1. A. Unless otherwise indicated, all general requirements apply to both new construction and an existing nursing home.
2. B. An existing nursing home shall provide for adequate ventilation through windows or mechanical means or a combination of both.
3. C. A new nursing home shall adhere to the requirements of this chapter.

4. D. Ventilation System Details.

   1. (1) All air-supply and air-exhaust systems shall be mechanically operated.
   2. (2) The ventilation rates shown in Table 1 under §D(10) of this regulation shall be considered the minimum acceptable rates and may not be construed as precluding the use of higher ventilation rates.
   3. (3) All fans serving exhaust systems shall be located at the discharge end of the system.

   4. (4) Outdoor air intakes shall be located:

      1. (a) As far as practical but not less than 25 feet from:

         1. (i) Exhaust outlets of ventilating systems;
         2. (ii) Combustion equipment stacks;
         3. (iii) Medical-surgical vacuum systems;
         4. (iv) Plumbing vent stacks; or
         5. (v) Areas that may collect vehicular exhaust and other noxious fumes; and

      2. (b) As high as practical, so that the bottom of the outdoor air intake is:

         1. (i) At least 6 feet above ground level; or
         2. (ii) At least 3 feet above roof level.
   5. (5) The ventilation systems shall be designed and balanced to provide the pressure relationships as shown in Table 1 under §D(10) of this regulation.
   6. (6) The bottoms of ventilation openings may not be not less than 3 inches above the floor of any room.
   7. (7) Corridors may not be used to supply air to or exhaust air from any room, except that air from corridors may be used to ventilate bathrooms, toilet rooms, janitors’ closets, and small electrical or telephone closets opening directly on corridors.

   8. (8) Filters.

      1. (a) A central ventilation or air conditioning system shall be equipped with filters having efficiencies no less than those specified in Table 2 under §D(11) of this regulation.
      2. (b) The filter bed shall be located upstream of the air conditioning equipment, unless a prefilter is employed.
      3. (c) If a prefilter is employed, the prefilter shall be upstream of the equipment and the main filter bed may be located further downstream.
      4. (d) A filter or filter efficiency shall comply with the standards of the Guidelines for Design and Construction of Residential Health, Care, and Support Facilities.
      5. (e) A filter frame shall be durable and carefully dimensioned and shall have an airtight fit with the enclosing duct work.
      6. (f) A joint between filter segments and the enclosing duct work shall be gasketed or sealed to provide a positive seal against air leakage.
      7. (g) A manometer shall be installed across each filter bed serving central air systems.

   9. (9) Air Ducts.

      1. (a) Air-handling duct systems shall meet the requirements applicable to nursing homes cited in NFPA 99 Health Care Facilities Code.
      2. (b) Fire and smoke dampers shall be constructed, located, and installed in accordance with the requirements of NFPA 101 Life Safety Code.
      3. (c) Air ducts that pass through a required smoke barrier shall be provided with a smoke damper at the barrier.
      4. (d) Smoke dampers shall activate by smoke detectors located in the ducts at the smoke barrier, or by the smoke detectors used to close smoke barrier doors.
      5. (e) Smoke dampers shall be controlled to close automatically to prevent flow of smoke-laden air in either direction.
      6. (f) Smoke dampers shall be equipped with automatic remote control reset devices, except that manual reopening will be permitted if smoke dampers are accessible.
      7. (g) All devices shall be interlocked with the fire alarm system.

   10. (10) Table 1. This table refers to the pressure relationships and ventilation of certain areas of a nursing home other than chronic disease hospitals.

