1. (a) General.

   1. (1) The obstetrical unit shall be located and designated to prohibit nonrelated traffic through the unit.
   2. (2) When delivery and operating rooms are in the same suite, access and service arrangements shall be such that neither staff nor patients need to travel through one (1) area to reach the other.
   3. (3) Except as permitted otherwise herein, existing facilities being renovated shall, as far as practicable, provide all the required support services.

2. (b) Postpartum unit.

   1. (1) Postpartum room.

      1. (A)
3. (i) A postpartum room shall have a minimum of:
4. (a) (a) One hundred square feet (100 sq. ft.) of clear floor area per bed in multibedded rooms; and

5. (b) (b) One hundred twenty square feet (120 sq. ft.) of clear floor area in single-bed rooms.

   1. (ii) These areas shall be exclusive of:
6. (a) (a) Toilet rooms;

7. (b) (b) Closets;

   1. (c) (c) Alcoves; or

      1. (d) (d) Vestibules.

         1. (iii) Where renovation work is undertaken, every effort shall be made to meet the above minimum standards.
         2. (iv) If it is not possible to meet the above square-foot standards, the authorities having jurisdiction may grant approval to deviate from this requirement.
         3. (v) In such cases, existing postpartum patient rooms shall have no less than:
8. (a) (a) Eighty square feet (80 sq. ft.) of clear floor area per bed in multiple-bed rooms; and

9. (b) (b) One hundred square feet (100 sq. ft.) in single-bed rooms.

   1. (B) In multibedded rooms there shall be a minimum clear distance of:

      1. (i) Four feet (4’) between the foot of the bed and the opposite wall;

         1. (ii) Three feet (3’) between the side of the bed and nearest wall; and
         2. (iii) Four feet (4’) between beds.
      2. (C) The maximum number of beds per room shall be two (2).

   2. (2) The following support services for this unit shall be provided:

      1. (A) Nurses' station;
      2. (B) Nurse office;
      3. (C) Charting facilities;
      4. (D) Toilet room for staff;
      5. (E) Staff lounge;
      6. (F) Lockable closets or cabinets for personal articles of staff;
      7. (G) Consultation/conference room or rooms;

      8. (H)

         1. (i) Patients’ lounge.
         2. (ii) The patients’ lounge may be omitted if all rooms are single-bedded rooms;

      9. (I)

         1. (i) Clean workroom or clean supply room.
         2. (ii) A clean workroom is required if clean materials are assembled within the obstetrical suite prior to use.
         3. (iii) It shall contain a work counter, a handwashing fixture, and storage facilities for clean and sterile supplies.
         4. (iv) If the room 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.
         5. (v) Soiled and clean workrooms or holding rooms shall:
10. (a) (a) Be separated; and

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

    1. (J)

       1. (i) Soiled workroom or soiled holding room for the exclusive use of the obstetrical suite.

          1. (ii) This room shall be separate from the clean workroom.
          2. (iii) The soiled workroom shall contain:
12. (a) (a) A clinical sink or equivalent flushing-rim fixture; and

13. (b) (b) A handwashing fixture.

    1. (iv) The above fixtures shall have a hot and cold mixing faucet.

       1. (v) The room shall have:
14. (a) (a) A work counter; and

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

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

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

       2. (K)

          1. (i) Medication station.
          2. (ii) Provision shall be made for storage and distribution of drugs and routine medications.
          3. (iii) This may be done:
16. (a) (a) From a medicine preparation room or unit;

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

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

       1. (iv) If used, a medicine preparation room or unit shall be under visual control of nursing staff.

          1. (v) It shall contain:
18. (a) (a) A work counter;

19. (b) (b) A sink;

    1. (c) (c) A refrigerator; and

       1. (d) (d) Double-locked storage for controlled substances.

          1. (vi) Convenient access to handwashing stations shall be provided.
          2. (vii) Standard cup-sinks provided in many self-contained units are not adequate for handwashing;

       2. (L)

          1. (i) Clean linen storage may be part of a clean workroom or a separate closet.
          2. (ii) When a closed cart system is used, the cart shall be stored out of the path of normal traffic;

       3. (M)

          1. (i) Nourishment station shall contain:
20. (a) (a) A sink;

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

    1. (c) (c) An ice dispenser;

       1. (d) (d) A refrigerator;
22. (e) (e) Cabinets; and

23. (f) (f) Equipment for serving hot or cold food.

