1. (a) Note. See other sections of this document for special care area units such as:

   1. (1) Postanesthesia care units;
   2. (2) Critical care units;
   3. (3) Rehabilitation units;
   4. (4) Pediatric units;
   5. (5) Postpartum care units; and/or
   6. (6) Other specialty units.

2. (b) Patient rooms. Each patient room shall meet the following requirements:

   1. (1) Maximum room capacity shall be two (2) patients;

   2. (2)

      1. (A) In new construction, patient rooms shall have a minimum of one hundred square feet (100 sq. ft.) of clear floor area per bed in semiprivate rooms and one hundred twenty square feet (120 sq. ft.) of clear floor area for single-bed rooms, exclusive of:

3. (i) Toilet rooms;

   1. (ii) Closets;

      1. (iii) Lockers;

         1. (iv) Wardrobes;
         2. (v) Alcoves; or
         3. (vi) Vestibules;

      2. (B) The dimensions and arrangement of rooms shall be such that there is a minimum of three feet (3’) between the sides and foot of the bed and:

         1. (i) Any wall or other fixed obstruction; or
         2. (ii) Another bed;
      3. (C) In semiprivate bedrooms, a clearance of four feet (4’) shall be available at the foot of each bed to permit the passage of equipment and beds.
      4. (D) Minor encroachments, including columns and lavatories, that do not interfere with functions may be ignored when determining space requirements for patient rooms.
      5. (E) Where renovation work is undertaken, every effort shall be made to meet the above minimum standards;

   2. (3)

      1. (A) Each patient room shall have a window with outside exposure and where the operation of windows or vents requires the use of tools or keys, such devices shall be:

         1. (i) On the same floor; and
         2. (ii) Easily accessible to staff;

      2. (B) The windowsills shall:

         1. (i) Not be higher than three feet (3’) above the floor; and
         2. (ii) Be above the grade;
      3. (C) Patient rooms in new construction intended for twenty-four-hour occupancy shall have windows.
      4. (D) If operable windows are installed, such devices shall be permanently secured or restricted to inhibit possible escape or suicide;
   3. (4) Nurse patient communication stations shall be provided in accordance with 20 CAR § 41-175(f), physical environment — electrical standards;

   4. (5)

      1. (A) Handwashing stations shall be provided to serve each patient room.
      2. (B) These handwashing stations shall be located in the toilet room;

   5. (6)

      1. (A) Each patient shall have access to a toilet room without having to enter the general corridor area.

      2. (B) One (1) toilet room shall serve no more than:

         1. (i) Four (4) patient beds; and
         2. (ii) Two (2) patient rooms;
      3. (C) In new construction, an additional handwashing station or sanitizing station shall be placed in the patient room where the toilet room serves more than one (1) bed.
      4. (D) The toilet room shall contain a water closet and a handwashing station and the door shall swing outward or be double-acting;

   6. (7) Each patient shall have within the room a separate wardrobe or closet that is suitable for:

      1. (A) Hanging full-length garments; and
      2. (B) Storing personal items;

   7. (8)

      1. (A) Visual privacy from casual observation by other patients and visitors shall be provided for each patient in semiprivate rooms with:

         1. (i) Cubicle curtains; or
         2. (ii) Equivalent built-in or movable dividers.
      2. (B) Provisions for privacy are not required within psychiatric or alcohol and drug units.

      3. (C) The method for providing privacy shall not obstruct passage of other patients to the:

         1. (i) Entrance;
         2. (ii) Toilet; or
         3. (iii) Lavatory.

      4. (D) All curtains shall:

         1. (i) Have a flame spread of zero (0) to twenty-five (25); and
         2. (ii) Comply with NFPA 13 requirements for clear space below sprinklers;
   8. (9) Each room shall communicate directly with a corridor without passage through another patient’s room;

   9. (10) Rooms existing partially below grade level shall not be used for patients unless they are:

      1. (A) Dry;
      2. (B) Well-ventilated; and
      3. (C) Otherwise suitable for occupancy;

   10. (11) Beds shall be arranged to:

       1. (A) Provide adequate room for all patient care procedures; and
       2. (B) Prevent the transmission of infections;

   11. (12)

       1. (A) Individual approved hospital-type beds shall be provided.
       2. (B) Bed rails shall be provided on beds for children;

   12. (13)

       1. (A) A reading light shall be provided for each patient bed.
       2. (B) The location and design shall be such that the light is not annoying to other patients; and

   13. (14)

       1. (A) A bedside table with drawer shall be provided for each bed.

