La. Admin. Code tit. 48 § I-4589

Current through Register Vol. 50, No. 9, September 20, 2024

Section I-4589 - General Appearance and Space Requirements

A. The ASC shall be constructed, arranged and maintained to ensure the safety and well-being of the patients and the general public it serves.

B. The ASC shall have a minimum of two operating and/or procedure rooms and a minimum of one postanesthesia recovery room to meet the needs of the patients being served. In addition to the operating and/or procedure rooms and post-anesthesia recovery rooms, the ASC may also have one or more treatment rooms.

C. The location of the operating and procedure rooms within the ASC, and the access to it, shall conform to professionally-accepted standards of practice, particularly for infection control, with respect to the movement of people, equipment and supplies in and out of the operating or procedure rooms.

1. The operating and procedure rooms temperature and humidity shall be monitored and maintained in accordance with accepted standards of practice and documented on a daily use log that is maintained for a minimum of 18 months.

D. The ASC shall have a separate waiting area sufficient in size to provide adequate seating space for family members and/or guests of the patient.

E. The ASC shall meet the following requirements including, but not limited to:

1. a sign shall be posted on the exterior of the ASC that can be viewed by the public which shall contain, at a minimum, the "doing business as" name that is on the ASCs license issued by the department;

2. signs or notices shall be prominently posted in the ASC stipulating that smoking is prohibited in all areas of the ASC;

3. policies and procedures shall be developed for maintaining a clean and sanitary environment at all times;

4. there shall be sufficient storage space for all supplies and equipment. Storage space shall be located away from foot traffic, provide for the safe separation of items, and prevent overhead and floor contamination;

5. all patient care equipment shall be clean and in working order. Appropriate inspections of patient care equipment shall be maintained according to manufacturers recommendations and ASC policies and procedures;

6. designated staff areas shall be provided for surgical and other personnel to include, but not be limited to:

a. dressing rooms;

b. toilet and lavatory facilities including soap and towels; and

c. closets or lockers to secure the personal belongings of the staff;

7. adequate toilet facilities shall be provided for patients and/or family which maintain proper ventilation, properly functioning toilet(s) in each toilet facility, hot and cold water in all lavatories, soap and towels;

8. a private area shall be provided for patients to change from street clothing into hospital gowns and to prepare for surgery;

9. provisions shall be made for securing patients personal effects;

10. all doors to the outside shall open outward and be provided with self-closing devices;

11. all stairways, ramps and elevators shall be provided with non-skid floor surfaces and all stairways shall have handrails on both sides;

12. an effective and on-going pest control program shall be maintained to ensure the ASC is free of insects and rodents;

13. proper ventilation, lighting and temperature controls shall be maintained in all areas of the ASC;

14. waste products shall be stored in covered containers of a capacity and type approved by the Office of Public Health, and disposal of such wastes shall be in a manner approved by the Office of Public Health;

15. each ASC shall provide for a covered entrance, well-marked, and illuminated for drop off and/or pick up of patients before and after surgery. The covered entrance shall extend to provide full overhead coverage of the entire transporting automobile and/or ambulance to permit protected transfer of patients. Vehicles in the loading area should not block or restrict movement of other vehicles in the drive or parking areas immediately adjacent to the ASC;

16. the ASC shall provide a separate room for meetings to ensure privacy between medical staff and family members;

17. patient and family parking spaces shall be provided adjacent to the ASC that are in proportion to the number of pre- and post-operative stations;

18. adequate staff and physician parking spaces shall be available.

F. Surgical Area

1. The surgical area shall be comprised of a minimum of two operating rooms. In new construction and renovation, each operating room shall have a minimum clear floor area of 250 square feet with a minimum clear area of 15 feet between fixed cabinets and built-in shelves.

2. The surgical/ procedure room area shall be located in a segregated and restricted section of the ASC and be removed from general lines of traffic of both visitors and other ASC personnel, and from other departments so as to prevent traffic through them.

