PURPOSE: The Department of Health, Division of Health Resources has the authority to establish construction standards for psychiatric hospitals. This rule provides standards for facilities to ensure functional, sanitary and fire-safe facilities.

PUBLISHER’S NOTE: The publication of the full text of the material that the adopting agency has incorporated by reference in this rule would be unduly cumbersome or expensive. Therefore, the full text of that material will be made available to any interested person at both the Office of the Secretary of State and the office of the adopting agency, pursuant to section 536.031.4, RSMo. Such material will be provided at the cost established by state law.

1. (1) All new psychiatric hospitals and additions to and remodeling of existing licensed psychiatric hospitals shall be designed to provide all of the facilities required by these rules and fire safety standards, arranged to accommodate with maximum convenience all of the functions required by these rules and arranged to provide comfortable, attractive, sanitary, fire-safe, secure and durable facilities for the patients. Any additions or alterations to a psychiatric hospital shall comply with these rules and shall provide all required facilities proportional to the number of beds. These rules are applicable to psychiatric hospitals which began operation or which began construction or renovation of a building for the purpose of operating a psychiatric hospital on any date after January 31, 1974. These rules do not prohibit the rendering of psychiatric care in any licensed general hospital on a short-term or an emergency basis by a licensed physician. The Department of Health, within its discretion and for good reason, may grant exceptions to these rules. The exceptions shall be in writing and shall be made a part of the Department of Health records for the facility.

   1. (A) General Construction—Related Authorities.

      1. 1. Construction of all psychiatric hospi-

tals and additions to or remodeling of psychiatric hospitals shall comply with all local and state regulations and codes. Facilities and equipment shall comply with the American National Standards Institute Specification A 117.1-1961 (R 1971) entitled “American Standard Specifications for Making Buildings and Facilities Accessible to, and Usable by, the Physically Handicapped.”

1. (B) Planning and Construction Procedure.

   1. 1. Plans and specifications shall be pre-

pared for the construction of all psychiatric hospitals and additions to and remodeling of psychiatric hospitals. The plans and specifications shall be prepared by an architect or a professional engineer licensed to practice in Missouri.

1. 2. Construction shall commence only

after the plans and specifications have received the written approval of the Department of Health and the construction shall be in conformance with the approved plans and specifications. The Department of Health shall be notified within five (5) days after construction begins. If construction of the project is not started within one (1) year after the date of approval of the plans and specifications, the plans and specifications shall be resubmitted to the Department of Health for its approval and shall be amended, if necessary, to comply with the then current rules before construction work commences (see 19 CSR 30-24.030).

1. (C) Site.

   1. 1. The facility shall be located reason-

ably accessible to the center of population of the community served, close to where competent medical and professional consultation is readily available and where employees can be recruited and retained.

1. 2. The site shall be away from nuisances

detrimental to the proposed project’s program.

1. 3. Adequate vehicular and pedestrian

access shall be provided within the lot lines to the main entrance, ambulance entrance, community activities and services, including loading and unloading space for delivery trucks. Roads, walks, ramps and entrances, etc., shall comply with the American National Standards Institute Specification A 117.1- 1961 (R 1971) entitled American Standard Specifications for Making Buildings and Facilities Accessible to, and Usable by, the Physically Handicapped.

1. 4. Adequate off-street parking shall be

provided.

1. 5. Plans for proposed new psychiatric

hospitals and additions to psychiatric hospitals shall be reviewed by the local fire protection agency assigned to that area. Fire lanes shall be provided and kept clear to provide immediate access for fire-fighting equipment.

1. (D) General Design. The following facilities shall be provided: 19 CSR 30-24

   1. 1. Administrative area with business

office with information center, telephone, switchboard and cashier’s window; administrator’s office; director of nurses’ office; director of medical services office; medical records room; medical library; lobby and waiting room; public telephone booth; public toilets and personnel toilets;

1. 2. Evaluation and treatment facilities.

   1. A. Clinical laboratory if required by

the program.

1. B. Radiographic room with adjoining

dark room, toilet and office if required by the program.

1. C. Pharmacy or drug room with min-

imum facilities for compounding.

1. D. Conference room.
2. E. Offices, examination rooms and

work space for consultation and interviewing.

1. F. Office and work space for physical

therapy staff, rehabilitation gymnasium, hydrotherapy area, thermotherapy and massage area and storage for supplies and equipment, if physical therapy program is provided.

1. G. Office and work space for occupa-

tional therapy staff and therapy area (minimum thirty-five (35) square feet per bed).

1. H. Recreational therapy area at ratio

of thirty-five (35) square feet per bed.

1. I. Offices for therapist and space for

examination and treatment if speech and hearing program is provided.

1. J. Office and work space for psycho-

logical testing, evaluation and counseling if psychological program is provided.

1. K. Social service facilities including

office space for private interview and counseling.

1. L. Office and work space for counsel-

ing, evaluation, pre-vocational programs and placement if vocational rehabilitation program is provided.

1. M. Schoolroom for children if chil-

dren are included in the program.

1. N. Offices, examination rooms and

work space if outpatient program is provided;

1. 3. Nursing units for adults.

