(b) Thermal insulation and acoustical insulation (if applicable) shall be provided on the following fixtures and equipment within a nursing home facility and shall comply with the following:

1. (1) boilers, smoke breeching and stacks;
2. (2) steam supply and condensate return piping;
3. (3) hot water piping above 180°F and all hot water heaters, generators and converters;
4. (4) hot water piping above 125°F, which is exposed to contact by residents;
5. (5) chilled water, refrigerant, other process piping and equipment operating with fluid temperatures below ambient dew point;
6. (6) water supply and drainage piping on which condensation may occur;
7. (7) air ducts and casings with outside surface temperatures below ambient dew point; and
8. (8) other piping, ducts, and equipment as necessary to maintain the efficiency of the system;
9. (9) insulation may be omitted from hot water and steam condensate piping not subject to contact by residents when such insulation is unnecessary for preventing excessive system heat loss or excessive heat gain;
10. (10) insulation, including finishes and adhesives on the exterior surfaces of ducts, pipes and equipment, shall have a flame spread rating of 25 or less and a smoke developed rating of 150 or less as determined by an independent testing laboratory in accordance with NFPA 255, Standard Methods of Test of Surface Burning Characteristics of Building Materials, 2000 edition. Further details concerning the material referenced herein are contained in section 711.2(a) of this Title;
11. (11) linings in air ducts and equipment including coatings and adhesives, and insulation on exterior surfaces of pipes and ducts in building spaces used as air supply plenums, shall have a flame spread rating of 25 or less and a smoke developed rating of 50 or less as determined by an independent testing laboratory in accordance with NFPA 255, Standard Method of Test of Surface Burning Characteristics of Building Materials, 2000 edition. Further details concerning the material referenced herein are contained in section 711.2(a) of this Title.

(c) Steam and hot water systems shall comply with the following:

1. (1) Boilers shall have the capacity to supply the normal requirements of all systems and equipment. The number and arrangement of boilers shall be such that when one boiler breaks down or routine maintenance requires that one boiler be temporarily taken out of service, the capacity of the remaining boiler(s) shall be at least 70 percent of the total required capacity.
2. (2) Boiler feed pumps, heating circulating pumps, condensate return pumps and fuel oil pumps shall be connected and installed to provide normal and standby service.
3. (3) Supply and return mains and risers of cooling, 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 ends.

(d) Heating and ventilating systems shall comply with the following:

1. (1) A minimum design temperature of 75°F at winter design conditions shall be provided for all occupied areas.

2. (2) All air-supply and air-exhaust systems shall be mechanically operated. All fans serving exhaust systems shall be located at the discharge end of the system. The ventilation rates shown in Table 8 of this section shall be considered as minimum acceptable rates and shall not be construed as precluding the use of higher ventilation rates.

   1. (i) Outdoor air intakes shall be located as far as practical but not less than 25 feet from exhaust outlets of ventilating systems, combustion equipment stacks, medical-surgical vacuum systems, plumbing vent stacks, or from areas which may collect vehicular exhaust and other noxious fumes. The bottom of outdoor air intakes serving central systems shall be located as high as practical but not less than six feet above ground level, or if installed above the roof, three feet above roof level.

   2. (ii) The ventilation systems shall be designed and balanced to provide the pressure relationship as shown in Table 8, below.

      TABLE 8

      PRESSURE RELATIONSHIPS AND VENTILATION OF CERTAIN AREAS OF

      NURSING HOME FACILITIES

      Area Designation	Pressure relationship to adjacent areas	Minimum air changes of outdoor air per hour supplied to room	Minimum total air changes per hour supplied to room	All air exhausted directly to outdoors	Recirculated within room units
      Patient Room	E	2	2	Optional	Optional
      Patient Area Corridor	E	2	4	Optional	Optional
      Examination & Treatment Room	E	2	6	Optional	Optional
      Physical Therapy	N	2	6	Optional	Optional
      Occupational Therapy	N	2	6	Optional	Optional
      Soiled workroom or soiled holding	N	2	10	Yes	No
      Clean workroom or clean holding	P	2	4	Optional	Optional
      Toilet room	N	Optional	10	Yes	No
      Bathroom	N	Optional	10	Yes	No
      Janitor closet	N	Optional	10	Yes	No
      Sterilizer Equipment room	N	Optional	10	Yes	No
      Linen & trash chute room	N	Optional	10	Yes	No
      Food Prep Center	E	2	10	Yes	No
      Warewashing Room	N	Optional	10	Yes	No
      Dietary Day Storage	E	Optional	2	Yes	No
      General Laundry	E	2	10	Yes	No
      Soiled linen sorting & storage	N	Optional	10	Yes	No
      Clean linen storage	P	2	2	Optional	Optional
      P=Positive N=Negative E=Equal

   3. (iii) The bottoms of ventilation openings shall be not less than 3 inches above the floor of any room.
   4. (iv) Corridors shall not be used to supply air to or exhaust air from any room, except that air from corridors may be used to ventilate bathrooms, toilet rooms, janitors' closets, and small electrical or telephone closets opening directly on corridors.

   5. (v) All central ventilation or air conditioning systems shall be equipped with filters having efficiencies no less than those specified in Table 9, below. The filter bed shall be located upstream of the air conditioning equipment, unless a prefilter is employed. In this case, the prefilter shall be upstream of the equipment and the main filter may be located further downstream.

      TABLE 9

      FILTER EFFICIENCIES FOR CENTRAL VENTILATION AND AIR CONDITIONING

      SYSTEMS IN NURSING HOME FACILITIES

      Area designation	Minimum number of filter beds	Filter efficiency (percent) of main filter bed
      Resident Care, Treatment, Diagnostic and Related Areas	1	80*
      Food Preparation Areas and Laundries	1	80
      Administrative, Bulk Storage and Soiled Holding Areas	1	25
      *May be reduced to 35 percent for all outdoor air systems.

