All health clinics must be designed, constructed, and maintained in a manner that is safe, clean, and functional for the type of care and treatment to be provided. The physical plant standards for health clinics, which include support services, care and treatment areas, construction standards, building systems and waivers, are set forth below.
007.01 Support Areas The health clinic may share the following support areas among detached structures, care and treatment areas, or with other licensed facilities.
7-007.01ADietary: If food preparation is provided on site, the facility must dedicate space and equipment for the preparation of meals. Food service physical environment and equipment must comply with the Food Code.7-007.01BLaundry: If the facility provides laundry services, the service may be provided by contract or on-site by the facility. 7-007.01B1 Contract: If contractual services are used, the facility must have areas for soiled linen awaiting pickup and separate areas for storage and distribution of clean linen.7-007.01B2 On-site: If on-site services are provided, the facility must have areas dedicated to laundry. 7-007.01B2a In new construction, if the facility processes bulk laundry, the laundry must be divided into separate soiled (sort and washer areas) and clean (drying, folding, and mending areas) rooms with a separate soaking and hand washing sink in the laundry area.7-007.01B2b Separate clean linen supply storage facilities must be conveniently located to care and treatment locations.7-007.01CDiagnostic: If the facility provides radiology or laboratory services, the services must comply with the following: 7-007.01C1 Imaging rooms must accommodate the operational and shielding requirements of the equipment installed, condition of the patient, and provide clear floor area adequate for the safety of staff and patients.7-007.01C2 Laboratory areas must provide for sample collection and protection, analyzing, testing, and storage. The facility must handle all potentially contagious and hazardous samples in a manner as to minimize transmission of infectious diseases.7-007.01DWaste Processing: The health clinic must provide areas to collect, contain, process, and dispose of medical and general waste produced within the health clinic in such a manner as to prevent the attraction of rodents, flies, and all other insects and vermin, and to minimize the transmission of infectious diseases.7-007.01EHousekeeping Room: The facility must have a room with a service sink and space for storage of supplies and housekeeping equipment.007.02 Care and Treatment Areas The health clinic must not share the following care and treatment areas among detached structures or with other facilities operated by another licensee. Care and treatment areas must comply with the following:
7-007.02AStaff Areas: Health clinics that provide nursing services must provide the following support areas for each distinct patient care and treatment areas. 7-007.02A1 Control Point: The facility must have an area or areas for charting and patient records, and call and alarm annunciation systems.7-007.02A2 Medication Station: The facility must have a medication station for storage and distribution of drugs and routine medications. Distribution may be done from a medicine preparation room or unit, from a self-contained medicine-dispensing unit, or by another system. If used, a medicine preparation room or unit must be under visual control of nursing staff and must contain a work counter, sink, refrigerator, and double-locked storage for controlled substances.7-007.02A3 Patient Facilities: The facility must have space for patient care, treatment, consultation, and waiting area.7-007.02A4 Utility Area: The facility must have a work area where clean materials are assembled. The work area must contain a work counter, a handwashing fixture, and storage facilities for clean and sterile supplies. If the area is used only for storage and holding as part of a system for distribution of clean and sterile supply materials, the work counter and handwashing fixtures may be omitted. A facility must have separate work rooms or holding rooms for soiled materials. A work room for soiled materials must contain a fixture for disposing wastes and a handwashing sink.7-007.02BEquipment and Supplies: The health clinic must have services and space to distribute, maintain, clean, and sanitize durable medical instruments, equipment, and supplies required for the care and treatment performed in the facility. 7-007.02B1 Durable Medical: The facility must ensure that the durable medical equipment is tested and calibrated in accordance with the manufacturer's recommendations.7-007.02B2 Sterile Processing: If sterile processing is completed onsite, the facility must have areas for decontamination and sterilizing of durable medical instruments and equipment. 