Mo. Code Regs. Ann. tit. 19, § 30-20.030
PURPOSE: This rule establishes up-to-date construction standards for new hospitals to help ensure accessible, functional, fire-safe and sanitary facilities.
PUBLISHER’S NOTE: The secretary of state has determined that the publication of the entire text of the material which is incorporated by reference as a portion of this rule would be unduly cumbersome or expensive. Therefore, the material which is so incorporated is on file with the agency who filed this rule, and with the Office of the Secretary of State. Any interested person may view this material at either agency’s headquarters or the same will be made available at the Office of the Secretary of State at a cost not to exceed actual cost of copy reproduction. The 19 CSR 30-20
entire text of the rule is printed here. This note refers only to the incorporated by reference material.
(1) New Hospital General Requirements.
also shall describe how essential services can be expanded in the future as the demand increases. Appropriate modifications or deletions in space requirements may be made when services are shared or purchased, provided the program indicates where the services are available and how they are to be provided.
(2) Planning and Construction Procedure.
(3) General Design.
(A) Site.
reasonably accessible to the community served, close to where competent medical and professional consultation is readily available and where employees can be recruited and retained.
clear to provide immediate access for the fire fighting equipment.
the lot lines to provide access to the main entrance, emergency entrance, entrances serving community activities and to service entrances, including loading and unloading docks for delivery trucks. Hospitals having an organized emergency service shall have the emergency entrance well marked to facilitate entry from the public roads or streets serving the site. Access to the emergency entrance shall not conflict with other vehicular traffic or pedestrian traffic. Paved walkways shall be provided for necessary pedestrian traffic.
be provided by the hospital as part of the program.
(B) Special Design Considerations for the Handicapped.
bed capacity or two (2) parking spaces, whichever is greater, shall be provided for handicapped visitors. Parking spaces for handicapped staff members shall be provided as required. Parking spaces for handicapped persons shall be at least twelve feet (12') wide and on level grade. Parking spaces for handicapped shall be located so there is access to sidewalks without going behind other parked cars.
or parking spaces to the building entrance shall be designed to facilitate travel by people in wheelchairs or on crutches.
entrances to a facility shall be designed to facilitate the building’s use by handicapped persons.
entrance to the building shall be arranged to be fully accessible to handicapped persons.
one (1) toilet and one (1) hand washing facility shall be available on each floor for physically handicapped patients and staff. At least one (1) wheelchair shower shall be provided in the patient area. Floors where the handicapped are specifically excluded from the entire area, such as boiler rooms, need not meet these requirements.
and toilets with hand washing facilities accessible to handicapped visitors shall be located in the hospital.
to an existing hospital, only that portion of the total hospital affected by the project, including that part of adjacent areas used for access by the handicapped, must comply with paragraphs (3)(B)1.–6. of this rule.
(4) General Design of Nursing Unit—Adult Medical, Surgical and Post-Partum Care (except special care areas such as recovery rooms, intensive care units and psychiatric units).
(1) or more doors. A single door leaf may be used if it is at least forty-four inches (44") wide. If double doors are used, both leaves shall equal at least forty-four inches (44") and one (1) leaf shall be at least thirty-two inches (32") wide. Doors shall not swing into the corridor unless recessed to avoid intrusion into the flow of traffic. The door hardware shall permit entry and egress without the use of hands. The toilet door shall swing out except when equipped with emergency rescue hardware.
(K) At least one (1) room in the hospital shall meet the following isolation requirements:
through an anteroom which contains facilities to assist staff in maintaining aseptic conditions. The anteroom shall contain a lavatory or sink equipped for handwashing, storage spaces for clean and soiled materials and gowning facilities;
viewing panel for observation from the anteroom; and
closet and a tub or shower shall be provided. A handwashing facility shall be located in the toilet or in the patient room.
(1) nursing unit, but at least one (1) service area shall be provided on each nursing floor. In addition to a nurses’ station, nurses’ office, equipment storage room, charting facilities and staff toilet facilities, service areas shall include:
(6) Special Care Units.
(6) beds.
storage and distribution of clean and sterile supplies is approved.
(7) Emergency Facilities.
(A) As a minimum, hospitals shall provide the following:
accessible to the pedestrian and a sheltered ambulance unloading area;
handwashing facilities, cabinets, medication storage space, work counter, suction and oxygen outlets, X-ray film illuminator and space for storage of emergency equipment;
treatment room; and
(B) Hospitals providing a fully equipped emergency service shall have, in addition to paragraphs (7)(A)1., 2. and 4. of this rule, the following:
nient to the emergency entrance, waiting room and treatment rooms;
ities, public telephone and drinking fountain;
stretchers out of line of traffic;
utility facilities; and
sink, work counter with handwashing facility and waste and soiled linen receptacles.
(8) Surgical Facilities.
(360) square feet exclusive of fixed and movable cabinets and shelves. The minimum dimension shall be eighteen feet (18'). Ceilings shall be at least nine feet six inches (9'6") high to accommodate surgical lights.
(9) Obstetrical Facilities.
(80) square feet per bed in two (2)-bed rooms.
(10) Normal Infant Nursery (if required by program).
contain a floor receptor or service sink and storage space for equipment and supplies.
(11) Observation Nursery (if required by program).
(13) Pediatric Facilities.
(6) cribs in each room.
(14) Dietary Facilities.
(B) To implement the type of food service selected, the following facilities shall be provided and designed:
for four (4) days’ supply;
ration to facilitate efficient food preparation and to provide for a safe and sanitary environment;
facilities;
tion carts;
ly and isolated from food preparation and serving area;
washing;
for cans, carts and mobile tray conveyors;
insects and rodents and accessible to the outside for pickup or disposal;
service accessible to food production area;
ities immediately available;
or a service sink and storage space for equipment; and
19 CSR 20-1.010.
(15) Radiology.
