Section He-P 812.24 - Physical Environment(a) The licensed premises shall be maintained so as to provide for the health, safety, well-being, comfort, and privacy of patients and personnel, including reasonable accommodations for patients and personnel with mobility limitations.(b) The licensed premises shall: (1) Have all emergency entrances and exits accessible at all times;(2) Be maintained in good repair and kept free of hazards to personnel and patients, including but not limited to hazards from falls, burns, or electric shocks;(3) Be free from environmental nuisances, including excessive noise and odors;(4) Keep all corridors free from obstructions; and(5) Take reasonable measures to prevent the presence of rodents, insects, and vermin to include, but not be limited to:a. Having tightly fitting screens on all doors, windows, or other openings to the outside unless the door is self-closing and remains closed when not in use;b. Repairing holes and caulking of pipe channels; andc. Extermination by a pesticide applicator licensed under RSA 430. (c) Equipment providing heat within an ASC including, but not limited to, gas furnace or boiler, oil furnace or boiler, wood furnace or boiler, or pellet furnace or boiler shall: (1) Maintain a temperature of at least 55 degrees Fahrenheit during the day if patient(s) are present; and(2) Be serviced once a year or as recommended by the manufacturer with written documentation of such service retained for at least 4 years.(d) Electric heating systems shall be exempt from (c) (2) above.(e) Portable space heating devices shall be prohibited, unless the following are met: (1) Such devices are used only in employee areas where personnel are present and awake at all times; and(2) The heating elements of such devices do not exceed 212 degrees Fahrenheit.(f) Any heating device other than a central plan shall be designed and installed so that:(1) Combustible material cannot be ignited by the device or its appurtenances;(2) If fuel-fired, such heating devices comply with the following: a. They shall be chimney or vent connected;b. They shall take air for combustion directly from outside; andc. They shall be designed and installed to provide for complete separation of the combustion system from the atmosphere of the occupied area; and(3) Any heating device has safety features to immediately stop the flow of fuel and shut down the equipment in case of either excessive temperatures or ignition failure.(g) Unvented fuel-fired heaters shall not be used in any ASC.(h) Plumbing shall be sized, installed, and maintained in accordance with the state building code under RSA 155-A. (i) Screens shall be provided for doors and windows that are left open to the outside.(j) Doors that are self-closing and remain closed when not in use shall be exempt from the requirement in (i) above.(k) The ASC shall have a telephone to which the patients have access.(l) Toilet and bathing facilities shall be provided to meet patient needs in relation to the number, acuity, and gender of the patients, but no less than one toilet per 8 patient care stations.(m) Separate toilet facilities with hand washing sinks shall be provided for personnel and visitors.(n) All toilets shall be vented out-of-doors.(o) Each bathroom shall be equipped with:(2) Paper towels or a hand-drying device providing heated air; and(3) Hot and cold running water.(p) All showers and tubs shall have slip resistant floors and surfaces which are intact, easily cleanable, and impervious to water.(q) All hand-washing facilities shall be provided with hot and cold running water.(r) All bathroom and closet doors must either swing or slide and have latches or locks which shall be designed for easy opening from the inside and outside in an emergency.(s) The licensee shall comply with all state and local codes and ordinances for: (t) The facility shall be accessible at all times of the year.(u) The licensee shall provide housekeeping and maintenance adequate to protect patients, personnel and the public.(v) Reasonable precautions, such as repair of holes and caulking of pipe channels, shall be taken to prevent the entrance of rodents and vermin.(w) Doors shall be of such width as to permit removal of a patient in a bed and meet the state fire and building codes.(x) Ventilation shall be provided throughout the entire ASC and, whenever necessary, mechanical means such as fans shall be provided to remove excessive heat, moisture, objectionable odors, dust, or explosive or toxic gases.(y) There shall be an emergency generator system to provide emergency power pursuant to the following, as adopted by the commissioner of the department of safety in Saf-C 6000, under RSA 153, and as amended pursuant to RSA 153:5, I by the state fire marshal with the board of fire control:(1) The Electrical Systems chapter of NFPA 99, Health Care Facilities Code; and (2) The Standard for Emergency and Standby Power Systems, NFPA 110. (z) Waste water shall be disposed of through a system which meets the requirements of RSA 485:1-A and Env-Wq 1000. Sink drains which have no connection to sanitary sewers or septic systems and similar methods of disposal above ground shall be strictly prohibited. (aa) Facilities shall provide for prompt cleaning of bedpans, urinals and other utensils.(ab) Any locking mechanism utilized by the facility on egress doors shall comply with the Ambulatory Health Care Occupancy Chapter of NFPA 101 as adopted by the commissioner of the department of safety under Saf-C 6000, under RSA 153, and as amended pursuant to RSA 153:5, I by the state fire marshal with the board of fire control.(ac) The ASC shall maintain a system for sterilization of equipment and supplies as follows: (1) The sterilization system shall be checked for effective sterilization in accordance with the manufacturer's recommendation; and(2) The results of these quality control tests shall be documented. (ad) The ASC shall have a storage room for clean/sterile supplies, including packs, which meets the following requirements: (1) There shall be provisions for ventilation, humidity, and temperature control;(2) Sterile supplies and equipment shall not be mixed with unsterile supplies; and(3) Sterile supplies shall be stored in dustproof and moisture free, labeled containers or cupboards. (ae) Signs shall be provided at all entrances to restricted areas and shall clearly indicate that surgical attire is required.(af) The ASC shall be divided into 3 designated areas, unrestricted, semi-restricted, and restricted, which are defined by the physical activities performed in each area and by the FGI's "Guidelines for Design and Construction of Outpatient Facilities, Chapter 2.7 Requirements for Outpatient Surgery Facilities" (2018 edition), available as noted in Appendix A. (ag) Operating room sizes shall be based on procedures to be performed, including the number of staff required and the amount and size of equipment that will be used. At a minimum operating room sizes shall meet the requirements of the FGI's "Guidelines for the Design and Construction of Outpatient Facilities, Chapter 2.1 Common Elements for Outpatient Facilities and Chapter 2.7 Requirement for Outpatient Surgery Facilities" (2018 edition), available as noted in Appendix A. In addition, at a minimum, the square footage requirements, shall take into account circulation pathways, sterile fields, movable equipment, and anesthesia work area.(ah) Operating rooms shall be located within the restricted corridors of the surgical suite.(ai) Semi-restricted areas shall have ceilings that are smooth and without crevices, scrubbable, non-absorptive, Non-perforated and capable of withstanding cleaning with chemicals. (aj) Restricted areas shall have ceilings that are monolithic. Cracks or perforations in these ceilings shall not be permitted and the central diffusers shall not be considered part of a monolithic ceiling. All access openings in these ceilings shall be gasketed. (ak) If utilizing lay-in ceilings, it shall be gasketed or each ceiling tile shall weigh at least one pound per square foot.(al) A nurse call system shall be required per the FGI's "Guidelines for the Design and Construction of Outpatient Facilities" (2018 edition), available as noted in Appendix A.N.H. Admin. Code § He-P 812.24
Amended by Volume XXXVIII Number 28, Filed July 12, 2018, Proposed by #12557, Effective 6/26/2018, Expires 12/24/2018.Amended by Volume XXXIX Number 50, Filed December 12, 2019, Proposed by #12926, Effective 11/26/2019, Expires 11/26/2029.