7-007.02B2a The facility must provide separate sterile processing and waste processing areas.7-007.02B2b In new construction and where provided, central sterile processing service area(s), must have separate soiled (sorting and decontamination) and clean (sterilizing and processing) rooms. The facility must have handwashing sinks in both clean and soiled rooms.7-007.02B3 Required Equipment: The facility must provide equipment adequate for meeting the care and treatment needs of patients.7-007.02B4 Equipment Storage: The facility must have space to store equipment, stretchers, wheelchairs, supplies, and linen out of the path of normal traffic.7-007.02CSurgery: A health clinic providing surgical services must have at least one operating or procedure room and the following support areas. In new construction and facilities with more than two surgery rooms, the following support areas and central processing areas must be located in restricted access areas: 1.Preoperative Patient Area: Preoperative patient area(s) must have sufficient space and equipment to accommodate both ambulatory and non-ambulatory patients. These areas must be under the direct visual control of the nursing staff.2.Recovery Area: Recovery area(s) must contain a medication station, handwashing sink, charting area, provisions for bedpan cleaning, and equipment and supply storage space.3.Dressing Area: The facility must have patient dressing and toilet rooms separate from staff gowning areas.4.Housekeeping Room: The facility must have soiled utility and housekeeping areas exclusively for the surgical suite.7-007.02DEmergency Care: A health clinic providing emergency services must have at least one procedure or treatment room. To support the provision of emergency care, the facility must have the following: 1.Entrance: A well marked, illuminated covered entrance at grade level for emergency vehicle and pedestrian access;2.Waiting Area: Patient and visitor waiting area(s) that are in direct observation of the reception, triage, or control station, and have access to a public phone and drinking fountain;3.Storage: Storage areas for general medical/surgical emergency supplies, medications, and equipment under staff control and out of the path of normal traffic; and4.Toilet Room: A patient toilet room with handwashing sink which is convenient to the procedure or treatment room(s).7-007.02ERehabilitation: A facility providing rehabilitation services must have at least one treatment room or cubicle, an area for specialized treatment and care, handwashing sink(s), storage for equipment and supplies, call system, medication storage, and distribution, and areas to allow for patient toileting, dressing, and consultation.7-007.02FObstetrics: A facility providing obstetric services must have at least one patient room, space, and equipment to allow for care and treatment of both mother and infant, handwashing sink, storage for equipment and supplies, call and alarm annunciation systems, medication storage, and distribution, and convenient accommodations for patient toileting, dressing, and consultation.007.03 Construction Standards All health clinics must be designed, constructed, and maintained in a manner that is safe, clean, and functional for the type of care and treatment to be provided. The standards for such facilities are set forth below.
7-007.03ACodes and Guidelines7-007.03A1 New Construction: New construction must comply with the following codes and guidelines to provide a safe and accessible environment that is conducive to the care and treatment to be provided: 1.Building: Building Construction Act, Neb. Rev. Stat. §§ 71-6401 to 71-6407;2.Plumbing: Plumbing Ordinance or Code, Neb. Rev. Stat. § 181915;3.Electrical: State Electrical Act, Neb. Rev. Stat. §§ 81-2101 to 812143;4.Elevators: Nebraska Elevator Code, Neb. Rev. Stat. § 48-418.12 and Department of Labor Regulations, 230 NAC 1;5.Boiler: Boiler Inspection Act, Neb. Rev. Stat. §§ 48-719 to 48-743;6.Accessibility: Nebraska Accessibility Requirements, State Fire Marshal Regulations, 156 NAC 1 to 12;7.Design: Guidelines for Design and Construction of Hospitals and Health Care Facilities, Chapter 9, 2001 edition, published by the American Institute of Architects; and8.Energy: Nebraska Energy Code, Neb. Rev. Stat. §§ 81-1608 to 81-1626, for construction initiated on or after July 1, 2005.7-007.03A2 All Facilities: All facilities must comply with the following applicable codes and standards to provide a safe environment: 1.Fire Codes: Nebraska State Fire Code Regulations, State Fire Marshal, 153 NAC 1; and2. The Food Code, Neb. Rev. Stat. § 81-2,244.01, as published by the Nebraska Department of Agriculture, except for compliance and enforcement provisions.7-007.03A3 Existing and New Facilities: Existing and new facilities must comply with the physical plant standards contained in 175 NAC 7-007. The facility must maintain all building materials and structural components so that total loads imposed do not stress materials and components more than one and one half times the working stresses allowed in the building code for new buildings of similar structure, purpose, or location.7-007.03BConflicts in Standards: In situations where the referenced codes and guidelines conflict with 175 NAC 7, the adopted rules and regulations of the Department and the Nebraska State Fire Marshal will prevail.7-007.03CInterpretations: All dimension, sizes, and quantities; noted herein will be determined by rounding fractions to the nearest whole number.7-007.03DFloor Area: Floor area is the space with ceilings at least seven feet in height and does not include areas such as enclosed storage, toilets, and bathing rooms, corridors, and halls. The space beyond the first two feet of vestibules and alcoves less than five feet in width will not be included in the required floor area. In rooms with sloped ceilings, at least half of the ceiling must be at least seven feet in height