(B) As a minimum, the radiology suite shall contain the following:
tion requirements of X ray and gamma-ray installations shall be in accordance with 19 CSR 20-10.010–19 CSR 20-10.190;
storage facilities;
toilet shall be accessible from each fluoroscopy room without entering the general corridor;
station; and
which is out of the direct line of normal traffic.
(16) Laboratory.
(B) The following minimum services shall be available in the hospital:
vacuum, gas and electric services;
ture recorder and alarms;
closet and lavatory; and
counter, handwashing facilities and space for patient seating.
(17) Pharmacy Facilities.
(B) As a minimum, the following functional areas shall be provided:
facilities;
plies, a refrigerator, a vault for narcotics, acceptable safe space for volatile liquids and an area for parental admixtures if appropriate.
(18) Outpatient Clinic Services.
(19) Central Services.
(21) Elevators.
(B) Numbers of Elevators.
tors shall be installed where patient-care facilities are located on any floor other than the main entrance floor.
dred (200) beds located on floors other than the main entrance floor, the number of elevators shall be determined from a study of the hospital operation and the estimated vertical transportation requirements.
(C) Details.
have inside dimensions that will accommodate a patient bed and attendants and shall be at least five feet (5') wide and eight feet (8') deep. The car door shall have a clear opening of not less than four feet (4').
automatic leveling device of the two (2)-way automatic maintaining type with an accuracy of plus or minus one-half inch ("1/2").
shall be equipped with a two (2)-way special service switch to permit cars to bypass all landing button calls and be dispatched directly to any floor.
telephones shall be accessible to wheelchair occupants.
door safety stops shall be of a type that will not be activated by heat or smoke.
to maintain the integrity of the enclosure.
(22) Linen and Refuse Chutes (if provided).
(23) Dumbwaiters, Conveyors and Material Handling Systems (if provided).
(24) Fire Prevention and Protection for New and Existing Facilities. 19 CSR 30-20
(B) General Operating Requirements.
exit discharge shall be maintained free of any obstructions or impediments at all times.
fire detection and alarm systems, smoke containment and evacuation systems, exit lighting, fire and smoke doors and other equipment required by this rule shall be tested at intervals not to exceed six (6) months and shall be continuously maintained in proper operating condition.
shall be applied to paneling and other materials at intervals as necessary to maintain the required flame-retardant properties.
curtains shall be inherently flame retardant or treated and maintained to retard flame.
plan shall be available to all personnel. The plan shall provide for the protection of all persons in the event of fire and for their evacuation to areas of refuge in or outside the building when necessary. All employees shall be periodically instructed and kept informed respecting their duties under the plan.
terly for each shift and shall include the simulated use of fire alarm signals and simulation of emergency fire conditions. The movement of patients is not required.
room, ward or compartment where flammable liquids, combustible gases or oxygen are used or stored and in any other hazardous location. The areas shall be posted with NO SMOKING signs.
throughout the hospital other than in specific designated areas where smoking may be permitted.
ed unless they have been treated to retard flame.
tainers shall be of noncombustible material.
shall be provided and located to provide the capability to fight fires in ordinary combustible material such as wood, cloth, paper and rubber. Class B and Class C portable fire extinguishers shall be provided and located to SENIOR SERVICES
provide the capability to fight fires from flammable liquids, gases or grease and in energized electrical equipment. Portable fire extinguishers rated ABC may be used in lieu of Class A, Class B and Class C fire extinguishers. Special situations such as computer rooms may require specific types of fire extinguishers.
after use or as indicated by inspection.
(C) Life Safety Requirements.
facilities and alterations to existing facilities built in accordance with Chapters 5, 6, 7 and 12 of the Life Safety Code 1981, Standards for the Installation of Air Conditioning and Ventilating Systems 1978 and Standard for the Installation of Sprinkler Systems 1980, all published by the National Fire Protection Association, shall be considered to be in full compliance with this rule if they also comply with subparagraph (24)(C)2.A. of this rule.
additions to existing hospitals and alterations to existing facilities shall comply with the following:
tem shall be installed in accordance with the Standard for the Installation of Sprinkler Systems 1980 published by the National Fire Protection Association. Operating rooms, X- ray rooms, delivery rooms, telephone equipment rooms, electrical switchgear and distribution rooms and special care areas may be exempted from sprinkler coverage, provided they are separated from other areas by one (1)-hour fire-resistive construction and provided with smoke detectors;
(1) story in height shall be constructed according to one (1) of the following types: I (443); I (332); II (111); II (222); II (000) or III (210) as described in the Standard Types Building Construction 1979 published by the National Fire Protection Association. All buildings with more than one (1) level below the level of exit discharge shall have all lower levels separated from the level of exit discharge by at least Type II (111) construction;
in height shall be of Type I (443), Type I (332) or Type II (222) construction as described in the Standard Types Building Construction 1979 published by the National Fire Protection Association;
ways, light or ventilation shafts, chutes and other vertical openings between stories shall be enclosed with construction having at least a one (1)-hour fire-resistance rating in buildings up to and including three (3) stories. In buildings of more than three (3) stories, all vertical openings shall be enclosed with construction having a two (2)-hour fire-resistance rating;
self-closing and shall be kept in a closed position. Exit doors shall bear a sign visible only in the direction of exit travel stating FIRE EXIT, KEEP DOOR CLOSED;
shall be of noncombustible materials;
pipes or conduits in floors, walls or partitions that are required to have fireor smoke-resisting capability shall be protected by filling the space between the penetrating item and the barrier with material which will maintain the rating of the barrier;
doors leading directly outside the building, interior stairs, smoke-proof towers, horizontal exits, and exit passageways;
described in paragraphs (24)(C)2.–4. of this rule shall be provided for each floor or fire section of the building. These exits shall be remote from each other;
J. Horizontal exits.
feet per patient shall be provided within the aggregated area of corridors, patient rooms, treatment rooms, lounge and other low hazard areas on each side of the horizontal exit. On floors other than patient floors, at least six (6) square feet per occupant shall be provided on each side of the horizontal exit for the total number of occupants in adjoining compartments.
