(e) General.

1. (1) Outpatient surgery is performed without anticipation of overnight patient stay.
2. (2) The functional program shall describe in detail staffing, patient types, hours of operation, function and space relationships, transfer provisions, and availability of offsite services.
3. (3) Visual and audible privacy shall be provided by design and include the registration, preparation, examination, treatment, and recovery areas.

(f)

1. (1) If the ambulatory surgery center is part of an acute care hospital or other medical facility, service may be shared to minimize duplication as appropriate.
2. (2) Where outpatient surgical services are provided within the same area or suite as inpatient surgery.

(g) Size.

1. (1) The extent (number and types) of the diagnostic, clinical, and administrative facilities to be provided will be determined by the:

   1. (A) Services contemplated; and
   2. (B) Estimated patient load as described in the functional program.

2. (2) Provisions shall be made for:

   1. (A) Patient examination, interview, and preparation testing; and
   2. (B) Obtaining vital signs of patient.

(h) Parking.

1. (1) Four (4) spaces for each room routinely used for surgical procedures plus one (1) space for each staff member should be provided.
2. (2) Additional parking spaces convenient to the entrance for pickup of patients after recovery should be provided.

(i) Administration and public areas. The following shall be provided:

1. (1) A covered entrance for pickup of patients after surgery;

2. (2) A lobby area including:

   1. (A) A waiting area;
   2. (B) Conveniently accessible wheelchair storage;
   3. (C) A reception/information desk;
   4. (D) Accessible public toilets;
   5. (E) Public telephone or telephones; and
   6. (F) Drinking fountain or fountains;

3. (3) Interview space or spaces for private interviews relating to:

   1. (A) Admission;
   2. (B) Credit; and
   3. (C) Demographic information gathering;

4. (4)

   1. (A) General and individual office or offices for business transactions, records, and administrative and professional staff.
   2. (B) These shall be separate from public and patient areas with provisions for confidentiality of records.
   3. (C) Enclosed office spaces for administration and consultation shall be provided;
5. (5) Multipurpose or consultation room or rooms;

6. (6) A medical records room equipped for:

   1. (A) Dictating;
   2. (B) Recording; and
   3. (C) Retrieval;
7. (7) Special storage, including locking drawers and/or cabinets, for staff personal effects; and
8. (8) General storage facilities (fifty square feet (50 sq. ft.) per operating room).

(j) Sterilizing facilities.

1. (1) A system for sterilizing equipment and supplies shall be provided.
2. (2) When sterilization is provided offsite, adequate sterile supplies shall be provided.

3. (3) If onsite processing facilities are provided, they shall include the following:

   1. (A)

(i) Soiled workroom.

1. (ii) This room shall be physically separated from all other areas of the department.

   1. (iii) Work space shall be provided to handle the cleaning and terminal sterilization/disinfection of all medical/surgical instruments and equipment.

      1. (iv) The soiled workroom shall contain:

(b) (b) Sinks;

1. (c) (c) Flush-type devices; and

   1. (d) (d) Washer/sterilizer decontaminators or other decontamination equipment.

      1. (v) Pass-through doors and washer/sterilizer decontaminators shall deliver into clean assembling areas/workrooms;

   2. (B)

      1. (i) Clean assembly/workroom.
      2. (ii) This room shall contain sterilization equipment.
      3. (iii) This workroom shall contain:

(b) (b) Work space; and

1. (c) (c) Equipment for terminal sterilizing of medical and surgical equipment and supplies.

   1. (iv) Access to sterilization room shall be restricted.

      1. (v) This room is exclusively for the inspection, assembly, and packaging of medical/surgical supplies and equipment for sterilization and shall contain work tables, counters, ultrasonic cleaning facilities for backup supplies and instrumentation or equipment.
      2. (vi) The room shall be designed to hold sterilizer carts for loading or prepared supplies for sterilization; and

   2. (C)

      1. (i) Clean/sterile storage.
      2. (ii) Storage for packs, etc., shall include provisions for ventilation, humidity, and temperature control.

(k) Clinical facilities.

1. (1)

   1. (A) Provisions shall be made to separate pediatric from adult patients.

   2. (B) This shall:

      1. (i) Include preoperative and postoperative care areas; and
      2. (ii) Allow for parental presence.

2. (2)

   1. (A) At least one (1) room shall be provided for examination and testing of patients prior to surgery, ensuring both visual and audible privacy.
   2. (B) This may be an examination room or treatment room as required by the written functional program.

   3. (C) Each room shall have a minimum floor area of eighty square feet (80 sq. ft.) excluding:

      1. (i) Vestibules;
      2. (ii) Toilets; and
      3. (iii) Closets.
   4. (D) Room arrangement shall permit at least two feet eight inches (2’ 8”) of clearance at each side and at the foot of the examination table.
   5. (E) A handwashing fixture and a counter or shelf space for writing shall be provided.