with areas less than five feet in height, not included in the required floor area.7-007.03EBathing Rooms: If the facility provides a tub or shower for patient bathing, they must be equipped with hand grips or other assistive devices.7-007.03FToilet Rooms: The facility must provide at least one room with a toilet and sink for patient use.7-007.03GPatient Rooms: The facility may provide rooms of the following types which allow for sleeping, afford privacy, provide access to furniture and belongings, and accommodate the care and treatment provided to the patient.7-007.03HIsolation Rooms: The number and type of isolation rooms in a health clinic must be determined by the facility and must ensure a safe environment for patients.7-007.03IObservation Areas: If the facility provides medical observation or behavior intervention methods, the facility must provide one or more appropriately equipped rooms for patients needing close supervision. Each room must: 1. Have appropriate temperature control, ventilation, and lighting;2. Be void of unsafe wall or ceiling fixtures and sharp edges;3. Have a way to observe the patient, such as an observation window or if necessary, flat wall mirrors so that all areas of the room are observable by staff from outside of the room;4. Have a way to assure that the door cannot be held closed by the patient in the room which could deny staff immediate access to the room; and5. Be equipped to minimize the potential of the patient's escape, injury, suicide, or hiding of restricted substances.7-007.03JBassinets: Each bassinet must have a minimum floor area of 40 square feet with at least 3 feet between bassinets.7-007.03KCubicles: Patient care and treatment cubicles must have a minimum floor area of 60 square feet with at least 3 feet between bedsides and adjacent side walls.7-007.03LExamination Rooms: Each examination room must have a minimum floor area of 80 square feet and a minimum of 3 feet clear dimension around 3 sides of the examination table or chair.7-007.03MTreatment Rooms: Treatment room for procedures performed under topical, local, or regional anesthesia without pre-operative sedation must have a minimum floor area of 120 square feet and a minimum of 10 feet clear dimension.7-007.03NProcedure Rooms: Procedure rooms for invasive and minor surgical procedures performed in conjunction with oral, parenteral, or intravenous sedation or under analgesic or dissociative drugs must have a minimum floor area of 200 square feet and a minimum of 14 feet clear dimension.7-007.03OOperating Rooms: Operating rooms for major surgical procedures that require general or regional block anesthesia and support of vital bodily functions must have a minimum floor area of 300 square feet and a minimum of 16 feet clear dimension.7-007.03PCorridors: The facility corridors must be wide enough to allow passage and be equipped as needed by the patients with safety and assistive devices to minimize injury. All stairways and ramps must have handrails.7-007.03QDoors: The health clinic doors must be wide enough to allow passage and be equipped for privacy, safety, and with assistive devices to minimize patient injury. 7-007.03Q1 All toilet and bathing room doors must provide privacy yet not create seclusion or prohibit staff access for routine or emergency care.7-007.03Q2 In new construction all toilet and bathing rooms used by patients with less than 50 square feet of clear floor area must not have doors that solely swing inward.7-007.03Q3 Doors may prevent escape and create seclusion where therapeutically required, such as emergency protective custody, detoxification and psychiatric locations.7-007.03ROutdoor Areas: Any outdoor area for patient usage provided by the facility must be equipped and situated to allow for patient safety and abilities.7-007.03SHandwashing Sinks: The facility must provide a handwashing sink equipped with towels and soap dispenser in all examination, treatment, isolation, and procedure rooms; available to every four care and treatment cubicle locations; and one scrub sink near the entrance of each operating room.7-007.03TPrivacy: In multiple bed patient care and treatment rooms, visual privacy, and window curtains must be provided for each patient. In new construction and new facilities, the curtain layout must totally surround each care and treatment location which will not restrict access to the entrance to the room, lavatory, toilet, or enclosed storage facilities.7-007.03UFinishes: Room finishes in care and treatment areas must comply with the following: 1. Washable room finishes provided in procedure rooms, existing isolation rooms, sterile processing rooms, workroom, laundry, and food-preparation areas must have smooth, non-absorptive surfaces which are not physically affected by routine housekeeping cleaning solutions and methods. Acoustic and lay-in ceilings, if used, must not interfere with infection control. Perforated, tegular, serrated cut, or highly textured tiles are not acceptable.2. Scrubbable room finishes provided in operating rooms and new isolation rooms must have smooth, non-absorptive, non-perforated surfaces that are not physically affected by harsh germicidal cleaning solutions and methods.007.04 Building Systems Health clinics must have building systems that are designed, installed and operated in such a manner as to provide for the safety, comfort, and well being of the patient.
