1. (1) Safety. The governing authority shall develop written policies and procedures designed to safeguard patients, staff, and visitors while in the birthing center and on its grounds. The policies and procedures shall include the following:

   1. (a) Safety rules and practices pertaining to personnel, equipment, liquids, and drugs, with particular attention to hazards of children, such as uncovered electrical outlets, unsafe toys, unprotected stairs, and unlocked storage cabinets, as well as walkways, parking lots, and outside play areas.
   2. (b) Provisions for reporting and investigation of accidental events regarding patients, visitors, and personnel (incidents), and corrective actions taken.
   3. (c) Provision for dissemination of safety-related information to employees and users of the facility.
   4. (d) Provision for syringe and needle storage, handling, and disposal.
   5. (e) Provide a security alarm and camera service to ensure controlled/limited access to the facility; activate protocols to screen family members and visitors; restrict public entry to the birthing center during certain hours and all general access to patient areas; provide panic buttons for staff and alarm bracelets for mothers and infants; and develop Code Pink plans to be approved by the Department.

2. (2) Housekeeping/Sanitation. The birthing center shall provide a safe and sanitary environment, properly constructed and maintained to protect the health of patients.

   1. (a) The birthing center shall be maintained in a clean condition and have written policies and procedures for housekeeping and sanitation. The birthing rooms shall be appropriately cleaned after each birth, using appropriate disinfectants to assure asepsis between each use, as approved by the Infection Control Committee.
   2. (b) The premises and equipment shall be kept clean and free of insects, rodents, litter, and rubbish.
   3. (c) There shall be strict adherence to regulations of OSHA for handling of medical waste, regulations of the Alabama Department of Environmental Management (ADEM), and other applicable federal regulations for disposal of medical waste (medical waste includes, but is not limited to, disposable gowns, soiled dressings, sponges, surgical gloves, bacteriological cultures, blood and blood products, excretions, secretions, other bodily fluids, catheters, needles, IV tubing with needles attached, scalpel blades, glassware, and syringes that have been removed from their original sterile containers).
   4. (d) Adequate arrangements for housekeeping staff shall be made, or housekeeping staff shall be employed to fulfill the above requirements. Primary patient care personnel shall not perform routine decontamination and housekeeping duties during periods in which they are caring for patients.

3. (3) Linen and Laundry.

   1. (a) An adequate supply of clean linen or disposable materials shall be available at all times for the proper care and comfort of patients.
   2. (b)  Provisions for proper laundering oflinen and washable goods shall be made. Linens used for draping must be sterilized. All reusable linens, including those used as sterilizing wrappers, must be laundered before reuse. Linens shall be handled, stored, processed, and transported in such a manner as to prevent the spread of infection. Soiled and clean linen must be handled and stored separately.
   3. (c) A sufficient supply of cloth or disposable towels shall be available so that a fresh towel can be used after each hand washing. Towels shall not be shared.

4. (4) Disaster Preparedness.

   1. (a) The birthing center shall have a posted plan for evacuation of patients, staff, and visitors in case of fire, severe weather, natural disasters or other emergencies, or threats to the personal safety of patients or staff.

   2. (b) Disaster Drills.

      1. 1. At least one fire or emergency drill shall be held every 3 months to familiarize employees with the drill procedure. Reports of the drills shall be maintained with records of attendance.
      2. 2. Records shall show that action has been taken to correct any identified problems with fire drills.
   3. (c) The birthing center shall develop a plan or methods to communicate with patients in the event of a disaster-related temporary closure of the facility. The birthing center shall advise the Department in writing of any such closure within 24 hours thereof.

5. (5) Infection Control.

   1. (a) An Infection Control Committee, or comparable group, comprised of the staff physician or consultant physician and members of the nurse-midwifery staff, nursing staff, administration, and other services of the birthing center, shall be established and shall be responsible for investigating, controlling, and preventing infections in the birthing center. The Infection Control Committee shall meet quarterly and maintain written documentation and an attendance roster for all such meetings.
   2. (b) There shall be written procedures to govern the use of aseptic techniques and procedures in all areas of the birthing center.
   3. (c) To keep infections at a minimum, such procedures and techniques shall be reviewed on an annual basis by the Infection Control Committee.
   4. (d) Continuing education shall be provided on an annual basis to all birthing center personnel on the causes, effects, transmission, prevention, and elimination of infection.
   5. (e) Reports of infections observed during any follow-up or return visit of the patient shall be made and kept as a part of the patient's medical record. The birthing center shall maintain a surveillance logbook recording all follow-up visits and telephone inquiries in which infections or other complaints are reported or observed. This logbook shall be reviewed at least once quarterly by the birthing center's staff physician or consultant physician.

   6. (f) Efforts shall be made to determine the origin of any infection, and if the birthing process was found to be related to acquiring the infection, remedial action shall be taken to prevent recurrence.

      1. 1. In the event of sustained numbers of infections (three or more patients in l week), the Department shall be immediately notified. Upon order of the Department, operation of the birthing center shall be discontinued until approval for continuation of operation is granted by the Department.
      2. 2. If the birthing center wishes to contest such closure, the Department shall provide an opportunity for a hearing under the contested case provisions of the Alabama Administrative Procedure Act. Such hearing shall be held not more than 2 working days after notice of appeal is given to the Department, unless the birthing center agrees otherwise. The birthing center shall be entitled to full rights of appeal from any adverse decision rendered as a result of the hearing, in accordance with state law.
   7. (g) Written policies and procedures shall be developed to ensure that employees with any communicable disease in an infectious stage shall not be on duty in the birthing center.
   8. (h) Call Records. In addition to the infection control record required by these rules, a facility must keep a record of all calls taken by the RN, CNM, CPM, or physician. The call record should include the patient's name, time and date of call, a brief description of the reason for the call, date of the procedure, location of any emergency department the patient is presenting to, if known and applicable, and any action taken in response. A full description of any adverse conditions and the instructions or treatment given in response must be noted in the patient's medical record.

Author: Dana Billingsley, Diane Milledge

Statutory Authority: Code of Ala. 1975, §22-2-2(6), et seq.; §22-21-20, et seq.

History: Filed November 19, 1987. Repealed: Filed April 16, 2010; effective May 21, 2010. New Rule: Published August 31, 2023; effective October 15, 2023.