shall have a two (2)-hour fire rating and doors shall have a one and one-half (1 1/2)-hour fire rating.
a horizontal exit if it serves one (1) direction only and is at least forty-four inches (44") wide.
eight feet (8') or more in width serving as a means of egress from both sides of the exit shall have the opening protection by a pair of swinging doors each arranged to swing in the opposite direction from the other, with each door leaf being at least forty-four inches (44") wide.
four inches by four inches (24" × 4") of wire glass in steel frame shall be provided in each horizontal exit door. Center mullions are prohibited;
have an exit access door leading directly to an exit-access corridor unless there is an exit door opening directly to the outside from the room at ground level. One (1) adjacent room, such as a sitting or anteroom, may intervene if all doors along the means of egress are equipped with nonlockable hardware and if the intervening room is not used to serve as an exit access for more than eight (8) patient sleeping beds. This requirement shall not apply to special care units with supervised nursing care;
required for exit access from inpatient areas in a hospital shall be at least eight feet (8') in clear and unobstructed width. Aisles, corridors and ramps in areas not intended for the housing, treatment or use of patients may be a minimum of forty-four inches (44") in clear and unobstructed width;
more than one thousand (1,000) square feet shall have at least two (2) exit access doors remote from each other;
subdivided with noncombustible partitions, provided that the arrangement allows for direct and constant visual supervision by nursing personnel. Rooms which are so subdivided shall not exceed five thousand (5,000) square feet. If the space is equipped with an electrically supervised smoke detection system, direct visual supervision is not required;
to at least two (2) approved exits. Means of egress shall not pass through any intervening rooms or spaces other than corridors or lobbies;
arranged that no corridor, aisle or passageway has a pocket or dead end exceeding thirty feet (30');
patient room door and an exit shall not exceed one hundred fifty feet (150'). Travel distance between any point in a room and an exit shall not exceed two hundred feet (200') and travel distance between any point in a hospital sleeping room or suite and an exit access door of that room or suite shall not exceed fifty feet (50');
shall discharge directly to the outside at grade or be arranged so travel is through an exit passageway discharging to the outside at grade;
side of the building may be subject to locking from the room side provided the door can be opened from the inside without the use of a key;
trash collection rooms and rooms or spaces, including repair shops used for the storage of combustible supplies and equipment in quantities deemed hazardous by the Department of Health, shall be separated from adjacent areas by construction having a one (1)-hour fire-resistance rating;
of flammable, combustible or hazardous materials which are considered a severe hazard shall be protected in accordance with the Safety Standards for Laboratories in Health- Related Institutions 1980 published by the National Fire Protection Association;
have a Class B interior finish with one (1) exception: individual rooms of not over four (4) patients in capacity may have a Class C interior finish in accordance with Section 6-5 of the Life Safety Code 1981 published by the National Fire Protection Association;
have a Class II interior floor finish as described in Section 6-5 of the Life Safety Code 1981 published by the National Fire Protection Association;
all other areas by partitions. Partitions shall be of noncombustible construction and may terminate the suspended ceiling. Corridor partitions shall form tight joints with the ceiling;
shall be constructed to resist the passage of smoke;
be constructed to resist the passage of smoke and shall be provided with latches of a type suitable for keeping the door tightly closed; AA. Smoke barriers shall be provided, regardless of building construction type, to divide into at least two (2) compartments every story used by inpatients for sleeping or treatment or any story having an occupant load of fifty (50) or more persons and to limit on any story the length and width of each smoke compartment to no more than one hundred fifty feet (150'). Horizontal exits may serve as smoke barriers; BB. Smoke barriers shall have a fireresistance rating of at least one (1) hour;
substantial doors, such as one and threefourth inches (1 3/4") thick solid-bonded core wood or construction that will resist fire for at least twenty (20) minutes. Each door leaf shall have a wireglass vision panel not exceeding one thousand two hundred ninetysix (1,296) square inches in metal frames. Corridor openings in smoke barriers shall be protected by a pair of swinging doors, each door to swing in a direction opposite from the other. The minimum door leaf width shall be forty-four inches (44"); and
self-closing or they may be held open by an automatic release device which shall be connected to a manual alarm system, an automatic smoke detection system and a complete automatic fire-extinguishing system. Activation of any of these three (3) systems shall initiate the closing action of all doors by zone or throughout the entire facility.
(25) Construction.
(26) Electrical Systems.
(A) General Requirements.
be listed as complying with standards of Underwriters’ Laboratories, Inc. or a similar recognized agency where the standards have been established.
tems shall be tested and demonstrated to show satisfactory compliance with the specified performance criteria and installation requirements. A written record of the results of performance tests made on special systems and equipment shall be furnished to the owner. Special systems shall include: high voltage cable “hi-pot” direct current test, isolated power systems leakage currents, conductive floors resistance values, equi-potential grounding systems continuity tests, fire alarm and smoke detection systems, emergency and disaster loud-speaker systems, patient emergency call system, all other alarm systems, and standby emergency generator power, lighting and automatic transfer systems.
shall supply full-load requirements continuously with the alternate source supplying power on an emergency basis to selected circuits when normal power supply is interrupted. One (1) alternate source shall be an onsite engine-driven generator facility utilizing on-site fuel.