    1. (ii) Space shall be included for temporary holding of unused or soiled dietary trays;

       1. (N)

          1. (i) Equipment storage room.
          2. (ii) Each unit shall provide sufficient storage area or areas located on the patient floor to keep its required corridor width free of equipment and supplies, but not less than:
24. (a) (a) Ten square feet (10 sq. ft.) per postpartum room; and

25. (b) (b) Twenty square feet (20 sq. ft.) per each LDR or LDRP outside of the patient room;

    1. (O) Storage space for stretchers and wheelchairs shall be provided in a strategic location out of corridors and away from normal traffic;

       1. (P) When bathing facilities are not provided in patient rooms, there shall be at least one (1) shower and/or bathtub for every six (6) beds or fraction thereof;

       2. (Q)

          1. (i) A housekeeping room shall be provided for the exclusive use of the obstetrical suite.
          2. (ii) It shall be directly accessible from the suite and shall contain:
26. (a) (a) A service sink or floor receptor; and

27. (b) (b) Provisions for storage of supplies and housekeeping equipment;

    1. (R)

       1. (i) Examination/treatment room and/or multipurpose diagnostic testing room shall have a minimum clear floor area of one hundred twenty square feet (120 sq. ft.).

          1. (ii) When utilized as a multipatient diagnostic testing room, a minimum clear floor area of eighty square feet (80 sq. ft.) per patient shall be provided.
          2. (iii) An adjoining toilet room shall be provided for patient use; and
       2. (S) Emergency equipment storage shall be located in close proximity to the nurses' station.

    2. (3) Airborne infection isolation room or rooms.

       1. (A) An airborne infection isolation room is not required for the obstetrical unit.

       2. (B) Provisions for the care of the perinatal patient with an airborne infection shall be determined by the infection prevention and control risk assessment.

          1. (c) Cesarean/delivery suite.

    3. (1)

       1. (A) Caesarean/delivery room or rooms shall have a minimum clear floor area of three hundred sixty square feet (360 sq. ft.) with a minimum dimension of sixteen feet (16’) exclusive of built-in shelves or cabinets.
       2. (B) There shall be a minimum of one (1) such room in every obstetrical unit.

    4. (2)

       1. (A) Delivery room or rooms shall have minimum clear area of three hundred square feet (300 sq. ft.) exclusive of fixed cabinets and built-in shelves.
       2. (B) An emergency communication system shall be connected with the obstetrical suite control station.

    5. (3)

       1. (A) Infant resuscitation:

          1. (i) Shall be provided within the Cesarean/delivery room or rooms and delivery rooms with a minimum clear floor area of forty square feet (40 sq. ft.) in addition to the required area of each room; or
          2. (ii) May be provided in a separate but immediately accessible room with a clear floor area of one hundred fifty square feet (150 sq. ft.).
       2. (B) Six (6) single or three (3) duplex electrical outlets shall be provided for the infant in addition to the facilities required for the mother.

    6. (4) Labor room or rooms — LDR or LDRP rooms may be substituted.

       1. (A) In renovation projects, existing labor rooms may have a minimum clear area of one hundred square feet (100 sq. ft.) per bed.
       2. (B) Where LDRs or LDRPs are not provided, a minimum of two (2) labor beds shall be provided for each Caesarean room and/or delivery room.
       3. (C) In facilities that have only one (1) Caesarean delivery room, two (2) labor rooms shall be provided.
       4. (D) Each room shall be designed for either one (1) or two (2) beds with a minimum clear area of one hundred twenty square feet (120 sq. ft.) per bed.

       5. (E) Each labor room shall:

          1. (i) Contain a handwashing fixture; and
          2. (ii) Have access to a private toilet room.
       6. (F) One (1) toilet room may serve two (2) labor rooms.
       7. (G) Labor rooms shall have controlled access with doors that are arranged for observation from a nurses' station.
       8. (H) At least one (1) shower, which may be separate from the labor room if under staff control, for use of patients in labor shall be provided.
       9. (I) Windows in labor rooms, if provided, shall be located, draped, or otherwise arranged to preserve patient privacy from casual observation from outside the labor room.