       2. (B) The lower portion of the table and/or enclosed shelves shall be provided for individual nursing care equipment.

          1. (c) Service areas.
   14. (1) Each services area may be arranged and located to serve more than one (1) nursing unit but at least one (1) such service area shall be provided on each nursing floor.
   15. (2) Some of the service areas may be combined in a single space.

   16. (3) The following service areas shall be located in or readily available to each nursing unit:

       1. (A)

          1. (i) Nursing station.
          2. (ii) Facilities for charting, clinical records, work counter, communication system, space for supplies, and convenient access to handwashing stations shall be provided.
          3. (iii) It may be combined with or include centers for reception and communication;

       2. (B)

          1. (i) Dictation area shall be provided.
          2. (ii) This area shall be adjacent to but separate from the nurses’ station;

       3. (C)

          1. (i) Toilet room or rooms for staff convenient to nurses’ station.
          2. (ii) May be unisex;

       4. (D)

          1. (i) Lounge facilities for staff.
          2. (ii) These facilities may be on another floor;

       5. (E)

          1. (i) Individual closets or compartments for the safekeeping of coats and personal effects of nursing personnel.
          2. (ii) These shall be located:
4. (a) (a) Convenient to the nurses’ station of personnel; or

5. (b) (b) In a central location;

   1. (F)

      1. (i) Multipurpose room or rooms for:
6. (a) (a) Staff;

7. (b) (b) Patients;

   1. (c) (c) Patients’ families;

      1. (d) (d) Patient conferences;
8. (e) (e) Reports;
9. (f) (f) Education;
10. (g) (g) Training sessions; and

11. (h) (h) Consultation.

    1. (ii) The rooms shall be accessible to each nursing unit.

       1. (iii) One (1) such room may serve several nursing units and/or departments;

       2. (G)

          1. (i) Examination/treatment room or rooms.
          2. (ii) Such rooms may be omitted if all patient rooms are single-bed rooms.
          3. (iii) It shall have a minimum floor area of one hundred twenty square feet (120 sq. ft.) excluding space for vestibule, toilet, closets, and work counters, whether fixed or movable.
          4. (iv) Centrally located examination and treatment room or rooms may serve more than one (1) nursing unit on the same floor.
          5. (v) The room shall contain:
12. (a) (a) A lavatory or sink equipped for handwashing;

13. (b) (b) A work counter;

    1. (c) (c) Storage facilities; and

       1. (d) (d) A desk, counter, or shelf space for writing.

          1. (vi) The emergency treatment room may be used for this purpose if it is conveniently located to the patient rooms;

       2. (H)

          1. (i) Clean workroom or clean supply room.
          2. (ii) If the room is used for preparing patient care items, it shall contain:
14. (a) (a) A work counter;

15. (b) (b) A handwashing fixture; and

    1. (c) (c) Storage facilities for clean and sterile supplies.

       1. (iii) If the room is used only for storage and holding as part of a system for distribution of clean and sterile materials, the work counter and handwashing fixture may be omitted.

          1. (iv) Soiled and clean workrooms or holding rooms shall:
16. (a) (a) Be separated; and

17. (b) (b) Have no direct connection;

    1. (I)

       1. (i) Soiled workroom or soiled holding room.

          1. (ii) This room shall be separate from the clean workroom.
          2. (iii) The soiled workroom shall contain a clinical sink or equivalent flushing-rim fixture.
          3. (iv) The room shall contain a lavatory or handwashing fixture.
          4. (v) The above fixtures shall both have a hot and cold mixing faucet.
          5. (vi) The room shall have:
18. (a) (a) A work counter; and

19. (b) (b) Space for separate covered containers for soiled linen and waste.