(C) Switchgear and Switchboards.
voltage electrical services or distribution switchboards for secondary voltage electrical services shall consist of dead-front metal enclosed assemblies of automatic circuit breakers or fused switches arranged to provide service-disconnecting means and overcurrent and short-circuit protection for entrance feeders and for distribution feeder conductors.
boards, switches and other equipment of the main service and distribution systems for both normal and emergency power shall be installed in separate dry, ventilated rooms which have a one (1)-hour fire rating and are reserved exclusively for electrical equipment. Piping of utility service systems carrying water or other liquids shall not be installed in the electrical equipment room.
board assemblies shall ensure that maximum available short-circuit currents are safely interrupted.
(D) Panelboards.
receptacle and appliance-branch circuits shall be located on the same floor as the loads they serve. Each outlet shall be located no farther than one hundred feet (100') from its supplying panelboard.
(E) Standby Emergency Electric Service.
generator utilizing on-site fuel shall be provided to deliver electrical power during an interruption of normal power supply. There shall be sufficient fuel on site to ensure continuous operation for twenty-four (24) hours.
in separate dry, ventilated rooms which have a one (1)-hour fire rating and are reserved exclusively for the engine-generator system equipment. Piping of utility service systems carrying water or other liquids which are not serving the engine-generator system shall not be installed within the engine-generator room.
be installed and arranged so that full voltage and frequency is available and supplying power to emergency loads within ten (10) seconds after normal power is interrupted. SENIOR SERVICES
shall be provided to elements of the distribution system as follows:
patients and personnel shall include:
exit directional signs;
electrical equipment, major mechanical equipment, pumps, elevator machinery, telephone switchboard and standby generator;
alarms activated by manual stations, waterflow alarm devices of the sprinkler system, fire and smoke detecting systems and alarms required for blood banks and medical gas systems;
intended for communication of emergency and disaster calls during outage of normal power. Radio transceivers where installed for emergency use shall be capable of operating for at least one (1) hour upon total failure of both normal and emergency power; and
least one (1) receptacle in the vicinity of standby generators;
and protection of patients shall include:
one (1) receptacle serving the following areas and functions related to patient care: anesthetizing locations, infant nurseries with a minimum of one (1) receptacle for each station, medication preparation areas, pharmacy dispensing areas, psychiatric patient areas, treatment rooms, nurses station, angiographic room, cardiac catheterization room, emergency treatment rooms, human physiology laboratories and the headwall of each patient room; and
tacles for—operating rooms, delivery rooms and labor rooms and recovery rooms, special care units, acute hemodialysis rooms, postoperative recovery areas, nurses’ call systems, bone and tissue banks, telephone equipment room, closets and blood banks;
lowing equipment shall be arranged for automatic connection to the standby emergency service: central suction systems serving medical and surgical functions; clinical air systems serving medical and surgical functions, if installed; sump pumps and other equipment required to operate for the safety of major equipment; fire pump, if installed; and smoke ventilation and evacuation systems, if installed; and
for either delayed automatic or manual connection to the standby emergency electrical service for the following equipment:
of operating, delivery, labor and recovery rooms; special care areas; nurseries; and general patient rooms. If the comfort heating system of a facility utilizes electricity as the energy source, standby emergency electric service shall be connected to the heating equipment of rooms, corridors and other spaces in which general care patients are located;
selected to provide service to all floors. Throw-over facilities shall be provided to permit temporary operation of all elevators for the release of patients or other persons from elevator cabs which may be trapped between floors;
systems for surgical and obstetrical delivery suites, infant nurseries, isolation rooms, emergency treatment spaces and laboratory fume hoods;
facilities, if provided; and
emergency electrical system shall be permanently and distinctively identified in a uniform manner.
essential to the safety of patients and personnel and for care, treatment and protection of patients shall be kept entirely independent of all other wiring, and equipment and shall not enter the same raceways, boxes or cabinets with other wiring, except when located in transfer switches and in exit or emergency lighting fixtures or in a common junction box attached to exit or emergency lighting fixture.
(F) Nurses’ Call Systems.
1. Patient nursing units.
patient room shall be served by at least one (1) calling station and each bed shall be provided with a call button. Two (2) call buttons serving adjacent beds may be served by one (1) calling station.
button or switch shall be provided for patients’ use at each toilet, bath, sitz bath and shower room intended for patient use. The station shall be accessible to a collapsed patient lying on the floor. Inclusion of a pull cord will satisfy this requirement.
tion or other floor unit station to indicate location of call placed and shall actuate a visible signal in the corridor at the patients’ room door, in the clean workroom, the soiled workroom and the nourishment station of the nursing unit.
additional visible signals shall be installed at corridor intersections.
more calling stations, indicating lights shall be provided at each station.
vide two (2)-way communication shall be equipped with an indicating light at each calling station which lights and remains lighted as long as the voice circuit is operating.
care or coronary care where patients are under constant surveillance, the nurses’ calling system may consist of a bedside station that will actuate an audible and visual signal that can be readily observed.
3. Patient treatment specialty areas.
may be used to summon assistance shall be provided in—operating rooms; delivery and labor rooms, recovery rooms, nurseries and special care units.
within diagnostic and treatment areas shall be provided with an emergency call station which shall activate an audible and visual signal within the unit.
(G) Lighting Systems.
machinery and equipment within buildings, approaches to buildings and parking lots shall be equipped with artificial lighting.
have general lighting in addition to local lighting provided by special lighting units at the surgical and obstetrical tables. Each fixed special lighting unit at the tables, except for portable units, shall be connected to an independent circuit.
eral illumination with provisions for reduction of light level at night.
shall be in accordance with paragraphs (26)(E)1.–4. of this rule and the Standard for Essential Electrical Service for Health Care Facilities 1977 published by the National Fire Protection Association.
