175 Neb. Admin. Code, ch. 9, § 007

Current through September 17, 2024

Section 175-9-007 - PHYSICAL PLANT STANDARDS

Each building must be maintained in a manner that is safe, clean, and functional for the type of care and treatment provided. All hospital buildings must comply with the Health Care Facility Licensure Act, 175 NAC 1, the Nebraska State Fire Code, 2012 Edition Life Safety Code requirements, and this chapter. Each building must comply with the following physical plant requirements unless otherwise specified:

007.01LAUNDRY SERVICES. Laundry service may be provided on-site by the facility or via contract and is to be provided in accordance with current, standards of practice, and in a manner to reduce any risk of cross-contamination or infection. A separate clean laundry supply storage area that is conveniently located to care and treatment locations is to be provided.

007.01(A)ON-SITE LAUNDRY. When on-site laundry services are provided, water temperatures in laundry equipment must exceed 160 degrees Fahrenheit; or the facility must use an acceptable sanitizer or disinfectant in accordance with the manufacturer's instructions.

007.01(B)CONTRACTED LAUNDRY. If contract services are used for laundry, separate dedicated areas for soiled laundry awaiting pickup and for clean laundry are to be provided.

007.01(C)BULK LAUNDRY. In new construction, if bulk laundry is performed, the facility is to have separate soiled areas for sorting and washing and separate clean areas for drying, folding, and mending with separate soaking sinks. Hand washing sinks must be located in the laundry area.

007.01(D)LINENS. An adequate supply of clean linens in good repair, with no holes, visibly worn areas, or stains must be maintained for patient use. Storage areas are to be conveniently located near patient care and treatment areas.

007.02WASTE PROCESSING. Medical and general waste must be handled in accordance with current standards of practice to reduce the risk of cross-contamination or infection. This is to include separate areas to collect, contain, process, and dispose of waste produced within the facility; and keeping all facility areas free of vermin.

007.03HOUSEKEEPING AND JANITORIAL SERVICES. A dedicated room with a service sink and space for storage of supplies, housekeeping, and janitorial equipment must be provided.

007.04MEDICATION STATION. A dedicated medication station must be provided for the storage and distribution of medications, biologicals, and devices. 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.

007.05UTILITY AREA. A work area is to be provided 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.

007.06EQUIPMENT AND SUPPLIES. Equipment and supplies required for care and treatment must be provided at the facility. The facility must have space to store, distribute, maintain, clean, and sanitize durable medical instruments, equipment, and supplies out of the path of normal traffic. Durable medical equipment is to be tested and calibrated in accordance with manufacturer's recommendations. The documentation of testing results and calibrations are to be maintained for a minimum of 7 years.

007.07STERILE PROCESSING. If sterile processing is completed onsite, it must be done in accordance with current standards of practice.

007.08ENDOSCOPE CLEANING AND REPROCESSING. Cleaning and reprocessing of contaminated endoscopes must be completed in accordance with current standards of practice, in a room dedicated for this function, which is separate from the area where endoscopic procedures are performed.

007.09INPATIENT ROOMS. Inpatient rooms are to have sufficient space for sleeping, privacy, furniture, and belongings, and to provide inpatient care and treatment. These rooms must:

(A) Not be located in any garage, storage area, shed or similar detached building;

(B) Not be accessed through a bathroom, food preparation area, laundry, or another patient room;

(C) Be located on an outside wall or atrium with a window with a minimum glass size of 8 square feet per patient. The window is to provide an unobstructed view of at least 10 feet;

(D) Contain at least 25 cubic feet of storage volume per patient;

(E) Have a minimum floor area of 100 square feet for single patient rooms and 80 square feet per bed for multiple patient rooms, with a maximum of 2 beds in new construction; and

(F) Have doors that provide privacy yet not create seclusion or prohibit staff access for routine or emergency care.

007.10TOILET ROOMS. Toilet rooms with hand washing sinks must be provided for patient use. Existing facilities must have a toilet and sink adjoining each bedroom or may have one shared toilet fixture per 4 licensed beds. Doors for toilet and bathing rooms must provide privacy yet not create seclusion or prohibit staff access for routine and emergency care as needed. In new construction, all toileting and bathing rooms used by patients with less than 500 square feet must not have doors that swing solely inward.

007.11BATHING ROOMS. A bathing room consisting of a tub or shower must be provided adjacent to each bedroom or as a central bathing room on each floor where inpatient rooms are located. Tubs and showers are to be equipped with hand grips or other assistive devices as needed to meet patient needs.

007.12ACTIVITY AREAS. If provided, activity areas are to have dedicated space for patient socialization and leisure time activities that must not be used for sleeping, offices or as a corridor. The area may be combined with dining areas. The area is to:

(A) Have furnishings to accommodate group and individual activities;

(B) Have a floor area of at least 15 square feet per patient; and

(C) Be available for all patients.

007.13CUBICLES. 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 or curtains.

007.14EXAMINATION 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.

007.15ISOLATION ROOMS. The number and type of isolation rooms in a hospital are to be determined by the licensee based upon an infection control risk assessment and individual facility needs. Each facility must have at least one room capable of isolating patients which has an adjoining toilet room.

007.16OBSERVATION AREAS. If medical observation, extended recovery, or behavior intervention is provided, the licensee must provide one or more appropriately equipped rooms for patients requiring close supervision based on the needs of the patient and the care and treatment provided. Each room is to:

(A) Ensure patient privacy;

(B) Have a system in place for the patient to call or summon for assistance if needed;

(C) Have appropriate temperature control, ventilation, and lighting;

(D) Be void of unsafe wall, ceiling fixtures, and area with sharp edges;

(E) Have a way for staff to observe the patient from outside the room, so that all areas of the room are observable; and

(F) Be equipped to minimize the potential of the patient's escape, injury, suicide or hiding of restricted substances.