       Area Designation	Pressure Relationship To Adjacent Areas	Minimum Air Changes of Outdoor Air per Hour Supplied to Room	Minimum Total Air Changes per Hour Supplied to Room	All Air Exhausted Directly to Outdoors	Recirculated Within Room Units
       (a) Resident Room	E	2	2	Optional	Optional
       (b) Resident Area Corridor	E	2	4	Optional	Optional
       (c) Examination and Treatment Room	E	2	6	Optional	Optional
       (d) Physical Therapy	N	2	6	Optional	Optional
       (e) Occupational Therapy	N	2	6	Optional	Optional
       (f) Soiled Workroom or Soiled Holding	N	2	10	Yes	No
       (g) Clean Workroom or Clean Holding	P	2	4	Optional	Optional
       (h) Toilet Room	N	Optional	10	Yes	No
       (i) Bathroom	N	Optional	10	Yes	No
       (j) Janitor Closet(s)	N	Optional	10	Yes	No
       (k) Sterilizer Equipment Room	N	Optional	10	Yes	No
       (l) Linen and Trash Chute Room	N	Optional	10	Yes	No
       (m) Food Preparation Center	E	2	10	Yes	No
       (n) Warewashing Room	N	Optional	10	Yes	No
       (o) Dietary Day Storage	E	Optional	10	Yes	No
       (p) Laundry, General	E	2	10	Yes	No
       (q) Soiled Linen Sorting and Storage	N	Optional	10	Yes	No
       (r) Clean Linen Storage	P	2	2	Optional	Optional
       Key: P = Positive, N = Negative, E = Equal

   11. (11) Table 2. This table refers to the filter efficiencies for central ventilation and air conditioning systems in a nursing home other than chronic disease hospitals.

       Area Designation	Minimum Number of Filter Beds	Filter Efficiencies (Percent) Main Filter Bed
       (a) Resident Care, Treatment, Diagnostic, and Related Areas. These areas may be reduced to 35 percent for all-outdoor air systems.	1	80
       (b) Food Preparation Areas and Laundries.	1	80
       (c) Administrative, Bulk Storage and Soiled Holding Areas.	1	25

   12. (12) Exhaust Hoods. All hoods over cooking surfaces shall comply with the requirements as provided in COMAR 10.15.03.

Authority: Health-General Article, §§19-308, 19-308.1, 19-323, and 19-1401 et seq.;
Public Safety Article, §14-110.1; Annotated Code of Maryland

Effective date: June 30, 1978 (5:13 Md. R. 1053)

This chapter is a compilation and revision of prior regulations contained in COMAR 10.07.02, Nursing Homes—Extended Care, and COMAR 10.07.05, Intermediate Care Facilities—Long-term Care (Type A). COMAR 10.07.02 was effective January 1, 1967; amended effective March 27, 1973 and April 16, 1975 (2:8 Md. R. 565). COMAR 10.07.05 was effective July 1, 1969 and amended effective March 27, 1973.

Regulation .01B amended effective January 7, 1991 (17:26 Md. R. 2975); June 22, 1992 (19:12 Md. R. 1134); January 17, 1994 (21:1 Md. R. 33); August 15, 1994 (21:16 Md. R. 1383); June 30, 1997 (24:13 Md. R. 931); June 1, 1998 (25:11 Md. R. 821)

Regulation .01B amended as an emergency provision effective January 1, 2001 (28:4 Md. R. 414); amended permanently effective May 14, 2001 (28:9 Md. R. 885)

Regulation .01B amended effective September 16, 2002 (29:18 Md. R. 1442); March 3, 2003 (30:4 Md. R. 316); September 13, 2004 (31:18 Md. R. 1350)

Regulation .01I-1, L-1, O-1, GG-1 adopted effective January 13, 1986 (13:1 Md. R. 16)

Regulation .01GG-1, KK-1 adopted effective August 3, 1981 (8:15 Md. R. 1306)

Regulation .01II-1 adopted effective January 26, 1987 (14:2 Md. R. 128)

Regulation .01-1 adopted effective June 1, 1998 (25:11 Md. R. 821)

Regulation .01-1 amended effective January 6, 2005 (31:26 Md. R. 1862)

Regulation .02 amended effective January 14, 1988 (15:1 Md. R. 20)

Regulation .02 repealed and new Regulation .02 adopted effective May 10, 1993 (20:9 Md. R. 778)

Regulation .02 amended effective August 24, 2009 (36:17 Md. R. 1312)

Regulation .02F amended effective April 8, 1996 (23:7 Md. R. 551)

Regulation .02G adopted effective September 16, 2002 (29:18 Md. R. 1442)

Regulation .03 amended effective May 10, 1993 (20:9 Md. R. 778); August 27, 2007 (34:17 Md. R. 1507); August 24, 2009 (36:17 Md. R. 1312); August 29, 2016 (43:17 Md. R. 953)

