1. (a) General considerations.

   1. (1) See 20 CAR § 43-142(a), physical facilities.

   2. (2)

      1. (A) This section applies to the outpatient care unit licensed under the facility as a department and under the rule of the governing body.
      2. (B) An outpatient care unit can be a:

2. (i) Part of the facility; or

   1. (ii) Separate freestanding facility.

      1. (C) An outpatient unit within the main facility building shall be located so outpatients do not traverse inpatient areas.

   2. (3) The general standards set forth in the following sections shall apply to each of the items below:

      1. (A) Outpatient psychiatric centers;
      2. (B) Primary care outpatient centers; and
      3. (C) Diagnosis and/or treatment centers.

   3. (4) Each element provided in the outpatient care facility shall:

      1. (A) Be described in the written functional program; and
      2. (B) Meet the requirements outlined herein as a minimum.

3. (b) General construction considerations. See 20 CAR § 43-142(a), physical facilities.

   1. (c) Site location, inspection, approval, and subsoil investigation. See 20 CAR § 43-142(d) – (m), physical facilities.

      1. (d) Construction documents. See 20 CAR § 43-142(k), physical facilities.
4. (e) Codes and standards. New/existing outpatient care facilities that do not meet the criteria of the NFPA, Life Safety Code for healthcare and/or ambulatory healthcare occupancies may be classified as a business occupancy as defined in LSC 101, Chapter 26 (new)/27 (existing) with exceptions noted within this part.

5. (f) General requirements for outpatient care facilities. As needed, the following elements shall be provided to satisfy the functional program:

   1. (1)

      1. (A) Functional program.
      2. (B) See 20 CAR § 43-142, physical facilities;

   2. (2)

      1. (A) Parking.
      2. (B) Each facility should provide adequate parking for staff and patients;

   3. (3)

      1. (A) Patient privacy.

      2. (B) Each facility design shall ensure patient audible and visual privacy and dignity during:

         1. (i) Interview;
         2. (ii) Examination;
         3. (iii) Treatment; and
         4. (iv) Recovery;

   4. (4)

      1. (A) Administration and public areas.

      2. (B) The following shall apply to each outpatient care facility described herein with additions and/or modification as noted for each specific type:

         1. (i)
6. (a) (a) Entrance.

7. (b) (b) Located at grade level and able to accommodate wheelchairs;

   1. (ii) Public services shall include:
8. (a) (a) Conveniently accessible wheelchair storage;

9. (b) (b) A reception and information counter or desk;

   1. (c)
   2. (1) (c)(1) Waiting space or spaces.

   3. (2) (2) Where an organized pediatric service is part of the outpatient care facility, provisions shall be made for separating pediatric and adult patients;

      1. (d) (d) Public toilets;
10. (e) (e) Drinking fountain; and

11. (f) (f) Public telephones;

    1. (iii)
12. (a) (a) Interview space or spaces.

13. (b) (b) Private interviews related to social services, credit, etc., shall be provided;

    1. (iv) General or individual offices for business transactions, records, and administrative and professional staffs shall be provided;

       1. (v) Clerical space or rooms for typing, clerical work, and filing, separated from public areas for confidentiality, shall be provided;

          1. (vi) Multipurpose room or rooms equipped for visual aids shall be provided for:
14. (a) (a) Conferences;

15. (b) (b) Meetings; and

    1. (c) (c) Health education purposes;

       1. (vii)
16. (a) (a) Special storage for staff personal effects with locking drawers or cabinets (may be individual desks or cabinets) shall be provided.

17. (b) (b) Such storage shall be:

    1. (1) (1) Near individual workstations; and

    2. (2) (2) Staff-controlled.

       1. (viii) General storage facilities for supplies and equipment shall be provided as needed for continuing operation; and

          1. (ix) In new construction and renovation where hemodialysis or hemoperfusion are routinely performed, there shall be a separate water supply and a drainage facility that do not interfere with handwashing;

    3. (5)

       1. (A) General purpose examination rooms.

       2. (B) For medical and similar examinations, rooms shall have a minimum floor area of eighty square feet (80 sq. ft.) excluding:

          1. (i) Vestibules;
          2. (ii) Toilets; and
          3. (iii) Closets.
       3. (C) 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.
       4. (D) A handwashing fixture and a counter or shelf space for writing shall be provided;

    4. (6)

       1. (A) Special-purpose examination rooms.
       2. (B) Rooms for special clinics such as eye, ear, nose, and throat examinations, if provided, shall be designed and outfitted to accommodate procedures and equipment used.
       3. (C) A handwashing station and a counter or shelf space for writing shall be provided;

    5. (7)

       1. (A) Treatment room or rooms.