(H) Convenience Receptacles.
1. Patient areas.
shall have one (1) duplex grounding-type receptacle located in the headwall on each side of each bed. One (1) duplex receptacle between beds of a two (2)-patient room may satisfy requirements for one (1) side of each bed. One (1) duplex grounding-type receptacle shall be provided for television, if used; one (1) for the electric bed, if used; and one (1) for each inside wall.
one (1) duplex grounding-type receptacle for each bassinet station.
psychiatric room shall be of the safe type or shall be provided with an on-off switch control located outside the patient sleeping room at a controlled or supervised location.
2. Corridors.
of at least twenty (20) amperes for general use and for floor cleaning equipment shall be located approximately fifty feet (50') apart in all corridors.
atric and psychiatric units shall be of the safety type or shall be controlled by switches located at a nurses’ station or other secure location.
3. Anesthetizing locations.
shall have at least three (3) receptacles. Receptacles in anesthetizing areas shall comply with the Standard for Inhalation Anesthetics 1980 published by the National Fire Protection Association.
where line voltage mobile X ray is used, an additional receptacle distinctively marked for X-ray use shall be provided.
devices, receptacles and wiring shall comply with the Standards for Inhalation Anesthetics 1980 published by the National Fire Protection Association.
4. Special areas.
mobile X-ray equipment installations shall conform to Article 517 of The National Electrical Code 1981 published by the National Fire Protection Association.
least one (1) double unit shall be installed in each operating room and in the X-ray viewing room of the radiology department.
electrical circuit(s) to equipment in wet areas shall be provided with five (5) milliampere ground fault interrupters. Wet areas include hydrotherapeutic tanks, if used, hydro-massage tubs, if used, and other locations identified by hospital administration. Where ground fault interrupters are used in critical areas, provision shall be made to ensure that other essential equipment will not be affected by a single interruption.
cial grounding system to be installed in special care areas, the system shall comply with Article 517 of The National Electrical Code 1981 published by the National Fire Protection Association.
(I) Fire Detection and Alarm Systems.
manual and automatic detection and alarm systems shall be provided in accordance with Chapter 12 of Life Safety Code 1981 published by the National Fire Protection Association.
be installed in the following locations: each exit from the fire area but no farther than one hundred fifty feet (150') from any point on the floor and installations shall be located so that no more than one hundred fifty feet (150') of horizontal distance on the same floor must be traveled to reach a station; at each nurses’ station or other patient care control station and at the telephone switchboard.
be installed in all corridors throughout the building spaced no more than seventy-five feet (75') apart and no more than thirty feet (30') from the ends of corridors. The automatic smoke detection system shall be electrically interconnected with the fire alarm system and the sprinkler system.
kler systems shall be connected into the fire alarm system to function as an automatic alarm initiating device.
indication of fire and shall be located and of a character that they can be effectively heard in all areas of the building above the ambient noise level of normal occupancy conditions.
device, either manual or automatic, shall cause the following actions to automatically occur within a building: all alarms shall be activated on the fire floor, on the floor above and on the floor below; alarms shall be activated in at least one (1) continuously supervised location; an alarm shall be transmitted to the fire department or to an approved central station located outside the premises; zone annunciators shall be energized to indicate location of alarm initiation; smoke doors shall release and close on the fire floor, on the floor above and on the floor below; smoke dampers shall release and close on the fire floor to isolate the smoke zone and smoke ventilation and evacuation systems, if installed, shall be activated.
the switchboard and in at least one (1) continuously supervised location.
system, if installed, shall be designed so operation of a manual pull station will not actuate it. 19 CSR 30-20
(27) Mechanical Systems.
(A) General Requirements.
the facility, all heating, ventilating and airconditioning systems shall be tested, balanced and operated to demonstrate to the owner or his/her representative that the installation and performance of these systems conform to the requirements of the plans and specifications.
owner shall be furnished with a complete set of manufacturer’s operating, maintenance and preventive maintenance instructions and parts lists and procurement information with numbers and description for each piece of equipment and test results. The owner also shall be provided with instruction in the operational use of systems and equipment.
ditioning system shall be capable of providing the temperatures and humidifies in the following areas:
Relative
Area Humidity
Designation Temperature (%) F° C° Min. Max. Operating Rooms 68–76 20–24 50 60 Delivery Rooms 70–76 21–24 50 60 Recovery Rooms 75 24 30 60 Intensive Care Rooms 72–78 22–26 30 60 Nursery Units 75 24 30 60 Special Care Nursery Unit 75–80 24–27 30 60 Patient Care, Treatment, Diagnostic and Related Areas 72–78 22–26 30 60
of maintaining an indoor winter temperature of seventy-five degrees Fahrenheit (75°F) in all other areas occupied by inpatients. The heating system shall be capable of maintaining an indoor winter temperature of seventytwo degrees Fahrenheit (72°F) in all nonpatient areas.
ity to supply the normal utility requirements of all systems and equipment.
ers shall be such that when one (1) boiler breaks down or is shut down for routine maintenance the remaining boiler(s) shall be capable of carrying the normal building load.
oil, natural gas, liquid propane gas or electricity. All boilers shall be suitable for dual fuel firing with the standby fuel stored onsite. The amount of on-site fuel storage shall be adequate for ninety-six (96) hours of continuous firing at design load. In the case of electric boilers or total electric installations, the dual fuel requirement may be waived SENIOR SERVICES Division 30—Division of Regulation and Licensure
depending on the type of electric service and sources of supply to the building.
effluent shall comply with both state and federal environmental standards.
ing pumps, condensate return pumps and fuel oil pumps shall be furnished in duplicate to provide normal and standby service.
twenty pounds per square inch (20 psi) shall be designed to supply zero (0) oxygen boiler feedwater to the boilers.
sufficient outdoor air to maintain combustion rates of equipment and to limit temperatures in working stations to no more than ninetyseven degrees Fahrenheit (97°F).