Regulation .03A amended effective May 24, 1982 (9:10 Md. R. 1021); June 22, 1992 (19:12 Md. R. 1134)

Regulation .03B amended effective August 1, 1994 (21:15 Md. R. 1304)

Regulation .03-1 adopted effective May 10, 1993 (20:9 Md. R. 778)

Regulation .04B amended effective December 7, 1992 (19:24 Md. R. 2125)

Regulation .05 amended effective August 1, 2016 (43:15 Md. R. 864)

Regulation .05B amended effective January 17, 1994 (21:1 Md. R. 33)

Regulation .05C amended effective January 25, 1980 (7:2 Md. R. 115)

Regulation .07 amended effective January 26, 1987 (14:2 Md. R. 128); May 20, 1996 (23:10 Md. R. 731); August 24, 2009 (36:17 Md. R. 1312)

Regulation .07A amended effective August 3, 1981 (8:15 Md. R. 1306)

Regulation .07G amended effective May 24, 1982 (9:10 Md. R. 1021); January 26, 1987 (14:2 Md. R. 128); March 3, 2003 (30:4 Md. R. 316)

Regulation .07-1 adopted effective January 1, 2007 (33:26 Md. R. 1996)

Regulation .08 amended effective June 22, 1992 (19:12 Md. R. 1134)

Regulation .08A, B, D amended effective January 26, 1987 (14:2 Md. R. 128)

Regulation .08A, E amended effective January 13, 1986 (13:1 Md. R. 16)

Regulation .08-1 adopted effective September 16, 2002 (29:18 Md. R. 1442)

Regulation .09A amended effective November 8, 1982 (9:22 Md. R. 2196); January 13, 1986 (13:1 Md. R. 16); January 17, 1994 (21:1 Md. R. 33)

Regulation .09B-1 adopted effective August 3, 1981 (8:15 Md. R. 1306)

Regulation .09C, D amended effective August 24, 2009 (36:17 Md. R. 1312)

Regulation .10 amended effective January 26, 1987 (14:2 Md. R. 128); June 30, 1997 (24:13 Md. R. 931)

Regulation .10E amended effective November 8, 1982 (9:22 Md. R. 2196)

Regulation .10H amended effective May 24, 1982 (9:10 Md. R. 1021)

Regulation .10 repealed and new Regulation .10 adopted effective August 6, 2001 (28:15 Md. R. 1396)

Regulation .11 amended effective January 26, 1987 (14:2 Md. R. 128)

Regulation .11O amended effective November 8, 1982 (9:22 Md. R. 2196)

Regulation .11 repealed and new Regulation .11 adopted effective August 6, 2001 (28:15 Md. R. 1396)

Regulation .11-1 adopted effective August 6, 2001 (28:15 Md. R. 1396)

Regulation .11-2 adopted effective August 6, 2001 (28:15 Md. R. 1396)

Regulations .12, .13, .18—.21 amended effective January 13, 1986 (13:1 Md. R. 16)

Regulation .12 amended effective January 26, 1987 (14:2 Md. R. 128)

Regulation .13 amended effective January 26, 1987 (14:2 Md. R. 128)

Regulation .14-1 adopted effective August 15, 1994 (21:16 Md. R. 1383)

Regulation .14-2 adopted effective August 15, 1994 (21:16 Md. R. 1383)

Regulation .15 amended effective January 26, 1987 (14:2 Md. R. 128); September 22, 2008 (35:19 Md. R. 1716)

Regulation .15B amended effective March 16, 1992 (19:5 Md. R. 577); June 5, 1995 (22:11 Md. R. 820)

Regulation .17 amended effective January 26, 1987 (14:2 Md. R. 128)

Regulation .18B amended effective January 26, 1987 (14:2 Md. R. 128)

Regulation .19A, B amended effective January 26, 1987 (14:2 Md. R. 128)

Regulation .20 amended effective January 26, 1987 (14:2 Md. R. 128)

Regulation .21 amended effective June 1, 1998 (25:11 Md. R. 821)

Regulation .21 repealed and new Regulation .21 adopted effective January 6, 2005 (31:26 Md. R. 1862)

