Ala. Admin. Code r. 420-5-2-.04

Current through Register Vol. 43, No. 1, October 31, 2024

Section 420-5-2-.04 - Physical Environment

(1) Submission of Plans and Specifications.

(a) Scope. A facility constructed or renovated after the effective date of these rules shall be classified as Ambulatory Health Care Occupancy of the Life Safety Code, and Business Occupancy of the building code, and shall comply with the codes and standards adopted by the State Board of Health.

(b) New Construction, Additions, and Major Alterations. When construction is contemplated, for new buildings, conversions, additions, or major alterations to existing buildings coming within the scope of these Rules, plans and specifications shall be submitted for review and approval to the Alabama Department of Public Health, in accordance with Alabama Administrative Code Rule 420-5-22, "Submission of Plans and Specifications for Health Care Facilities." Facilities shall comply with the requirements for Outpatient Surgical Facilities in the Guidelines for Design and Construction of Hospitals and Health Care Facilities, as adopted by the State Board of Health.

(c) Minor Alterations and Remodeling. Minor alterations and remodeling which do not affect the structural integrity of the building, which do not change functional operation, which do not affect fire safety, and which do not add beds or facilities over those for which the surgical center is licensed need not be submitted for approval.

(d) Inspections. The State Board of Health and its authorized representatives shall have access to the work for inspection wherever it is in preparation of progress.

(2) General.

(a) Location. The ambulatory surgical center shall be located in an attractive setting with sufficient parking space provided, with provisions for meeting the needs of the handicapped.

(b) Local Restrictions. The ambulatory surgical center shall comply with local zoning, building, and fire ordinances.

(c) Structural Soundness. The building shall be structurally sound, free from leaks and excessive moisture, in good repair, and painted at intervals to be reasonably attractive inside and out.

(d) Fire Extinguisher. An all-purpose fire extinguisher shall be provided at each exit and special hazard areas, and located so a person would not have to travel more than 75 feet to reach an extinguisher. Fire extinguisher shall be of a type approved by the local fire department or State Fire Marshal and shall be inspected at least annually. An attached tag shall bear the initials or name of the inspector and date inspected.

(e) Ventilation. The building shall be well ventilated at all times with a comfortable temperature maintained.

(f) Garbage Disposal. Space and facilities shall be provided for the sanitary storage and disposal of waste by incineration, containerization, removal, or by a combination of these techniques. Infectious waste materials shall be rendered noninfectious on the premises by appropriate measures.

(g) Elevators. Multistory facilities shall be equipped with at least one automatic elevator of a size sufficient to carry a patient on a stretcher.

(h) Doors. Minimum width of doors to all rooms needing access for stretchers shall be 3 feet 8 inches wide and doors shall swing into rooms.

(i) Pest Control. The premises must be kept free from rodent and insect infestation.

(j) Corridors. Corridors shall comply with the following:

1. All rooms shall open onto corridor leading to exit.

2. Corridor used by patients shall be as a minimum 6 feet wide.

3. Service corridor may be as a minimum 4 feet wide.

(k) Occupancy. No part of an ambulatory surgical center may be rented, leased or used for any commercial purpose, or for any purpose not necessary or in conjunction with the operation of the center. Food and drink machines may be maintained or a diet kitchen provided.

(l) Lighting. All areas of the center shall have sufficient artificial lighting to prevent accidents and provide proper illumination for all services.

(m) Emergency Lighting. Emergency lighting systems shall be provided to adequately light corridors, operating rooms, exit signs, stairways, and lights on each exit sign on exterior at each exit in case of electrical power failure.

(n) Emergency Power. Emergency generator shall be provided to make equipment operable in case of power failure.

(o) Exits. Each floor of a center shall have two or more exitways remote from each other, leading directly to the outside or to a two hour fire resistive passage to the outside. Exits shall be so located that the maximum distance from any point in a floor area, room or space to an exit doorway shall not exceed 100 feet except that when a sprinkler system is installed the distance of travel shall not exceed 150 feet.

(p) Exit Doors. Exit doors shall meet the following criteria:

1. Shall be no less than 44 inches wide.

2. Shall swing in the direction of exit and shall not obstruct the travel along any required fire exit.

(q) Exit Signs. Exits shall be equipped with approved illuminated signs bearing the word "Exit" in letters at least 4 1/2 inches high. Exit signs shall be placed in corridors and passageways to indicate the direction of exit.

(r) Interior Finish and Decorative Materials. All combustible decorative and acoustical material to include wallpaneling shall be as follows:

1. Materials on wall and ceiling in corridors and rooms occupied by four or more persons shall carry a flame spread rating of 25 or less and a smoke density rating of 450 or less in accordance with ASTM E-84.

2. Rooms occupied by less than four persons shall have a flame spread rating of 75 or less and a smoke density rating of 450 or less in accordance with ASTM E-84.

(s) Floors. All floors in operating and recovery areas shall be smooth resilient tile and be free from cracks and finished so that they can be easily cleaned. All other floors shall be covered with hard tile, resilient tile or carpet or the equivalent. Carpeting is prohibited as floor covering in operating and recovery areas.

(t) Carpet. Carpet assemblies (carpet and/or carpet and pad) shall carry a flame spread rating of 75 or less and a smoke density rating of 450 or less in accordance with ASTM E-84.

(u) Curtains. All draperies and cubicle curtains shall be rendered and maintained flame retardant.

(v) Handicap Facilities. The facility shall be accessible to the physically handicapped and shall comply with ANSI A117.1 "Making Buildings and Facilities Accessible and Usable by the physically Handicapped."

(3) Service Facilities. Facilities licensed prior to July 28, 2004, shall comply with the following.