(B) Heating, Ventilating and Air-Conditioning Systems.
tems shall be mechanically operated.
tioning systems shall be designed to maintain general pressure relationships and ventilation rates as shown in Table 1 in paragraph (27)(B)3. of this rule.
used in all areas of the hospital listed in Table 1 in paragraph (27)(B)3. of this rule; variable air-volume systems may be used in areas not listed in this table and where direct patient care is not affected. Consideration may be given to special design innovations in areas of Table 1, provided that pressure relationship as an indication of direction of air flow and total number of air changes during occupied periods in those areas listed in Table 1 are maintained. General Pressure Relationship and Ventilation
Pressure Relationship
Area to Adjacent
Designation Areas
Operating Room (for recirculating air system) Operating Room (all-outdoor-air system) Trauma Room Examination and Treatment Room Delivery Room Nursery Unit Recovery Room Intensive Care Patient Room Patient Room Corridor Isolation Room Isolation Room—Alcove or Anteroom Examination Room Medication Room Pharmacy Treatment Room X-ray Fluoroscopy X-ray, Other Diagnostic Rooms Physical Therapy and Hydrotherapy Soiled Workroom or Soiled Holding Clean Workroom or Clean Holding Autopsy Darkroom Nonrefrigerated Body Holding Room Toilet Room Bedpan Room Bathroom Janitor’s Closet Sterilizer Equipment Room Linen and Trash Chute Rooms Laboratory, General Laboratory, Media Transfer Food Preparation Centers Warewashing Dietary Day Storage Laundry, General Soiled Linen Sorting and Storage Clean Linen Storage Anesthesia Storage Central Services Soiled or Decontamination Room Clean Workroom Equipment Storage P = Positive N = Negative E = Equal V = May Vary For maximum energy conservation, use of a recirculated filtered air system is preferred. An all-outdoor-air system may be used, where required by local codes, provided that appropriate heat recovery procedures are utilized for exhaust air. Heat recovery systems should be utilized where appropriate, especially for those areas where all air is required to be exhausted to the outside. Requirements for outdoor air changes may be deleted or reduced and total air changes per hour supplied may be reduced to 25% of the figures listed when the affected room is unoccupied and unused provided that indicated pressure relationship is maintained. In addition, positive provisions such as an interconnect with room lights must be included to insure that the listed ventilation rates including outdoor air are automatically resumed upon reoccupancy of the space. This exception does not apply to certain areas such as toilets and storage which would be considered as in use even though unoccupied. Rooms normally used for diagnostic X rays and only occasionally for fluoroscopic procedures may utilize recirculated air without requirements for all air to be exhausted directly to outdoors. of Certain Hospital Areas
Air Changes Hour Supplied
P P P E P P P P E E
E P P E N V N N P N N N N N N N N N N P E N V V N P V N P V Table 1
Minimum Minimum Total Air of Air per Changes per Hour Supplied to Room to Room
Optional Optional Optional Optional Optional Optional Optional
Optional Optional
Optional Optional Optional
Optional All Air Exhausted Directly to Outdoors
25 Optional
12 Optional 6 Optional 12 Optional 12 Optional 6 Optional 6 Optional 2 Optional 2 Optional
6 Optional 4 Optional 4 Optional 6 Optional
6 Optional 6 Optional
4 Optional
6 Optional 4 Optional
2 Optional
2 Optional
4 Optional 2 Optional 19 CSR 30-20
Yes
Yes Yes
Yes
Yes
Yes Yes Yes Yes Yes Yes Yes Yes Yes
Yes Yes
Yes Yes
Yes Yes Recirculated Within Room Units
No No No
Optional No No No No Optional Optional No No Optional Optional Optional Optional No Optional Optional No Optional No No No No No No No No No Optional No No No No No No Optional No No Optional Optional SENIOR SERVICES
acceptable means of introducing the required two (2) air changes of outside air into patient rooms. If incremental, electrohydronic or fan coil units are used, a separate system of one hundred percent (100%) outside air properly tempered year-round shall be used to introduce outside air to the patient rooms. This air quantity shall equal the amount of air being exhausted from the patient room’s toilet room, but in no case shall it be less than two (2) air changes per hour. If incremental heating, ventilating and air conditioning units are used, the ventilating air passages shall be permanently closed.
less than twenty-five feet (25') from exhaust outlets of ventilating systems, combustion equipment stacks, medical-surgical clinical suction discharges and plumbing vent stacks or from areas which may collect vehicular exhaust and other noxious fumes. Plumbing and vacuum vents that terminate above the level of the top of the air intake may be located as close as ten feet (10'). The bottom of outside air intakes serving central systems shall be located no less than six feet (6') above ground level, or if installed above the roof, no less than three feet (3') above the roof level.
delivery rooms and nurseries shall be delivered at or near the ceiling of the area served. All air returned from operating rooms, delivery rooms and nurseries shall be removed near the floor level.
located remote from each other shall be provided in each operating and delivery room.
and return) openings shall not be less than six inches (6") above the floor of any room except as indicated in paragraph (27)(B)7. of this rule.
ply 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 onto corridors provided that ventilation can be accomplished by undercutting of doors.