3. (3)

   1. (A) Treatment room or rooms for minor surgical and cast procedures shall have a minimum floor area of one hundred twenty square feet (120 sq. ft.) excluding:

      1. (i) Vestibules;
      2. (ii) Toilets; and
      3. (iii) Closets.
   2. (B) The minimum room dimension shall be ten feet (10’).

4. (4)

   1. (A) Each operating room shall have a minimum clear area of three hundred sixty square feet (360 sq. ft.) exclusive of cabinets and shelves, but may be larger to accommodate the functional plan that requires additional staff and/or equipment.
   2. (B) An emergency communication system connected with the surgical suite control station shall be provided.
   3. (C) There shall be at least one (1) X-ray film illuminator in each room.

5. (5)

   1. (A)

      1. (i) Room or rooms for postanesthesia recovery shall be provided as required by volume and procedure type.
      2. (ii) Two (2) per operating room is the minimum.
   2. (B) At least three feet (3’) shall be provided at each side and at the foot of each bed as needed for work and/or circulation.
   3. (C) If pediatric surgery is part of the program, separation from the adult section and space for parents shall be provided.
   4. (D) Soundproofing of the area and the ability to view the patient from the nursing station shall be considered.
   5. (E) Bedpans shall be supplied in this area.
6. (5) A supervised postrecovery area shall be provided for patients who do not require postanesthesia recovery but need recovery time prior to leaving the facility.

7. (6) The following services shall be provided in surgical service areas:

   1. (A) A control station located to permit visual surveillance of all traffic entering the operating suite;

   2. (B)

      1. (i) A drug distribution station for the storage and preparation of medications to be administered to patients.
      2. (ii) The station shall include:

(b) (b) Double-locked security for controlled substances; and

1. (c) (c) Convenient access to handwashing stations;

   1. (C)

      1. (i) Scrub facilities shall be located near the entrance to each operating room.
      2. (ii) Stations may serve two (2) operating rooms if needed, but shall be arranged to minimize incidental splatter on nearby personnel or supply carts;

   2. (D) A soiled workroom that includes:

      1. (i) A clinical sink or equivalent flushing-type fixture;
      2. (ii) A work counter;
      3. (iii) A sink for handwashing; and
      4. (iv) Waste receptacle or receptacles;

   3. (E)

      1. (i) Fluid waste disposal facilities convenient to the general operating rooms.
      2. (ii) Note. A clinical sink or equivalent equipment in a soiled workroom shall meet this requirement;
   4. (F) Anesthesia storage facilities in accordance with NFPA 99;
   5. (G) Medical gas supply and storage to include space for reserve nitrous oxide and oxygen cylinders;
   6. (H) Storage room or rooms for equipment and supplies used in the surgical suite;

   7. (I)

      1. (i) Appropriate change areas for staff working within the surgical suite.
      2. (ii) The areas shall include:

(b) (b) Showers;

1. (c) (c) Toilets;

   1. (d) (d) Lavatories for handwashing; and

(e) (e) Space for donning scrub attire;

1. (J)

   1. (i) A separate patient change area that includes:

(b) (b) Lockers;

1. (c) (c) Toilets;

   1. (d) (d) Clothing change or gowning area or areas; and

(e) (e) Space for medication administration.

1. (ii) The functional program shall include provisions for securing patients’ personal effects;

   1. (K) A convenient stretcher storage area out of the direct line of traffic;

   2. (L)

      1. (i) A housekeeping room that includes:

(b) (b) Space for housekeeping supplies and equipment.

1. (ii) This room shall be for the exclusive use of the surgical suite;

   1. (M) Space for temporary storage of wheelchairs;
   2. (N) Convenient access to and use of emergency “crash carts” for both the surgical and recovery areas;
   3. (O) An area for the storage and processing of clean and soiled linen; and

   4. (P) Laundry services shall conform to 20 CAR § 41-167, physical facilities — linen services.

      1. (l) Diagnostic facilities. Diagnostic services shall be provided onsite or offsite for preadmission tests as required by the functional program.
      2. (m) Details and finishes. All details and finishes shall meet the standards in 20 CAR § 41-171, physical facilities — details and finishes, with the following exceptions:

2. (1)

   1. (A) Minimum patient corridor width shall be five feet (5’) except that corridors in the operating room section, where patients are transported on stretchers or beds, shall be eight feet (8’) wide.
   2. (B) Passages and corridors used exclusively for staff access may be forty-four inches (44”) in clear width;
3. (2) Patient toilet rooms shall be equipped with doors and hardware that permit access from the outside in emergencies; and
4. (3) Flammable anesthetics shall not be used.

(p) Electrical. Electrical installations shall conform to 20 CAR § 41-175, physical environment — electrical standards, with the following exceptions:

1. (1) Eight (8) hours of onsite fuel for the emergency generator; and
2. (2) Emergency call system is required in all patient toilet rooms.