   1. A. This unit shall be located conve-

nient to the treatment area.

1. B. Wardrobe space for each patient

shall be provided in the patient’s room.

1. C. If centralized toilet facilities are

provided in lieu of private toilets the following minimum facilities must be provided for each sex: one (1) water closet for no more than six (6) beds; one (1) lavatory (with tamper-proof mirror) for no more than four (4) beds; and provide at least one (1) convenience electrical outlet for each lavatory.

1. D. The maximum travel distance from

any patient room to a toilet facility shall not exceed fifty feet (50').

1. E. The size of the nursing units shall

not exceed thirty-six (36) beds unless justified by the program.

1. F. Patients’ room area shall be at least

eighty (80) square feet per bed in multi-bed patients’ rooms and one hundred (100) square feet per bed in private patients’ rooms. The maximum room capacity shall not exceed four (4) patients.

1. G. The following service facilities

shall be provided in each nursing unit for adults: nurses’ station with medicine preparation area; nurses’ toilet; clean and soiled utility rooms; accessible conference room; and floor pantry with sink.

1. H. Bathing facilities shall be provided

at the ratio of one (1) tub for each patient floor and one (1) shower for each eight (8) beds. Tubs and showers shall be accessible from the corridor.

1. I. Clean linen storage.
2. J. All rooms assigned to patients for a

period of five (5) or more daylight hours shall be outside rooms. This requirement does not prohibit the use of security rooms for sleeping.

1. K. Each patient room shall have a

minimum window area of not less than oneeighth (1/8) of the floor area.

1. L. Equipment and supply storage

large enough to accommodate wheelchairs, etc.

1. M. Janitor’s closet.
2. N. Telephone alcove (minimum of

one (1) per floor).

1. O. At least two (2) private rooms shall

be provided for maximum security with recessed lighting, detention screens or shatter-proof windows and lockable doors that swing out or are equipped with emergency release hardware. If shatter-proof windows are used, windows are to be lockable;

1. 4. If children’s nursing unit is provided

requirements are the same as for adults except nursing unit shall not be more than twenty (20) beds. Larger units shall be justified by the program; and

1. 5. Service departments.

   1. A. A central sterilizing and supply

department with receiving and cleanup room, clean workroom including sterilizing facilities, sterile supply storage area and nonsterile supply storage area shall be provided.

1. B. Dietary facilities with food prepa-

ration area with handwashing facilities; food serving facilities for make up of patient trays; commercial type dishwashing equipment adequately isolated from food preparation area and ventilated; lavatory in dishwashing area; three (3)-compartment sink; refrigerated and freezer storage; day storage; food cart storage area; trash and waste disposal facilities; can washing facilities; staff dining facilities; patient dining facilities at ratio of twelve (12) square feet per bed; office; janitor’s closet with storage for housekeeping supplies and equipment; and lockers and toilet facilities shall be provided.

1. C. Food serving line for ambulatory

patients and personnel shall be located outside or adjacent to food preparation area.

1. D. If a disposal is desired, it shall be

located in the drainboard or a fourth sink is to be provided.

1. E. Housekeeping facilities (supply

storage) shall be provided.

1. F. Unless commercial or other laun-

dry facilities are available, each psychiatric facility shall have a laundry of sufficient capacity to process seven (7) full days’ laundry in the workweek and contain the following areas: sorting area; processing area; and clean linen and sewing room separate from laundry.

1. G. When no laundry is provided in

the hospital, a soiled linen storage room and clean linen storage and sewing room shall be provided.

1. H. Mechanical facilities with boiler

and pump room; mechanical room; engineers’ space; and maintenance shops shall be provided.

1. I. Employees’ facilities with female

locker room, toilet and shower room; male locker room, toilet and shower room shall be provided.

1. J. General storage space at ratio of

twelve (12) square feet per bed for the first fifty (50) beds, plus eight (8) square feet per bed for the next twenty-five (25) beds, plus five (5) square feet per bed for any additional beds over seventy-five (75) shall be provided. General storage space is to be concentrated in one area.

1. (E) General Design—Details.

   1. 1. Required corridors and aisles shall be

at least eight feet (8') wide. No part of the area of any required corridor or aisle shall be counted as part of the required area of any space adjacent to the corridor or aisle. A continuous system of unobstructed corridors and aisles shall extend through the enclosed portion of each story of the building, connecting all rooms and spaces with each other and with all entrances, exitways and elevators except work suites such as the administrative suite and the dietary area, which are occupied primarily by employed personnel, may have within them such corridors or aisles as are deemed advisable; but these are not subject to the widths stated previously.

1. 2. Therapeutic corridors are permitted

provided they shall not exceed one hundred fifty feet (150') in length and the minimum width between permanent partitions is at least sixteen feet (16') wide. Furniture shall be arranged and maintained to provide an unobstructed passageway six feet (6') wide for exit purposes.

1. 3. The width of stairways shall not be

less than three feet eight inches (3'8"). The width shall be measured between handrails where handrails project more than three and one-half inches (3 1/2").

1. 4. Doors through which residents will

pass, including exit doors, shall be at least forty-four inches (44") wide except doors to toilets and bathrooms, which shall be at least twenty-eight inches (28") wide.