    7. (5) Recovery room or rooms — LDR or LDRP rooms may be substituted.

       1. (A) Each recovery room shall:

          1. (i) Contain at least two (2) beds; and
          2. (ii) Have a nurses' station with charting facilities located to permit visual control of all beds.
       2. (B) Each room shall include stations for handwashing and dispensing medicine.
       3. (C) A clinical sink with bedpan flushing device shall be available, as shall storage for supplies and equipment.

       4. (D) There shall be:

          1. (i) Enough space for baby and crib; and
          2. (ii) A chair for the support person.
       5. (E) There shall be the ability to maintain visual privacy of the new family.

    8. (6) Service areas.

       1. (A) Individual rooms shall be provided as indicated in the following standards, otherwise, alcoves or other open spaces that do not interfere with traffic may be used.

       2. (B) The following services shall be provided:

          1. (i) A control/nurses’ station located to restrict unauthorized traffic into the suite;
          2. (ii)
28. (a) (a) Soiled workroom or soiled holding room.

29. (b) (b) This room shall be separate from the clean workroom.

    1. (c) (c) The soiled workroom shall contain a:
    2. (1) (1) Clinical sink; or

    3. (2) (2) Equivalent flushing-rim fixture.

       1. (d) (d) The room shall contain a handwashing fixture.
30. (e) (e) The above fixtures shall have a hot and cold mixing faucet.

31. (f) (f) The room shall have:

    1. (1) (1) A work counter; and
    2. (2) (2) Space for separate covered containers for soiled linen and waste.
32. (g) (g) Rooms used only for temporary holding of soiled material may omit the clinical sink and work counter.

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

    1. (iii) Fluid waste disposal.

       1. (C)

          1. (i) The following services may be shared with the surgical facilities if the functional program reflects this concern.
          2. (ii) Where shared, areas shall be arranged to avoid direct traffic between the delivery and operating rooms:
34. (a) (a) A supervisor’s office or station;

35. (b)

    1. (1) (b)(1) A waiting room with toilets, telephones, and drinking fountains conveniently located.

    2. (2) (2) The toilet room shall contain handwashing stations;

       1. (c)
    3. (1) (c)(1) Sterilizing facilities with high-speed sterilizers convenient to all Caesarean/delivery rooms.

    4. (2) (2) Sterilization facilities shall be:

       1. (A) (A) Separate from the delivery area; and
       2. (B) (B) Adjacent to clean assembly.
    5. (3) (3) High-speed autoclaves shall only be used in an emergency situation (i.e., a dropped instrument and no sterile replacement readily available).

    6. (4) (4) Sterilization facilities would not be necessary if the flow of materials were handled from a central service department based on the usage of the delivery room (DR);

       1. (d) (d) A drug distribution station with:
    7. (1) (1) Handwashing stations; and

    8. (2) (2) Provisions for:

       1. (A) (A) Controlled storage;
       2. (B) (B) Preparation; and
       3. (C) (C) Distribution of medication;

36. (e)

    1. (1) (e)(1) Scrub facilities for Caesarean and delivery rooms.
    2. (2) (2) Two (2) scrub stations shall be provided adjacent to the entrance to each Caesarean/delivery room.
    3. (3) (3) Scrub facilities should be arranged to minimize any splatter on nearby personnel or supply carts.
    4. (4) (4) In new construction, view windows at scrub stations to permit the observation of room interiors;

37. (f)

    1. (1) (f)(1) Clean workroom or clean supply room.
    2. (2) (2) A clean workroom shall be provided if clean materials are assembled within the obstetrical suite prior to use.

    3. (3) (3) If a clean workroom is provided it shall contain:

       1. (A) (A) A work counter;
       2. (B) (B) A sink equipped for handwashing; and
       3. (C) (C) Space for storage of supplies.
    4. (4) (4) A clean supply room may be provided when the narrative program defines a system for the storage and distribution of clean and sterile supplies;

38. (g)

    1. (1) (g)(1) Medical gas storage facilities.
    2. (2) (2) Main storage of medical gases may be outside or inside the facility in accordance with NFPA 99.
    3. (3) (3) Provision shall be made for additional separate storage of reserve gas cylinders necessary to complete at least one (1) day’s procedures;

39. (h) (h) A clean sterile storage area readily available to the delivery room, size to be determined on:

    1. (1) (1) Level of usage;
    2. (2) (2) Functions provided; and

    3. (3) (3) Supplies from the hospital central distribution area;

       1. (i)
    4. (1) (i)(1) An anesthesia workroom for cleaning, testing, and storing anesthesia equipment.

