Title 902 | Chapter 020 | Regulation 230
902 KAR 20:230.Comprehensive physical rehabilitation hospital; facility specifications.
Section 1.
Definitions.(1)
"Certificate of need" means an authorization by the Commission for Health Economics Control in Kentucky to proceed to acquire, to establish, to offer, to substantially change the bed capacity, or to substantially change a health service pursuant to KRS Chapter 216B.(2)
"Facility" means a comprehensive physical rehabilitation hospital.(3)
"License" means an authorization issued by the Commission for the purpose of operating a hospital facility.(4)
"Licensure agency" means the Division for Licensing and Regulation in the Office of the Inspector General, Cabinet for Human Resources.Section 2.
Preparation and Approval of Plans and Specifications. After receiving a certificate of need, the following procedures shall be followed:(1)
Before construction is begun for the erection of new buildings or alterations to existing buildings or any change in a facility, the licensee or applicant shall submit plans to the licensure agency for approval.(2)
All architectural, mechanical and electrical drawings shall bear the seal of an architect registered in the Commonwealth of Kentucky or the seal of a professional engineer registered in the Commonwealth of Kentucky, or both.(3)
Drawings shall not exceed thirty-six (36) inches by forty-six (46) inches when trimmed.(4)
All such plans and specifications must be approved by the licensure agency prior to commencement of construction of new buildings or alterations of existing buildings.(5)
Plans and specifications in specific detail as required by the Kentucky Building Code shall be submitted, together with architectural and/or engineering stamps as required by KRS Chapters 322 and 323, to the Department of Housing, Buildings and Construction for determining compliance with the Kentucky Building Code. All such plans and specifications must be approved by the Department of Housing, Buildings and Construction. Appropriate local building permits shall be obtained prior to commencement of construction.Section 3.
Submission of Plans and Specifications for Facilities.(1)
First stage, schematic plans.(a)
Single line drawings of each floor shall show the relationship of the various departments or services to each other and the room arrangement in each department. The name of each room shall be noted. Drawings shall include typical patient room layouts scaled (one-half (1/2) inch = one (1) foot) with dimensions noted. The proposed roads and walks, service and entrance courts, parking and orientation shall be shown in a plot plan.(b)
If the project is an addition, or is otherwise related to existing buildings on the site, plans shall show the existing facilities and general arrangements of those buildings.(2)
Second stage, preliminary plans. Preliminary sketch plans shall include the following:(a)
Architectural.1.
Plans of basement, floors and roof showing space assignment, sizes, and outline of fixed and movable equipment;2.
All elevators and typical sections;3.
Plot plan showing roads, parking, and sidewalks;4.
Areas and bed capacities by floors.(b)
Mechanical.1.
Single line layout of all duct and piping systems;2.
Riser diagrams for multistory construction;3.
Scale layout of boilers and major associated equipment and central heating, cooling, and ventilating units.(c)
Electrical.1.
Plans showing space assignments, sizes and outlines of fixed equipment such as transformers, main switch and switchboards, and generator sets;2.
Simple riser diagram for multistory building construction, showing arrangement of feeders, subfeeders, bus work, load centers, and branch circuit panels.(d)
Outline specifications.1.
General description of the construction, including interior finishes, types and locations of acoustical material, and special floor covering;2.
Description of the air-conditioning, heating, and ventilation systems and their controls; duct and piping systems; and dietary, laundry, sterilizing and other special equipment;3.
General description of electrical service including voltage, number of feeders, and whether feeders are overhead or underground.(3)
Third stage, contract documents.(a)
Working drawings. Working drawings shall be complete and adequate for bid, contract, and construction purposes. Drawings shall be prepared for each of the following branches of the work: architectural, structural, mechanical, and electrical. They shall include the following:1.
Architectural drawings.a.
Approach plan showing all new topography, newly established levels and grades, existing structures on the site (if any), new building structures, roadways, walks, and parking areas;b.
Plan of each basement, floor, and roof;c.
Elevations of each facade;d.
Sections through building;e.
Required scale and full-size details;f.
Schedule of doors, windows, and room finishes;g.
Layout of typical and special rooms indicating all fixed equipment and major items of movable equipment. Equipment not included in contract shall be so indicated;h.
Conveying systems. Details of construction, machine and control spaces necessary, size and type of equipment, and utility requirements for the following: dumbwaiters: electric, hand, hydraulic; elevators: freight, passenger, patient; loading dock devices; pneumatic tube systems.2.
Structural drawings.a.
Plans for foundations, floors, roofs, and all intermediate levels with sizes, sections, and the relative location of the various structural members;b.
Dimensions of special openings;c.
Details of all special connections, assemblies, and expansion joints.3.
Mechanical drawings.a.
Heating, steam piping, and air-conditioning systems. Radiators and steam heated equipment such as sterilizers, warmers, and steam tables; heating and steam mains and branches with pipe sizes; diagram of heating and steam risers with pipe sizes; sizes, types, and capacities of boilers, furnaces, hot water heaters with stokers, oil burners, or gas burners; pumps, tanks, boiler breeching, and piping and boiler room accessories; air-conditioning systems with required equipment, water and refrigerator piping, and ducts; supply and exhaust ventilation systems with heating/cooling connections and piping; air quantities for all room supply and exhaust ventilating duct openings.b.
Plumbing, drainage, and standpipe systems - size and elevation of: street sewer, house drains, street water main, and water service into the building; location and size of soil, waste, and water service with connection to house drains, clean-outs, fixtures, and equipment; size and location of hot, cold and circulating branches, and risers from the service entrance, and tanks; riser diagram for all plumbing stacks with vents, water risers, and fixture connections; gas, oxygen, and vacuum systems; standpipe and sprinkler systems where required; all fixtures and equipment that require water and drain connections.4.
Electrical drawings.a.
Electric service entrance with switches and feeders to the public service feeders, characteristics of the light and power current, transformers and their connections if located in the building;b.
Location of main switchboard, power panels, light panels, and equipment. Diagram of feeders and conduits with schedule of feeder breakers or switches;c.
Light outlets, receptacles, switches, power outlets and circuits;d.
Telephone layout showing service entrance telephone switchboard, strip boxes, telephone outlets and branch conduits;e.
Nurses' call systems with outlets for beds, duty stations, door signal light, annunciators, and wiring diagrams;f.
Emergency electrical system with outlets, transfer switch, sources of supply, feeders, and circuits;g.
All other electrically operated systems and equipment.(b)
Specifications. Specifications shall supplement the drawings to fully describe types, sizes, capacities, workmanship, finishes and other characteristics of all materials and equipment and shall include:1.
Cover or title sheet;2.
Index;3.
Sections describing materials and workmanship in detail for each class of work.(c)
Access to the work. Representatives of the appropriate state agencies shall have access at all reasonable times to the work wherever it is in preparation or progress, and the contractor shall provide proper facilities for such access and inspection.Section 4.
Compliance with Building Codes, Ordinances and Regulations.(1)
This section may be administered independently from other sections of this administrative regulation.(2)
General. Nothing stated herein shall relieve the sponsor from compliance with building codes, ordinances, and regulations which are enforced by city, county, or state jurisdictions.(3)
The following requirements shall apply where applicable and as adopted by the respective agency authority:(a)
Requirements for safety pursuant to 815 KAR 10:020, as amended;(b)
Requirements for plumbing pursuant to 815 KAR 20:010-191, as amended;(c)
Requirements for air contaminants for incinerators pursuant to 401 KAR 59:020 and 401 KAR 61:010;(d)
Requirements for elevators pursuant to 815 KAR 4:010;(e)
Requirements for making buildings and facilities accessible to and usable by the physically handicapped pursuant to KRS 198B.260 and administrative regulations promulgated thereunder.(4)
Prior to occupancy the facility shall have final approval from appropriate agencies.(5)
All facilities shall be currently approved by the Fire Marshal's Office in accordance with the Life Safety Code before relicensure is granted by the licensing agency.Section 5.
Facility Requirements and Special Conditions.(1)
A copy of the narrative program as submitted in the Certificate of Need application for each project shall be provided by the sponsor which describes the functional space requirements, staffing patterns, departmental relationships, and other basic information relating to the fulfillment of the objectives of the facility.(2)
The extent (number and types of rooms) of the diagnostic, clinical, and administrative facilities to be provided shall be determined by the services contemplated and the estimated patient load as described in the narrative program.(3)
Facilities shall be available to the public, staff, and patients who may be physically handicapped with special attention given to ramps, drinking fountain height, and mirrors.Section 6.
Nursing Unit.(1)
Patient rooms. Each patient room shall meet the following requirements:(a)
Maximum room capacity shall be four (4) patients.(b)
Minimum room areas exclusive of toilet rooms, closets, lockers, wardrobes, or vestibules shall be 125 square feet in one (1) bed rooms and 100 square feet per bed in multibed rooms.(c)
Multibed rooms shall be designed to permit no more than two (2) beds side by side parallel to the window wall with not less than a four (4) foot space provided between beds, and at least a three (3) foot space between the side of a bed and the nearest wall, fixed cabinet, or heating/cooling element. A minimum of four (4) feet is required between foot of bed and opposite wall, or foot of the opposite bed in multibed rooms.(d)
Window. All patient rooms must have windows operable without the use of tools and shall have sills not more than three (3) feet above the floor. Window area shall be at least eight (8) percent of patient room floor area.(e)
Nurses' calling system. See Section 34(7) of this administrative regulation.(f)
Lavatory. In single and two (2) bed rooms with private toilet room, the lavatory may be located in the toilet room. Where two (2) patient rooms share a common toilet, a lavatory shall be provided in each patient room.(g)
Wardrobe or closet for each patient. Minimum clear dimensions shall be one (1) foot ten (10) inches by one (1) foot and eight (8) inches with full length hanging space, clothes rod and shelf.(h)
Cubicle curtains, or equivalent built-in devices shall be provided to furnish complete privacy for each patient at any one time in multibed rooms. Design for privacy shall not restrict patient access to the toilet, lavatory, or room entrance.(i)
No patient room shall be located more than 120 feet from the nurses' station, the clean workroom and the soiled workroom. No room shall be used as a patient room where the access is through another patient's room. At least sixty (60) percent of the beds in the nursing unit shall be located in rooms designed for one (1) or two (2) beds.(2)
Service areas in each nursing unit. The size and disposition of each service area will depend on the number of beds and types of disabilities to be served. Although identifiable spaces are required for each of the indicated functions, consideration will be given to multiple-use design solutions which provide equal, though unspecified, areas. Certain service areas may be arranged and located to serve more than one (1) nursing unit, but at least one (1) such service area shall be provided on each nursing floor unless noted otherwise. Service areas shall include:(a)
Administrative center or nurses' station for charting, doctors' charting, communications, and storage for supplies and nurses' personal effects.(b)
Clean workroom or clean holding area. The clean workroom shall contain a work counter, hand-washing and storage facilities. The clean holding room shall be part of a system for storage and distribution of clean and sterile supplies and shall be similar to the clean workroom except that the work counter and hand-washing facilities may be omitted.(c)
Soiled workroom or soiled holding room. The soiled workroom shall contain a clinical sink or equivalent flushing rim fixture, sink equipped for hand washing, work counter, waste receptacle, and linen receptacle. A soiled holding room shall be part of a system for collection and disposal of soiled materials and shall be similar to the soiled workroom except that the clinical sink and work counter may be omitted.(d)
Lounge and toilet room(s) for staff including lockers for storage of personal effects readily accessible. (May serve more than one (1) nursing unit.)(e)
Multipurpose room for conferences, demonstrations and consultation. (May serve more than one (1) nursing unit.)(f)
Medicine area. Provision shall be made for convenient and prompt twenty-four (24) hour distribution of medicine to patients. This may be from a medicine preparation room or unit, a self-contained medicine dispensing unit, or by another approved system. If used, a medicine preparation room or unit shall be under the nursing staff's visual control and a work counter, refrigerator, and locked storage for biologicals and drugs. A medicine dispensing unit may be located at the nurses' station, in the clean workroom, or in an alcove or other space under direct control of the nursing or pharmacy staff. The controlled substances locker must be under double lock. A hand-washing facility shall be provided.(g)
Clean linen storage. There shall be an enclosed storage space for clean linen. This area may be designated within the clean workroom. If a closed cart system is used, storage may be in an alcove.(h)
Nourishment station. This shall contain a sink equipped for hand-washing equipment for serving between scheduled meals, refrigerator, storage cabinets, and ice making-dispenser units to provide patient service and treatment. (May serve more than one (1) nursing unit on the same floor.)(i)
Stretcher and wheelchair parking area or alcove. This shall be located out of the path of normal traffic. (May serve more than one (1) nursing unit on the same floor.)(j)
Janitor's closet for storage of housekeeping supplies and equipment with a floor receptor or service sink. (May serve more than one (1) nursing unit on the same floor.)(k)
Equipment storage room with sufficient space for equipment such as I.V. stands, inhalators, air mattresses, and walkers. (May serve more than one (1) nursing unit on the same floor.)(l)
Emergency equipment storage. Space for equipment such as crash carts shall be provided and be under direct control of the nursing staff in close proximity to the nurses' station and out of traffic. (May serve more than one (1) nursing unit on the same floor.)(3)
Patients' bathing facilities. There shall be at least one (1) shower stall or one (1) bathtub for each twelve (12) beds not individually served. Each tub or shower shall be in an individual room or privacy enclosure which provides space for the private use of the bathing fixture, for drying and dressing, and for a wheelchair and an assisting attendant. Showers and central bathing facilities shall be at least four (4) feet square without curbs, and designed to permit use by a wheelchair patient.(4)
Patient toilet rooms.(a)
The minimum dimensions of a room containing only a water closet shall be five (5) feet by six (6) feet. Additional space shall be provided if a lavatory is located within the same room. The configuration of patient toilet rooms must provide for side transfers.(b)
A toilet room shall be directly accessible from each patient room without going through the general corridor. One (1) toilet room may serve two (2) patient rooms, but not more than four (4) beds. (The lavatory may be omitted from the toilet room if one is provided in each patient room.)(c)
Doors to toilet rooms shall have a minimum width of two (2) feet ten (10) inches to admit a wheelchair.(5)
Isolation room. If provided for in the program narrative, isolation room(s) shall be required for those prone to infections as well as those suffering from infections. Each isolation room shall have:(a)
Only one (1) patient per room;(b)
Separate toilet room with bath or shower and lavatory for the exclusive use of the patient allowing for direct entry from the patient bed area; and(c)
Facilities outside and immediately adjacent to the patient room for maintaining aseptic conditions.Section 7.
