isolation rooms.

18
The ranges listed are the minimum
and maximum limits where control is specifically
needed. The maximum and minimum limits are
not intended to be independent of a spaces
associated temperature. The humidity is
expected to be at the higher end of the range
when the temperature is also at the higher end,
and vice versa. See Figure 2.1-1 for a graphic
representation of the indi-cated changes on a
psychrometric chart. Shaded area is acceptable
range.

A7

Recirculating devices with

HEPA filters may have
potential uses in exist-ing

14

Some surgeons may require

room temperatures that are
outside of the indi-cated range.
All operating room design
conditions shall be developed
in con-sultation with surgeons,
anesthesiologists, and nursing
staff.

15

The term trauma room as used

here is the operating room
space in the emer-gency
department or other trauma
reception area that is used for
emergency surgery. The first aid
room and/or emergency room
used for initial treatment of
accident victims may be
ventilated as noted for the
treatment room. Treatment
rooms used for bronchoscopy
shall be treated as
bronchoscopy rooms. Treatment
rooms used for cryosurgery
procedures with nitrous oxide
shall contain provisions for
exhausting waste gases.

16

In a ventilation system that

recirculates air, HEPA filters
can be used in lieu of
exhausting the air from these
spaces to the outside. In this
application, the return air shall
be passed through the HEPA
filters before it is introduced
into any other spaces.

17

The endoscopic instrument

processing room is a room
adjacent to the gas-trointestinal
endoscopy room that is used for
cleaning endoscopic equipment
and instruments.

18

When required, appropriate

hoods and exhaust devices
for the removal of noxious
gases or chemical vapors
shall be provided (see
Section 2.1-10.2.4.5. (2)
and NFPA 99).

19
The air movement
relationships for laboratories

apply between laboratory and

adjacent non-laboratory spaces.
Reference DHHS publication
Biosafety in Microbiological
and Biomedical Laboratories
(CDC and NIH) on the CDC
Web site.

facilities as interim,
supplemental
environmental controls to
meet requirements for the
control of airborne

19

Where temperature ranges are

indicated, the systems shall be capable of maintaining the rooms at any point within the range
during normal operation. A single figure
indicates a heating or cooling capacity of at
least the indicated tempera-ture. This is usually
applicable when patients may be undressed
and require a warmer environment. Nothing in
these guidelines shall be construed as precluding the use of temperatures lower than those
noted when the

Limitations in design must

be recognized. The
design of either portable
or fixed sys-tems should
prevent stagnation and
short circuiting of airflow.
The sup-ply and exhaust
locations should direct
clean air to areas where
health care workers are
likely to work, across the

29

patients comfort and

medical conditions make lower

tempera-tures
Unoccupied
storage

infectious agents.

infectious source, and

then to

desirable.
areas

rooms

such
shall

as
have

temperatures appropriate for the

function intended.

10room
Total air
changes per
for patient
rooms,
intermediate
care,

labor/delivery/recovery
rooms,
and
labor/delivery/recovery/
postpartum
may
be
reduced
to 4rooms
when
supplemental
heating and/or
cooling
systems
(radiant
heating
and
cooling,
baseboard
heating, etc.) are
used.

*11

Differential pressure shall be a

minimum of 0.01 water gauge
(2.5 Pa). If alarms are installed,

the exhaust, so that

the health care
worker is not in
position between the

infectious source and the exhaust

location. The design of such systems should also allow for easy
access for scheduled preventative
main-tenance and cleaning.

132

A11

The verification of

trail, ball-in-tube, or
flutterstrip. These

airflow direction can

include a simple visual

devices will require a

minimum differential air

method such as smoke

pressure to indicate
airflow direction.

2006

Guidelines for Design Health Care Facilities

and Construction of

2 . 1 G E N E R A L H O S P I TA L S

Table 2.1-4
Hot Water UseGeneral Hospital

Table 2.1-3
Filter Efficiencies for Central
Ventilation and Air Conditioning
Systems in General Hospitals

Area designation

Clinical

Filter bed
No.
no. 1
filter beds (MERV, %)

All areas for inpatient care,

2
8 (30%)
treatment, and diagnosis, and
those areas providing direct
service or clean supplies such as
sterile and clean processing, etc.
Protective environment room

8 (30%)

Laboratories

13 (80%)

Liters per hour per bed1

11.9
Gallons per hour per bed1
3
41-492
Temperature (oC)
105-1202
Temperature (oF)

11

1.

Additional roughing or
prefilters should be considered to
reduce maintenance required for
filters with efficiency higher than 75
percent.

2.

MERV = minimum efficiency

rating value. MERVs are based on
ASHRAE 52.2.

7.2
2
493
1203

Quantities indicated for design demand

of hot water are for general refer-ence minimums

and shall not substitute for accepted engineering
design procedures using actual number and types of
fixtures to be installed.

21

Design will also be affected by

temperatures of cold water used for mix-ing,

length of run and insulation relative to heat loss,
etc. As an example, total quantity of hot water
needed will be less when temperature avail-able
at the outlet is very nearly that of the source tank
and the cold water used for tempering is
relatively warm.

Administrative, bulk storage,

1
8 (30%)
soiled holding areas, food
preparation areas, and laundries

Notes

Dietary

The range represents the maximum and minimum

allowable temperatures.