    5. (2) (2) It shall contain:

       1. (A) (A) A work counter;
       2. (B) (B) A sink; and
       3. (C) (C) Provisions for separation of clean and soiled items;
40. (j) (j) Equipment storage room or rooms for equipment and supplies used in the obstetrical suite;

41. (k)

    1. (1) (k)(1) Staff clothing change areas.
    2. (2) (2) The clothing change area shall be designed to encourage one-way traffic and cross-traffic between clean and contaminated personnel.

    3. (3) (3) The area shall contain:

       1. (A) (A) Lockers;
       2. (B) (B) Showers;
       3. (C) (C) Toilets;
       4. (D) (D) Handwashing stations; and

       5. (E) (E) Space for donning and disposing scrub suits and booties;

          1. (l) (l) Male and female support persons change area designed as described above;
          2. (m)
    4. (1) (m)(1) Lounge and toilet facilities for obstetrical staff convenient to delivery, labor, and recovery areas.
    5. (2) (2) The toilet room shall contain handwashing stations;
42. (n) (n) An on-call room or rooms for physician and/or staff may be located elsewhere in the facility;

43. (o)

    1. (1) (o)(1) Environmental services closet.
    2. (2) (2) See 20 CAR § 43-164, physical facilities — cleaning and sanitizing carts, employee facilities, and environmental closets, for detailed requirements; and

44. (p) (p) An area for storing stretchers out of the path of normal traffic.

    1. (d) LDR and LDRP facilities.
    2. (1) When provided by the narrative program, delivery procedures in accordance with birthing concepts may be performed in the LDR or LDRP rooms.

    3. (2) LDR room or rooms may be located:

       1. (A) In a separate LDR suite; or
       2. (B) As part of the Caesarean/delivery suite.
    4. (3) The postpartum unit may contain LDRP rooms.

    5. (4) These rooms shall have a minimum of two hundred fifty square feet (250 sq. ft.) of clear floor area with a minimum dimension of thirteen feet (13’), exclusive of:

       1. (A) Toilet room;
       2. (B) Closet;
       3. (C) Alcove; or
       4. (D) Vestibules.
    6. (5) There should be enough space for a crib and reclining chair for a support person.
    7. (6) An area within the room but distinct from the mother’s area shall be provided for infant stabilization and resuscitation.

    8. (7)

       1. (A) See Table 4 of Appendix A for medical gas outlets.

       2. (B) These outlets shall be located in the room so that they are accessible to the:

          1. (i) Mother's delivery area; and
          2. (ii) Infant resuscitation area.
    9. (8) When renovation work is undertaken, every effort shall be made to meet the above minimum standards.
    10. (9) If it is not possible to meet the above square-foot standards, the authorities having jurisdiction may grant approval to deviate from this requirement.
    11. (10) In such cases, existing LDR or LDRP rooms may have a minimum clear area of two hundred square feet (200 sq. ft.).

    12. (11) Each LDR or LDRP room shall:

        1. (A) Be for single occupancy; and
        2. (B) Have direct access to a private toilet with shower or tub.
    13. (12) Each room shall be equipped with handwashing facilities with hands-free operation area acceptable for scrubbing.
    14. (13) Examination lights may be portable, but shall be immediately accessible.

    15. (14) Finishes shall be selected:

        1. (A) To facilitate cleaning; and
        2. (B) With resistance to strong detergents.
    16. (15) A window or windows shall be provided for LDRP room or rooms.
    17. (16) Windows or doors within a normal sightline that would permit observation into the room shall be arranged or draped as necessary for patient privacy.
    18. (17) Additional requirements for windows are provided above in subdivision (b)(2)(A) of this section.

Codification Notes: “LDR” means labor delivery recovery. "LDRP" means labor delivery recovery postpartum. "NFPA" means National Fire Protection Association.