Outpatient Suite.(1)
General. Facilities for outpatient clinic care shall be provided if included in the narrative plan.(2)
Outpatient department. If outpatient services are provided, the extent of the administrative, clinical and diagnostic facilities to be provided will depend on the estimated patient load as described in the program narrative. The planning of outpatient facilities shall provide for the privacy and dignity of the patient during interview, examination, and treatment. Facilities shall be located so that outpatients do not traverse inpatient areas and the following shall be provided:(a)
Entrance at grade level which is sheltered from weather and able to accommodate wheelchair access.(b)
Reception and control area located near the entrance and waiting area(s).(c)
Wheelchair storage out of the line of direct traffic.(d)
Public waiting area with toilet facilities, public telephone and drinking fountain.(e)
Interview space(s) for private interviews relating to social service, credit and admissions.(f)
General purpose examination room(s) for medical examinations. Each room shall have a minimum floor area of eighty (80) square feet, excluding such spaces as vestibule, toilet, closet and work counter. Examination table shall be placed to provide at least thirty (30) inches clearance to each side and at the foot of the table. A lavatory or sink equipped for hand washing shall be provided in each room.(g)
Patient toilet facilities shall be provided. The number required will depend on the actual patient load of the department.(h)
Nurses' station for nurses' charting, doctors' charting, communications and storage for supplies and nurses' personal effects.(i)
Staff toilet room located convenient to the nurses' station.(j)
Clean workroom. It shall contain a work counter, sink equipped for hand washing, and storage space for clean and sterile supplies.(k)
Soiled workroom. It shall contain a clinical sink or equivalent flushing type fixture, work counter, sink equipped for hand washing, waste receptacle and linen receptacle.(l)
Drug distribution station for storage and preparation of medication. It shall contain a work counter, sink equipped for hand washing, and storage facilities. Controlled substances shall be under double lock.(m)
Wheelchair and stretcher alcove located convenient to the entrance to the department.(n)
Janitor's closet. It shall contain a floor receptor or service sink with storage space for housekeeping supplies and equipment for exclusive use in the outpatient department.(o)
Equipment storage room.Section 8.
Radiology Suite. If the facility provides diagnostic radiology services directly, then the suite shall contain the following:(1)
Radiographic room(s);(2)
Film processing facilities;(3)
Viewing and administrative area(s);(4)
Film storage facilities;(5)
Toilet room with hand-washing facility. It shall be located directly accessible from each fluoroscopy room without entering the general corridor area;(6)
Dressing area(s) for ambulatory patients with convenient access to toilets;(7)
Waiting room or alcove for ambulatory patients;(8)
Holding area for stretcher patients. It shall be located out of the direct line of normal traffic; and(9)
Hand-washing facilities shall be provided in each radiographic room unless the room is used only for routine diagnostic screening such as for chest x-rays.Section 9.
Laboratory Suite. Facilities shall be provided directly or through an effective contract arrangement with a nearby hospital for laboratory service for the following:(1)
Hematology;(2)
Clinical chemistry. An acid-shower and eyewashing facility shall be provided nearby;(3)
Urinalysis. A specimen toilet with hand-washing facility shall be provided nearby;(4)
Cytology;(5)
Bacteriology;(6)
Waiting area for ambulatory patients;(7)
Administrative support areas;(8)
Blood storage facilities;(9)
Blood specimen collection area. It shall contain work counter, hand-washing facilities, and space for patient seating;(10)
Glass-washing and sterilizing facilities; and(11)
Recording and filing facilities.Section 10.
Physical Therapy Suite. Each rehabilitation facility shall provide physical therapy services; however, the physical therapy area can be shared with the occupational therapy services, if called for in the program narrative. Each physical therapy suite shall contain the following items:(1)
Office space;(2)
Waiting space;(3)
Treatment area(s) for thermotherapy, diathermy, ultrasonics, hydrotherapy, etc. Cubicle curtains around each individual treatment area shall be provided for privacy purposes. Hand-washing facilities shall be provided but one (1) lavatory or sink may serve more than one (1) treatment cubicle. Facilities for collection of wet and soiled linen or other material shall be provided;(4)
Exercise area(s);(5)
Storage for clean linen, supplies, and equipment;(6)
Patients' dressing areas, showers, lockers and toilet rooms;(7)
Janitor's closet with floor receptor or service sink and storage space for housekeeping supplies and equipment; and(8)
Wheelchair and stretcher storage area. (Items contained in subsections (1), (2), (5), (7) and (8) of this section may be planned and arranged for shared use by occupational therapy patients and staff if the approved narrative program reflects this sharing concept.)Section 11.
Occupational Therapy Suite. Each rehabilitation facility shall provide occupational therapy services; however, the occupational therapy area can be shared with the physical therapy services, if called for in the program narrative. The following shall be provided:(1)
Office space;(2)
Waiting space;(3)
Work areas and counters suitable for wheelchair access;(4)
Hand-wash facilities;(5)
Storage for supplies and equipment.Section 12.
Social Work Suite. Each rehabilitation facility shall contain a social work suite. The following shall be provided:(1)
Office space(s) for staff.(2)
Office space for private interviewing and counseling for all family members.Section 13.
Psychological Services Suite. Each rehabilitation facility shall contain a psychological service suite. The following shall be provided:(1)
Office(s).(2)
Workspace for testing, evaluation, and counseling.Section 14.
Speech and Language Therapy Suite. Each rehabilitation facility shall contain a speech and language therapy suite. The following shall be provided:(1)
Office(s) for therapists.(2)
Space for evaluation and treatment.(3)
Space for equipment and storage.Section 15.
Area for Teaching Activities of Daily Living (should be combined with rehabilitative engineering function, as needed).(1)
An area for teaching activities shall be provided.(2)
It shall include a bedroom, bath, kitchen, and space for stairs.Section 16.
Prosthetics and Orthotics Service. Depending on the needs of those served and the stated institutional goals, the facility shall provide or make arrangements for the following:(1)
Work space for technician(s).(2)
Space for evaluation and fittings (with a provision for privacy).(3)
Space for equipment, supplies, and storage.Section 17.
Vocational Therapy Services. Depending upon the needs of those served and the stated institutional goals, the facility shall provide or make arrangements for the following:(1)
Office(s).(2)
Workspace for vocational services activities such as evaluation (prevocational and vocational).(3)
Training.(4)
Counseling and placement.Section 18.
Respiratory Therapy Services. Depending upon the needs of those served and the stated institution goals, the facility shall provide or make arrangements for the following:(1)
Storage for equipment and supplies.(2)
Space and utilities for cleaning and sanitizing equipment.(3)
Service facilities for calibrating, adjusting, servicing, and minor repairs and equipment.(4)
Respiratory services shall be conveniently accessible on a twenty-four (24) hour basis to the facility.(5)
If respiratory services such as testing and demonstration for outpatients are part of the program, additional facilities and equipment shall be provided as necessary for appropriate function of the service, including but not limited to:(a)
Patient waiting area with provision for wheelchairs.(b)
Reception and control station.(c)
Patient toilets and hand-washing facilities.(d)
Room(s) for patient education and demonstration.Section 19.
Pharmacy Suite. If required by program, the size and type of services to be provided in the pharmacy will depend upon the type of drug distribution system to be used and whether the facility proposes to provide, purchase, or share pharmacy services. This shall be explained in the narrative program. Provision shall be made for the following functional areas:(1)
Dispensing area with hand-washing facility.(2)
Editing or order review area.(3)
Area for compounding.Section 20.
Dietary Department. Food facilities shall be designed and equipped to meet requirements of the narrative program. If a commercial service will be used, dietary areas and equipment shall be designed to accommodate the requirements for sanitary storage, processing, and handling. The department shall include the following facilities unless acceptable commercially prepared dietary services, meals, and or disposables are to be used:(1)
Control station for the receiving of food supplies.(2)
Food preparation facilities. Conventional food preparation systems require space and equipment for preparing, cooking, and baking. Convenience food service systems such as frozen prepared meals, bulk packages entrees, and individual package portions, or systems using contractual commissary services require space and equipment for thawing, portioning, cooking and/or baking.(3)
Hand-washing facility(ies) located conveniently accessible in the food preparation area.(4)
Patients' meals service facilities. Examples are those required for tray assembly and distribution.(5)
Dishwashing space. It shall be located in a room or alcove separate from the food preparation and serving area. Commercial-type dishwashing equipment shall be provided. Space shall also be provided for receiving, scraping, sorting and stacking of soiled dishware and tableware prior to cleanup. The area shall be designed to allow clean dishware and tableware to be removed at a different location than the one used for the soiled dishware and tableware. A hand-washing lavatory shall be conveniently located.(6)
Pot-washing facilities.(7)
Refrigerated storage to accommodate a three (3) day minimum supply.(8)
Dry storage to accommodate a three (3) day minimum supply.(9)
Storage areas and sanitizing facilities for cans, carts and mobile tray conveyors.(10)
Waste storage facilities shall be located in a separate room easily accessible to the outside for direct pickup or disposal.(11)
Dining space for ambulatory patients, staff and visitors.(12)
Office(s) or desk spaces for dieticians or the dietary service manager.(13)
Toilets with hand-washing facilities for use by the dietary staff shall be immediately available.(14)
Janitor's closet located within the department. It shall contain a floor receptor or service sink with storage for housekeeping supplies and equipment to be used exclusively in this area.Section 21.
Patient's Dining, Recreation, and Day Spaces. The following areas shall be provided and may be in separate or adjoining spaces:(1)
Inpatients and residents. A total of twenty-five (25) square feet per bed.(2)
Outpatients. A total of twenty (20) square feet per person when dining is a part of their day care program. (If dining is not part of the program, provide at least ten (10) square feet per person for recreation and day spaces.)(3)
Storage. Storage spaces shall be provided for recreational equipment and supplies.Section 22.
Administrative and Public Areas. The following shall be provided:(1)
Lobby. It shall include:(a)
Storage space for wheelchairs;(b)
Reception and information counter or desk;(c)
Waiting space(s); and(d)
Public toilet facilities designed for use by the physically handicapped.(2)
Interview space(s) for private interviews relating to social services, credit, and admissions.(3)
Director of nurses' office.(4)
Staff toilet rooms.(5)
Medical library facilities.(6)
General or individual office(s) for business transactions, medical and financial records, administrative and professional staffs use.(7)
Administrator's office.(8)
Multipurpose room(s) for conferences, meetings, and health education purposes including provisions for showing visual aids.(9)
Storage for office equipment and supplies.Section 23.
Medical Records Unit. This unit shall include:(1)
Medical records administrator/technician office or space;(2)
Active record storage area;(3)
Record review and dictating room; and(4)
Work area for sorting, recording, and microfilming.Section 24.
Sterilizing Facilities. A system for the sterilization of equipment and supplies shall be provided. Storage area for clean supplies and sterile supplies shall be provided.Section 25.
Central Stores. The following shall be provided:(1)
Off-street unloading facilities.(2)
Control station for receiving supplies.(3)
General storage rooms which are adequate in size to meet the needs of the facility.Section 26.
Laundry. On-site processing and off-site processing.(1)
If linen is to be processed on the site, the following shall be provided:(a)
Soiled linen receiving, holding, and sorting room with hand-washing facilities.(b)
Laundry processing room with commercial-type equipment which can process seven (7) days of linen needs within a regularly scheduled work week. Hand-washing facilities shall be provided.(c)
Storage for laundry supplies.(d)
Clean linen inspection and mending room.(e)
Clean linen storage, issuing, and holding room or area.(f)
Janitor's closet. It shall contain a floor receptor or service sink with storage space for housekeeping supplies and equipment to be utilized exclusively in this department.(g)
Cart storage and cart sanitizing facilities.(h)
Arrangement of equipment and procedures shall be in a manner to permit an orderly work flow with a minimum of cross traffic that might mix clean and soiled operations.(2)
If linen is to be processed off the site, the following shall be provided:(a)
Soiled linen holding room with a hand-washing facility conveniently accessible.(b)
Clean linen receiving, holding, inspection and storage room(s).Section 27.
Employees' Facilities.(1)
Female locker room. This room shall have lounge space, lockers for personal effects and a separate toilet room. The area shall be designed for use by the physically handicapped. In some cases shower facilities may be appropriate depending on the size of the facility.(2)
Male locker room. This room shall have lockers and a separate toilet room. The area shall be designed for use by the physically handicapped. In some cases shower facilities may be appropriate depending on the size of the facility.Section 28.
Engineering Service and Equipment Areas. The following shall be provided:(1)
Room(s) or separate building(s) for boilers, mechanical equipment and electrical equipment;(2)
Engineer's office;(3)
Maintenance shop;(4)
Storage room for building maintenance supplies;(5)
Storage room for central housekeeping equipment and supplies;(6)
Office and administrative support space for person(s) in charge of central housekeeping; and(7)
Yard equipment storage.Section 29.
Waste Processing Services. Rehabilitation facilities which are part of an acute care hospital may share waste processing. Freestanding facilities shall provide the following:(1)
Storage and disposal. Space and facilities shall be provided for the sanitary storage and disposal of waste by incineration, mechanical destruction, compaction, containerization, removal or by a combination of these techniques.(2)
Incinerator. A gas, electric, or oil-fired incinerator shall be provided for the complete destruction of pathological and infectious waste. Infectious waste includes, but is not limited to, waste materials from isolation rooms, dressings and material from open wounds and laboratory specimens. The incinerator may be shared by two (2) or more institutions located on a common "campus."(a)
The incinerator capacity required will vary with the type and quantity of waste to be processed. If approved by local authorities and described in the functional program, items of small mass such as dressings, isolation room waste, laboratory specimens, may be sterilized on site by autoclaving or rendered safe by other acceptable procedure and disposed of in municipal landfill or incinerator. Waste tissue and contaminated combustible solids shall be rendered safe by such methods as sterilization or incineration. Culture plates, tubes, sputum cups, contaminated sponges, swabs and the like shall be sterilized before they are washed and discarded.(b)
Consideration shall be given to the recovery of waste heat from on-site incinerators which are used to dispose of large amounts of waste materials.Section 30.