Regulation .21E amended effective November 8, 1982 (9:22 Md. R. 2196)

Regulation .21-1 adopted effective January 17, 1994 (21:1 Md. R. 33)

Regulation .21-1 repealed and new Regulation .21-1 adopted effective January 6, 2005 (31:26 Md. R. 1862)

Regulation .21-2 adopted effective January 6, 2005 (31:26 Md. R. 1862)

Regulation .21-3 adopted effective January 6, 2005 (31:26 Md. R. 1862)

Regulation .21-4 adopted effective January 6, 2005 (31:26 Md. R. 1862)

Regulation .22B amended effective August 3, 1981 (8:15 Md. R. 1306)

Regulation .24 repealed and new Regulation .24 adopted effective April 21, 2008 (35:8 Md. R. 805)

Regulation .26F amended and .26G—H repealed effective January 17, 1983 (10:1 Md. R. 28)

Regulation .26EE amended effective October 25, 1982 (9:21 Md. R. 2106); September 16, 2002 (29:18 Md. R. 1442)

Regulation .27A, B amended effective March 3, 2003 (30:4 Md. R. 316)

Regulation .27B amended effective January 26, 1987 (14:2 Md. R. 128)

Regulation .28 amended effective January 26, 1987 (14:2 Md. R. 128); January 17, 1994 (21:1 Md. R. 33)

Regulation .28C amended effective January 14, 1988 (15:1 Md. R. 20)

Regulation .31A amended effective September 16, 2002 (29:18 Md. R. 1442)

Regulation .32F amended effective January 17, 1994 (21:1 Md. R. 33)

Regulation .32G amended effective January 26, 1987 (14:2 Md. R. 128)

Regulation .33E amended effective January 26, 1987 (14:2 Md. R. 128)

Regulations .35—.41 adopted effective January 13, 1986 (13:1 Md. R. 16)

Regulation .35 amended effective December 16, 1996 (23:25 Md. R. 1785)

Regulation .36 amended effective December 16, 1996 (23:25 Md. R. 1785); September 16, 2002 (29:18 Md. R. 1442)

Regulation .36C amended effective March 3, 2003 (30:4 Md. R. 316)

Regulation .37 amended effective December 16, 1996 (23:25 Md. R. 1785); September 16, 2002 (29:18 Md. R. 1442)

Regulation .38 amended effective December 16, 1996 (23:25 Md. R. 1785)

Regulation .39A and B amended effective October 1, 1990 (17:19 Md. R. 2320)

Regulation .39C and D repealed effective October 1, 1990 (17:19 Md. R. 2320)

Regulation .39G amended effective June 30, 1986 (13:13 Md. R. 1491)

Regulation .40A amended effective June 30, 1986 (13:13 Md. R. 1491)

Regulations .40 and .41 recodified to Regulations .43 and .44, respectively, Appendix recodified as Regulation .40 and amended, and new Regulations .41 and .42 adopted effective October 1, 1990 (17:19 Md. R. 2320)

Regulation .41 repealed and new Regulation .41 adopted effective September 13, 2004 (31:18 Md. R. 1350)

Regulation .41A amended effective August 1, 1994 (21:15 Md. R. 1304)

Regulation .41D amended effective June 30, 1986 (13:13 Md. R. 1491)

Regulation .43C adopted effective October 1, 1990 (17:19 Md. R. 2320)

Regulations .45—.51 adopted effective January 7, 1991 (17:26 Md. R. 2975)

Regulations .45—.51 repealed as an emergency provision effective January 1, 2001 (28:4 Md. R. 414); repealed permanently effective May 14, 2001 (28:9 Md. R. 885)

Regulations .45—.60 adopted as an emergency provision effective January 1, 2001 (28:4 Md. R. 414); adopted permanently effective May 14, 2001 (28:9 Md. R. 885)

Regulation .49D amended effective September 16, 2002 (29:18 Md. R. 1442)

Regulation .54D adopted effective March 3, 2003 (30:4 Md. R. 316)

Regulation .61 adopted effective August 24, 2009 (36:17 Md. R. 1312)

Chapter revised effective June 17, 2019 (46:12 Md. R. 536)