1. 5. Exit doors shall swing in the direction

of exit travel. Doors to patient rooms may swing into the rooms they serve provided doors are equipped with rescue hardware. Doors to small toilet rooms may swing outward into the adjacent room. If they swing inward they shall be equipped with rescue hardware. No doors shall swing into required corridors or aisles unless they are recessed the full width of the door, except doors to janitor’s closets, linen closets or doors to similar small spaces which are open only temporarily may swing into the corridor.

1. 6. Ceilings in corridors, storage rooms,

patients’ toilet rooms and other minor rooms shall not be less than seven feet six inches (7' 6"). Ceilings in all other rooms shall not be less than eight feet no inches (8' 0").

1. 7. Drinking fountains shall be located in

or near the lobby and recreation area and in each nursing unit corridor. The fountain shall be accessible to residents in wheelchairs.

1. 8. The floors of toilets, baths, bedpan

rooms, floor pantries, utility rooms and janitor’s closets shall have smooth, waterproof surfaces which are wear-resistant. The floors of residents’ rooms and corridors shall be easily cleanable. The floors of kitchens and food preparation areas shall be waterproof, greaseproof, smooth, slip-resistant and durable.

1. 9. The walls of kitchens, utility rooms,

baths, showers, dishwashing rooms, janitor’s closets and spaces with sinks shall have waterproof painted, glazed or similar finishes to a point at least thirty inches (30") above the sink or counter top. The remaining wall surfaces of the rooms and rooms where food is stored shall have a smooth surface with painted or equally washable finish in light color. The base shall be waterproof and free from spaces which may harbor insects.

1. 10. The ceilings of all kitchens, dish-

washing and other rooms where food and drink are prepared shall have a smooth washable finish.

1. 11. Wall and ceiling surfaces of all

required corridors and exitways shall be of such material or so treated as not to have a flame-spread classification of more than twenty-five (25) according to the method for the “Fire Hazard Classification of Building Materials” of Underwriters’ Laboratories, Inc. Patient rooms and small office spaces shall have wall and ceiling surfaces with a flame-spread classification of not more than seventy-five (75). Floor finish shall have a flame-spread rating of not more than seventyfive (75). Carpeting, including the backing or underpad shall have a flame-spread rating of not more than seventy-five (75) when tested according to ASTME-84-72. The smoke density factor shall not exceed one hundred fifty (150).

1. 12. Adequate space, consistent with the

need, shall be provided for residents using crutches, walkers, wheelchairs and wheel stretchers, and the like. All required facilities, including toilets, lavatories, baths, showers, drinking fountains, telephones, and the like, shall be accessible to the handicapped.

1. 13. Minimum space for showers shall be

nine (9) square feet with a minimum inside dimension of two feet six inches (2' 6"). Curbs shall not exceed one inch (1") in height and shall have sloped edges.

1. 14. Mirrors shall be sized and posi-

tioned to make the mirrors convenient both for residents in wheelchairs and those in a standing position.

1. 15. Bathtubs other than therapeutic tubs

shall not be elevated.

1. 16. Paper towel dispensers and soap dis-

pensers shall be provided at all lavatories used for handwashing. Toilet paper holders shall be provided at all water closets.

1. 17. Public telephones shall be located on

shelves convenient for residents in wheelchairs.

1. (F) General Construction—Specifications and Details.

   1. 1. All psychiatric hospitals and additions

to and remodeling of existing psychiatric hospitals shall be constructed to provide safe, comfortable, secure, fire-safe, sanitary and durable facilities for the patients. Existing buildings, if converted to use as psychiatric hospitals, shall be considered to be new psychiatric hospitals and shall comply with all of the rules for new psychiatric hospitals.

1. 2. The requirements of the 1967 Edition

of the Life Safety Code by the National Fire Protection Association shall be complied with insofar as they may apply and to the extent they are not superseded by requirements specifically stated in these rules.

1. 3. The following elements of the build-

ing shall be constructed to qualify for the stated fire-resistance ratings as determined by standards established by the Underwriters’ Laboratories, Inc.:

1. A. Exterior walls and structural ele-

ments of one (1)-story buildings thirty feet (30') or more from any other building(s) or from a lot line shall be of at least one (1)- hour fire-resistive construction;

1. B. Exterior walls of one (1)-story

buildings less than thirty feet (30’) from any other building or from a lot line shall be of at least two (2)-hour fire-resistive construction;

1. C. Exterior walls and structural ele-

ments of multi-story buildings shall be of at least two (2)-hour fire-resistive construction;

1. D. Fire walls shall be of at least two

(2)-hour fire-resistive construction;

1. E. Columns, interior bearing walls

and other structural elements supporting floor construction shall be of at least two (2)- hour fire-resistive construction;

1. F. Columns, interior bearing walls

and other structural elements supporting roof construction only shall be of at least one (1)- hour fire-resistive construction in buildings not more than one (1) story in height, exclusive of the basement and of at least two (2)- hour fire-resistive construction in all other buildings; and

1. G. Other construction, including non-

bearing partitions and curtain walls, etc. shall be of at least one (1)-hour fire-resistive construction.