   6. (vi) All filter(s) efficiencies shall be average atmospheric dust spot efficiencies tested in accordance with ANSI/ASHRAE Standard 52.2-1999, Method of Testing Air-Cleaning Devices for Removal Efficiency by Particle Size, 1999 edition. Further details concerning this referenced material are contained in section 711.2(b) of this Title.
   7. (vii) Filter frames shall be durable and carefully dimensioned and shall provide an air-tight fit with the enclosing duct work. All joints between filter segments and the enclosing duct work shall be gasketed or sealed to provide seal against air leakage.
   8. (viii) A manometer shall be installed across each filter bed serving central air systems.
   9. (ix) Air handling duct systems shall meet the requirements of NFPA 90A, Standard for the Installation of Air Conditioning and Ventilating Systems, 1999 edition. Further details concerning the material referenced herein are contained in section 711.2(a) of this Title.

   10. (x) Fire and smoke dampers shall be constructed, located and installed in accordance with the requirements of NFPA 90A, Standard for the Installation of Air Conditioning and Ventilating Systems, 1999 edition. Access for maintenance shall be provided at all dampers. Further details concerning the material referenced herein are contained in section 711.2(a) of this Title.

       1. (a) Supply and exhaust ducts which pass through a required smoke barrier and through which smoke can be transferred to another area shall be provided with dampers at the barrier, controlled to close automatically to prevent flow of air or smoke in either direction when the fan, which moves the air through the duct, stops. Dampers shall be equipped with remote control reset devices except that manual reopening will be permitted if dampers are conveniently located.
       2. (b) Return air ducts which pass through a required smoke barrier shall be provided with a damper at the barrier actuated by smoke or products of combustion (other than heat) detectors. These dampers shall be operated by the detectors used to actuate door closing devices in the smoke partition or by detectors located to sense smoke in the return air duct from the smoke zone.
   11. (xi) Exhaust hoods in food preparation centers shall have an exhaust rate of not less than 50 cubic feet per minute per square foot of face area. Face area is defined for this purpose as the open area from the exposed perimeter of the cooking surfaces. All hoods over cooking ranges shall be equipped with grease filters, fire extinguishing systems, and heat actuated fan controls. Cleanout openings shall be provided every 20 feet in horizontal exhaust duct systems serving these hoods.

   12. (xii) Boiler room shall be provided with sufficient outdoor air to maintain combustion rates of equipment and to limit temperature in working stations to 97°F.

       (e) All plumbing and other piping systems shall comply with this subdivision.

3. (1) Plumbing fixtures shall comply with the following:

   1. (i) The material used for plumbing fixtures shall be of non-absorptive acid-resistant material.
   2. (ii) The water supply spout for lavatories and sinks required in resident care areas shall be mounted so that its discharge point is a minimum distance of five inches above the rim of the fixture. All fixtures used by medical and nursing staff, and all lavatories used by residents and food handlers 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 in length, except that handles on clinical sinks shall be not less than six inches long.
   3. (iii) Clinical sinks shall have an integral trap in which the upper portion of a visible trap seal provides a water surface.
   4. (iv) Shower bases and tubs shall provide non-slip surfaces for standing residents.

4. (2) Water supply systems shall comply with the following:

   1. (i) Systems shall be designed to supply water at sufficient pressure to operate all fixtures and equipment during maximum demand periods.
   2. (ii) Each water service main, branch main, riser and branch to a group of fixtures shall be valved. Stop valves shall be provided at each fixture.
   3. (iii) Backflow preventers (vacuum breakers) shall be installed on hose bibbs, janitors' sinks, bedpan flushing attachments, and on all other fixtures to which hoses or tubing can be attached.
   4. (iv) Flush valves installed on plumbing fixtures shall be of a quiet operating type, equipped with silencers.
   5. (v) Bedpan flushing devices shall be provided in each resident toilet room.
   6. (vi) Water distribution systems shall be arranged to provide hot water at each hot water outlet at all times. Hot water at shower, bathing and handwashing facilities shall not exceed 110°F.

5. (3) Hot water heaters and tanks shall comply with the following:

   1. (i) The hot water heating system shall have sufficient capacity to supply water at the temperatures and amounts indicated below. Water temperatures shall be taken at hot water point of use or inlet to processing equipment.

   2. (ii) Storage tank(s) shall be fabricated of corrosion-resistant metal or lined with non-corrosive material.

      Use	Gallons (per hour per bed)	Liters (per second per bed)	Temperature (oF)
      Clinical	6-½	.007	110
      Dietary	4	.004	180
      Laundry	4-½	.005	180

6. (4) Drainage systems shall comply with the following:

   1. (i) Insofar as is possible drainage piping shall not be installed within the ceiling, or installed in an exposed location in food preparation centers, food serving facilities, food storage areas, or other critical areas. Special precautions shall be taken to protect these areas from possible leakage or condensation from necessary overhead piping systems.
   2. (ii) Building sewers shall discharge into a community sewage system. Where such a system is not available, a facility providing sewage treatment must conform to applicable local and State regulations.
7. (5) If used, nonflammable medical gas systems installations shall be in accordance with the requirements of NFPA 99, Standard for Health Care Facilities, 1999 edition. Further details concerning this referenced material are contained in section 711.2(a) of this Title.
8. (6) If used, clinical vacuum (suction) system installations shall be in accordance with the requirements of Compressed Gas Association, Inc. (CGA) Pamphlet E-10, Maintenance of Medical Gas and Vacuum Systems in Health Care Facilities. Further details concerning this referenced material are contained in section 711.2(b) of this Title.