    1. (vii) Rooms used only for temporary holding of soiled material may omit the clinical sink and work counter.

       1. (viii) If the flushing-rim clinical sink is eliminated, facilities for cleaning bedpans shall be provided elsewhere;

       2. (J)

          1. (i) Medication station.
          2. (ii) Provisions shall be made for distribution of medications.
          3. (iii) This may be done:
20. (a) (a) From a medicine preparation room or unit;

21. (b) (b) From a self-contained medicine dispensing unit; or

    1. (c) (c) By another approved system.

       1. (iv) Medicine preparation room.
22. (a) (a) This room shall be designed to allow for visual supervision by the nursing staff.

23. (b) (b) It shall contain:

    1. (1) (1) A work counter;
    2. (2) (2) A sink adequate for handwashing;
    3. (3) (3) A refrigerator; and

    4. (4) (4) Locked storage for controlled drugs.

       1. (c) (c) When a medicine preparation room is to be used to store one (1) or more self-contained medicine dispensing units, the room shall be designed with adequate space to prepare medicines with the self-contained medicine dispensing unit or units present.

          1. (v) Self-contained medicine dispensing unit.

24. (a) (a) A self-contained medicine dispensing unit may be located at the nurses’ station, in the clean workroom, or in an alcove, provided the unit has adequate:

    1. (1) (1) Security for controlled drugs; and
    2. (2) (2) Adequate lighting to easily identify drugs.

25. (b) (b) Convenient access to handwashing stations shall be provided.

    1. (c) (c) Standard cup-sinks provided in many self-contained units are not adequate for handwashing;

       1. (K)

          1. (i) Clean linen storage.
          2. (ii) A separate closet or a designated area within the clean workroom shall be provided.
          3. (iii) If a closed cart system is used, storage may be in an alcove.
          4. (iv) Carts shall be out of the path of traffic;

       2. (L)

          1. (i) Nourishment station.
          2. (ii) This shall contain:
26. (a) (a) A sink equipped for handwashing;

27. (b) (b) Equipment for serving nourishment between scheduled and unscheduled meals;

    1. (c) (c) A refrigerator;

       1. (d) (d) Storage cabinets; and

28. (e) (e) Icemaker units to provide ice for patients’ service and treatment.

    1. (iii) Ice for human consumption shall be from self-dispensing units.

       1. (iv) Handwashing stations shall be in or immediately accessible to the nourishment station;

       2. (M)

          1. (i) Equipment storage room.
          2. (ii) This shall be for equipment such as:
29. (a) (a) IV stands;

30. (b) (b) Inhalators;

    1. (c) (c) Air mattresses; and

       1. (d) (d) Walkers;

       2. (N)

          1. (i) Parking for stretchers and wheelchairs.
          2. (ii) This shall be located out of the path of normal traffic;

       3. (O)

          1. (i) Showers and bathtubs.
          2. (ii) When individual bathing facilities are not provided in patient rooms, there shall be at least one (1) shower and/or bathtub for every twelve (12) beds without such facilities.
          3. (iii) Each bathtub or shower shall be in an individual room or enclosure that provides privacy for:
31. (a) (a) Bathing;

32. (b) (b) Drying; and

    1. (c) (c) Dressing.

       1. (iv) Special bathing facilities including space for attendant shall be provided for patients on stretchers, carts, and wheelchairs at the ratio of:
33. (a) (a) One (1) per one hundred (100) beds; or

34. (b) (b) A fraction thereof.

    1. (v) This may be on a separate floor if convenient for use;

       1. (P)

          1. (i) Emergency equipment storage.
          2. (ii) Space for emergency equipment such as a “crash cart” shall be:
35. (a) (a) Provided; and

36. (b) (b) Under control of the nursing staff; and

    1. (Q)

       1. (i) Environmental services closet.

          1. (ii) See 20 CAR § 41-168, physical facilities — cleaning and sanitizing carts, employee facilities, and environmental closets, for detailed requirements.
          2. (d) Airborne infection isolation room or rooms.
    2. (1) Rooms for patients who are suffering from infections shall be provided at the rate of one (1) for every thirty (30) beds or fraction thereof.