1. 4. The height and area of each building

or fire section thereof between fire walls shall be within the limitations established by the Basic Building Codes of the Building Officials Conference of America (BOCA Code) for buildings of the same occupancy and the next less restrictive type of construction.

1. 5. Doors between rooms and the

required corridors shall not have louvers nor transoms. Doors shall be one and threefourths inches (1 3/4") solid core wood or metal doors with equivalent or greater fire resistance.

1. 6. When linen and refuse chutes are

used, they shall be designed as follows:

1. A. Service openings to chutes shall

have approved class B, one and one-half (1 1/2)-hour fire doors;

1. B. Service openings to chutes shall be

located in a room or closet of not less than one (1)-hour fire-resistive construction and the entrance door to the room or closet shall be a class C, three-fourths (3/4)-hour fire door;

1. C. Minimum diameter of gravity type

chutes shall be two feet no inches (2'0"); 19 CSR 30-24

1. D. Chutes shall terminate in or dis-

charge directly into a refuse room or linen chute room separated from the incinerator or laundry. Such rooms shall be of not less than two (2)-hour fire-resistive construction and the entrance door shall be a class B, one and one-half (1 1/2)-hour fire door; and

1. E. Chutes shall extend at least four

feet no inches (4'0") above the roof and shall be covered by a metal skylight glazed with thin plain glass.

1. 7. Dumbwaiters, conveyors and material

handling systems shall not open into any corridor or exitway but shall open into a room enclosed by not less than one (1)-hour fireresistive construction. The entrance door to the room shall be a class C three-fourths (3/4)-hour fire door.

1. 8. Any penetrations of fire walls other

than doors, such as openings for ducts, shall be protected by approved automatic protective assemblies with a fire-resistance rating at least as high as that of the wall.

1. 9. Each floor of a psychiatric hospital

shall have at least two (2) exits remote from each other and so located that the distance of travel to the exit shall not be more than one hundred feet (100') from the door to any room nor one hundred fifty feet (150') from any point in a room. If the entire building is completely protected by a standard automatic sprinkler system, these distances may be increased by fifty feet (50').

1. 10. Every exit shall be so arranged that

no corridor has a pocket or dead-end exceeding thirty feet (30') in which occupants might be trapped. Distance shall be measured from the door of the room to the exit.

1. 11. Interior exitways shall be isolated

from the rest of the building by floors, ceilings and walls with a two (2)-hour fire-resistance rating as determined by the Underwriters’ Laboratories and shall have one and onehalf (1 1/2)-hour, B-label interior fire doors.

1. 12. Horizontal exits are permissible

where located in compliance with paragraphs (1)(F)9. and 10. A horizontal exit shall be through a fire wall to a fire-safe area on the same story of the building and shall be subject to all requirements of other exits except the door may swing in either direction. The fire-safe area on either side of the fire wall shall be sufficiently large to provide a floor area of at least thirty (30) square feet per person for all persons who would normally occupy the space on both sides of the fire wall. The fire wall shall have a fire-resistance rating of not less than two (2) hours and shall extend from floor-to-floor or roof, from exterior wall to exterior wall, shall have no doors except the required exit and shall have no other penetrations except ducts with automatic fire dampers.

1. 13. Each story of a facility or each por-

tion of a story between fire walls, which is in excess of five thousand (5000) square feet in floor area, shall be subdivided by smoke-barrier partitions located to provide floor areas between them of not more than five thousand (5000) square feet and located to provide a total floor area on either side of each such partition of at least thirty (30) square feet each for all patients on the entire floor. Smoke-barrier partitions shall be provided where necessary to separate elevator lobbies and required aisles from adjoining required corridors.

1. 14. Smoke-barrier partitions shall have a

fire-resistance rating of not less than one (1) hour. They shall be continuous from exterior wall to exterior wall and from the floor to the floor or roof deck above and shall be penetrated only to the extent allowed by paragraphs (1)(F)18. and 19.

1. 15. Doors in smoke-barrier partitions

required by paragraph (1)(F)13. shall be located only in main corridors or in rooms open to the public. They shall be one and three-fourths inches (1 3/4") thick solid core wood doors or metal doors with equivalent or greater fire resistance and if glazed shall be glazed with wired glass.

1. 16. Any penetrations of smoke-barrier

partitions other than doors, such as openings for ducts, shall be equipped with automatic smoke dampers.

1. 17. All doors to required exitways and to

the outside of grade level and all vestibule doors shall swing outward in the direction of exit travel. They shall be self-closing and shall be normally closed.

1. 18. All exit doors to required exitways

shall be one and one-half (1 1/2)-hour B-label doors. All doors in horizontal exits shall be one and one-half (1 1/2)-hour B-label doors. All doors in smoke-barrier partitions, required corridor partitions and one (1)-hour partitions around hazardous areas shall be one and three-fourths inches (1 3/4") solid core doors or metal doors with equivalent or greater fire resistance. Doors in two (2)-hour partitions at boiler rooms, furnace rooms, incinerator rooms and rooms for similar hazardous occupancy shall be one and one-half (1 1/2)-hour B-label doors.