       2. (B) Rooms for diagnosis and/or treatment if provided shall have a minimum floor area of one hundred twenty square feet (120 sq. ft.) excluding:

          1. (i) Vestibule;
          2. (ii) Toilet; and
          3. (iii) Closets.
       3. (C) The minimum room dimension shall be ten feet (10’).
       4. (D) A handwashing fixture and counter or shelf for writing shall be provided;

    6. (8)

       1. (A) Observation room or rooms.

       2. (B) Observation rooms for the isolation of suspect or disturbed patients shall:

          1. (i) Have a minimum floor area of eighty square feet (80 sq. ft.); and
          2. (ii) Be convenient to a nurse or control station.

       3. (C) This is to:

          1. (i) Permit close observation of patients; and
          2. (ii) Minimize possibilities of patients’:
18. (a) (a) Hiding;

19. (b) (b) Escape;

    1. (c) (c) Injury; or

       1. (d) (d) Suicide.
       2. (D) An examination room may be modified to accommodate this function.
       3. (E) A toilet room with lavatory should be immediately accessible;

    2. (9)

       1. (A) Control station.
       2. (B) A work counter, communication system, space for supplies, and provisions for charting shall be provided;

    3. (10)

       1. (A) Medication distribution station.

       2. (B) This may be a part of the control station and shall include:

          1. (i) A work counter;
          2. (ii) A sink;
          3. (iii) A refrigerator; and
          4. (iv) Locked storage for biologicals and medications;

    4. (11)

       1. (A) Clean holding.
       2. (B) A separate room or closet for storing clean and sterile supplies shall be provided.
       3. (C) This storage shall be in addition to that of cabinets and shelves;

    5. (12)

       1. (A) Soiled holding.
       2. (B) Provisions shall be made for separate collection, storage, and disposal of soiled materials;

    6. (13)

       1. (A) Sterilizing facilities.
       2. (B) A system for sterilizing equipment and supplies shall be provided if required by the narrative program;

    7. (14)

       1. (A) Wheelchair storage space.
       2. (B) Such storage shall be out of the direct line of traffic;

    8. (15)

       1. (A) The need for and number of required airborne infection isolation rooms shall be determined by an infection control risk assessment.
       2. (B) When required, the airborne infection isolation room or rooms shall comply with the general requirements of 20 CAR § 43-143(d);

    9. (16)

       1. (A) Imaging suite.
       2. (B) See 20 CAR § 43-151, physical facilities — imaging suite;

    10. (17)

        1. (A) Laboratory.
        2. (B) See 20 CAR § 43-154, physical facilities — laboratory services;

    11. (18)

        1. (A) Rehabilitation services.
        2. (B) See 20 CAR § 43-175, physical facilities — rehabilitation facilities;

    12. (19)

        1. (A) Environmental services, safety services, physical environment.
        2. (B) See 20 CAR § 43-142, physical facilities;

    13. (20)

        1. (A) Staff facilities.
        2. (B) See 20 CAR § 43-165, physical facilities — engineering service and equipment areas;

    14. (21)

        1. (A) Waste processing services.
        2. (B) See 20 CAR § 43-166, physical facilities — waste processing services;

    15. (22)

        1. (A) Social spaces/group therapy.
        2. (B) See Rules for Hospitals and Related Institutions in Arkansas,20 CAR § 41-181(f)(3), physical facilities — psychiatric hospitals and alcohol/drug abuse inpatient treatment centers;

    16. (23) Details shall comply with the following standards:

        1. (A)

           1. (i) Minimum patient corridor width shall be five feet (5’).
           2. (ii) Staff-only corridors may be forty-four inches (44”) wide;

        2. (B)

           1. (i) Each building shall have two (2) exits that are remote from each other.
           2. (ii) Other details relating to exits and fire safety shall comply with:
20. (a) (a) NFPA 101; and

21. (b) (b) The standards outlined herein;

    1. (C)

       1. (i) Items such as drinking fountains, telephone booths, vending machines, etc., shall not:
22. (a) (a) Restrict corridor traffic; or

23. (b) (b) Reduce corridor width below the minimum.