Details and Finishes.(1)
Details.(a)
All doors to patient-room toilets and patient-room bathrooms shall swing outward or be equipped with hardware that will permit access in an emergency.(b)
Windows and outer doors which may be frequently left in an open position shall be provided with insect screens.(c)
Thresholds and expansion joint covers shall be made flush with the floor surface to facilitate use by wheelchairs and carts and shall be constructed to resist passage of smoke.(d)
The location and arrangements of lavatories and sinks equipped with blade handles for hand-washing purposes shall provide a minimum of sixteen (16) inches clearance to each side of the centerline of the fixture.(e)
Provisions for hand drying shall be included at all hand-washing facilities except scrub sinks. These shall be single use, separate paper or cloth units enclosed in such a way as to provide protection against dust or soil and insure single unit dispensing. Hot air dryers are permitted provided that installation is such as to minimize contamination by recirculated air.(f)
Grab bars shall be provided at all patients' toilets, showers, and tubs. The bars shall have one and one-half (1 1/2) inches clearance to walls and shall be of sufficient strength and anchorage to sustain a concentrated load of 250 pounds for a period of five (5) minutes.(g)
Handrails shall be provided on both sides of corridors used by patients. A clear distance of one and one-half (1 1/2) inches shall be provided between the handrail and the wall, and the top of the rail shall be about thirty-two (32) inches above the floor, except for special care areas such as those serving children.(h)
Ends of handrails and grab bars shall be constructed to prevent snagging the clothes of patients.(i)
Location and arrangement of hand-washing facilities shall permit their proper use and operation. Particular care should be given to clearance required for blade-type operating handles. Lavatories intended for use by handicapped patients shall be installed to permit wheelchairs to slide under them.(j)
Recessed soap dishes shall be provided at all showers and bathtubs.(k)
Mirrors shall be arranged for convenient use by patients in wheelchairs as well as by patients in a standing position.(l)
Protection requirements of x-ray and gamma-ray installations shall be approved by the Radiation and Product Safety Branch, Office of Consumer Health Protection, Department for Health Services, Cabinet for Human Resources.(m)
The minimum ceiling height shall be eight (8) feet, with the following exceptions:1.
Boiler rooms shall have ceiling clearances not less than two (2) feet six (6) inches above the main boiler header and connecting piping.2.
Radiographic, and other rooms containing ceiling-mounted equipment or ceiling-mounted light fixtures shall have sufficient height to accommodate the equipment or fixtures and their normal movement.3.
Ceiling and corridors, storage rooms, and toilet rooms shall be not less than seven (7) feet eight (8) inches. Ceilings in small minor spaces which are normally unoccupied may be reduced to seven (7) feet.4.
Suspended tracks, rails, and pipes located in the path of traffic for patients in beds and/or stretchers, including service areas for inpatients shall be not less than seven (7) feet above the floor.(n)
Recreation rooms, exercise rooms, and similar spaces where impact noises may be generated shall not be located directly over patient bed areas, unless special provisions are made to minimize such noise.(o)
Rooms containing heat-producing equipment such as boiler rooms, laundries, and food preparation areas shall be insulated and ventilated to prevent any floor surface from exceeding a temperature of ten (10) degrees Fahrenheit above the ambient room temperature.(p)
Noise reduction criteria. Partition, floor, and ceiling construction in patient areas shall comply with Table 1, Section 35 of this administrative regulation.(2)
Finishes.(a)
Floor materials shall be easily cleanable and have wear resistance appropriate for the location involved. Floors in areas used for food preparation or food assembly shall be water-resistant and grease-proof. Joints in tile and similar material in such areas shall be resistant to food acids. In all areas subject to frequent wet cleaning methods, floor materials shall not be physically affected by germicidal and cleaning solutions. Floors that are subject to traffic while wet, such as shower and bath areas, kitchens and similar work areas, shall have a nonslip finish.(b)
Adjacent dissimilar floor materials shall be flush with each other to provide an unbroken surface.(c)
Walls generally shall be washable; and in the immediate area of plumbing fixtures, the finish shall be smooth and moisture-resistant. Finish, trim, and floor and wall construction in dietary and food preparation areas shall be free from spaces that can harbor rodents and insects.(d)
Wall bases in kitchens, and other areas subject to frequent wet cleaning methods shall be made integral and coved with the floor, tightly sealed within the wall, and constructed without voids that can harbor harmful bacteria.(e)
Ceilings throughout the facility shall be easily cleanable. Ceilings in dietary and food preparation areas shall have a finished ceiling covering all overhead piping and ductwork. Finished ceilings may be omitted in mechanical and equipment spaces, shops, general storage areas and similar spaces, unless required for fire-resistive purposes.(f)
Acoustical type ceilings shall be provided for corridors in patient areas, nurses' stations, dayrooms, recreation rooms, dining areas, and waiting areas.Section 31.
Elevators. General. All buildings having patients' facilities, such as bedrooms, dining rooms or recreation areas, or critical services, such as diagnostic or therapy areas, located on other than the main entrance floor shall have elevators.(1)
Number of elevators.(a)
At least one (1) hospital-type elevator shall be installed where one (1) to fifty-nine (59) patient beds are located on any floor other than the main entrance floor.(b)
At least two (2) hospital-type elevators shall be installed where sixty (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.(c)
At least three (3) 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 inpatient services are located on a floor other than those containing patient beds.(d)
For facilities with more than 350 beds number of elevators shall be determined from a study of the facility plan and the estimated vertical transportation requirements.(2)
Cars and platforms. Cars of hospital-type elevators shall have inside dimensions that will accommodate a hospital bed and attendant and shall be at least five (5) feet wide by seven (7) feet and six (6) inches deep. The car door shall have a minimum clear opening of not less than three (3) feet and eight (8) inches.(3)
Leveling. Elevators shall have automatic leveling of the two (2) way automatic maintaining type with accuracy within plus or minus one-half (1/2) inch.(4)
Operation. Elevators, except freight elevators, shall be equipped with a two (2) way special service switch to permit cars to bypass all landing button calls and be dispatched directly to any floor.Section 32.
Construction.(1)
Design. Every building and every portion thereof shall be designed and constructed to sustain all dead and live loads in accordance with accepted engineering practices and standards, including seismic forces when applicable.(2)
Foundations. Foundations shall rest on natural solid bearing, if a satisfactory bearing is available at reasonable depths. Proper soil-bearing values shall be established in accordance with recognized standards. If solid bearing is not encountered at practical depths, the structure shall be supported on driven piles, augured piles, poured caissons or equivalent designed to support the intended load without detrimental settlement, except that one (1) story buildings may rest on a fill designed by a soils engineer. When engineered fill is used, site preparation and placement of fill shall be done under the direct full-time supervision of the soils engineer. The soils engineer shall issue a final report on the compacted fill operation and certification of compliance with the job specifications. All footings shall extend to a depth not less than one (1) foot below the estimated frost line.(3)
Natural disasters. Special provisions shall be made in the design of buildings in geographic areas where local experience reflects loss of life or extensive damage to buildings resulting from tornadoes, floods, earthquakes, etc.Section 33.
Mechanical Requirements.(1)
General. Prior to completion of the contract and final acceptance of the facility, the architect and/or engineer shall obtain from the contractor certification in writing that all mechanical systems have been tested and that the installation and performance of these systems conform with the final plans and specifications.(2)
Incinerators. The design and installation shall comply with the current Kentucky standards for control of air contaminants for incinerators regulations as applicable to hospitals.(3)
Steam and hot water systems.(a)
Boilers. If boilers are used, a minimum of two (2) shall be provided and the combined capacity of the boilers, based upon the published Steel Boiler Institute or Institute of Boiler and Radiation Manufacturer's net rating, must be able to supply 150 percent of the normal requirements for all systems and equipment in the facility.(b)
Boiler accessories. Boiler feed pumps, condensate return pumps, fuel oil pumps, and circulation pumps shall be connected and installed to provide normal and standby service.(c)
Valves. Supply and return mains and risers of cooling, heating, and process steam systems shall be valved to isolate the various sections of each system. Each piece of equipment shall be valved at the supply and return ends except that vacuum condensate returns need not be valved at each piece of equipment.(4)
Thermal and acoustical installation.(a)
Insulation shall be provided on the following within the building:1.
Boilers, smoke breeching, and stacks;2.
Steam supply and condensate return piping;3.
Hot water piping above 120 degrees Fahrenheit at all hot water heaters, generators and converters;4.
Chilled water, refrigerant, other process piping and equipment operating with fluid temperatures below ambient dew point;5.
Water supply and drainage piping on which condensation may occur;6.
Air ducts and casings with outside surface temperature below ambient dew point or temperature above eighty (80) degrees Fahrenheit; and7.
Other piping, ducts, and equipment as necessary to maintain the efficiency of the system.(b)
Insulation on cold surfaces shall include an exterior vapor barrier.(5)
Air-conditioning, heating and ventilation systems.(a)
Temperatures for areas occupied by inpatients, the indoor winter design temperature shall be seventy-five (75) degrees Fahrenheit. For all other occupied areas, the indoor winter design temperature shall be seventy-two (72) degrees Fahrenheit. For all other occupied areas, the indoor summer design temperature shall be seventy-five (75) degrees Fahrenheit.(b)
Ventilation system details. All air-supply and air-exhaust systems shall be mechanically operated. All fans serving exhaust systems shall be located at the discharge end of the system. The ventilation rates as shown on Table 2, Section 35 of this administrative regulation, shall be considered as minimum acceptable rates and shall not be construed as precluding the use of higher ventilation rates.1.
Outdoor air intakes shall be located as far as practical but not less than twenty-five (25) feet from exhaust outlets of ventilation systems, combustion equipment stacks, medical surgical vacuum systems, plumbing vent stacks, or from areas which may collect vehicular and other noxious fumes. Plumbing and vacuum vents that terminate above the level of the top of the air intake may be located as close as ten (10) feet. The bottom of outside air intakes serving central air systems shall be located as high as practical but not less than six (6) feet above ground level or if installed above the roof, three (3) feet above roof level.2.
The ventilation systems shall be designed and balanced in accordance with the pressure relationship as shown in Table 2, Section 35 of this administrative regulation.3.
Where two (2) filter beds are required in central ventilation and air-conditioning equipment, Filter Bed No. 1 shall be located upstream of the air-conditioning equipment and Filter Bed No. 2 shall be located downstream of the supply fan, any recirculating spray water system, and water reservoir type humidifiers. Where only one (1) filter bed is required, it shall be located upstream of the air-conditioning equipment unless an additional prefilter is employed. In this case, the prefilter shall be located upstream of the equipment and the main filter may be located further downstream.4.
All room supply, return and exhaust outlets shall be located not less than three (3) inches AFF.5.
All central ventilation or air-conditioning systems shall be equipped with filters having minimum efficiencies as listed below:Area Designation | Minimum No. of Filters | Filter Efficiencies % | |
No. 1 | No. 2 | ||
Burn Care Unit | 2 | 25 | 90 |
Patient Care, Treatment, Diagnostic and Related Areas | 2 | 25 | 90* |
Food Preparation and Laundry | 1 | 80 | -- |
Administrative, Storage, and Soiled Holding | 1 | 25 | -- |
6.
All filter efficiencies as listed above shall be average atmospheric dust spot efficiencies tested in accordance with ASHRAE Standard 52-76.7.
Filter frames shall be durable and carefully dimensioned, and shall provide an airtight fit with the enclosing ductwork. All joints between filter segments and the enclosing ductwork shall be gasketed or sealed to provide a positive seal against air leakages.8.
A manometer or its equivalent shall be installed across each filter bed in central air systems.9.
Ducts which penetrate construction intended for x-ray or other ray protection shall not impair the effectiveness of the protection.10.
Laboratories shall be provided with outdoor air at a rate of two (2) air changes per hour. If this ventilation rate does not provide the air required to ventilate fume hoods and safety cabinets, additional outdoor air shall be provided. A filter with ninety (90) percent minimum efficiency shall be installed in the air supply system at its entrance to the media transfer room.11.
Laboratory hoods for general use shall have a minimum average face velocity of seventy-five (75) feet per minute. Hoods in which infections or highly radioactive materials are processed shall have a face velocity of 100 feet per minute and each hood shall have an independent exhaust system with the fan installed at the discharge point of the system. Hoods used for processing infectious materials shall be equipped with a means of disinfection.12.
Duct systems serving hoods in which highly radioactive materials and strong oxidizing agents are used shall be constructed of stainless steel for a minimum of ten (10) feet from the hood and shall be equipped with washdown facilities.13.
Boiler rooms shall be provided with sufficient outdoor air to maintain combustion rates of equipment and reasonable temperatures in the rooms and in adjoining areas.(6)
Plumbing systems. All plumbing systems shall be designed and installed in accordance with the requirements of the current Kentucky plumbing standards administrative regulations applicable to hospitals.(a)
Plumbing fixtures.1.
The material used for plumbing fixtures shall be of nonabsorptive acid-resistant material.2.
Lavatories and sinks required in patient care areas shall have the water supply spout mounted so that its discharge point is a minimum of five (5) inches above the rim of the fixture. All fixtures used by medical and nursing staff and all lavatories used by patients and food handlers shall be equipped with valves which can be operated without the use of hands. Where blade handles are used for this purpose, they shall not exceed four and one-half (4 1/2) inches in length, except that handles on scrub sinks and clinical sinks shall be not less than six (6) inches long.3.
Clinical sinks shall have an integral trap in which the upper portion of a visible trap seal provides a water surface.4.
Shower bases and tubs shall provide nonslip surfaces for patients.(b)
Water supply systems.1.
Systems shall be designed to supply water at sufficient pressure to operate all fixtures and equipment during maximum demand periods.2.
Each water service main, branch main, riser and branch to a group fixture shall be valved. Stop valves shall be provided at each fixture.3.