3. The surgical/procedure room area shall be defined by the following unrestricted, semi-restricted and restricted areas.

a. Unrestricted Area. This area shall include a central control point established to monitor the entrance of patients, personnel and materials into the restricted areas. Street clothes are permitted in this area, and traffic is not limited.

b. Semi-Restricted Area. This area shall include the peripheral support areas of the surgical center which includes storage areas for clean and sterile supplies, work areas for storage and processing of instruments and corridors leading to the restricted areas of the surgical center. Staff attire appropriate for the semi-restricted area shall be defined in policy. Traffic in this area is limited to authorized personnel and patients.

c. Restricted Area. This area shall include operating and procedure rooms, the clean core and scrub sink areas. Surgical attire, including hair coverings and masks, shall be required in accordance with professionally accepted standards.

4. The operating/procedure room(s) shall be appropriately equipped to safely provide for the needs of the patient and in accordance with accepted clinical practices. The operating/procedure room(s) shall consist of a clear and unobstructed floor area to accommodate the equipment and personnel required, allowing for aseptic technique. Only one surgical case or procedure can be performed in an operating/procedure room at a time.

5. There shall be scrub-up facilities in the surgical center which provide hot and cold running water and that are equipped with knee, foot or elbow faucet controls.

6. Space for supply and storage of medical gases, including space for reserve cylinders shall be provided. Provisions shall be made for the secure storage of all medical gas cylinders to prevent tipping and falling. Policies and procedures shall be developed for testing of medical gases.

7. Equipment storage room(s) shall be provided for equipment and supplies used in the operating/procedure room(s). Equipment storage room(s) shall be located within the semi-restricted area.

a. Stretchers shall be stored in an area that is convenient for use, out of the direct line of traffic and shall not create an obstacle for egress.

8. There shall be emergency resuscitation equipment and supplies including a defibrillator and tracheostomy set available to both surgery and post-anesthesia recovery areas.

a. The numbers of crash carts (emergency medical supply carts) in the ASC should be based on current professionally accepted standards of practice adopted from a national association or organization and defined in policies and procedures, and shall be immediately available to both surgery and post-anesthesia recovery areas.

G. Post-Anesthesia Recovery Area

1. Rooms for post-anesthesia recovery in an ASC shall be provided in accordance with the functional program and sufficient in size and equipment to efficiently and safely provide for the needs of the staff and patients. There shall be at least one separate post-anesthesia recovery area within the ASC.

2. Provisions to ensure patient privacy such as cubicle curtains shall be made.

3. The post-anesthesia recovery area shall be accessible directly from the semi-restricted area and adjacent to the operating/procedure rooms.

4. A nurses station(s) shall be located within the post-anesthesia recovery area and shall be centrally located with complete visualization of all patients in the post-anesthesia recovery area.

a. Each nurses station or nursing care area shall be equipped to perform nursing functions to include:

i. desk space;

ii. chart racks and/or electronic medical record equipment;

iii. telephone(s) or other communication equipment; and

iv. lockable cupboard, closet or room designed for the storage and preparation of patient medications.

b. A double-locked storage shall be provided for controlled substances. Separate areas shall be provided for the separation of internal and external drugs and medications. This area shall be well lighted with temperature controls and accessible only to authorized personnel. A separate refrigerator for pharmaceuticals shall be provided and monitored regularly for documented compliance with temperature controls. A sink with running hot and cold water and sufficient work area shall also be provided in the area of drug preparation.

5. Hand washing station(s) shall be available in the post-anesthesia recovery area.

6. The post-anesthesia recovery area shall have a minimum of 80 square feet provided for each patient in a lounge chair/stretcher

H. There shall be sufficient space between and around lounge chairs/stretchers and between fixed surfaces and lounge chairs/stretchers to allow for nursing and physician access to each patient.

I. General and individual office(s) for business transactions, records and administrative and professional staff shall be provided within the ASC. Space for private patient interviews relating to admission shall be provided within the ASC.

La. Admin. Code tit. 48, § I-4589

Promulgated by the Department of Health, Bureau of Health Services Financing, LR 431755 (9/1/2017).

AUTHORITY NOTE: Promulgated in accordance with R.S. 40:2131-2141.