1. 19. Doors in fire separations, horizontal

exits and smoke-stop partitions may be held open only by electric hold-open devices. The doors shall close upon actuation of the fire alarm system and shall be capable of being opened and closed manually. In addition, these doors shall close by at least one (1) of the following methods:

1. A. Actuation of an approved automat-

ic extinguishing system or a complete smoke or products of combustion detection system; and

1. B. Actuation of a local device

designed to detect smoke or other products of combustion other than heat.

1. 20. If doors in paragraph (1)(F)19. are

in main corridors, they shall be a pair of doors not less than five feet four inches (5' 4") wide.

1. 21. Any door to stairway enclosures or

in walls surrounding hazardous areas shall not be equipped with hold-open devices.

1. 22. The aggregate width of required

exitways shall be such as to provide twentytwo inch (22")-wide exit units at the rate of one (1) exit unit of stair width for each fifteen (15) persons served and one (1) exit unit of width for passageways within the exitways, other than stairs, for each thirty (30) persons served.

1. (G) General Construction—Structural Requirements.

   1. 1. All new psychiatric hospitals and

additions to and remodeling of existing psychiatric hospitals shall be of sufficient structural strength to resist all stresses imposed by dead loads, live loads and lateral or uplift forces, such as wind, without exceeding, in any of the structural materials, the allowable working stresses established for these materials by generally accepted good engineering practice.

1. 2. Compliance with the BOCA Code,

insofar as it may apply, shall be deemed to be in compliance with this regulation.

1. (H) Mechanical Requirements.

   1. 1. Prior to completion of the contract

and final acceptance of the facility, the architect or engineer shall obtain from the contractor certification that all mechanical systems have been tested and performance of these systems has been tested and performance of these systems conform to the requirements of the plans and specifications.

1. 2. Upon completion of the contract, the

contractor shall furnish the owner with a complete set of specifications and as-built drawings and a bound volume containing operating instructions, manufacturers’ catalog numbers and description and part list for each piece of equipment.

1. 3. Incinerators, if provided, shall be gas,

electric or oil-fired. Design and construction of incinerators and refuse chutes shall be in accordance with Part III of the NFPA Standard No. 82. Incinerators shall conform to current rules of the Air Quality Program. If facilities such as an operating room or a laboratory are provided, an incinerator capable of complete destruction of pathological wastes is required.

1. 4. Boilers shall have the capacity, based

upon the published Steel Boiler Institute Net Ratings or Institute of Boiler and Radiator Manufacturers’ Net Ratings to supply the normal requirements of all systems and equipment. The number and arrangement of boilers shall be such that when one (1) boiler breaks down or when routine maintenance requires that one (1) boiler temporarily be taken out-of-service, the capacity of the remaining boiler(s) shall be no less than seventy percent (70%) of the total required capacity except standby boiler (heating) capacity is not required for separate building units of the hospital, in which only ambulatory patients are housed.

1. 5. Boiler feed pumps, condensate return

pumps, fuel-oil pumps and circulating pumps shall be connected and installed to provide standby service when any pump breaks down.

1. 6. Supply and return mains and risers of

space heating and process steam systems shall be valved to isolate the various sections of each system. Each piece of equipment shall be valved at the supply and return end.

1. 7. Boilers, smoke breeching, steam sup-

ply piping, high pressure steam return piping and hot water-space heating supply and return piping shall be insulated with insulation having a flame-spread rating of twentyfive (25) or less and a smoke-developed rating of fifty (50) or less.

1. 8. Backflow-prevention devices shall be

provided on makeup lines to boilers and other systems in which treated water is used.

1. 9. If natural gas is the primary fuel, an

alternate fuel sufficient for twenty-four (24) hours operation is to be stored on the side or evidence of a contract with a fuel supplier to supply an alternate fuel is to be provided.

1. 10. The heating system shall be capable

of maintaining a temperature of seventy-five degrees Fahrenheit (75°F) for all occupied areas at winter-design conditions.

1. 11. All air supply and air-exhaust sys-

tems shall be mechanically operated. All fans serving exhaust systems shall be located at or near the point of discharge from the building. The ventilation rates shown on Table 1 shall be considered as minimum acceptable rates and shall not be construed as precluding the use of higher ventilation rates if they are required to meet design conditions.

1. 12. Outdoor ventilation air intakes, oth-

er than for individual room units, shall be located as far away as practicable but no less than twenty-five feet (25') from the exhaust from any ventilating system or combustion equipment. The bottom of outdoor intakes serving central air systems shall be located as high as possible but not less than eight feet (8') above the ground level or, if installed through the roof, three feet (3') above roof level.

1. 13. The ventilation systems shall be

designed and balanced to provide the general pressure relationship to adjacent areas shown in Table 1.

1. 14. Room supply air inlets, recirculation

and exhaust air registers shall be located not less than three inches (3") above the floor. This does not apply to cabinet units.

1. 15. Corridors shall not be used to sup-

ply air to or exhaust air from any room, except that air from corridors may be used to ventilate rooms such as bathrooms, toilet rooms or janitor’s closets which open directly on corridors.