Backflow preventers (vacuum breakers) shall be installed on hose bibbs, laboratory sinks, janitors' sinks, bedpan flushing attachments, and all other fixtures to which hoses or tubing can be attached.4.
Flush valves installed on plumbing fixtures shall be of a quiet operating type.5.
Bedpan flushing devices shall be provided in each patient toilet room and in the soiled workrooms located in the patient nursing units.6.
An auxiliary water supply shall be available to provide potable water in case of emergencies.(c)
Hot water heating systems.1.
The hot water heating equipment shall have a sufficient capacity to supply water at the temperature and amounts indicated below:Hot-water Use | |||
Clinical | Dishwasher | Laundry | |
Gal/hr/bed | 6-1/2 | 4 | 4 1/2 |
Temp. F. | 110 | 180* | 160** |
**Required temperature of 160 degrees Fahrenheit is that measured in the washing machine and shall be supplied so that the temperature will be maintained over the entire wash and rinse cycles.
2.
Storage tank(s) shall be fabricated or corrosive-resistant metal or be lined with noncorrosive material.(d)
Drainage systems.1.
Drain lines from sinks in which acid wastes may be poured shall be fabricated from an acid-resistant material.2.
Piping over food preparation centers, food serving facilities, food storage areas, and other critical areas shall be kept to a minimum and shall not be exposed. Special precautions shall be taken to protect these areas from possible leakage or condensation from necessary overhead piping systems.3.
Building sewers shall discharge into a community sewerage system. Where such a system is not available, a facility providing sewage treatment shall be installed which conforms to all applicable local and state administrative regulations.4.
Nonflammable medical gas systems. If used, nonflammable medical gas systems installations shall be in accordance with the requirements of NFPA Standard 56A and 56F.5.
At least two (2) patient rooms in each nursing unit and the examination/treatment rooms shall have oxygen and vacuum outlets.6.
In patient rooms with oxygen and vacuum outlets, one (1) set of those outlets may serve two (2) beds.Section 34.
Electrical Requirements.(1)
General.(a)
All material including equipment, conductors, controls, and signaling devices shall be installed to provide a complete electrical system with the necessary characteristics and capacity to supply the electrical facilities shown in the specifications or indicated on the plans. All materials shall be listed as complying with applicable standards of Underwriters' Laboratories, Inc., or other similarly established standards.(b)
All electrical installations and systems shall be tested to show that the equipment is installed and operates as planned or specified. A written record of performance tests on special electrical systems and equipment shall be supplied to the owner.(2)
Switchboard and power panels. Circuit breakers or fusible switches that provide disconnecting means and overcurrent protection for conductors connected to switchboards and panel boards shall be enclosed or guarded to provide a dead-front type of assembly. The main switchboard shall be located in a separate enclosure accessible only to authorized persons. The switchboard shall be convenient for use, readily accessible for maintenance, clear of traffic lanes, and in a dry ventilated space devoid of corrosive fumes or gases. Overload devices shall be suitable for operating properly in the ambient temperature conditions.(3)
Panel boards. Lighting and appliance panel boards shall be located on the same floor as the circuits they serve.(4)
Lighting.(a)
All spaces occupied by people, machinery, and equipment within buildings, and the approaches thereto, and parking lots shall have lighting.(b)
Patients' bedrooms shall have general lighting and night lighting. A reading light shall be provided for each patient. Flexible light arms shall be mechanically operated to prevent the bulb from coming in contact with the bed linen. Patients' reading lights and other fixed lights not switched at the door shall have switch controls located convenient to the luminaire. A fixed type night light, mounted at approximately sixteen (16) inches above the floor, shall be provided in each patient room. All switches for control of lighting in patient areas shall be of the quiet operating type. Switches in patients' rooms shall be installed not more than forty-eight (48) inches above the floor to be reached from a wheelchair.(c)
Nursing unit corridors shall have general illumination with provisions for reduction of light levels at night. Refer to Table 3, Section 35 of this administrative regulation.(5)
Receptacles (convenience outlets).(a)
Bedroom. Each patient bedroom shall have duplex receptacles as follows: one (1) on each side of the head of the bed; one (1) for the television, if used; and one (1) on another wall. Receptacles for general use shall be located convenient for use from a wheelchair.(b)
Corridors. Duplex receptacles for general use shall be installed approximately fifty (50) feet apart and within twenty-five (25) feet of ends of corridors.(6)
Equipment installation in special areas.(a)
X-ray and gamma-ray installations. X-ray stationary installations and mobile equipment shall conform to the current Kentucky standards for radiographic and radioisotope equipment and use administrative regulations applicable to hospitals.(b)
X-ray film illuminator units. At least two (2) units shall be installed in the x-ray viewing room.(c)
The electrical circuit(s) to fixed or portable equipment in hydrotherapy units shall be provided with five (5) milliampere ground fault interrupters.(7)
Nurses' calling system.(a)
General. In general patient areas, each room shall be served by at least one (1) calling station and each bed shall be provided with a call button. Two (2) call buttons serving adjacent beds may be served by one (1) calling station. Calls shall register at an annunciator panel at the nurses' station and shall actuate a visible signal in the corridor at the patient room door, in the clean workroom, the soiled workroom, the nourishment station, and the nurses' lounge of the nursing unit. In multicorridor nursing units, additional visible signals shall be installed at corridor intersections. In rooms containing two (2) or more calling stations, indicating lights shall be provided at each station. Nurses' calling systems which provide two (2) way voice communication shall be equipped with an indicating light at each calling station which lights and remains lighted as long as the voice circuit is operating.(b)
Patients' emergency. A nurses' call emergency button shall be provided for patients' use at each patient's toilet, bath, and shower room on the nursing unit floors. Such buttons shall be usable by a collapsed patient lying on the floor; inclusion of a pull cord will satisfy this requirement.(8)
Fire alarms and fire detection systems. The design and installation of these systems must be approved by the State Fire Marshal's Office.(9)
Emergency electrical.(a)
General. To provide electricity during interruption of the normal electric supply, an emergency source of electricity shall be provided and connected to certain circuits for lighting and power.(b)
Sources. The source of this emergency electric service shall be as follows:1.
An emergency generating set, when the normal service is supplied by one (1) or more central station transmission lines.2.
An emergency generating set or a central station transmission line, when the normal electric supply is generated on the premises.(c)
Emergency generating set. The required emergency generating set, including the prime mover and generator, shall be located on the premises and shall be reserved exclusively for supplying the emergency electrical system. Generator sets shall be self-sufficient insofar as possible without dependency on public utilities that may be subject to cutoff or outages. Exception: a system of prime movers which are ordinarily used to operate other equipment and alternately used to operate the emergency generator(s) will be permitted provided that the number and arrangement of the prime movers are such that when one (1) of them is out of service (due to breakdown or for routine maintenance), the remaining prime mover(s) can operate the required emergency generator(s) and provided that the connection time requirements as listed in Section 34(9)(e) of this administrative regulation are met. The emergency generator set shall be of sufficient kilowatt capacity to supply all lighting and power load demands of the emergency electrical system. The power factor rating of the generator shall be not less than eighty (80) percent.(d)
Emergency electrical connections. Emergency electric service shall be provided to circuits as follows:1.
Lighting.a.
Exitways and all necessary ways of approach thereto, including exterior of exits, exit doorways, stairways, and corridors.b.
Laboratory, nursing station, medication preparation dispensing area.c.
Generator set location, switch-gear location, mechanical room and boiler room.d.
Elevator cabs.e.
Night light in patient rooms.2.
Equipment. Essential to life safety and for protection of important equipment or vital materials:a.
Nurses' calling system.b.
Paging or speaker systems, if intended for issuing instructions during emergency conditions. Alarms required for medical gas systems.c.
Fire pump and jockey pump, if installed.d.
Pump for central suction system.e.
Sewerage or sump lift pump, if installed.f.
Blood bank refrigerator.g.
Duplex receptacles in patient corridors, and at least one (1) duplex receptacle located on the patient headwall in each patient room.h.
Elevator service that will reach every patient floor. Manual throw over facilities shall be provided to allow temporary operation of any elevator for the release of persons who may be trapped between floors.i.
Equipment necessary for maintaining telephone service.3.
Heating. Equipment for heating general patient rooms; except that service for heating of those rooms will not be required under either of the following conditions:a.
The design temperature is higher than twenty (20) degrees Fahrenheit, based on the Median of Extremes as shown in the current edition of the ASHRAE Handbook of Fundamentals.b.
The facility is supplied by two (2) or more electrical services supplied from separate generating sources, or a utility distribution network having multiple power light sources and arranged to provide mechanical and electrical separation, so that a fault between the facility and generating sources will not likely cause an interruption of the facility service feeders.(e)
Details. The emergency electrical system shall be so controlled that after interruption of the normal electric power supply, the generator is brought to full voltage and frequency and it must be connected within ten (10) seconds through one (1) or more primary automatic transfer switches to all emergency lighting systems; alarms systems; blood banks; nurses' calling systems; equipment necessary for maintaining telephone service; pump for central suction system; and task illumination and receptacles in patient rooms and patient corridors. All other lighting and equipment required to be connected to the emergency system shall either be connected through the above described primary automatic transfer switching or shall be subsequently connected through other automatic or manual transfer switching. Receptacles connected to the emergency system shall be distinctively marked for identification. Storage-battery-powered lights, provided to augment the emergency lighting or for continuity of lighting during the interim of transfer switching immediately following an interruption of the normal service supply, shall not be used as a substitute for the requirement of a generator. Where stored fuel is required for emergency generator operation, the storage capacity shall be sufficient for not less than twenty-four (24) hours of continuous operation.Section 35.
Table 1 - Sound Transmission Limitations for Rehabilitation Facilities. Table 2 - Pressure Relationships and Ventilation of Certain Rehabilitation Areas. Table 3 - Lighting Levels for Rehabilitation Facilities.Table 1. Sound Transmission Limitations in Rehabilitation Facilities. | ||||
Location | Airborne Sound Transmission Class (STC) a* | Impact Insulation Class (IIC) b* | ||
Partitions | Floors | Floors | ||
Patients' room to patients' room | 45 | 45 | 45 | |
Public space to patients' room d* | 50 | 50 | 50 c* | |
Service areas to patients' room e* | 55 | 55 | 55 c* | |
b* - Impact insulation class (IIC) shall be determined in accordance with criteria set forth in HUD FT/TS-24, "A Guide to Airborne, Impact and Structure Borne Noise - Control in Multifamily Dwellings."
c* - Impact noise limitation applicable only when corridor, public space, or service area is over patients' room.
d* - Public space includes lobbies, dining rooms, recreation rooms, treatment rooms, and similar spaces.
e* - Service areas 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 patients' rooms, offices, nurses' stations and similar occupied spaces shall be effectively isolated relating to noise transmission.
Note: The requirements set forth in this table assume installation methods which will not appreciably reduce the efficiency of the assembly as tested.
TABLE 2.- PRESSURE RELATIONSHIPS AND VENTILATION OF CERTAIN REHABILITATION AREAS. | |||||
Area Designation | Pressure Relationship Adjacent Areas | Minimum Air Changes of Outdoor Air per Hour | Minimum Total Air Changes per Hour | All Air Exhausted Directly to Outdoors | Recirculated Within Room Units |
Isolation anteroom | N | 2 | 8 | Yes | No |
Isolation room | E | 2 | 8 | Yes | No |
Dental operatory | N | 2 | 6 | Optional | No |
Patient room | V | 1 | 4 | Optional | Optional |
Patient area corridor | N | 1 | 4 | Optional | Optional |
Occupational therapy | N | 1 | 4 | Optional | Optional |
Physical therapy and hydrotherapy | N | 2 | 6 | Optional | Optional |
Speech & hearing unit | V | 1 | 4 | Optional | Optional |
Soiled workroom and clean holding | N | 2 | 8 | Yes | No |
Clean workroom and clean holding | P | 1 | 4 | Optional | Optional |
Activities of daily living | V | 1 | 4 | Optional | Optional |
X-ray, diagnostic | V | 2 | 6 | Optional | Optional |
Treatment room | V | 2 | 6 | Optional | Optional |
Laboratory | N | 2 | 6 | Optional | Optional |
Dark room Y | N | 2 | 10 | Yes | Yes |
Toilet room and locker room | N | Optional | 10 | Yes | No |
Bedpan room | N | Optional | 10 | Yes | No |
Bathroom | N | Optional | 10 | Yes | No |
Janitor's closet | N | Optional | 10 | Yes | No |
Sterilizer equipment room | N | Optional | 10 | Yes | No |
Linen and trash chute room | N | Optional | 10 | Yes | No |
Food preparation center | N | Optional | 10 | Yes | No |
Ware-washing room | N | 2 | 10 | Yes | No |
Personal care room | N | Optional | 10 | Yes | No |
Dietary day storage | V | Optional | 2 | Optional | No |
Laundry, general | V | 2 | 10 | Yes | No |
Soiled linen sorting and storage | N | Optional | 10 | Yes | No |
Clean linen storage | P | Optional | 4 | Optional | Optional |
Table 3. Lighting Levels for Rehabilitation Facilities | |
Area | Foot-candles* |
Administrative and lobby areas, day | 100 |
Administrative and lobby areas, night | 20 |
Chapel and quiet area | 30 |
Corridors and interior ramps | 30 |
Corridor night lighting | 10 |
Dining area and kitchen | 50 |
Doorways | 10 |
Examination and treatment room: | |
General | 50 |
Examining table | 100 |
Exit stairways and landings | 30 |
Janitor's closet | 20 |
Nurses' station, general, day | 50 |
Nurses' station, general, night | 20 |
Nurses' desk or counter, for charts & records | 150 |
Nurses' medicine area, preparations & storage | 100 |
Occupational therapy | 30 |
Patient care unit or room, general | 10 |
Patient care room, reading | 50 |
Patient care room, night light (variable) | .5 to 1.5 |
Physical therapy | 30 |
Stairways other than exits | 50 |
Toilet and bathing facilities | 30 |
Clean workroom | 100 |
Soiled workroom | 100 |
Nurses' lounge | 30 |
Laundry, general | 50 |
HISTORY: (14 Ky.R. 92; 439; eff. 9-10-1987; 18 Ky.R. 830; eff. 10-16-1991; Crt eff. 4-30-2019.)
