SubPart 715-1 - Standards for Freestanding Ambulatory Care Facility Construction Projects Approved or Completed Prior to January 1, 2011

Effective Date: 
Wednesday, December 29, 2010
Doc Status: 
Complete
Statutory Authority: 
Public Health Law, Section 2803

Section 715-1.1 - Applicability

715-1.1 Applicability.

(a) This Subpart sets forth minimum construction and physical environment standards applicable to:

(1) diagnostic center and treatment center facilities built and to portions of such facilities renovated or altered prior to January 1, 2011;

(2) general hospital offsite outpatient facilities built and to portions of such facilities renovated or altered prior to January 1, 2011; and,

(3) general hospital offsite outpatient facility construction projects and diagnostic center and treatment center facility construction projects approved by the commissioner or department prior to January 1, 2011.

(b) Whenever used in this Subpart, the terms below shall have the following meanings:

(1) Ambulatory care facilities shall refer collectively to general hospital offsite outpatient facilities and diagnostic center and treatment center facilities.

(2) Ambulatory surgery facilities shall refer collectively to freestanding ambulatory surgery center facilities and general hospital offsite ambulatory surgery center facilities.

(3) Ambulatory medical facilities shall refer collectively to general hospital offsite outpatient facilities other than offsite ambulatory surgery center facilities and diagnostic center and treatment center facilities other than ambulatory surgery center facilities.

(c) Notwithstanding any provision in this section to the contrary, this Subpart shall not apply to freestanding adult day health care program facilities.

Effective Date: 
Wednesday, December 29, 2010
Doc Status: 
Complete

Section 715-1.2 - Pertinent standards

715-1.2 Pertinent standards. Ambulatory care facilities shall comply with all pertinent requirements, technical standards and codes set forth or incorporated by reference into Part 711 of this Title.

Effective Date: 
Wednesday, December 29, 2010
Doc Status: 
Complete

Section 715-1.3 - Ambulatory care facility construction projects approved or completed prior to October 14, 1998

715-1.3 Ambulatory care facility construction projects approved or completed prior to October 14, 1998.

This section applies to ambulatory care facility construction projects approved by the commissioner or department prior to October 14,1998 and to ambulatory care facility construction projects not requiring such approval that were completed prior to October 14, 1998.

(a) Ambulatory care facilities shall comply with Chapter 39, "Existing Business Occupancies", of NFPA 101, Life Safety Code, 2000 edition, which is described in more detail in section 711.2(a) of this Title.

(b) Ambulatory care facilities shall include all pertinent elements described in this section. When services are shared or purchased, the commissioner may approve appropriate deletions and modifications in space and equipment requirements to avoid duplication. With respect to ambulatory care facilities that provide specialized services or a limited scope of services, the commissioner may, on the basis of an approved program, waive compliance with the requirements of this Subpart, provided that the granting of waiver would not adversely affect the life safety, efficiency or function of the facility.

(c) An ambulatory care facility's administration and public areas shall include and comply with the following:

(1) An entrance located at grade level, sheltered from the weather, and able to accommodate wheelchairs.

(2) A lobby that shall include:

(i) wheelchair storage space(s);

(ii) a reception and information counter or desk;

(iii) waiting space; however, no corridor, sub corridor or passageway shall be used as waiting space;

(iv) public toilet facilities;

(v) public telephone(s); and

(vi) drinking fountain(s).

(3) Interview space for private interviews relating to social services, credit and admissions.

(4) General or individual office for business transactions, records and administrative and professional staffs. Adequate space for storage and processing medical records shall be provided.

(5) Multi-purpose rooms for conferences, meetings and health education purposes.

(6) Special storage for employees' personal effects.

(7) General storage facilities for office supplies, sterile supplies, pharmaceutical supplies, splints and other orthopedic supplies, housekeeping supplies and equipment.

(d) An ambulatory care facility's clinical areas shall include and comply with the following:

(1) One or more general purpose examination rooms for medical, obstetrical and similar examinations, which shall include a lavatory or sink equipped for hand washing and a counter or shelf space for writing.

(2) Special purpose examination rooms. The room sizes for special clinics such as eye, dental, and ear, nose and throat examinations shall be determined by types of equipment used. A lavatory or sink equipped for hand washing and a counter or shelf space for writing shall be provided.

(3) One or more treatment rooms for outpatient surgical procedures and cast procedures which shall have a minimum floor area of approximately one hundred twenty square feet, excluding such space as vestibule, toilet, closet and work counter whether fixed or movable. A work counter, storage cabinets and lavatory or sink equipped for hand washing with foot or knee control shall be provided. The minimum room dimension shall be ten feet.