1. 16. Central systems designed for recir-

culation of air shall be equipped with a minimum of two (2) filter beds. Filter bed No. 1 shall be located upstream of the conditioning equipment and shall have a minimum efficiency of thirty percent (30%). Filter bed No. 2 shall be located downstream of the conditioning equipment and shall have a minimum efficiency of ninety percent (90%). Central systems using one hundred percent (100%) outdoor air shall be provided with filters rated at eighty percent (80%) efficiency. The filter efficiencies shall be warranted by the manufacturer and shall be based on the National Bureau of Standards Dust Spot Test Method with Atmospheric Dust. Filter frames shall be durable and 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.

1. 17. A manometer shall be installed

across each filter bed serving central air systems.

1. 18. Ducts shall be constructed of iron,

steel, aluminum or other approved materials such as clay, fiberglass or asbestos cement.

1. 19. Duct interiors or linings shall meet

the Erosion Test method described in UL Pub. No. 181. Duct linings, coverings, vapor barriers and adhesives used for applying them shall have a flame-spread classification of not more than twenty-five (25) and a smokedeveloped rating not more than fifty (50).

1. 20. Ducts which pass through fire walls

shall be provided with approved automatic fire dampers on both sides of the wall except that three-eighths inch (3/8") steel plates may be used in lieu of fire dampers for openings not exceeding eighteen inches (18") in diameter. An approved fire damper shall be provided on each opening through each fire partition and on each opening through the walls of a vertical shaft. Ducts which pass through a required smoke barrier shall be provided with dampers which are actuated by products of combustion other than heat. Access for maintenance shall be provided at all dampers.

1. 21. Cold-air ducts shall be insulated

wherever necessary to maintain the efficiency of the system or to minimize condensation problems.

1. 22. The air from dining areas may be

used to ventilate the food preparation areas only after it has passed through a filter with eighty percent (80%) efficiency.

1. 23. Exhaust hoods in food preparation

centers shall have a minimum exhaust rate of one hundred (100) cubic feet per minute per square foot of hood face area. All hoods over cooking ranges shall be equipped with automatic fire-extinguishing systems and heatactuated fan controls. Extinguishing systems shall be provided with steam, dry powder or carbon dioxide. Cleanout openings shall be provided every twenty feet (20') in horizontal exhaust duct systems serving hoods.

1. 24. Boiler rooms shall be provided with

sufficient outdoor air to maintain combustion rates of equipment and reasonable temperatures in the rooms and in adjoining areas.

1. 25. The requirements of the current edi-

tion of the National Plumbing Code shall be complied with insofar as they may apply and to the extent they are not superseded by requirements specifically stated in these regulations.

1. 26. The material used for plumbing fix-

tures shall be of nonabsorptive material.

1. 27. Lavatories and sinks required in

patient care areas shall have the water supply spout mounted so that its discharge point is a minimum distance of five inches (5") above the rim of the fixture. All lavatories used by medical and nursing staff and food handlers except those in patient’s toilets shall be trimmed with valves which can be operated without the use of hands. Where blade handles are used for this purpose, they shall not exceed four and one-half inches (4 1/2") in length, except the handles on clinical sinks shall not be less than six inches (6") long.

1. 28. Clinical sinks shall have an integral

trap in which the upper portion of a visible trap seal provides a water surface.

1. 29. Water supply systems shall be

designed to supply water to the fixtures and equipment on the upper floors at a minimum pressure of fifteen (15 psi) pounds per square inch during maximum demand periods.

1. 30. Each water service main, branch

main, riser and branch to a group of fixtures should be valved. Stop valves shall be provided at each fixture. 19 CSR 30-24

1. 31. Hot, cold and chilled water piping

and waste piping on which condensation may occur shall be insulated. Insulation of cold and chilled water lines shall include an exterior vapor barrier.

1. 32. Backflow preventers (vacuum break-

ers) shall be installed on hose bibbs and on all fixtures to which hoses or tubing can be attached such as janitors’ sinks and bedpan flushing attachments.

1. 33. Flush valves installed on plumbing

fixtures shall be of a quiet-operating type, equipped with silencers. TABLE 1—GENERAL PRESSURE RELATIONSHIPS AND VENTILATION

OF CERTAIN HOSPITAL AREAS

Area Designation

Intensive care Patient room Patient area corridor Isolation room Isolation anteroom Treatment room X-ray, fluoroscopy room Physical therapy and hydrotherapy Soiled workroom Clean workroom Autopsy and darkroom Toilet room Bedpan room Bathroom Janitor’s closet Sterilizer equipment room Linen and trash chute rooms Laboratory, general Food preparation centers Dishwashing room Dietary day storage Laundry, general Soiled linen sorting and storage Clean linen storage Recreation areas Central medical and surgical supply Soiled or decontamination room Clean workroom Unsterile supply storage Occupational therapy

+=Positive –= Negative

Pressure Relationship to Adjacent Areas

+

– – – + – – – – – – – –

–

– +

– +

All Supply Air from Outdoors

— — — — — — — — — — — — — — — — — — — — — — — — —

— — — —

0=Equal Minimum Air Changes of Outdoor Air per Hour

— — — — — —

— —

—

—=Optional Minimum Total Air to Outdoors Changes Recirculated per Hour within Room All Air Exhausted Directly

— No — — — — Yes No Yes No — No Yes No — — — — — — Yes No Yes No Yes No Yes No Yes No Yes No Yes No — — Yes No Yes No — No Yes No Yes No — — — No

— No — — — — — No

1. 34. Hot water distribution systems shall

be arranged to provide hot water and at each fixture at all times.