902 KAR 20:230.Comprehensive physical rehabilitation hospital; facility specifications.
Section 1.
Definitions.(1)
"Certificate of need" means an authorization by the Commission for Health Economics Control in Kentucky to proceed to acquire, to establish, to offer, to substantially change the bed capacity, or to substantially change a health service pursuant to KRS Chapter 216B.(2)
"Facility" means a comprehensive physical rehabilitation hospital.(3)
"License" means an authorization issued by the Commission for the purpose of operating a hospital facility.(4)
"Licensure agency" means the Division for Licensing and Regulation in the Office of the Inspector General, Cabinet for Human Resources.Section 2.
Preparation and Approval of Plans and Specifications. After receiving a certificate of need, the following procedures shall be followed:(1)
Before construction is begun for the erection of new buildings or alterations to existing buildings or any change in a facility, the licensee or applicant shall submit plans to the licensure agency for approval.(2)
All architectural, mechanical and electrical drawings shall bear the seal of an architect registered in the Commonwealth of Kentucky or the seal of a professional engineer registered in the Commonwealth of Kentucky, or both.(3)
Drawings shall not exceed thirty-six (36) inches by forty-six (46) inches when trimmed.(4)
All such plans and specifications must be approved by the licensure agency prior to commencement of construction of new buildings or alterations of existing buildings.(5)
Plans and specifications in specific detail as required by the Kentucky Building Code shall be submitted, together with architectural and/or engineering stamps as required by KRS Chapters 322 and 323, to the Department of Housing, Buildings and Construction for determining compliance with the Kentucky Building Code. All such plans and specifications must be approved by the Department of Housing, Buildings and Construction. Appropriate local building permits shall be obtained prior to commencement of construction.Section 3.
Submission of Plans and Specifications for Facilities.(1)
First stage, schematic plans.(a)
Single line drawings of each floor shall show the relationship of the various departments or services to each other and the room arrangement in each department. The name of each room shall be noted. Drawings shall include typical patient room layouts scaled (one-half (1/2) inch = one (1) foot) with dimensions noted. The proposed roads and walks, service and entrance courts, parking and orientation shall be shown in a plot plan.(b)
If the project is an addition, or is otherwise related to existing buildings on the site, plans shall show the existing facilities and general arrangements of those buildings.(2)
Second stage, preliminary plans. Preliminary sketch plans shall include the following:(a)
Architectural.1.
Plans of basement, floors and roof showing space assignment, sizes, and outline of fixed and movable equipment;2.
All elevators and typical sections;3.
Plot plan showing roads, parking, and sidewalks;4.
Areas and bed capacities by floors.(b)
Mechanical.1.
Single line layout of all duct and piping systems;2.
Riser diagrams for multistory construction;3.
Scale layout of boilers and major associated equipment and central heating, cooling, and ventilating units.(c)
Electrical.1.
Plans showing space assignments, sizes and outlines of fixed equipment such as transformers, main switch and switchboards, and generator sets;2.
Simple riser diagram for multistory building construction, showing arrangement of feeders, subfeeders, bus work, load centers, and branch circuit panels.(d)
Outline specifications.1.
General description of the construction, including interior finishes, types and locations of acoustical material, and special floor covering;2.
Description of the air-conditioning, heating, and ventilation systems and their controls; duct and piping systems; and dietary, laundry, sterilizing and other special equipment;3.
General description of electrical service including voltage, number of feeders, and whether feeders are overhead or underground.(3)
Third stage, contract documents.(a)
Working drawings. Working drawings shall be complete and adequate for bid, contract, and construction purposes. Drawings shall be prepared for each of the following branches of the work: architectural, structural, mechanical, and electrical. They shall include the following:1.
Architectural drawings.a.
Approach plan showing all new topography, newly established levels and grades, existing structures on the site (if any), new building structures, roadways, walks, and parking areas;b.
Plan of each basement, floor, and roof;c.
Elevations of each facade;d.
Sections through building;e.
Required scale and full-size details;f.
Schedule of doors, windows, and room finishes;g.
Layout of typical and special rooms indicating all fixed equipment and major items of movable equipment. Equipment not included in contract shall be so indicated;h.
Conveying systems. Details of construction, machine and control spaces necessary, size and type of equipment, and utility requirements for the following: dumbwaiters: electric, hand, hydraulic; elevators: freight, passenger, patient; loading dock devices; pneumatic tube systems.2.
Structural drawings.a.
Plans for foundations, floors, roofs, and all intermediate levels with sizes, sections, and the relative location of the various structural members;b.
Dimensions of special openings;c.
Details of all special connections, assemblies, and expansion joints.3.
Mechanical drawings.a.
Heating, steam piping, and air-conditioning systems. Radiators and steam heated equipment such as sterilizers, warmers, and steam tables; heating and steam mains and branches with pipe sizes; diagram of heating and steam risers with pipe sizes; sizes, types, and capacities of boilers, furnaces, hot water heaters with stokers, oil burners, or gas burners; pumps, tanks, boiler breeching, and piping and boiler room accessories; air-conditioning systems with required equipment, water and refrigerator piping, and ducts; supply and exhaust ventilation systems with heating/cooling connections and piping; air quantities for all room supply and exhaust ventilating duct openings.b.
Plumbing, drainage, and standpipe systems - size and elevation of: street sewer, house drains, street water main, and water service into the building; location and size of soil, waste, and water service with connection to house drains, clean-outs, fixtures, and equipment; size and location of hot, cold and circulating branches, and risers from the service entrance, and tanks; riser diagram for all plumbing stacks with vents, water risers, and fixture connections; gas, oxygen, and vacuum systems; standpipe and sprinkler systems where required; all fixtures and equipment that require water and drain connections.4.
Electrical drawings.a.
Electric service entrance with switches and feeders to the public service feeders, characteristics of the light and power current, transformers and their connections if located in the building;b.
Location of main switchboard, power panels, light panels, and equipment. Diagram of feeders and conduits with schedule of feeder breakers or switches;c.
Light outlets, receptacles, switches, power outlets and circuits;d.
Telephone layout showing service entrance telephone switchboard, strip boxes, telephone outlets and branch conduits;e.
Nurses' call systems with outlets for beds, duty stations, door signal light, annunciators, and wiring diagrams;f.
Emergency electrical system with outlets, transfer switch, sources of supply, feeders, and circuits;g.
All other electrically operated systems and equipment.(b)
Specifications. Specifications shall supplement the drawings to fully describe types, sizes, capacities, workmanship, finishes and other characteristics of all materials and equipment and shall include:1.
Cover or title sheet;2.
Index;3.
Sections describing materials and workmanship in detail for each class of work.(c)
Access to the work. Representatives of the appropriate state agencies shall have access at all reasonable times to the work wherever it is in preparation or progress, and the contractor shall provide proper facilities for such access and inspection.Section 4.
Compliance with Building Codes, Ordinances and Regulations.(1)
This section may be administered independently from other sections of this administrative regulation.(2)
General. Nothing stated herein shall relieve the sponsor from compliance with building codes, ordinances, and regulations which are enforced by city, county, or state jurisdictions.(3)
The following requirements shall apply where applicable and as adopted by the respective agency authority:(a)
Requirements for safety pursuant to 815 KAR 10:020, as amended;(b)
Requirements for plumbing pursuant to 815 KAR 20:010-191, as amended;(c)
Requirements for air contaminants for incinerators pursuant to 401 KAR 59:020 and 401 KAR 61:010;(d)
Requirements for elevators pursuant to 815 KAR 4:010;(e)
Requirements for making buildings and facilities accessible to and usable by the physically handicapped pursuant to KRS 198B.260 and administrative regulations promulgated thereunder.(4)
Prior to occupancy the facility shall have final approval from appropriate agencies.(5)
All facilities shall be currently approved by the Fire Marshal's Office in accordance with the Life Safety Code before relicensure is granted by the licensing agency.Section 5.
Facility Requirements and Special Conditions.(1)
A copy of the narrative program as submitted in the Certificate of Need application for each project shall be provided by the sponsor which describes the functional space requirements, staffing patterns, departmental relationships, and other basic information relating to the fulfillment of the objectives of the facility.(2)
The extent (number and types of rooms) of the diagnostic, clinical, and administrative facilities to be provided shall be determined by the services contemplated and the estimated patient load as described in the narrative program.(3)
Facilities shall be available to the public, staff, and patients who may be physically handicapped with special attention given to ramps, drinking fountain height, and mirrors.Section 6.
Nursing Unit.(1)
Patient rooms. Each patient room shall meet the following requirements:(a)
Maximum room capacity shall be four (4) patients.(b)
Minimum room areas exclusive of toilet rooms, closets, lockers, wardrobes, or vestibules shall be 125 square feet in one (1) bed rooms and 100 square feet per bed in multibed rooms.(c)
Multibed rooms shall be designed to permit no more than two (2) beds side by side parallel to the window wall with not less than a four (4) foot space provided between beds, and at least a three (3) foot space between the side of a bed and the nearest wall, fixed cabinet, or heating/cooling element. A minimum of four (4) feet is required between foot of bed and opposite wall, or foot of the opposite bed in multibed rooms.(d)
Window. All patient rooms must have windows operable without the use of tools and shall have sills not more than three (3) feet above the floor. Window area shall be at least eight (8) percent of patient room floor area.(e)
Nurses' calling system. See Section 34(7) of this administrative regulation.(f)
Lavatory. In single and two (2) bed rooms with private toilet room, the lavatory may be located in the toilet room. Where two (2) patient rooms share a common toilet, a lavatory shall be provided in each patient room.(g)
Wardrobe or closet for each patient. Minimum clear dimensions shall be one (1) foot ten (10) inches by one (1) foot and eight (8) inches with full length hanging space, clothes rod and shelf.(h)
Cubicle curtains, or equivalent built-in devices shall be provided to furnish complete privacy for each patient at any one time in multibed rooms. Design for privacy shall not restrict patient access to the toilet, lavatory, or room entrance.(i)
No patient room shall be located more than 120 feet from the nurses' station, the clean workroom and the soiled workroom. No room shall be used as a patient room where the access is through another patient's room. At least sixty (60) percent of the beds in the nursing unit shall be located in rooms designed for one (1) or two (2) beds.(2)
Service areas in each nursing unit. The size and disposition of each service area will depend on the number of beds and types of disabilities to be served. Although identifiable spaces are required for each of the indicated functions, consideration will be given to multiple-use design solutions which provide equal, though unspecified, areas. Certain service areas may be arranged and located to serve more than one (1) nursing unit, but at least one (1) such service area shall be provided on each nursing floor unless noted otherwise. Service areas shall include:(a)
Administrative center or nurses' station for charting, doctors' charting, communications, and storage for supplies and nurses' personal effects.(b)
Clean workroom or clean holding area. The clean workroom shall contain a work counter, hand-washing and storage facilities. The clean holding room shall be part of a system for storage and distribution of clean and sterile supplies and shall be similar to the clean workroom except that the work counter and hand-washing facilities may be omitted.(c)
Soiled workroom or soiled holding room. The soiled workroom shall contain a clinical sink or equivalent flushing rim fixture, sink equipped for hand washing, work counter, waste receptacle, and linen receptacle. A soiled holding room shall be part of a system for collection and disposal of soiled materials and shall be similar to the soiled workroom except that the clinical sink and work counter may be omitted.(d)
Lounge and toilet room(s) for staff including lockers for storage of personal effects readily accessible. (May serve more than one (1) nursing unit.)(e)
Multipurpose room for conferences, demonstrations and consultation. (May serve more than one (1) nursing unit.)(f)
Medicine area. Provision shall be made for convenient and prompt twenty-four (24) hour distribution of medicine to patients. This may be from a medicine preparation room or unit, a self-contained medicine dispensing unit, or by another approved system. If used, a medicine preparation room or unit shall be under the nursing staff's visual control and a work counter, refrigerator, and locked storage for biologicals and drugs. A medicine dispensing unit may be located at the nurses' station, in the clean workroom, or in an alcove or other space under direct control of the nursing or pharmacy staff. The controlled substances locker must be under double lock. A hand-washing facility shall be provided.(g)
Clean linen storage. There shall be an enclosed storage space for clean linen. This area may be designated within the clean workroom. If a closed cart system is used, storage may be in an alcove.(h)
Nourishment station. This shall contain a sink equipped for hand-washing equipment for serving between scheduled meals, refrigerator, storage cabinets, and ice making-dispenser units to provide patient service and treatment. (May serve more than one (1) nursing unit on the same floor.)(i)
Stretcher and wheelchair parking area or alcove. This shall be located out of the path of normal traffic. (May serve more than one (1) nursing unit on the same floor.)(j)
Janitor's closet for storage of housekeeping supplies and equipment with a floor receptor or service sink. (May serve more than one (1) nursing unit on the same floor.)(k)
Equipment storage room with sufficient space for equipment such as I.V. stands, inhalators, air mattresses, and walkers. (May serve more than one (1) nursing unit on the same floor.)(l)
Emergency equipment storage. Space for equipment such as crash carts shall be provided and be under direct control of the nursing staff in close proximity to the nurses' station and out of traffic. (May serve more than one (1) nursing unit on the same floor.)(3)
Patients' bathing facilities. There shall be at least one (1) shower stall or one (1) bathtub for each twelve (12) beds not individually served. Each tub or shower shall be in an individual room or privacy enclosure which provides space for the private use of the bathing fixture, for drying and dressing, and for a wheelchair and an assisting attendant. Showers and central bathing facilities shall be at least four (4) feet square without curbs, and designed to permit use by a wheelchair patient.(4)
Patient toilet rooms.(a)
The minimum dimensions of a room containing only a water closet shall be five (5) feet by six (6) feet. Additional space shall be provided if a lavatory is located within the same room. The configuration of patient toilet rooms must provide for side transfers.(b)
A toilet room shall be directly accessible from each patient room without going through the general corridor. One (1) toilet room may serve two (2) patient rooms, but not more than four (4) beds. (The lavatory may be omitted from the toilet room if one is provided in each patient room.)(c)
Doors to toilet rooms shall have a minimum width of two (2) feet ten (10) inches to admit a wheelchair.(5)
Isolation room. If provided for in the program narrative, isolation room(s) shall be required for those prone to infections as well as those suffering from infections. Each isolation room shall have:(a)
Only one (1) patient per room;(b)
Separate toilet room with bath or shower and lavatory for the exclusive use of the patient allowing for direct entry from the patient bed area; and(c)
Facilities outside and immediately adjacent to the patient room for maintaining aseptic conditions.Section 7.