13

Provisions shall be made to provide 180oF

(82oC) rinse water at ware-washer (may be by separate
booster) unless a chemical rinse is provided.

14

o
o
Provisions
shall
be
made
to
provide
160
Fnot
(71
C)
hot
water
atbe
the
laundry
equipment
when
needed.
(This
may
by
steam
jet
or
separate
booster
heater.)
However,
itwill
is
emphasized
that
this
does
imply
that
all
water
used
would
at
this
temperature.
Water
temperatures
for
acceptable
laundry
results
vary
according
to
type
of
cycle,
time
of
operation,
and
formula
ofbe
soap
and
bleach
as
well
as
type
and
degree
of
soil.
Lower
temperatures
may
be
adequate
forrequired
most
procedures
in
many

facilities, but the higher 160

F (71oC) should be available when needed
for special conditions.
o

3.

The
filtration
efficiency
ratings are based on average dust
spot efficiency per ASHRAE 52.1.

2006 Guidelines for Design and

Construction of Health Care Facilities

133

Laundry
7.6
2
714
1604

2 . 1 G E N E R A L H O S P I TA L S

Table 2.1-5
Station Outlets for Oxygen, Vacuum (Suction), and Medical Air Systems in Hospitals1

Section

Location

2.1-3.1.1
2.1-3.1.3

Patient rooms (medical and surgical)

1/bed
Examination/treatment
1/room
(medical, surgical, and postpartum care)
Airborne infection isolation/protective
1/bed
environment rooms
Seclusion room (medical, surgical,
1/bed
and postpartum)
Intermediate care
2/bed
Critical care (general)
3/bed
Airborne infection isolation
3/bed
Coronary critical care
3/bed
Pediatric critical care
3/bed
Newborn intensive care
3/bassinet
1/4 bassinets2
Newborn nursery (full-term)
Pediatric nursery
1/bassinet
Pediatric and adolescent
1/bed
Psychiatric patient rooms

Seclusion treatment room

General operating room

2/room
Cardio, ortho, neurological
2/room
Orthopedic surgery
2/room
Surgical cysto and endo
1/room
Post-anesthesia care unit
1/bed
Phase II recovery3
1/bed
Anesthesia workroom
1 per workstation
Postpartum bedroom
1/bed
Labor room
1/room
Cesarean/delivery room
2/room
Infant resuscitation space4
1/bassinet
OB recovery room
1/bed
Labor/delivery/recovery (LDR)
1/bed
Labor/delivery/recovery/postpartum (LDRP)
1/bed
Initial emergency management
1/bed
Triage area (definitive emergency care)
1/station
Definitive emergency care exam/treatment rooms
1/bed
Definitive emergency care observation unit
1/bed
Trauma/cardiac room(s)
2/bed
Orthopedic and cast room
1/room
MRI
1/room
Cardiac catheterization lab
2/bed
Autopsy room

2.1-3.2.2/3.2.3
2.1-3.2.4
2.1-3.3
2.1-3.4.2
2.1-3.4.2.2
2.1-3.4.3
2.1-3.4.5
2.1-3.4.6
2.1-3.6.6
2.1-3.6.8
2.1-3.7.1
2.1-3.8.2
2.1-3.8.3
2.1-5.3.2.1
2.1-5.3.2.2
2.1-5.3.2.3
2.1-5.3.2.4
2.1-5.3.3.2
2.1-5.3.3.3
2.1-5.3.5.11
2.1-4.2.1
2.1-4.3.1
2.1-4.3.2/4.3.3
2.1-4.3.4
2.1-4.3.5
2.1-4.4
2.1-4.4
2.1-5.1.2.5
2.1-5.1.3.4
2.1-5.1.3.7 (1)
2.1-5.1.3.8 (2)
2.1-5.1.3.7 (1)
2.1-5.1.3.7 (3)
2.1-5.5.5
2.1-5.4.1
2.1-5.12.2.2

Oxygen

Vacuum

Medical Air

1/bed
1/room

1/bed

1/bed

2/bed
3/bed
3/bed
2/bed
3/bed
3/bassinet
1/4 bassinets2
1/bassinet
1/bed

1/bed
1/bed
1/bed
1/bed
1/bed
3/bassinet
1/4 bassinets2
1/bassinet
1/bed

3/room
3/room
3/room
3/room
3/bed
3/bed

1/bed
1/room
3/room
1/bassinet
3/bed
1/bed
1/bed
1/bed
1/station
1/bed
1/bed
3/bed
1/room
1/room
2/bed
1 per workstation

1/bed

1 per workstation

1/room
1/room
1/bassinet
1/room

1/bed

1/bed

1/room
2/bed

For any area or room not described above, the facility clinical staff shall determine outlet requirements after consultation with the authority having jurisdiction.

Four bassinets may share one outlet that is accessible to each bassinet.

If the Phase II recovery area is a separate area from the PACU, only one vacuum per bed or station shall be required.

14
When infant resuscitation takes place in a room such as cesarean section/delivery or LDRP, then the infant resuscitation services must be
provided in that room in addition to the minimum service required for the mother.

134

2006 Guidelines for Design and

Construction of Health Care Facilities