1. 35. Plumbing fixtures which require hot

water and which are intended for patient use shall be supplied with water which is controlled to provide a maximum water temperature of one hundred ten degrees Fahrenheit (110°F) at the fixture.

1. 36. The hot water heating equipment

shall have sufficient capacity to supply the water at the temperatures and amounts indicated—

Use

Clinical Dietary Laundry

gal/hr/bed 6 1/2 4 4 1/2 Temp° F 110° 180° 180°

1. 37. Hot water storage tank(s) shall be

provided and shall be fabricated of corrosion resistant metal.

1. 38. Waste water piping over food-prepa-

ration centers, food-serving facilities, foodstorage areas and other critical areas shall be kept to a minimum and shall not be exposed. Special precautions shall be taken to protect these areas from possible leakage of, or condensation from, necessary overhead piping systems.

1. 39. Building sewers shall discharge into

a community sewage system. Where such a system is not available, the facility shall provide a private sewage disposal system approved by the Department of Health or the Clean Water Commission of the Department of Natural Resources.

1. 40. Automatic fire-extinguishing sys-

tems shall be installed in areas such as central soiled linen holding rooms, maintenance shops, trash rooms, bulk storage rooms and adjacent corridors, attics accessible for storage, range hoods and laundry and trash chutes. Storage rooms of less than a one hundred (100) square foot area and spaces used for storage of nonhazardous materials are excluded from this requirement. Sprinkler heads shall be installed at the top and at alternate floor levels of trash and laundry chutes.

1. 41. Nonflammable medical gas system

installations if provided shall be in accordance with the requirements of NFPA Standard No. 56F.

1. (I) Electrical Requirements.

   1. 1. All material including equipment,

conductors, controls and signaling devices shall be installed to provide a complete electrical system with the necessary characteristics and capacity to supply the electrical facilities shown in the specifications or indicated on the plans. All materials shall be listed as complying with applicable standards of Underwriters’ Laboratories, Inc. or other similarly established standards.

1. 2. The installing contractor shall be

responsible for testing all electrical installations and systems and shall show that the equipment is correctly installed and operated as planned or specified.

1. 3. Circuit breakers or fuses that provide

disconnecting means and overcurrent protection for conductors connected to switchboards and distribution panelboards shall be enclosed or guarded to provide a dead-front type of assembly. The main power distribution panel shall be located so as to be accessible only to authorized persons. It shall be readily accessible for maintenance, clear of traffic lanes and in a dry ventilated space devoid of corrosive fumes or gases. Overload protective devices shall be suitable for operating properly in the ambient temperature conditions.

1. 4. Lighting and appliance panelboards

shall be provided for the circuits on each floor. This requirement does not apply to emergency system circuits.

1. 5. All spaces occupied by people,

machinery and equipment within buildings and the approaches thereto and parking lots shall have electric lighting. Patients’ bedrooms shall have general lighting. A reading light shall be provided for each patient. Patients’ reading lights and other fixed lights not switched at the door shall have switch controls convenient for use at the luminaire. All switches for control of lighting in patient area shall be of the quiet-operating type.

1. 6. Each patient bedroom shall have

duplex receptacles as follows: one (1) on each side of the head of each bed (for parallel adjacent beds); receptacles for luminaires, television and motorized beds, if used; and one (1) receptacle on another wall.

1. 7. Single receptacles for equipment such

as floor cleaning machines shall be installed approximately fifty feet no inches (50' 0") apart in all corridors. Duplex receptacles for general use shall be installed approximately fifty feet (50') apart in all corridors and within twenty-five feet no inches (25' 0") of ends of corridors.

1. 8. A manually-operated, electrically-

powered fire-alarm system which will serve to alert all areas of the hospital when activated shall be installed in each facility. In multistory buildings or in multi-building facilities, the signal shall be coded or otherwise arranged to indicate the location of the station operated. Pre-signal systems will not be permitted except when telephone switchboard is attended at all times. 19 CSR 30-24

1. 9. To provide electricity during an inter-

ruption of the normal electric supply that could affect the nursing care, treatment or safety of the occupants, an emergency source of electricity shall be provided and connected to certain circuits for lighting and power. Separate building units in which only ambulatory patients, physically and mentally capable of finding their way to the outside in event of an emergency are housed, are not required to have emergency power, provided facilities for instantaneous lighting for corridors and exits are available.

1. 10. The source of this emergency elec-

tric service shall be an emergency generating set, when the normal service is supplied by one (1) or more central station transmission lines. When the normal electric supply is generated on the premises, the source may be an emergency generating set or a central station transmission line.