7-007.04AWater and Sewer Systems: The facility must have and maintain an accessible, adequate, safe, and potable supply of water. Where an authorized public water supply of satisfactory quantity, quality, and pressure is available, the facility must be connected to it and its supply used exclusively. 7-007.04A1 The collection, treatment, storage, and distribution potable water system of a facility that regularly serves 25 or more individuals must be constructed, maintained, and operated in accordance with all provisions of the Nebraska Safe Drinking Water Act and Title 179 Regulations Governing Public Water Systems.7-007.04A2 The collection, treatment, storage and distribution potable water system of a facility that serves less than 25 individuals on a regular basis must be maintained and operated as if it were a public water system in accordance with the Regulations Governing Public Water Systems, 179 NAC 2-002, 3 and 4. The facilities must report to the Department the result of all tests that indicate the water is in violation of the standards set out in 179 NAC 2-002 or 3. The facilities must construct all water wells in accordance with 178 NAC 12, Water Well Construction, Pump Installation, and Water Well Decommissioning Standards.7-007.04A3 The water distribution system must be protected with anti-siphon devices, and air-gaps to prevent potable water system and equipment contamination.7-007.04A4 Continuously circulated filtered and treated water systems must be provided as required for the care and treatment equipment used in the health clinic.7-007.04A5 The facility must maintain a sanitary and functioning sewage system.7-007.04BHot Water System: The facility must maintain hot and cold water to all hand washing and bathing locations. The hot water system must have the capacity to provide continuous hot water at temperatures as required by 175 NAC 7.7-007.04CHeating and Cooling Systems: The facility must provide a heating and air conditioning system for the comfort of the patient and capable of maintaining the temperature in patient care and treatment areas as follows: 7-007.04C1 In existing and new facilities, the systems must be capable of producing a temperature of at least 70 degrees Fahrenheit during heating conditions and a temperature that does not exceed 85 degrees Fahrenheit during cooling conditions.7-007.04C2 In new construction the systems must be capable of producing a temperature of at least 75 degrees Fahrenheit during heating conditions and a temperature that does not exceed 80 degrees Fahrenheit during cooling conditions.7-007.04C3 In new construction, central air distribution, and return systems must have the following percent dust rated filters : 1. General areas: 30 +%; and2. Procedure and operating rooms: 90 +%.7-007.04C4 Surgical areas must have heating and cooling systems that are capable of producing room temperatures at a range between 68 and 73 degrees Fahrenheit and humidity at a range between 30 and 60% relative humidity.7-007.04C5 Airflow must move from clean to soiled locations. In new construction, air movement must be designed to reduce the potential of contamination of clean areas.7-007.04C6 Floors in operating, procedure, and other locations subject to wet cleaning methods or body fluids must not have openings to the heating and cooling system.7-007.04DVentilation System: All facilities must provide exhaust and clean air to prevent the concentrations of contaminants which impair health or cause discomfort to patients and employees. 7-007.04D1 Existing and new facilities must have adequate ventilation.7-007.04D2 New construction must provide mechanical exhaust ventilation system for windowless toilets, baths, laundry rooms, housekeeping rooms, kitchens, and similar rooms at ten air changes per hour.7-007.04D3 New construction must provide mechanical ventilation system(s) capable of providing air changes per hour (hereafter ACH) as follows: 1. Care and treatment areas: 5 ACH;2. Procedure and respiratory isolation areas: 15 ACH; and3. Operating rooms: 20 ACH.7-007.04EElectrical System: The facility must have an electrical system that has sufficient capacity to maintain the care and treatment services that are provided and that properly grounds care and treatment areas. 7-007.04E1 New construction and new facilities must have ground fault circuit interrupters protected outlets in wet areas and within 6 feet of sinks.7-007.04E2 All facilities must provide minimum illumination levels as follows: 1. General purpose areas: 5 foot candles;2. General corridors: 10 foot candles;3. Personal care and dining areas: 20 foot candles;4. Reading and activity areas: 30 foot candles;5. Food preparation areas: 40 foot candles;6. Hazardous work surfaces: 50 foot candles;7. Care and treatment locations: 70 foot candles;8. Examination task lighting: 100 foot candles;9. Procedure task lighting: 200 foot candles; and10. Surgery task lighting: 1000 foot candles. Light levels are measured at 30 inches above the floor in multiple areas in the room being evaluated and the readings are averaged.