(4) One or more observation rooms for handling isolation, suspect, or disturbed patients which shall be conveniently located to nurses' station or other control station to permit close observation of patients and to minimize their hiding, escape, injury or suicide. Patients shall have access to a toilet room without entering the general corridor area. In facilities having an annual patient visit load of fifteen thousand or fewer, a separate room is not required if an examination room is modified to accommodate this function.

(5) Facilities for charting and for clinical records or nurses' station(s) with work counter, communication system, and space for supplies shall be provided. A separate space may be omitted if these functions are accommodated in each examination room and each treatment room.

(6) A medicine preparation room or unit, a self-contained medicine dispensing unit, or other approved system shall be provided. If used, a medicine preparation room or unit shall be under nursing staff's visual control and contain a work counter, refrigerator, and locked storage for biologicals and drugs. A medicine dispensing unit may be located at the nurses' station, in the clean workroom, or in an alcove or other space under direct control of nursing or pharmacy staff.

(7) A pharmacy, close to the reception area, shall be provided, if required by the operational program of the facility. A pharmacy need not be provided in facilities performing only termination of pregnancy procedures, if justified by the program, and if approved by the commissioner. The pharmacy should include space for:

(i) administrative functions, including requisitioning, recording, reporting, receiving, storage, including refrigeration, and counting;

(ii) quality control area if bulk compounding and/or packaging functions are performed;

(iii) locked storage for drugs and biologicals;

(iv) dispensing area;

(v) hand washing facilities;

(vi) drug information area; and,

(vii) sterile products area.

(8) If procedures for termination of pregnancy are performed, the facilities shall also have:

(i) procedure rooms with a minimum dimension of twelve feet by fifteen feet;

(ii) scrub-up facilities adjacent to the procedure rooms;

(iii) separate male and female locker and dressing rooms and toilet rooms;

(iv) recovery room, consisting of two recovery beds for each procedure room, and lounge with sitting space for four patients for each procedure room;

(v) stretcher parking area or alcove;

(vi) patient dressing and toilet facilities;

(vii) storage space for oxygen and inhalation.

(9) A radiology suite with equipment for diagnostic imaging and other radiology procedures shall be provided, if required by the operational program of the facility. Radiology suites located outside of New York City shall comply with applicable requirements of Part 16 of this Title. Radiology suites located in New York City shall comply with applicable requirements of Article 175 of the New York City Health Code. If therapeutic radiology is provided, the suite shall contain:

(i) radiographic room(s);

(ii) file processing facilities;

(iii) viewing and administration area(s);

(iv) file storage facilities;

(v) toilet room with hand washing facilities directly accessible from each fluoroscopy room without entering the general corridor area; and

(vi) dressing area(s) with convenient access to public toilets.

(10) Laboratory facilities shall be provided directly within the ambulatory care facility or through an effective contract arrangement with a clinical laboratory. If clinical laboratory services are provided through such a contract, then at least the following minimum laboratory facilities shall be provided in the ambulatory care facility:

(i) Laboratory work counter(s), with sink and vacuum, gas and electric services.

(ii) Lavatory(ies) or counter sink(s) equipped for hand washing.

(iii) Storage cabinet(s) or closet(s).

(iv) Specimen collection facilities. Urine collection rooms shall be equipped with a water closet and lavatory. Blood collection facilities shall have space for a chair and work counter.

(e) An ambulatory care facility's service areas shall include and comply with the following:

(1) At least one janitor's closet shall be included on each floor, which shall contain a floor receptor or service sink and storage for housekeeping supplies and equipment.

(2) A clean workroom or clean holding room with a work counter, hand washing and storage facilities. The clean holding room shall be part of a system for storage and distribution of clean and sterile supply materials and shall be similar to the clean workroom except that the work counter and hand washing facilities may be omitted.

(3) A soiled workroom or soiled holding room. The soiled workroom shall contain a clinical sink or equivalent flushing rim fixture, sink equipped for hand washing, work counter, waste receptacle and linen receptacle. A soiled holding room shall be part of a system for the collection and disposal of soiled materials and shall be similar to the soiled workroom except that the clinical sink and the work counter may be omitted.

(4) Sterilizing facilities used for the sterilization of equipment and supplies shall be provided, which may be in the clean workroom.

(5) Stretcher storage space.

(6) Employees' facilities, consisting of locker rooms, lounges, toilets or shower facilities, as required, shall be provided to accommodate the needs of all personnel and volunteers.

(f) Ambulatory care facility engineering service and equipment areas shall include and comply with the following:

(1) Equipment room(s) for boilers, mechanical equipment and electrical equipment.

(2) Storage room(s). General storage areas for bulk office and janitor's supplies, clinical supplies, educational materials.

(3) Waste processing services, consisting of:

(i) Space and facilities for the sanitary storage and disposal of waste by incineration, mechanical destruction, compaction, containerization, removal, or by a combination of these techniques.