1. 11. The required emergency generating

set shall be located on the premises and shall be reserved exclusively for supplying the emergency electrical system. The emergency generator set shall be of sufficient kilowatt capacity to supply all lighting and power load demands of the emergency system. The power factor rating of the generator shall be not less than eighty percent (80%).

1. 12. Emergency electric service shall be

provided to at least the following light circuits:

1. A. Exitways and all necessary ways of

approach thereto including exit signs and exit direction signs, exterior of exits, exit doorways, stairways and corridors;

1. B. Dining and recreation rooms—if

located other than on grade level;

1. C. Nursing station and medication

preparation area;

1. D. Generator set location, switch—

gear location and boiler room;

1. E. Telephone switchboard; and
2. F. Kitchen, X-ray and laboratory.
3. 13. Emergency electric service shall be

provided to the following equipment:

1. A. Alarm systems including fire

alarms actuated at manual stations, water flow alarm devices of sprinkler systems if electrically operated, fire-detecting and smoke-detecting systems, paging or speaker systems if intended for issuing instructions during emergency conditions and alarms required for nonflammable medical gas systems, if installed;

1. B. Fire pump, if installed;
2. C. Sewerage or sump-lift pump, if

installed;

1. D. All required duplex receptacles in

patient corridors;

1. E. Equipment such as burners and

pumps necessary for operation of one (1) or more boilers and their necessary auxiliaries and controls required for heating and sterilization; and

1. F. Equipment necessary for maintain-

ing telephone service.

1. 14. Where electricity is the only source

of power normally used for space heating, the emergency service shall provide for heating of patient rooms. Emergency heating of patients’ rooms will not be required in areas where the design temperature is higher than plus twenty degrees Fahrenheit (+20°F) based on the median of extremes as shown in the current edition of the ASHRAE Handbook of Fundamentals, or the hospital is supplied by at least two (2) utility service feeders, each supplied by separate generating sources, or a network distribution system fed by two (2) or more generators, with the hospital feeders so routed, connected and protected that a fault any place between the generators and the hospital will not likely cause an interruption of more than one (1) of the hospital service feeders.

1. 15. The emergency electrical system

shall be so controlled that after interruption of the normal electric power supply the generator is brought to full voltage and frequency and connected within ten (10) seconds through one (1) or more primary automatic transfer switches to all emergency lighting, all alarms and equipment necessary for maintaining telephone service and receptacles in patient corridors. All other lighting and equipment required to be connected to the emergency system shall either be connected through the previously described primary automatic transfer switching or shall be subsequently connected through other automatic or manual transfer switching. Receptacles connected to the emergency system shall be distinctively marked for identification. Storage battery-powered lights, provided to augment the emergency lighting or for continuity of lighting during the interim of transfer switching immediately following an interruption of the normal service supply, shall not be used as a substitute for the requirements of a generator. Where fuel is normally stored on the site, the storage capacity shall be sufficient for twenty-four (24) hours operation of required emergency electric services. Where fuel is normally piped underground to the site from a utility distribution system, storage facilities on the site will not be required.

1. (J) Elevators.

   1. 1. All psychiatric hospitals where either

patients’ beds or facilities such as diagnostic, recreation, patient dining or therapy rooms are located on other than the first floor, shall have at least one (1) electric or electrohydraulic elevator (for purposes of these requirements, the first floor is that floor first reached from the main front entrance).

1. 2. At least two (2) hospital-type eleva-

tors shall be installed where sixty to two hundred (60–200) patient beds are located on floors other than the first or where inpatient facilities are located on a floor other than that containing the patient beds.

1. 3. At least three (3) hospital-type eleva-

tors shall be installed where two hundred one to three hundred fifty (201–350) patient beds are located on floors other than the first or where inpatient facilities are located on a floor other than that containing the patient beds.

1. 4. For hospitals with more than three

hundred fifty (350) beds, the number of elevators shall be determined from a study of the hospital plan and the estimated vertical transportation requirements.

1. 5. Elevator cars and platforms shall be

constructed of noncombustible material, except that fire-retardant treated material may be used if all exterior surfaces of the car are covered with metal. Cars of hospital-type elevators shall have inside dimensions that will accommodate a patient’s bed and attendants and shall be at least five feet no inches wide by seven feet six inches (5' 0" × 7' 6") deep with a capacity of four thousand pounds (4000 lbs). The car door shall have a clear opening of not less than three feet ten inches (3' 10").

1. 6. Elevators shall have automatic level-

ing of the two (2)-way automatic maintaining type with accuracy within plus or minus onehalf inch (±1/2").

1. 7. Elevators (except freight elevators)

shall be equipped with two (2)-way special service switches to permit cars to bypass all landing button calls and be dispatched directly to any floor.

1. 8. The contractor shall be required to

cause inspections and tests to be made and shall deliver to the owner written certification that the installation meets the requirements set forth in this section and all pertinent safety requirements.

AUTHORITY: section 197.080, RSMo Supp. 1993.* This rule was previously filed as 13 CSR 50-24.010 and also 19 CSR 10-24.010. Original rule filed Jan. 31, 1974, effective March 1, 1974.

*Original authority 1953, amended 1993.