7-007.04FEssential Power System: Facilities must have an emergency power generator for all care and treatment locations which involve general anesthetics or electrical life support equipment, and in emergency procedure and treatment rooms. 7-007.04F1 Existing and new facilities must maintain emergency power for essential care and treatment equipment and lighting, medical gas systems, and nurse call systems.7-007.04F2 New construction must maintain emergency power for essential care and treatment equipment and lighting, medical gas systems, ventilation and heating systems, and nurse call systems.7-007.04F3 Facilities with electrical life support equipment must maintain essential power systems and must have on-site fuel source. The minimum fuel source capacity must allow for non-interrupted system operation.7-007.04GCall Systems: Call system(s) must be operable from patient procedure and operating rooms, recovery bed, and toilet areas. The system must transmit a receivable (visual, audible, tactile, or other) signal to on-duty staff which readily notifies and directs the staff to the location where the call was activated. 7-007.04G1 In new construction, the call system must have a dedicated emergency call device which allows activation by a patient from treatment rooms and cubicles, and toilet and bathing fixtures.7-007.04G2 In new construction, in locations where patients are unable to activate the call, a dedicated staff assist call device must promptly summon other staff for assistance.7-007.04G3 Existing health clinics, except ambulatory surgical centers, that do not have a nurse call system are not required to provide a nurse call system.7-007.04HMedical Gas System: The facility must safely provide medical gas and vacuum by means of portable equipment or building systems as required by patients receiving care and treatment. 7-007.04H1 The installation, testing, and certification of nonflammable medical gas, clinical vacuum, and air systems must comply with the requirements of 153 NAC 1, Nebraska State Fire Code Regulations.7-007.04H2 The facility must identify portable and system components, and periodically test and approve all medical gas piping, alarms, valves, and equipment for patient care and treatment. The facility must document such approvals for review and reference.007.05 Waivers The Department may waive any provision of 175 NAC 7 relating to construction or physical plant requirements of a health clinic upon proof by the licensee satisfactory to the Department (a) that such waiver would not unduly jeopardize the health, safety, or welfare of the persons served by the facility, (b) that such provision would create an unreasonable hardship for the facility, and (c) that such waiver would not cause the State of Nebraska to fail to comply with any applicable requirements of Medicare or Medicaid so as to make the state ineligible for the receipt of all funds to which it might otherwise be entitled.
7-007.05AUnreasonable Hardship: In evaluating the issue of unreasonable hardship, the Department will consider the following: 1. The estimated cost of the modification or installation;2. The extent and duration of the disruption of the normal use of areas used by persons residing in or served by the facility resulting from construction work;3. The estimated period over which the cost would be recovered through reduced insurance premiums and increase reimbursement related to costs;4. The availability of financing; and5. The remaining useful life of the building.7-007.05BWaiver Terms and Conditions: Any such waiver may be granted under the terms and conditions and for such period of time as are applicable and appropriate to the waiver. Terms and conditions and period of waiver include but are not limited to: 1. Waivers that are granted to meet the special needs of a patient remain in effect as long as required by the patient;2. Waivers may be granted for a period of time that ends at the time the conditions of approval no longer exist;3. Waivers may be granted to permit a facility time to come into compliance with the physical plant standards for a period of one year. Upon submission of proof of ongoing progress, the waiver may be continued for an additional year; and4. An applicant or licensee must submit a request for waiver of any construction or physical plant requirements set forth in 175 NAC 7. An applicant for a waiver may construct a request for a waiver form or obtain a form from the Department.7-007.05CDenial of Waiver: If the Department denies a health clinic's request for waiver, the facility may request an administrative hearing as provided in the Administrative Procedure Act (APA) and the Department's rules and regulations adopted and promulgated under the APA.175 Neb. Admin. Code, ch. 7, § 007