(a) Admission Office. There shall be a room designated as the admission office where patients may discuss personal matters in private. The admission office may be combined with the business office and medical record room if privacy can be maintained when confidential matters are being discussed. This space shall be separated from the treatment area by walls and partitions.

(b) Waiting Room. A waiting room in the administrative section shall be provided with sufficient seating for the maximum number of persons that may be waiting at any time. Public toilets shall be available.

(c) Storage. A janitor's closet shall be provided in the administrative area and surgical suites.

4. Treatment Facilities. Facilities licensed prior to July 28, 2004, shall comply with the following:

(a) Examining Room. An examining room of sufficient size to have three feet of clearance at the end and sides of the examining table shall be provided. The examining room will contain a desk suitable for writing, a chair, a lavatory or sink for handwashing, instrument table and shelves or other equipment for storage of equipment as needed.

(b) Operating Room. Operating rooms shall be in accordance with current practices of NFPA 99, Health Care Facilities. Walls and ceilings shall have a smooth and washable surface. Size of room shall be as a minimum 12 feet by 12 feet.

(c) Scrub Area. Scrub-up space shall be provided convenient to the operating rooms. As a minimum, the following shall be provided:

1. Scrub sink with knee, elbow or foot controls

2. Soap dispenser

3. Single service towel dispenser

(d) Recovery Room. One or more recovery rooms containing beds for at least half the greatest number of procedures performed in any one day in any month shall be provided. Reclining type vinyl upholstered chairs or recovery stretcher may be substituted in lieu of beds. Other items for the patients' comfort may be provided in the room. Units for oxygen, resuscitation and suction shall be available in the recovery area.

(e) Post-Recovery Observation Rooms. Facilities electing to be permitted to admit patients for periods in excess of twelve hours shall meet the following requirements:

1. Observation rooms shall be so located as to minimize the entrance of odors, noise and other nuisances.

2. Observation rooms shall be directly accessible from the nursing/utility areas provided that accessibility from any public space other than the food service area will be acceptable. In no case shall a patient's room be used for access to another patient's room.

3. Patients' rooms shall contain a minimum of 120 square feet per bed for private room; 80 square feet per bed for rooms with two beds. No room shall house more than two patients. These dimensions shall not be construed as establishing a maximum.

4. There shall be sufficient space to permit nursing procedures and the placing of beds at least three (3) feet apart and two (2) feet from the wall at the side of the bed.

5. Each bed in semiprivate rooms must have ceiling suspended curtains which extend around the bed to provide total visual privacy, in combination with adjacent walls and curtains.

6. Accommodations for each patient shall include:

(i) A separate bed of proper size and height for the convenience of the resident.

(ii) A clean, comfortable mattress.

(iii) Bedding appropriate to the weather and climate.

(iv) Functional furniture appropriate to the patient's needs, and individual closet space in the room with clothes racks and shelves accessible to the resident or to a significant other.

7. Each post-recovery observation room shall be equipped with or located near a toilet. Safety hand grips shall be provided at each toilet, and meet ANSI guideline requirements for grab bars.

8. The nurses' station must be equipped to receive patient calls through a communication system from both observation rooms and the toilet.

9. Provision must be made for storage of sufficient clean linens to accommodate all observation beds.

(f) Clean Workroom. A clean workroom shall be provided sufficient in size to process and store clean and sterile supply materials and equipment and must contain a work counter and sink.

(g) Sterilization. An autoclave must be provided, adequate in size to sterilize the equipment in use.

(h) Soiled Workroom. The soiled workroom shall contain a clinical sink or equivalent flushing rim fixture, handwashing sink, work counter, waste receptacle, and linen receptacle.

(i) Toilets. At least one toilet and lavatory with a soap dispenser and disposable towel dispenser shall be provided for each recovery room. Toilet facilities shall be provided at no less than one toilet facility per ten recovery beds.

(j) Locker Room. Provide nurses and doctors locker/change rooms. The locker rooms shall contain lockers, water closet, lavatory and change area.

(k) Refrigeration. A refrigerator shall be provided with provisions for safeguarding drugs. The refrigerator shall maintain drugs at a temperature of 42 degrees F. + 6 degrees F. A separate refrigerator shall be provided for snacks, juices, etc., which may be required by patients.

(l) Outpatient Surgery Change Area. A separate area shall be provided where outpatients can change from street clothing into hospital gowns and be prepared for surgery. This shall include holding room(s), lockers, toilets separated as to sex, and clothing change or gown area(s).

(m) Medicine Preparation Area. Medicines and drugs shall be prepared for administration in an area which contains a counter and a sink. Where possible this area shall be located in such a manner to prevent contamination of medicines being prepared for administration.

(5) Housekeeping Services.

(a) Personnel. Sufficient personnel are employed to maintain the facility clean and orderly. Primary patient care personnel shall not perform routine decontamination and housekeeping duties during periods in which they are caring for patients.

(b) Techniques. Written procedures outlining techniques to be followed in routine housekeeping and decontamination are developed and followed. Procedure rooms must be cleaned using appropriate disinfectants to assure asepsis between each procedure as approved by the Infection Control Committee.

(6) Soiled Linen/Trash Collection Rooms. Rooms used for the collection or storage of soiled linen or trash, constructed after July 28, 2004, shall have a one hour wall with at least a 45 minute self closing door enclosing the room, separating the room from the rest of the family.

Author: Victor Hunt

Ala. Admin. Code r. 420-5-2-.04

Filed September 1, 1982. Amended: Filed February 20, 1991. Amended: Filed February 20, 1997; effective March 27, 1997. Amended: Filed June 18, 2002; effective July 23, 2002. Amended: Filed June 23, 2004; effective July 28, 2004.

Statutory Authority:Code of Ala. 1975, §§ 22-2-2(6), etseq.; 22-21-28, etseq.