Outpatient Suite.(1)
General. Facilities for outpatient clinic care shall be provided if included in the narrative plan.(2)
Outpatient department. If outpatient services are provided, the extent of the administrative, clinical and diagnostic facilities to be provided will depend on the estimated patient load as described in the program narrative. The planning of outpatient facilities shall provide for the privacy and dignity of the patient during interview, examination, and treatment. Facilities shall be located so that outpatients do not traverse inpatient areas and the following shall be provided:(a)
Entrance at grade level which is sheltered from weather and able to accommodate wheelchair access.(b)
Reception and control area located near the entrance and waiting area(s).(c)
Wheelchair storage out of the line of direct traffic.(d)
Public waiting area with toilet facilities, public telephone and drinking fountain.(e)
Interview space(s) for private interviews relating to social service, credit and admissions.(f)
General purpose examination room(s) for medical examinations. Each room shall have a minimum floor area of eighty (80) square feet, excluding such spaces as vestibule, toilet, closet and work counter. Examination table shall be placed to provide at least thirty (30) inches clearance to each side and at the foot of the table. A lavatory or sink equipped for hand washing shall be provided in each room.(g)
Patient toilet facilities shall be provided. The number required will depend on the actual patient load of the department.(h)
Nurses' station for nurses' charting, doctors' charting, communications and storage for supplies and nurses' personal effects.(i)
Staff toilet room located convenient to the nurses' station.(j)
Clean workroom. It shall contain a work counter, sink equipped for hand washing, and storage space for clean and sterile supplies.(k)
Soiled workroom. It shall contain a clinical sink or equivalent flushing type fixture, work counter, sink equipped for hand washing, waste receptacle and linen receptacle.(l)
Drug distribution station for storage and preparation of medication. It shall contain a work counter, sink equipped for hand washing, and storage facilities. Controlled substances shall be under double lock.(m)
Wheelchair and stretcher alcove located convenient to the entrance to the department.(n)
Janitor's closet. It shall contain a floor receptor or service sink with storage space for housekeeping supplies and equipment for exclusive use in the outpatient department.(o)
Equipment storage room.Section 8.
Radiology Suite. If the facility provides diagnostic radiology services directly, then the suite shall contain the following:(1)
Radiographic room(s);(2)
Film processing facilities;(3)
Viewing and administrative area(s);(4)
Film storage facilities;(5)
Toilet room with hand-washing facility. It shall be located directly accessible from each fluoroscopy room without entering the general corridor area;(6)
Dressing area(s) for ambulatory patients with convenient access to toilets;(7)
Waiting room or alcove for ambulatory patients;(8)
Holding area for stretcher patients. It shall be located out of the direct line of normal traffic; and(9)
Hand-washing facilities shall be provided in each radiographic room unless the room is used only for routine diagnostic screening such as for chest x-rays.Section 9.
Laboratory Suite. Facilities shall be provided directly or through an effective contract arrangement with a nearby hospital for laboratory service for the following:(1)
Hematology;(2)
Clinical chemistry. An acid-shower and eyewashing facility shall be provided nearby;(3)
Urinalysis. A specimen toilet with hand-washing facility shall be provided nearby;(4)
Cytology;(5)
Bacteriology;(6)
Waiting area for ambulatory patients;(7)
Administrative support areas;(8)
Blood storage facilities;(9)
Blood specimen collection area. It shall contain work counter, hand-washing facilities, and space for patient seating;(10)
Glass-washing and sterilizing facilities; and(11)
Recording and filing facilities.Section 10.
Physical Therapy Suite. Each rehabilitation facility shall provide physical therapy services; however, the physical therapy area can be shared with the occupational therapy services, if called for in the program narrative. Each physical therapy suite shall contain the following items:(1)
Office space;(2)
Waiting space;(3)
Treatment area(s) for thermotherapy, diathermy, ultrasonics, hydrotherapy, etc. Cubicle curtains around each individual treatment area shall be provided for privacy purposes. Hand-washing facilities shall be provided but one (1) lavatory or sink may serve more than one (1) treatment cubicle. Facilities for collection of wet and soiled linen or other material shall be provided;(4)
Exercise area(s);(5)
Storage for clean linen, supplies, and equipment;(6)
Patients' dressing areas, showers, lockers and toilet rooms;(7)
Janitor's closet with floor receptor or service sink and storage space for housekeeping supplies and equipment; and(8)
Wheelchair and stretcher storage area. (Items contained in subsections (1), (2), (5), (7) and (8) of this section may be planned and arranged for shared use by occupational therapy patients and staff if the approved narrative program reflects this sharing concept.)Section 11.
Occupational Therapy Suite. Each rehabilitation facility shall provide occupational therapy services; however, the occupational therapy area can be shared with the physical therapy services, if called for in the program narrative. The following shall be provided:(1)
Office space;(2)
Waiting space;(3)
Work areas and counters suitable for wheelchair access;(4)
Hand-wash facilities;(5)
Storage for supplies and equipment.Section 12.
Social Work Suite. Each rehabilitation facility shall contain a social work suite. The following shall be provided:(1)
Office space(s) for staff.(2)
Office space for private interviewing and counseling for all family members.Section 13.
Psychological Services Suite. Each rehabilitation facility shall contain a psychological service suite. The following shall be provided:(1)
Office(s).(2)
Workspace for testing, evaluation, and counseling.Section 14.
Speech and Language Therapy Suite. Each rehabilitation facility shall contain a speech and language therapy suite. The following shall be provided:(1)
Office(s) for therapists.(2)
Space for evaluation and treatment.(3)
Space for equipment and storage.Section 15.
Area for Teaching Activities of Daily Living (should be combined with rehabilitative engineering function, as needed).(1)
An area for teaching activities shall be provided.(2)
It shall include a bedroom, bath, kitchen, and space for stairs.Section 16.
Prosthetics and Orthotics Service. Depending on the needs of those served and the stated institutional goals, the facility shall provide or make arrangements for the following:(1)
Work space for technician(s).(2)
Space for evaluation and fittings (with a provision for privacy).(3)
Space for equipment, supplies, and storage.Section 17.
Vocational Therapy Services. Depending upon the needs of those served and the stated institutional goals, the facility shall provide or make arrangements for the following:(1)
Office(s).(2)
Workspace for vocational services activities such as evaluation (prevocational and vocational).(3)
Training.(4)
Counseling and placement.Section 18.
Respiratory Therapy Services. Depending upon the needs of those served and the stated institution goals, the facility shall provide or make arrangements for the following:(1)
Storage for equipment and supplies.(2)
Space and utilities for cleaning and sanitizing equipment.(3)
Service facilities for calibrating, adjusting, servicing, and minor repairs and equipment.(4)
Respiratory services shall be conveniently accessible on a twenty-four (24) hour basis to the facility.(5)
If respiratory services such as testing and demonstration for outpatients are part of the program, additional facilities and equipment shall be provided as necessary for appropriate function of the service, including but not limited to:(a)
Patient waiting area with provision for wheelchairs.(b)
Reception and control station.(c)
Patient toilets and hand-washing facilities.(d)
Room(s) for patient education and demonstration.Section 19.
Pharmacy Suite. If required by program, the size and type of services to be provided in the pharmacy will depend upon the type of drug distribution system to be used and whether the facility proposes to provide, purchase, or share pharmacy services. This shall be explained in the narrative program. Provision shall be made for the following functional areas:(1)
Dispensing area with hand-washing facility.(2)
Editing or order review area.(3)
Area for compounding.Section 20.
Dietary Department. Food facilities shall be designed and equipped to meet requirements of the narrative program. If a commercial service will be used, dietary areas and equipment shall be designed to accommodate the requirements for sanitary storage, processing, and handling. The department shall include the following facilities unless acceptable commercially prepared dietary services, meals, and or disposables are to be used:(1)
Control station for the receiving of food supplies.(2)
Food preparation facilities. Conventional food preparation systems require space and equipment for preparing, cooking, and baking. Convenience food service systems such as frozen prepared meals, bulk packages entrees, and individual package portions, or systems using contractual commissary services require space and equipment for thawing, portioning, cooking and/or baking.(3)
Hand-washing facility(ies) located conveniently accessible in the food preparation area.(4)
Patients' meals service facilities. Examples are those required for tray assembly and distribution.(5)
Dishwashing space. It shall be located in a room or alcove separate from the food preparation and serving area. Commercial-type dishwashing equipment shall be provided. Space shall also be provided for receiving, scraping, sorting and stacking of soiled dishware and tableware prior to cleanup. The area shall be designed to allow clean dishware and tableware to be removed at a different location than the one used for the soiled dishware and tableware. A hand-washing lavatory shall be conveniently located.(6)
Pot-washing facilities.(7)
Refrigerated storage to accommodate a three (3) day minimum supply.(8)
Dry storage to accommodate a three (3) day minimum supply.(9)
Storage areas and sanitizing facilities for cans, carts and mobile tray conveyors.(10)
Waste storage facilities shall be located in a separate room easily accessible to the outside for direct pickup or disposal.(11)
Dining space for ambulatory patients, staff and visitors.(12)
Office(s) or desk spaces for dieticians or the dietary service manager.(13)
Toilets with hand-washing facilities for use by the dietary staff shall be immediately available.(14)
Janitor's closet located within the department. It shall contain a floor receptor or service sink with storage for housekeeping supplies and equipment to be used exclusively in this area.Section 21.
Patient's Dining, Recreation, and Day Spaces. The following areas shall be provided and may be in separate or adjoining spaces:(1)
Inpatients and residents. A total of twenty-five (25) square feet per bed.(2)
Outpatients. A total of twenty (20) square feet per person when dining is a part of their day care program. (If dining is not part of the program, provide at least ten (10) square feet per person for recreation and day spaces.)(3)
Storage. Storage spaces shall be provided for recreational equipment and supplies.Section 22.
Administrative and Public Areas. The following shall be provided:(1)
Lobby. It shall include:(a)
Storage space for wheelchairs;(b)
Reception and information counter or desk;(c)
Waiting space(s); and(d)
Public toilet facilities designed for use by the physically handicapped.(2)
Interview space(s) for private interviews relating to social services, credit, and admissions.(3)
Director of nurses' office.(4)
Staff toilet rooms.(5)
Medical library facilities.(6)
General or individual office(s) for business transactions, medical and financial records, administrative and professional staffs use.(7)
Administrator's office.(8)
Multipurpose room(s) for conferences, meetings, and health education purposes including provisions for showing visual aids.(9)
Storage for office equipment and supplies.Section 23.
Medical Records Unit. This unit shall include:(1)
Medical records administrator/technician office or space;(2)
Active record storage area;(3)
Record review and dictating room; and(4)
Work area for sorting, recording, and microfilming.Section 24.
Sterilizing Facilities. A system for the sterilization of equipment and supplies shall be provided. Storage area for clean supplies and sterile supplies shall be provided.Section 25.
Central Stores. The following shall be provided:(1)
Off-street unloading facilities.(2)
Control station for receiving supplies.(3)
General storage rooms which are adequate in size to meet the needs of the facility.Section 26.
Laundry. On-site processing and off-site processing.(1)
If linen is to be processed on the site, the following shall be provided:(a)
Soiled linen receiving, holding, and sorting room with hand-washing facilities.(b)
Laundry processing room with commercial-type equipment which can process seven (7) days of linen needs within a regularly scheduled work week. Hand-washing facilities shall be provided.(c)
Storage for laundry supplies.(d)
Clean linen inspection and mending room.(e)
Clean linen storage, issuing, and holding room or area.(f)
Janitor's closet. It shall contain a floor receptor or service sink with storage space for housekeeping supplies and equipment to be utilized exclusively in this department.(g)
Cart storage and cart sanitizing facilities.(h)
Arrangement of equipment and procedures shall be in a manner to permit an orderly work flow with a minimum of cross traffic that might mix clean and soiled operations.(2)
If linen is to be processed off the site, the following shall be provided:(a)
Soiled linen holding room with a hand-washing facility conveniently accessible.(b)
Clean linen receiving, holding, inspection and storage room(s).Section 27.
Employees' Facilities.(1)
Female locker room. This room shall have lounge space, lockers for personal effects and a separate toilet room. The area shall be designed for use by the physically handicapped. In some cases shower facilities may be appropriate depending on the size of the facility.(2)
Male locker room. This room shall have lockers and a separate toilet room. The area shall be designed for use by the physically handicapped. In some cases shower facilities may be appropriate depending on the size of the facility.Section 28.
Engineering Service and Equipment Areas. The following shall be provided:(1)
Room(s) or separate building(s) for boilers, mechanical equipment and electrical equipment;(2)
Engineer's office;(3)
Maintenance shop;(4)
Storage room for building maintenance supplies;(5)
Storage room for central housekeeping equipment and supplies;(6)
Office and administrative support space for person(s) in charge of central housekeeping; and(7)
Yard equipment storage.Section 29.
Waste Processing Services. Rehabilitation facilities which are part of an acute care hospital may share waste processing. Freestanding facilities shall provide the following:(1)
Storage and disposal. Space and facilities shall be provided for the sanitary storage and disposal of waste by incineration, mechanical destruction, compaction, containerization, removal or by a combination of these techniques.(2)
Incinerator. A gas, electric, or oil-fired incinerator shall be provided for the complete destruction of pathological and infectious waste. Infectious waste includes, but is not limited to, waste materials from isolation rooms, dressings and material from open wounds and laboratory specimens. The incinerator may be shared by two (2) or more institutions located on a common "campus."(a)
The incinerator capacity required will vary with the type and quantity of waste to be processed. If approved by local authorities and described in the functional program, items of small mass such as dressings, isolation room waste, laboratory specimens, may be sterilized on site by autoclaving or rendered safe by other acceptable procedure and disposed of in municipal landfill or incinerator. Waste tissue and contaminated combustible solids shall be rendered safe by such methods as sterilization or incineration. Culture plates, tubes, sputum cups, contaminated sponges, swabs and the like shall be sterilized before they are washed and discarded.(b)
Consideration shall be given to the recovery of waste heat from on-site incinerators which are used to dispose of large amounts of waste materials.Section 30.
