Ala. Admin. Code r. 420-5-1-.04

Current through Register Vol. 42, No. 6, March 29, 2024

Section 420-5-1-.04 - Physical Environment

(1)Existing Facilities. An existing abortion or reproductive health center shall comply with the requirements for Existing Ambulatory Health Care Occupancy in the currently adopted National Fire Protection Association (NFPA) 101, Life Safety Code.

(2)Submission of Plans and Specifications.

(a) Scope. A facility constructed or renovated after the effective date of these rules shall be classified as Business Occupancy of the International Building Code, and New Ambulatory Health Care Occupancy of the NFPA Life Safety Code. The facility shall comply with the codes and standards adopted by the State Board of Health in effect at the time of plan submission.

(b) New Facilities, Additions, and Alterations. Plans and specifications shall be submitted for review and approval to the Alabama Department of Public Health, for any building that is intended to contain an abortion center, and for additions and alterations to existing facilities. Submissions shall be in accordance with Alabama Administrative Code Chapter 420-5-22, "Submission of Plans and Specifications for Health Care Facilities."

(c) Minor Alterations and Remodeling. See Alabama Administrative Code Chapter 420-5-22, "Submission of Plans and Specifications for Health Care Facilities," for exceptions to the plan submittal requirements in the case of certain minor alterations or remodeling projects.

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

(3)General.

(a) Location. The abortion or reproductive health center shall be located with sufficient parking space provided.

(b) Local Restrictions. The abortion or reproductive health center shall comply with local zoning, building, and fire ordinances in addition to these Rules.

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

(d) Fire Extinguisher. An all-purpose fire extinguisher shall be provided at each exit, special hazard areas and located so that a person will not have to travel more than 75 feet from any point to reach the nearest extinguisher. Fire extinguishers shall be of a type approved by the local fire department or State Fire Marshal and shall be inspected in accordance with the manufacturer's specifications, but not less than monthly. An attached tag shall bear the initials or name of the inspector and date inspected. Maintenance on each extinguisher shall be performed by trained personnel at least annually. Maintenance tags showing the year, month, and name of the individual performing maintenance shall be attached to the extinguisher.

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

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

(g) Elevators. In multi-story (more than two stories) buildings, at least one elevator for patient use shall be provided.

(h) Doors. Minimum width of doors to all rooms needing access for stretchers shall be 3 feet.

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

(j) Corridors. Corridors must be of sufficient width to allow stretchers to be maneuvered without impediment. All corridors used as a means of exit shall be a minimum of 44 inches in width and not be obstructed, or wider when required by code.

(k) Occupancy. No part of an abortion or reproductive health center may be rented, leased, or used for any commercial purpose, or for any purpose not necessary for the operation of the center.

(l) Lighting. All areas of the center shall have sufficient lighting to prevent accidents and promote efficiency of service.

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

(n) Exits. Each floor of an abortion clinic shall have two or more exits remote from each other, leading directly to the outside or to an exit passageway to the outside. Fire resistance ratings of all exit components shall comply with the adopted codes.

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

1. Shall be no less than 36 inches wide.

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

(p) Exit Signs. Exits shall be equipped with approved illuminated signs. Exit signs shall be placed in corridors and passageways to indicate the direction of exit. Exit signs may be omitted at the main exterior exit doors when such is allowed by code.

(q) Interior Finish. Interior wall and ceiling finishes, including combustible, decorative and acoustical material, shall have fire classification as required by code.

(r) Floors. All interior floors shall be covered wall-to-wall with resilient tile, hard tile, carpet, or the equivalent, and shall have a fire classification as required by code.

(s) Physically Handicapped. The facility shall comply with ANSI A117.1 making buildings and facilities accessible to, and usable by, the physically handicapped.

(t) An abortion or reproductive health center shall be equipped with ultrasound equipment and a device capable of displaying the Department of Public Health's abortion educational video program. All such equipment shall be maintained in good operating condition.

(4)Service Facilities.

(a) Admission Office. There shall be a room designated as the admission office where patients may discuss personal matters in private. The admission office may be combined with the business office and medical records room if privacy can be maintained when confidential matters are being discussed.

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

(c) Storage. A janitor's closet and ample storage space shall be provided in the administrative area.

(5)Treatment Facilities.

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

(b) Procedure Room. The procedure room shall have walls and floors covered with a washable surface, a scrub sink with knee, elbow, or foot controls, soap dispenser, and single service towel dispenser.

(c) Recovery Room. One or more recovery rooms containing sufficient beds for recovering patients shall be provided. Reclining type vinyl upholstered chairs may be substituted in lieu of beds. Other items for the patients' comfort may be provided in the room.