sive care rooms may be ventilated by induction units if the induction units contain only a reheat coil and if only the primary air supplied from a central system passes through the reheat coil.
tioning systems shall be equipped with filters having efficiencies no less than those specified in Table 2 in paragraph (27)(B)16. of this rule. Where two (2) filter banks are required, filter bank number 1 shall be located upstream of the air-conditioning equipment and filter bank number 2 shall be downstream of the supply fan, recirculating spray water systems, water reservoir-type humidifiers and cooling coils. Drift eliminators shall be used downstream of cooling coils to prevent the carry-over of moisture from the cooling coils to filter bank number 2. Where terminal filters are used in operating rooms and delivery rooms, the second filter bank may be located immediately downstream of the first filter bank.
required, it shall be located upstream of the air-conditioning equipment unless an additional pre-filter is employed. In this case, the pre-filter shall be upstream of the equipment and the main filter may be located farther downstream.
carefully dimensioned and shall provide an airtight fit with the enclosing ductwork. All joints between filter segments and the enclosing ductwork shall be gasketed or sealed to provide a positive seal against air leakage.
across each filter bank serving sensitive areas or central air systems.
Air-Conditioning Systems in General Hospitals
Minimum Number of Filter
Area Designation Filter Beds Efficiencies Filter Filter Bed #1 Bed #2
(%) (%)
Operating Rooms, Delivery Rooms, Nurseries, Recovery Rooms and Intensive Care Units 2 25 90 Patient Care, Treatment, Diagnostic and Related Areas 2 25 90* Food Preparation Areas and Laundries 1 80 — Administrative, Bulk Storage and Soiled Holding Areas 1 25 — *May be reduced to 80% for systems using all-outdoorair.
intended for X-ray or other ray protection shall not impair the effectiveness of the protection.
constructed, located and installed in accordance with the Standard for the Installation of Air Conditioning and Ventilating Systems 1978 published by the National Fire Protection Association. All fire and smoke dampers shall be accessible for servicing.
which pass through a smoke partition shall be provided with dampers at the partition and controlled to close automatically to prevent flow of air or smoke when a smoke detector located in the duct or at the smoke partition is actuated. Dampers shall be equipped with remote control reset devices. On high-velocity systems, a time delay shall be provided so the fan will be stopped prior to damper closing. Engineered smoke evacuation systems will be considered for approval on a case-bycase basis.
1 in paragraph (27)(B)3. of this rule do not provide sufficient air for use by hoods and safety cabinets, additional make-up air shall be provided as necessary to maintain the required room pressure relationship.
lowing general requirements: have an average face velocity of not less than seventy-five feet (75') per minute, be connected to an exhaust system which is separate from the building exhaust system, have an exhaust fan located at the discharge end of the system and have an exhaust duct system of noncombustible corrosion-resistant material designed to meet the planned usage of the hood.
cesses infectious or radioactive materials shall have a minimum face velocity of one hundred feet (100') per minute, shall be connected to an independent exhaust system shall have filters with a ninety-nine and ninetyseven one-hundredths percent (99.97%) efficiency in the exhaust stream; and shall be designed and equipped to permit the safe removal, disposal and replacement of contaminated filters.
which radioactive strong oxidizing agents are used shall be constructed of stainless steel for a minimum distance of ten feet (10') above the hood and shall be equipped with washdown facilities.
centers shall comply with the requirements of The Standards for the Installation of Equipment for the Removal of Smoke and Grease- Laden Vapors From Commercial Cooking Equipment 1980 published by the National Fire Protection Association. All hoods and cooktop surfaces shall be equipped with automatic fire suppression systems, automatic fan controls and fuel shutoff.
storage rooms shall comply with The Standard for Inhalation Anesthetics 1980 published by the National Fire Protection Association.
(C) Piping systems shall be run in spaces that are generally accessible for maintenance and repair. Piping shall be installed with adequate provision for expansion and contraction and securely supported from the structure.
utilized where necessary to maintain water temperatures.
als shall be equipped with insulating unions or flanges.
from mains or risers in order to isolate sections of both the hot or chilled water systems. All risers shall be equipped with drain valves and vent cocks.
ment connections for ease in servicing equipment.
(E) Insulation.
dance with the Commercial and Industrial Insulation Standards Manual of the Midwest Insulating Contractors Association (MICA).
following: boilers, smoke breeching and stacks; steam supply and condensate return piping; hot water piping above one hundred degrees Fahrenheit (100°F) and all hot water heaters, generators and converters; chilled water piping, refrigerant piping and other process piping and equipment operating with fluid temperatures below the ambient dew point; water supply and drainage piping on which condensation may occur; air ducts and casings with outside surface temperature below the ambient dew point or temperature above eighty degrees Fahrenheit (80°F); and other piping, ducts and equipment necessary to maintain the efficiency of the systems.
include an exterior vapor barrier.
adhesives on the exterior surfaces of ducts, pipes and equipment, shall have a flame spread rating of twenty-five (25) or less and a smoke developed rating of fifty (50) or less in accordance with the Standard for Installation of Air Conditioning and Ventilating Systems 1978 published by the National Fire Protection Association.
insulation on exterior surfaces of pipes and ducts in building spaces used as air supply plenums shall have a flame spread rating of twenty-five (25) or less and a smoke developed rating of fifty (50) or less as determined by an independent testing laboratory in accordance with the Standard for Surface Burning Characteristics of Building Materials 1979 published by the National Fire Protection Association.
tems supplying operating rooms, delivery rooms, recovery rooms, nurseries, isolation rooms and intensive care units unless terminal filters of at least ninety percent (90%) efficiency are installed downstream of the linings.