    3. (2) These may be located:

       1. (A) Within each nursing unit; or
       2. (B) Placed together in a separate unit.
    4. (3) See also 20 CAR § 41-148, physical facilities — critical care unit for the requirements of critical care units.
    5. (4) Psychiatric and alcohol/drug unit or units beds need not be included in the bed count ratio to establish the number of rooms.

    6. (5) Each isolation room shall be a single-bed room and planned as required for a normal patient room except as follows:

       1. (A) Each airborne infection isolation room shall have an area for handwashing, gowning, and storage of clean and soiled materials located directly outside the entry door to the patient room;
       2. (B) Airborne infection isolation room perimeter walls, ceiling, and floors, including penetrations, shall be sealed tightly so that air does not infiltrate the environment from the outside or from other spaces;
       3. (C) Airborne infection isolation room or rooms shall have self-closing devices on all room exit doors;
       4. (D) Separate toilet, bathtub or shower, and handwashing stations are required for each airborne infection isolation room;
       5. (E) Airborne infection isolation rooms may be used for noninfectious patients when not needed for patients with airborne infectious disease;
       6. (F) Windows shall not be operable without the use of a key or tool controlled by the nursing staff; and
       7. (G) Each room shall have a permanently installed visual mechanism to constantly monitor the pressure status of the room when occupied by patients with an airborne infectious disease.

37. (e) Protective isolation rooms.

    1. (1) In facilities where procedures such as organ transplants, burn therapy, and immunosuppressive treatments are performed, special design provisions including special ventilation may be necessary to meet the needs of the functional program.
    2. (2) Refer to Table 4 of Appendix A for air pressure and ventilation.

    3. (3) Each protective isolation room shall be a single-bed room and planned as required for a normal patient room except as follows:

       1. (A) Each protective isolation room shall have an anteroom for handwashing, gowning, and storage of clean and soiled materials located directly outside the entry door to the patient room;
       2. (B) Protective isolation room perimeter walls, ceiling, and floors, including penetrations, shall be sealed tightly so that air does not infiltrate the environment from the outside or from other spaces;
       3. (C) Protective isolation room or rooms shall have self-closing devices on all room exit doors;
       4. (D) Separate toilet, bathtub or shower, and handwashing stations are required for each protective isolation room;
       5. (E) Protective isolation rooms may be used for nonimmunosuppressed patients, except airborne infectious patients are prohibited; and
       6. (F) Windows shall not be operable without the use of a key or tool controlled by the nursing staff.

38. (f) Seclusion rooms.

    1. (1) Each hospital shall provide one (1) or more single-bed rooms for patients needing close supervision if suitable psychiatric facilities are not available elsewhere in the community.
    2. (2) Such rooms shall comply with the applicable requirements in 20 CAR § 41-151, physical facilities — psychiatric nursing unit.

39. (g) Observation rooms. Patients in observation status may be accommodated within the facility:

    1. (1)

       1. (A) In private, semiprivate, or multipatient rooms.

       2. (B) Furniture shall be arranged to:

          1. (i) Provide adequate room for patient care procedures; and
          2. (ii) Prevent the transmission of infection;

    2. (2)

       1. (A) Cubicle curtains, privacy screens, or an approved equivalent shall be provided for patient privacy in all multipatient rooms.
       2. (B) The utilization of such curtains or screens shall be such that each patient shall have privacy;

    3. (3) Each room or cubicle shall be provided with:

       1. (A) Oxygen;
       2. (B) Vacuum; and
       3. (C) A nurse call button unless direct observation is afforded and maintained;
    4. (4) Hand hygiene facilities shall be available within the area;

    5. (5)

       1. (A) Hospital-grade furniture shall be provided.
       2. (B) Bed rails shall be provided on beds;

    6. (6)

       1. (A) For each area in which a patient bed is utilized, a reading light shall be provided for each bed.
       2. (B) The location and design shall be such that the light is not annoying to other patients;
    7. (7) Patient toilets shall be provided and accessible to all patients; and
    8. (8) Adequate space shall be provided for medical supplies.

Codification Notes: “IV” means intravenous.