(d) Clean Workroom. A clean workroom shall be provided sufficient in size to process and store clean and sterile supply materials and equipment, and must contain a work counter and sink. An autoclave or gas sterilizer must be provided adequate in size to sterilize the equipment in use.

(e) Soiled Workroom. The soiled workroom shall contain a sink, work counter, waste receptacle. The clean and soiled workroom may be combined if aseptic techniques can be provided.

(f) Toilets. At least one toilet and lavatory with a soap dispenser and towel dispenser shall be provided for each multi-bed recovery room. Toilet facilities shall be provided at no less than one water closet and lavatory per ten recovery beds.

(g) Refrigerator. A refrigerator shall be provided with provisions for safeguarding drugs. The refrigerator shall be capable of maintaining drugs at a temperature of 42 degrees Fahrenheit plus or minus 6 degrees Fahrenheit. If food or beverages are to be stored with drugs, they must be clearly labeled and precautions must be taken to prevent moisture produced by foods and beverages from contaminating drug container contents or defacing labels.

(6)Equipment and Supplies.

(a) Testing and Diagnostic Equipment. All testing and diagnostic equipment shall be maintained in good working order at all times. If equipment is obsolete or permanently unusable because of irreparable damage or malfunction to the equipment or any other condition that renders its use detrimental to patient care, it shall be immediately separated from the equipment currently in use, clearly tagged as permanently unusable, and properly disposed of as soon as possible. If equipment is temporarily unusable, it shall be immediately separated from equipment currently in use and clearly tagged as being temporarily unusable until it is repaired or otherwise made fit for use. Equipment is temporarily unusable if in need of repair or if not maintained in accordance with manufacturer standards, regardless of whether there is an apparent defect. Tagged equipment shall not be returned to use until repaired and tested to ensure proper operation.

(b) Preventive Maintenance. There shall be a schedule of preventive maintenance developed for all equipment in the facility integral to patient care to assure satisfactory operation thereof. This schedule shall cover at least the following equipment:

1. Ultrasound: All ultrasound machines must be tested and calibrated by a trained, qualified technician in accordance with the manufacturer's recommendations. In no event shall testing and calibration be done less than annually.

2. Autoclave: All autoclaves must be tested and maintained at least annually by a trained, qualified technician in accordance with the manufacturer's recommendations, except that necessary routine weekly cleaning, maintenance, and inspection may be performed by properly trained clinic staff or a trained, qualified technician in accordance with the manufacturer's recommendations. Dated chemical indicators shall be used with every load to ensure sterilization. Biological indicator testing must be performed every 40 service-hours, and the results of the biological indicator testing must be logged.

(c) The facility must maintain a record for all equipment containing the following information: manufacturer, make, and model of the equipment; date of purchase of the equipment; any dates on which the equipment was removed from service for repair or maintenance and, if applicable, date equipment was returned to service; date and description of all tests, maintenance, or repairs performed on the equipment, including all routine inspection and maintenance performed by clinic personnel; the names and qualifications of the company and technician performing the tests, maintenance, or repairs; and the results of any tests, maintenance, or repairs. In addition, all manufacturer literature and information must be maintained in this record. If any of this information is not available for equipment purchased prior to October 2006, the fact of the missing information shall be noted in the equipment record, and, if there is no record of proper maintenance in the last year, the equipment must be immediately tested and, if necessary, calibrated or repaired.

(d) Medications and supplies which have deteriorated or reached their expiration dates shall not be used for any reason. All expired or deteriorated items shall be disposed of promptly and properly. Each facility shall examine all stored medications and supplies no less frequently than once each month and shall remove from its inventory all deteriorated items and all items for which the expiration date has been reached. The facility shall maintain a log recording each such examination with its date, time, the person conducting the examination, and a description of each item or group of items removed from inventory and the reason for such removal.

(7)Housekeeping Services.

(a) Personnel. Sufficient personnel are to be employed to maintain the facility clean and orderly.

(b) Techniques. There shall be written procedures outlining techniques to be followed in routine housekeeping and decontamination are to be developed and maintained.

Ala. Admin. Code r. 420-5-1-.04

Filed September 1, 1982. Amended: Filed February 20, 1997; effective March 27, 1997. Amended: Filed June 18, 2002; effective July 23, 2002. Repealed and Replaced: Filed April 17, 2003; effective May 22, 2003. Amended: Filed February 21, 2007; effective March 28, 2007. Amended: Filed February 21, 2007; effective March 28, 2007. Amended: Filed November 15, 2013; effective December 20, 2013.

Authors: Rick Harris, W.T. Geary, Jr., M.D., Brian Hale, Victor Hunt

Statutory Authority:Code of Ala. 1975, §§ 22-21-20, et seq.