Details and Finishes.(1)
Details.(a)
All doors to patient-room toilets and patient-room bathrooms shall swing outward or be equipped with hardware that will permit access in an emergency.(b)
Windows and outer doors which may be frequently left in an open position shall be provided with insect screens.(c)
Thresholds and expansion joint covers shall be made flush with the floor surface to facilitate use by wheelchairs and carts and shall be constructed to resist passage of smoke.(d)
The location and arrangements of lavatories and sinks equipped with blade handles for hand-washing purposes shall provide a minimum of sixteen (16) inches clearance to each side of the centerline of the fixture.(e)
Provisions for hand drying shall be included at all hand-washing facilities except scrub sinks. These shall be single use, separate paper or cloth units enclosed in such a way as to provide protection against dust or soil and insure single unit dispensing. Hot air dryers are permitted provided that installation is such as to minimize contamination by recirculated air.(f)
Grab bars shall be provided at all patients' toilets, showers, and tubs. The bars shall have one and one-half (1 1/2) inches clearance to walls and shall be of sufficient strength and anchorage to sustain a concentrated load of 250 pounds for a period of five (5) minutes.(g)
Handrails shall be provided on both sides of corridors used by patients. A clear distance of one and one-half (1 1/2) inches shall be provided between the handrail and the wall, and the top of the rail shall be about thirty-two (32) inches above the floor, except for special care areas such as those serving children.(h)
Ends of handrails and grab bars shall be constructed to prevent snagging the clothes of patients.(i)
Location and arrangement of hand-washing facilities shall permit their proper use and operation. Particular care should be given to clearance required for blade-type operating handles. Lavatories intended for use by handicapped patients shall be installed to permit wheelchairs to slide under them.(j)
Recessed soap dishes shall be provided at all showers and bathtubs.(k)
Mirrors shall be arranged for convenient use by patients in wheelchairs as well as by patients in a standing position.(l)
Protection requirements of x-ray and gamma-ray installations shall be approved by the Radiation and Product Safety Branch, Office of Consumer Health Protection, Department for Health Services, Cabinet for Human Resources.(m)
The minimum ceiling height shall be eight (8) feet, with the following exceptions:1.
Boiler rooms shall have ceiling clearances not less than two (2) feet six (6) inches above the main boiler header and connecting piping.2.
Radiographic, and other rooms containing ceiling-mounted equipment or ceiling-mounted light fixtures shall have sufficient height to accommodate the equipment or fixtures and their normal movement.3.
Ceiling and corridors, storage rooms, and toilet rooms shall be not less than seven (7) feet eight (8) inches. Ceilings in small minor spaces which are normally unoccupied may be reduced to seven (7) feet.4.
Suspended tracks, rails, and pipes located in the path of traffic for patients in beds and/or stretchers, including service areas for inpatients shall be not less than seven (7) feet above the floor.(n)
Recreation rooms, exercise rooms, and similar spaces where impact noises may be generated shall not be located directly over patient bed areas, unless special provisions are made to minimize such noise.(o)
Rooms containing heat-producing equipment such as boiler rooms, laundries, and food preparation areas shall be insulated and ventilated to prevent any floor surface from exceeding a temperature of ten (10) degrees Fahrenheit above the ambient room temperature.(p)
Noise reduction criteria. Partition, floor, and ceiling construction in patient areas shall comply with Table 1, Section 35 of this administrative regulation.(2)
Finishes.(a)
Floor materials shall be easily cleanable and have wear resistance appropriate for the location involved. Floors in areas used for food preparation or food assembly shall be water-resistant and grease-proof. Joints in tile and similar material in such areas shall be resistant to food acids. In all areas subject to frequent wet cleaning methods, floor materials shall not be physically affected by germicidal and cleaning solutions. Floors that are subject to traffic while wet, such as shower and bath areas, kitchens and similar work areas, shall have a nonslip finish.(b)
Adjacent dissimilar floor materials shall be flush with each other to provide an unbroken surface.(c)
Walls generally shall be washable; and in the immediate area of plumbing fixtures, the finish shall be smooth and moisture-resistant. Finish, trim, and floor and wall construction in dietary and food preparation areas shall be free from spaces that can harbor rodents and insects.(d)
Wall bases in kitchens, and other areas subject to frequent wet cleaning methods shall be made integral and coved with the floor, tightly sealed within the wall, and constructed without voids that can harbor harmful bacteria.(e)
Ceilings throughout the facility shall be easily cleanable. Ceilings in dietary and food preparation areas shall have a finished ceiling covering all overhead piping and ductwork. Finished ceilings may be omitted in mechanical and equipment spaces, shops, general storage areas and similar spaces, unless required for fire-resistive purposes.(f)
Acoustical type ceilings shall be provided for corridors in patient areas, nurses' stations, dayrooms, recreation rooms, dining areas, and waiting areas.Section 31.
Elevators. General. All buildings having patients' facilities, such as bedrooms, dining rooms or recreation areas, or critical services, such as diagnostic or therapy areas, located on other than the main entrance floor shall have elevators.(1)
Number of elevators.(a)
At least one (1) hospital-type elevator shall be installed where one (1) to fifty-nine (59) patient beds are located on any floor other than the main entrance floor.(b)
At least two (2) hospital-type elevators shall be installed where sixty (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.(c)
At least three (3) 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 inpatient services are located on a floor other than those containing patient beds.(d)
For facilities with more than 350 beds number of elevators shall be determined from a study of the facility plan and the estimated vertical transportation requirements.(2)
Cars and platforms. Cars of hospital-type elevators shall have inside dimensions that will accommodate a hospital bed and attendant and shall be at least five (5) feet wide by seven (7) feet and six (6) inches deep. The car door shall have a minimum clear opening of not less than three (3) feet and eight (8) inches.(3)
Leveling. Elevators shall have automatic leveling of the two (2) way automatic maintaining type with accuracy within plus or minus one-half (1/2) inch.(4)
Operation. Elevators, except freight elevators, shall be equipped with a two (2) way special service switch to permit cars to bypass all landing button calls and be dispatched directly to any floor.Section 32.
Construction.(1)
Design. Every building and every portion thereof shall be designed and constructed to sustain all dead and live loads in accordance with accepted engineering practices and standards, including seismic forces when applicable.(2)
Foundations. Foundations shall rest on natural solid bearing, if a satisfactory bearing is available at reasonable depths. Proper soil-bearing values shall be established in accordance with recognized standards. If solid bearing is not encountered at practical depths, the structure shall be supported on driven piles, augured piles, poured caissons or equivalent designed to support the intended load without detrimental settlement, except that one (1) story buildings may rest on a fill designed by a soils engineer. When engineered fill is used, site preparation and placement of fill shall be done under the direct full-time supervision of the soils engineer. The soils engineer shall issue a final report on the compacted fill operation and certification of compliance with the job specifications. All footings shall extend to a depth not less than one (1) foot below the estimated frost line.(3)
Natural disasters. Special provisions shall be made in the design of buildings in geographic areas where local experience reflects loss of life or extensive damage to buildings resulting from tornadoes, floods, earthquakes, etc.Section 33.
Mechanical Requirements.(1)
General. Prior to completion of the contract and final acceptance of the facility, the architect and/or engineer shall obtain from the contractor certification in writing that all mechanical systems have been tested and that the installation and performance of these systems conform with the final plans and specifications.(2)
Incinerators. The design and installation shall comply with the current Kentucky standards for control of air contaminants for incinerators regulations as applicable to hospitals.(3)
Steam and hot water systems.(a)
Boilers. If boilers are used, a minimum of two (2) shall be provided and the combined capacity of the boilers, based upon the published Steel Boiler Institute or Institute of Boiler and Radiation Manufacturer's net rating, must be able to supply 150 percent of the normal requirements for all systems and equipment in the facility.(b)
Boiler accessories. Boiler feed pumps, condensate return pumps, fuel oil pumps, and circulation pumps shall be connected and installed to provide normal and standby service.(c)
Valves. Supply and return mains and risers of cooling, heating, and process steam systems shall be valved to isolate the various sections of each system. Each piece of equipment shall be valved at the supply and return ends except that vacuum condensate returns need not be valved at each piece of equipment.(4)
Thermal and acoustical installation.(a)
Insulation shall be provided on the following within the building:1.
Boilers, smoke breeching, and stacks;2.
Steam supply and condensate return piping;3.
Hot water piping above 120 degrees Fahrenheit at all hot water heaters, generators and converters;4.
Chilled water, refrigerant, other process piping and equipment operating with fluid temperatures below ambient dew point;5.
Water supply and drainage piping on which condensation may occur;6.
Air ducts and casings with outside surface temperature below ambient dew point or temperature above eighty (80) degrees Fahrenheit; and7.
Other piping, ducts, and equipment as necessary to maintain the efficiency of the system.(b)
Insulation on cold surfaces shall include an exterior vapor barrier.(5)
Air-conditioning, heating and ventilation systems.(a)
Temperatures for areas occupied by inpatients, the indoor winter design temperature shall be seventy-five (75) degrees Fahrenheit. For all other occupied areas, the indoor winter design temperature shall be seventy-two (72) degrees Fahrenheit. For all other occupied areas, the indoor summer design temperature shall be seventy-five (75) degrees Fahrenheit.(b)
Ventilation system details. All air-supply and air-exhaust systems shall be mechanically operated. All fans serving exhaust systems shall be located at the discharge end of the system. The ventilation rates as shown on Table 2, Section 35 of this administrative regulation, shall be considered as minimum acceptable rates and shall not be construed as precluding the use of higher ventilation rates.1.
Outdoor air intakes shall be located as far as practical but not less than twenty-five (25) feet from exhaust outlets of ventilation systems, combustion equipment stacks, medical surgical vacuum systems, plumbing vent stacks, or from areas which may collect vehicular and other noxious fumes. Plumbing and vacuum vents that terminate above the level of the top of the air intake may be located as close as ten (10) feet. The bottom of outside air intakes serving central air systems shall be located as high as practical but not less than six (6) feet above ground level or if installed above the roof, three (3) feet above roof level.2.
The ventilation systems shall be designed and balanced in accordance with the pressure relationship as shown in Table 2, Section 35 of this administrative regulation.3.
Where two (2) filter beds are required in central ventilation and air-conditioning equipment, Filter Bed No. 1 shall be located upstream of the air-conditioning equipment and Filter Bed No. 2 shall be located downstream of the supply fan, any recirculating spray water system, and water reservoir type humidifiers. Where only one (1) filter bed is required, it shall be located upstream of the air-conditioning equipment unless an additional prefilter is employed. In this case, the prefilter shall be located upstream of the equipment and the main filter may be located further downstream.4.
All room supply, return and exhaust outlets shall be located not less than three (3) inches AFF.5.
All central ventilation or air-conditioning systems shall be equipped with filters having minimum efficiencies as listed below:Area Designation | Minimum No. of Filters | Filter Efficiencies % | |
No. 1 | No. 2 | ||
Burn Care Unit | 2 | 25 | 90 |
Patient Care, Treatment, Diagnostic and Related Areas | 2 | 25 | 90* |
Food Preparation and Laundry | 1 | 80 | -- |
Administrative, Storage, and Soiled Holding | 1 | 25 | -- |
6.
All filter efficiencies as listed above shall be average atmospheric dust spot efficiencies tested in accordance with ASHRAE Standard 52-76.7.
Filter frames shall be durable and carefully dimensioned, and shall provide an airtight fit with the enclosing ductwork. All joints between filter segments and the enclosing ductwork shall be gasketed or sealed to provide a positive seal against air leakages.8.
A manometer or its equivalent shall be installed across each filter bed in central air systems.9.
Ducts which penetrate construction intended for x-ray or other ray protection shall not impair the effectiveness of the protection.10.
Laboratories shall be provided with outdoor air at a rate of two (2) air changes per hour. If this ventilation rate does not provide the air required to ventilate fume hoods and safety cabinets, additional outdoor air shall be provided. A filter with ninety (90) percent minimum efficiency shall be installed in the air supply system at its entrance to the media transfer room.11.
Laboratory hoods for general use shall have a minimum average face velocity of seventy-five (75) feet per minute. Hoods in which infections or highly radioactive materials are processed shall have a face velocity of 100 feet per minute and each hood shall have an independent exhaust system with the fan installed at the discharge point of the system. Hoods used for processing infectious materials shall be equipped with a means of disinfection.12.
Duct systems serving hoods in which highly radioactive materials and strong oxidizing agents are used shall be constructed of stainless steel for a minimum of ten (10) feet from the hood and shall be equipped with washdown facilities.13.
Boiler rooms shall be provided with sufficient outdoor air to maintain combustion rates of equipment and reasonable temperatures in the rooms and in adjoining areas.(6)
Plumbing systems. All plumbing systems shall be designed and installed in accordance with the requirements of the current Kentucky plumbing standards administrative regulations applicable to hospitals.(a)
Plumbing fixtures.1.
The material used for plumbing fixtures shall be of nonabsorptive acid-resistant material.2.
Lavatories and sinks required in patient care areas shall have the water supply spout mounted so that its discharge point is a minimum of five (5) inches above the rim of the fixture. All fixtures used by medical and nursing staff and all lavatories used by patients and food handlers shall be equipped with valves which can be operated without the use of hands. Where blade handles are used for this purpose, they shall not exceed four and one-half (4 1/2) inches in length, except that handles on scrub sinks and clinical sinks shall be not less than six (6) inches long.3.
Clinical sinks shall have an integral trap in which the upper portion of a visible trap seal provides a water surface.4.
Shower bases and tubs shall provide nonslip surfaces for patients.(b)
Water supply systems.1.
Systems shall be designed to supply water at sufficient pressure to operate all fixtures and equipment during maximum demand periods.2.
Each water service main, branch main, riser and branch to a group fixture shall be valved. Stop valves shall be provided at each fixture.3.
Backflow preventers (vacuum breakers) shall be installed on hose bibbs, laboratory sinks, janitors' sinks, bedpan flushing attachments, and all other fixtures to which hoses or tubing can be attached.4.