(F) All new hospitals shall be equipped with central-piped oxygen and clinical suction systems. Consideration also shall be given to installing central-piped nitrous oxide, nitrogen, clinical air, carbon dioxide and natural gas.
accordance with the Standard For Nonflammable Medical Gas Systems 1977 published by the National Fire Protection Association.
tified in some manner by the following color code: oxygen—green, nitrous oxide—light blue, clinical air—yellow, carbon dioxide— gray, nitrogen—black, and clinical suction— yellow.
shall be installed as outlined in Table 3. Table 3 Station Outlets for Oxygen and Vacuum (Suction) Systems Location Oxygen Suction Patient Room for Adult Medical, Surgical and Postpartum Care and for Pediatrics Examination and Treatment Room for Nursing Unit Patient Room for Intensive Care Nursery and Pediatric Nursery General Operating Room Cystoscopy and Special Procedure Room Recovery Room for Surgical and Obstetrical Patients Delivery Room Labor Room Treatment Room for Emergency Care Autopsy Room Anesthesia Workroom Clinical
A A
B B
C C
A A F F
D D
E E F G A A
D D — D — D 19 CSR 30-20
A—One outlet accessible to each bed. One outlet may serve two beds. B—One outlet. Portable equipment for the administration of oxygen and suction may be considered acceptable in lieu of a piped system. C—Two outlets for each bed or provide one outlet with Y fitting. D—One outlet. E—One outlet for each bed. F—Two outlets. G—Three outlets.
gas exhaust system shall be provided, except nonflammable waste anesthesia gases may be connected into the clinical suction system provided the anesthesia gases are not detrimental to the clinical suction pumps and the pumps are vented directly to the atmosphere.
(G) Plumbing Systems.
designed and installed in accordance with applicable state and local codes.
2. Plumbing fixtures.
absorptive acid-resistant material.
tory and sink located in patient care area shall be mounted so that its discharge point is a minimum distance of five inches (5") above the rim of the fixture. All fixtures used by medical and nursing staff and all lavatories used by patients and food handlers shall be trimmed with valves which can be operated without the use of hands. When blade handles are used for this purpose, they shall not exceed four and one-half inches (4 1/2") in length, except that handles on scrub sinks and clinical sinks shall be not less than six inches (6") long. All lavatories and sinks shall be equipped with stop valves.
flushing device and shall have an integral trap in which the upper portion of a visible trap seal provides a water surface.
ed with nonslip surfaces.
with kneeor foot-operated controls.
be quiet operating types.
treatment areas shall be the elongated bowl type with nonreturn stops, backflow preventers and silencers. Seats shall be the split type.
provided in each patient toilet room except those in psychiatric units, alcohol abuse units and other ambulatory care facilities.
3. Water supply systems. SENIOR SERVICES
designed to supply water at sufficient pressure to operate all fixtures and equipment during maximum demand periods.
main, riser and branch to a group of fixtures shall be valved. Stop valves shall be provided at each fixture.
breakers shall be installed on hose bibbs, laboratory sinks, janitors’ sinks, bedpan-flushing attachments, autopsy tables and on all other fixtures to which hoses or tubing can be attached.
designed to provide hot water at each hot water outlet at all times. Hot water at showers and bathing facilities shall not exceed one hundred ten degrees Fahrenheit (110°F). Hot water at handwashing facilities shall not exceed one hundred twenty degrees Fahrenheit (120°F).
4. Hot water-heaters and tanks. Hot water heating equipment shall have sufficient capacity to supply water at the temperatures and amounts indicated in Table 4. Water temperatures are to be taken at hot water point of use of inlet to processing equipment.
Table 4
Hot Water Use
Clinical Dietary Laundry
Gallons (per hour per bed) 6 1/2 4 4 1/2 Liters (per second per bed) .007 .004 .005 Temperatures (°F) 110 120* 160** Temperature (°C) 43 49* 71**
*The rinse water temperature of automatic warewashing equipment shall be one hundred eighty degrees Fahrenheit (180°F). **Sufficient hot water is to be delivered to the laundry to maintain this temperature in the washing machine during the entire wash and rinse period.
use of water softeners to soften domestic hot water and boiler water make-up whenever the water supply exceeds five (5) grain hardness.
6. Drainage systems.
acid wastes may be poured shall be fabricated from an acid-resistant material.
blood cell counters shall be of carefully selected material to prevent undesirable chemical reactions between blood count wastes and plumbing system materials such as copper, lead, brass and solder.
installed in an exposed location in operating and delivery rooms, recovery rooms, nurseries, food preparation centers, food service facilities, food storage areas and other critical areas; special precautions shall be taken to protect any of these areas from possible leakage or condensation from necessary overhead drainage piping systems. These special precautions include requiring noncorrosive semi-circular drip troughs with a minimum four inch (4")-outside diameter to be installed under the drainage pipe in the direction of slope to a point where the pipe leaves the protected space and terminates at that point— usually at a wall. The trough shall be supported with noncorrosive strap hangers and screws from the pipe above. Trough joints and hanging screw penetrations shall be sealed to maintain watertight integrity throughout.
in general operating and delivery rooms. Flushing rim-type floor drains may be installed in cystoscopic operating rooms.
into a community sewerage system when available. If such a system is not available, a facility providing sewage treatment shall conform to 10 CSR 20-6.010.
(28) Service Facilities.
AUTHORITY: sections 192.005.2 and 197.080, RSMo 1986.* This rule was previously filed as 13 CSR 50-20.031 and 19 CSR 10-20.031. Original rule filed June 2, 1982, effective Nov. 11, 1982. Amended: Filed June 14, 1988, effective Oct. 13, 1988.
*Original authority: 192.005.2, RSMo 1985 and 107.080, RSMo 1953.