007.16(i)OBSERVATION AREA DOORS. Doors may be used to prevent escape and create seclusion where therapeutically required, such as for emergency protective custody, detoxification and in psychiatric locations.

007.17CORRIDORS. Building corridors must be wide enough to allow passage and be equipped as needed for the patient with safety and assistive devices to minimize injury. All stairways and ramps must have handrails.

007.18OUTDOOR SPACES. Any outdoor area for patient usage is to be equipped and situated to allow for patient safety and abilities.

007.19HANDWASHING SINKS. A handwashing sink equipped with towels and soap dispenser must be provided in close proximity of all examination, treatment, isolation, and procedure rooms; available to every four care and treatment cubicle locations; and a scrub sink must be provided near the entrance of each operating room.

007.20PRIVACY. In multiple bed patient rooms, visual privacy, and window curtains must be provided for each patient. In new facilities and new construction, the curtain layout must totally surround each care and treatment location and not restrict access to the entrance to the room, lavatory, toilet, or enclosed storage facilities.

007.21FINISHES. Special room finishes must be provided, including:

(A) Washable room finishes 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, serrated cut, or highly textured tiles cannot be used.

(B) Scrubbable finishes in all 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.

007.22BUILDING SYSTEMS. Building systems are to be designed, installed, and operated in a manner to provide for the safety, comfort, and well-being of the patient and must include the following:

007.22(A)CALL SYSTEMS. Call systems must be operable from procedure, treatment, operating rooms, recovery areas, toilet rooms, and bathing rooms. The system must transmit a receivable signal to on-duty staff which readily notifies staff and identifies the locations where the call was activated. The type of call system utilized must be able to be modified to meet individual patient needs. If patients are unable to activate the call, there must be a device the patient, designee or staff can utilize to summon other staff for assistance as needed.

007.22(B)ELECTRICAL SYSTEM. An electrical system must have the capacity to maintain the care and treatment services that are provided.

007.23ESSENTIAL POWER SYSTEM. A licensee must maintain an emergency power system for all essential care and treatment areas, lighting, medical gas systems, nurse call systems, and any area that utilizes general anesthetics or electrical life support systems.

007.23(A)FUEL SOURCE. Electrical support equipment must maintain essential power systems and must have an on-site fuel source. The minimum fuel source capacity must allow for non-interrupted system operations.

007.24HEATING AND COOLING SYSTEMS. A licensee must provide a heating and air conditioning system to maintain inpatient room temperatures at a level comfortable for each patient. Floors in operating, procedure, and other locations subject to wet cleaning methods or body fluids must not have openings to the heating or cooling system.

007.24(A)SURGICAL AREAS HEATING AND COOLING SYSTEM. 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.

007.24(B)AIRFLOW. 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.

007.25ILLUMINATION LEVELS. Minimum illumination levels which are measured at 30 inches above the floor in multiple areas in the room must be provided as follows:

(A) General purpose areas: 5 foot candles;

(B) General corridors: 10 foot candles;

(C) Personal care and dining areas: 20 foot candles;

(D) Reading and activity areas: 30 foot candles;

(E) Food preparation areas: 40 foot candles;

(F) Hazardous work surfaces: 50 foot candles;

(G) Care and treatment locations: 70 foot candles;

(H) Examination task lighting: 100 foot candles;

(I) Procedure task lighting: 200 foot candles; and

(J) Surgery task lighting: 1000 foot candles.

007.26MEDICAL GAS SYSTEMS. Medical gas and vacuum by means of portable equipment or building systems as required for the type of care and treatment provided at the facility must be provided safely. The hospital must identify portable and system components and periodically test and approve all medical gas piping, alarms, valves, and equipment used for patient care and treatment. Documentation of such testing and approval must be retained for a minimum of 7 years. All medical gas systems must comply with the requirements of 153 NAC 1, the Nebraska State Fire Code, and Life Safety Code requirements.

007.27WATER AND SEWER SYSTEMS. An accessible and safe potable supply of water must be available and maintained. Where an authorized public water supply of satisfactory quality, quantity, and pressure is available, the facility must be connected to it and must use it exclusively. All water distribution systems must be protected with anti-siphon devices and air gaps to prevent contamination. All licensees must maintain a sanitary and functioning sewage system and the following:

(A) 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 The Nebraska Safe Drinking Water Act, and its implementing regulations;

(B) The collection, treatment, storage, and distribution potable water system of a facility that regularly 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 Nebraska Safe Drinking Water Act, and its implementing regulations; and

(C) Continuously circulated, filtered, and treated water systems must be provided as required for the care and treatment equipment used.

007.28VENTILATION SYSTEM. Exhaust and clean air must be provided to prevent the concentrations of contaminants which could impair health or cause discomfort to patients and employees.

007.28(A)MECHANICAL EXHAUST VENTILATION. Buildings with new construction must have a mechanical ventilation system which provides minimum air exchanges per hour at the following rates:

(i) Care and treatment areas, 5 exchanges per hour;

(ii) Procedure and isolation areas, 15 air exchanges per hour; and

(iii) Operating rooms, 20 air exchanges per hour.

175 Neb. Admin. Code, ch. 9, § 007

Amended effective 11/11/2023

Amended effective 11/12/2023