Flush valves installed on plumbing fixtures shall be of a quiet operating type.5.
Bedpan flushing devices shall be provided in each patient toilet room and in the soiled workrooms located in the patient nursing units.6.
An auxiliary water supply shall be available to provide potable water in case of emergencies.(c)
Hot water heating systems.1.
The hot water heating equipment shall have a sufficient capacity to supply water at the temperature and amounts indicated below:Hot-water Use | |||
Clinical | Dishwasher | Laundry | |
Gal/hr/bed | 6-1/2 | 4 | 4 1/2 |
Temp. F. | 110 | 180* | 160** |
**Required temperature of 160 degrees Fahrenheit is that measured in the washing machine and shall be supplied so that the temperature will be maintained over the entire wash and rinse cycles.
2.
Storage tank(s) shall be fabricated or corrosive-resistant metal or be lined with noncorrosive material.(d)
Drainage systems.1.
Drain lines from sinks in which acid wastes may be poured shall be fabricated from an acid-resistant material.2.
Piping over food preparation centers, food serving facilities, food storage areas, and other critical areas shall be kept to a minimum and shall not be exposed. Special precautions shall be taken to protect these areas from possible leakage or condensation from necessary overhead piping systems.3.
Building sewers shall discharge into a community sewerage system. Where such a system is not available, a facility providing sewage treatment shall be installed which conforms to all applicable local and state administrative regulations.4.
Nonflammable medical gas systems. If used, nonflammable medical gas systems installations shall be in accordance with the requirements of NFPA Standard 56A and 56F.5.
At least two (2) patient rooms in each nursing unit and the examination/treatment rooms shall have oxygen and vacuum outlets.6.
In patient rooms with oxygen and vacuum outlets, one (1) set of those outlets may serve two (2) beds.Section 34.
Electrical Requirements.(1)
General.(a)
All material including equipment, conductors, controls, and signaling devices shall be installed to provide a complete electrical system with the necessary characteristics and capacity to supply the electrical facilities shown in the specifications or indicated on the plans. All materials shall be listed as complying with applicable standards of Underwriters' Laboratories, Inc., or other similarly established standards.(b)
All electrical installations and systems shall be tested to show that the equipment is installed and operates as planned or specified. A written record of performance tests on special electrical systems and equipment shall be supplied to the owner.(2)
Switchboard and power panels. Circuit breakers or fusible switches that provide disconnecting means and overcurrent protection for conductors connected to switchboards and panel boards shall be enclosed or guarded to provide a dead-front type of assembly. The main switchboard shall be located in a separate enclosure accessible only to authorized persons. The switchboard shall be convenient for use, readily accessible for maintenance, clear of traffic lanes, and in a dry ventilated space devoid of corrosive fumes or gases. Overload devices shall be suitable for operating properly in the ambient temperature conditions.(3)
Panel boards. Lighting and appliance panel boards shall be located on the same floor as the circuits they serve.(4)
Lighting.(a)
All spaces occupied by people, machinery, and equipment within buildings, and the approaches thereto, and parking lots shall have lighting.(b)
Patients' bedrooms shall have general lighting and night lighting. A reading light shall be provided for each patient. Flexible light arms shall be mechanically operated to prevent the bulb from coming in contact with the bed linen. Patients' reading lights and other fixed lights not switched at the door shall have switch controls located convenient to the luminaire. A fixed type night light, mounted at approximately sixteen (16) inches above the floor, shall be provided in each patient room. All switches for control of lighting in patient areas shall be of the quiet operating type. Switches in patients' rooms shall be installed not more than forty-eight (48) inches above the floor to be reached from a wheelchair.(c)
Nursing unit corridors shall have general illumination with provisions for reduction of light levels at night. Refer to Table 3, Section 35 of this administrative regulation.(5)
Receptacles (convenience outlets).(a)
Bedroom. Each patient bedroom shall have duplex receptacles as follows: one (1) on each side of the head of the bed; one (1) for the television, if used; and one (1) on another wall. Receptacles for general use shall be located convenient for use from a wheelchair.(b)
Corridors. Duplex receptacles for general use shall be installed approximately fifty (50) feet apart and within twenty-five (25) feet of ends of corridors.(6)
Equipment installation in special areas.(a)
X-ray and gamma-ray installations. X-ray stationary installations and mobile equipment shall conform to the current Kentucky standards for radiographic and radioisotope equipment and use administrative regulations applicable to hospitals.(b)
X-ray film illuminator units. At least two (2) units shall be installed in the x-ray viewing room.(c)
The electrical circuit(s) to fixed or portable equipment in hydrotherapy units shall be provided with five (5) milliampere ground fault interrupters.(7)
Nurses' calling system.(a)
General. In general patient areas, each room shall be served by at least one (1) calling station and each bed shall be provided with a call button. Two (2) call buttons serving adjacent beds may be served by one (1) calling station. Calls shall register at an annunciator panel at the nurses' station and shall actuate a visible signal in the corridor at the patient room door, in the clean workroom, the soiled workroom, the nourishment station, and the nurses' lounge of the nursing unit. In multicorridor nursing units, additional visible signals shall be installed at corridor intersections. In rooms containing two (2) or more calling stations, indicating lights shall be provided at each station. Nurses' calling systems which provide two (2) way voice communication shall be equipped with an indicating light at each calling station which lights and remains lighted as long as the voice circuit is operating.(b)
Patients' emergency. A nurses' call emergency button shall be provided for patients' use at each patient's toilet, bath, and shower room on the nursing unit floors. Such buttons shall be usable by a collapsed patient lying on the floor; inclusion of a pull cord will satisfy this requirement.(8)
Fire alarms and fire detection systems. The design and installation of these systems must be approved by the State Fire Marshal's Office.(9)
Emergency electrical.(a)
General. To provide electricity during interruption of the normal electric supply, an emergency source of electricity shall be provided and connected to certain circuits for lighting and power.(b)
Sources. The source of this emergency electric service shall be as follows:1.
An emergency generating set, when the normal service is supplied by one (1) or more central station transmission lines.2.
An emergency generating set or a central station transmission line, when the normal electric supply is generated on the premises.(c)
Emergency generating set. The required emergency generating set, including the prime mover and generator, shall be located on the premises and shall be reserved exclusively for supplying the emergency electrical system. Generator sets shall be self-sufficient insofar as possible without dependency on public utilities that may be subject to cutoff or outages. Exception: a system of prime movers which are ordinarily used to operate other equipment and alternately used to operate the emergency generator(s) will be permitted provided that the number and arrangement of the prime movers are such that when one (1) of them is out of service (due to breakdown or for routine maintenance), the remaining prime mover(s) can operate the required emergency generator(s) and provided that the connection time requirements as listed in Section 34(9)(e) of this administrative regulation are met. The emergency generator set shall be of sufficient kilowatt capacity to supply all lighting and power load demands of the emergency electrical system. The power factor rating of the generator shall be not less than eighty (80) percent.(d)
Emergency electrical connections. Emergency electric service shall be provided to circuits as follows:1.
Lighting.a.
Exitways and all necessary ways of approach thereto, including exterior of exits, exit doorways, stairways, and corridors.b.
Laboratory, nursing station, medication preparation dispensing area.c.
Generator set location, switch-gear location, mechanical room and boiler room.d.
Elevator cabs.e.
Night light in patient rooms.2.
Equipment. Essential to life safety and for protection of important equipment or vital materials:a.
Nurses' calling system.b.
Paging or speaker systems, if intended for issuing instructions during emergency conditions. Alarms required for medical gas systems.c.
Fire pump and jockey pump, if installed.d.
Pump for central suction system.e.
Sewerage or sump lift pump, if installed.f.
Blood bank refrigerator.g.
Duplex receptacles in patient corridors, and at least one (1) duplex receptacle located on the patient headwall in each patient room.h.
Elevator service that will reach every patient floor. Manual throw over facilities shall be provided to allow temporary operation of any elevator for the release of persons who may be trapped between floors.i.
Equipment necessary for maintaining telephone service.3.
Heating. Equipment for heating general patient rooms; except that service for heating of those rooms will not be required under either of the following conditions:a.
The design temperature is higher than twenty (20) degrees Fahrenheit, based on the Median of Extremes as shown in the current edition of the ASHRAE Handbook of Fundamentals.b.
The facility is supplied by two (2) or more electrical services supplied from separate generating sources, or a utility distribution network having multiple power light sources and arranged to provide mechanical and electrical separation, so that a fault between the facility and generating sources will not likely cause an interruption of the facility service feeders.(e)
Details. The emergency electrical system shall be so controlled that after interruption of the normal electric power supply, the generator is brought to full voltage and frequency and it must be connected within ten (10) seconds through one (1) or more primary automatic transfer switches to all emergency lighting systems; alarms systems; blood banks; nurses' calling systems; equipment necessary for maintaining telephone service; pump for central suction system; and task illumination and receptacles in patient rooms and patient corridors. All other lighting and equipment required to be connected to the emergency system shall either be connected through the above described primary automatic transfer switching or shall be subsequently connected through other automatic or manual transfer switching. Receptacles connected to the emergency system shall be distinctively marked for identification. Storage-battery-powered lights, provided to augment the emergency lighting or for continuity of lighting during the interim of transfer switching immediately following an interruption of the normal service supply, shall not be used as a substitute for the requirement of a generator. Where stored fuel is required for emergency generator operation, the storage capacity shall be sufficient for not less than twenty-four (24) hours of continuous operation.Section 35.
Table 1 - Sound Transmission Limitations for Rehabilitation Facilities. Table 2 - Pressure Relationships and Ventilation of Certain Rehabilitation Areas. Table 3 - Lighting Levels for Rehabilitation Facilities.Table 1. Sound Transmission Limitations in Rehabilitation Facilities. | ||||
Location | Airborne Sound Transmission Class (STC) a* | Impact Insulation Class (IIC) b* | ||
Partitions | Floors | Floors | ||
Patients' room to patients' room | 45 | 45 | 45 | |
Public space to patients' room d* | 50 | 50 | 50 c* | |
Service areas to patients' room e* | 55 | 55 | 55 c* | |
b* - Impact insulation class (IIC) shall be determined in accordance with criteria set forth in HUD FT/TS-24, "A Guide to Airborne, Impact and Structure Borne Noise - Control in Multifamily Dwellings."
c* - Impact noise limitation applicable only when corridor, public space, or service area is over patients' room.
d* - Public space includes lobbies, dining rooms, recreation rooms, treatment rooms, and similar spaces.
e* - Service areas 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 patients' rooms, offices, nurses' stations and similar occupied spaces shall be effectively isolated relating to noise transmission.
Note: The requirements set forth in this table assume installation methods which will not appreciably reduce the efficiency of the assembly as tested.
TABLE 2.- PRESSURE RELATIONSHIPS AND VENTILATION OF CERTAIN REHABILITATION AREAS. | |||||
Area Designation | Pressure Relationship Adjacent Areas | Minimum Air Changes of Outdoor Air per Hour | Minimum Total Air Changes per Hour | All Air Exhausted Directly to Outdoors | Recirculated Within Room Units |
Isolation anteroom | N | 2 | 8 | Yes | No |
Isolation room | E | 2 | 8 | Yes | No |
Dental operatory | N | 2 | 6 | Optional | No |
Patient room | V | 1 | 4 | Optional | Optional |
Patient area corridor | N | 1 | 4 | Optional | Optional |
Occupational therapy | N | 1 | 4 | Optional | Optional |
Physical therapy and hydrotherapy | N | 2 | 6 | Optional | Optional |
Speech & hearing unit | V | 1 | 4 | Optional | Optional |
Soiled workroom and clean holding | N | 2 | 8 | Yes | No |
Clean workroom and clean holding | P | 1 | 4 | Optional | Optional |
Activities of daily living | V | 1 | 4 | Optional | Optional |
X-ray, diagnostic | V | 2 | 6 | Optional | Optional |
Treatment room | V | 2 | 6 | Optional | Optional |
Laboratory | N | 2 | 6 | Optional | Optional |
Dark room Y | N | 2 | 10 | Yes | Yes |
Toilet room and locker room | N | Optional | 10 | Yes | No |
Bedpan room | N | Optional | 10 | Yes | No |
Bathroom | N | Optional | 10 | Yes | No |
Janitor's closet | N | Optional | 10 | Yes | No |
Sterilizer equipment room | N | Optional | 10 | Yes | No |
Linen and trash chute room | N | Optional | 10 | Yes | No |
Food preparation center | N | Optional | 10 | Yes | No |
Ware-washing room | N | 2 | 10 | Yes | No |
Personal care room | N | Optional | 10 | Yes | No |
Dietary day storage | V | Optional | 2 | Optional | No |
Laundry, general | V | 2 | 10 | Yes | No |
Soiled linen sorting and storage | N | Optional | 10 | Yes | No |
Clean linen storage | P | Optional | 4 | Optional | Optional |
Table 3. Lighting Levels for Rehabilitation Facilities | |
Area | Foot-candles* |
Administrative and lobby areas, day | 100 |
Administrative and lobby areas, night | 20 |
Chapel and quiet area | 30 |
Corridors and interior ramps | 30 |
Corridor night lighting | 10 |
Dining area and kitchen | 50 |
Doorways | 10 |
Examination and treatment room: | |
General | 50 |
Examining table | 100 |
Exit stairways and landings | 30 |
Janitor's closet | 20 |
Nurses' station, general, day | 50 |
Nurses' station, general, night | 20 |
Nurses' desk or counter, for charts & records | 150 |
Nurses' medicine area, preparations & storage | 100 |
Occupational therapy | 30 |
Patient care unit or room, general | 10 |
Patient care room, reading | 50 |
Patient care room, night light (variable) | .5 to 1.5 |
Physical therapy | 30 |
Stairways other than exits | 50 |
Toilet and bathing facilities | 30 |
Clean workroom | 100 |
Soiled workroom | 100 |
Nurses' lounge | 30 |
Laundry, general | 50 |
HISTORY: (14 Ky.R. 92; 439; eff. 9-10-1987; 18 Ky.R. 830; eff. 10-16-1991; Crt eff. 4-30-2019.)