    1. (ii) Out-of-traffic storage space for portable equipment shall be provided;

       1. (D)

          1. (i) The minimum nominal door width for patient use shall be three feet (3’).
          2. (ii) If the outpatient facility services hospital inpatients, the minimum nominal width of doors to rooms used by hospital inpatients transported in beds shall be three feet eight inches (3’ 8”);

       2. (E)

          1. (i) Doors, sidelights, borrowed lights, and windows glazed to within eighteen inches (18”) of the floor shall be constructed with:
24. (a) (a) Safety glass;

25. (b) (b) Wired glass; or

    1. (c) (c) Similar materials.

       1. (ii) Glazing materials used for shower doors and bath enclosures shall be safety glass or plastic;
       2. (F) Threshold and expansion joints covers shall be flush with the floor surface;
       3. (G) Handwashing stations shall be located and arranged to permit proper use and operation;
       4. (H) Provisions for hand drying shall be included at all handwashing facilities;
       5. (I) Radiation protection for X-ray and gamma ray installations shall be in accordance with the rules of the Department of Health; and
       6. (J) The minimum ceiling height shall be seven feet eight inches (7’ 8”);

    2. (24) Finishes shall comply with the following:

       1. (A) Cubicle curtains and draperies shall:

          1. (i) Be noncombustible or flame-retardant; and
          2. (ii) Pass both the large-scale and small-scale tests required by NFPA 701;
       2. (B) The flame spread and smoke development ratings of finishes shall comply with NFPA 101Chapter 38;

       3. (C)

          1. (i) Floor materials shall be:
26. (a) (a) Readily cleanable; and

27. (b) (b) Appropriately wear-resistant.

    1. (ii) In all areas subject to wet cleaning, floor materials shall not be physically affected by liquid germicidal and cleaning solutions.

       1. (iii) Floors subject to traffic while wet, including showers and bath areas, shall have a nonslip surface;

       2. (D) Wall finishes:

          1. (i) Shall be washable; and
          2. (ii) In the proximity of plumbing fixtures; shall be smooth and water-resistant;

       3. (E) Wall bases in areas frequently subject to wet cleaning methods shall be:

          1. (i) Monolithic and coved with the floor;
          2. (ii) Tightly sealed to the wall; and
          3. (iii) Constructed without voids; and

       4. (F)

          1. (i) Floor and wall areas penetrated by pipes, ducts, and conduits shall be tightly sealed to minimize entry of rodents and insects.
          2. (ii) Joints of structural elements shall be similarly sealed;

    2. (25)

       1. (A) Provision for disasters.
       2. (B) See 20 CAR § 43-141, physical environment; and

    3. (26)

       1. (A) Mechanical, plumbing, and electrical.

       2. (B) Small outpatient clinics that provide space and equipment serving four (4) or fewer direct patient care workers at one (1) time shall comply with the following minimum requirements:

          1. (i) Emergency lighting shall be connected to rechargeable backup batteries as a means of emergency illumination; and
          2. (ii) A protected premises fire alarm system as defined in Chapter 3, NFPA 72 is required.

       3. (C) Large outpatient facilities that provide space and equipment for more than four (4) direct patient care workers at one (1) time shall comply with the following minimum requirements:

          1. (i) Emergency lighting and power shall be provided in accordance with NFPA 99, NFPA 101, and NFPA 110;
          2. (ii) Any fire alarm system shall be:
28. (a) (a) As required by NFPA 101; and

29. (b) (b) Installed per NFPA 72;

    1. (iii) The installation, testing, and certification of nonflammable medical gas and air systems shall comply with the requirements of NFPA 99;

       1. (iv) Clinical vacuum system installed shall be in accordance with NFPA 99;

          1. (v) All electrical material and equipment shall be installed, tested, and certificated in accordance with NFPA 70 and NFPA 99;
          2. (vi) The mechanical system shall comply with 20 CAR § 43-169, physical facilities — mechanical requirements, with the following exceptions:
30. (a) (a) Redundant space heating and water heating capability are not required unless required by the written functional program;

31. (b) (b) Ducted return air systems are not required unless required by the written narrative; and

    1. (c) (c) Standby fuel for space and water heating is not required;

       1. (vii)

32. (a) (a) A nurses’ emergency call system shall be provided for all patient use at each patient:

    1. (1) (1) Toilet;
    2. (2) (2) Bath;
    3. (3) (3) Sitz bath; and
    4. (4) (4) Shower room.

33. (b) (b) This system shall be accessible to a patient lying on the floor.

    1. (c) (c) Inclusion of a pull cord shall satisfy this standard; and

       1. (viii) Fire extinguisher or extinguishers shall be provided and be easily accessible per NFPA requirements.

Codification Notes: “NFPA” means National Fire Protection Association.