(ii) If provided, design and construction of incinerators and trash chutes shall be in accordance with the requirements of NFPA 82, Standard on Incinerators and Waste and Linen Handling Systems and Equipment, 1999 edition, as described in more detail in section 711.2(a) of this Title.

(iii) If provided, the incinerator shall be in a separate room or placed outdoors and be designed and equipped to conform to the requirements prescribed by air pollution regulations in the area.

(g) Ambulatory care facility details and finishes shall include and comply with the following:

(1) Minimum widths of public corridors shall be four feet. In facilities where terminations of pregnancy are performed, these corridors shall be five feet.

(2) Minimum widths of doors for patient access to examination, consultation and treatment rooms shall be two feet six inches. In facilities where terminations of pregnancy are performed, these doors shall be three feet two inches.

(3) Toilet rooms, which may be used by patients, shall be equipped with doors and hardware which will permit access from the outside in any emergency. When such rooms have only one opening, or are small, the doors shall be capable of opening outward, or be otherwise designed to be opened without need to push against a patient who may have collapsed within the room.

(4) Doors on all openings between corridors and rooms or space subject to occupancy, except elevator doors, shall be swing type.

(5) Doors, except doors to spaces such as small closets, which are not subject to occupancy, shall not swing into corridors in a manner that might obstruct traffic flow or reduce the required corridor width. Large walk-in type closets are considered subject to occupancy.

(6) Doors, sidelights, borrowed lights, and windows in which the glazing extends down to within 18 inches of the floor thereby creating possibility of accidental breakage by pedestrian traffic, shall be glazed with safety glass, wire glass, or plastic glazing material that will resist breaking and will not create dangerous cutting edges when broken. Similar materials shall be used in wall openings of playrooms and exercise rooms unless required otherwise for fire safety. Safety glass or plastic glazing materials shall be used for shower doors and bath enclosures.

(7) Thresholds and expansion joint covers shall be made flush with the floor surface to facilitate use of wheelchairs and carts.

(8) The location and arrangement of hand washing facilities shall permit their proper use and operation. Particular care shall be given to the clearances required for blade-type operating handles.

(9) Paper towel dispensers and waste receptacles shall be provided at all hand washing fixtures.

(10) In facilities where procedures for termination of pregnancy are performed, the arrangement of corridor doors, elevators and other passages shall be adequate to allow a stretcher-borne patient to be moved from each procedure room and recovery room to a street level exit.

(11) All buildings having examination rooms, treatment rooms or diagnostic services located on other than the main entrance floor shall have an elevator.

(12) Mechanical facilities shall conform to Subpart 712-1 of this Part, where applicable.

(13) Electrical facilities shall conform to Subpart 712-1 of this Title, where applicable.

Effective Date: 
Wednesday, December 29, 2010
Doc Status: 
Complete

Section 715-1.4 - Ambulatory medical facility construction projects approved or completed between October 14, 1998 and December 31, 2010

715-1.4 Ambulatory medical facility construction projects approved or completed between October 14, 1998 and December 31, 2010.

This section applies to ambulatory medical facility construction projects approved by the department or commissioner between October 14, 1998 and December 31, 2010 and to ambulatory medical facility construction projects not requiring such approval that are completed between October 14, 1998 and December 31, 2010. (a) Ambulatory medical facilities other than chronic renal dialysis facilities shall comply with Chapter 39, "Existing Business Occupancies", of NFPA 101, Life Safety Code, 2000 edition. Chronic renal dialysis facilities shall comply with provisions of NFPA 101, Life Safety Code, 2000 edition, applicable to new or existing Ambulatory Health Care Centers, as appropriate. The materials referred to in this subdivision are described in more detail in section 711.2(a) of this Title.

(b) Ambulatory medical facilities, where specifically indicated, shall comply with applicable provisions of the 1996-97 Guidelines for Design and Construction of Hospital and Health Care Facilities, 1996 edition, which is described in more detail in section 711.2(b)(6) of this Title.

(c) Ambulatory medical facilities shall include all pertinent elements described in this section. The amount and types of diagnostic, clinical and administrative facilities to be provided shall be determined by the services contemplated and the estimated patient volume as described in the construction application. When services are shared or purchased, the commissioner may approve appropriate deletions and modifications in space and equipment requirements to avoid duplication. With respect to ambulatory medical facilities that provide specialized services or a limited scope of services, the commissioner may, on the basis of an approved program, waive compliance with the requirements of this Subpart, provided that the waiver does not adversely affect the health and safety or function of the facility.

(d) The design and size of each examination, treatment, or patient care room or space provided shall be determined by the equipment used therein, efficient access to the patient and the need for safe circulation of health care personnel within the space.

(e) All ambulatory medical facilities shall include:

(1) at least one private toilet for the exclusive use of patients;

(2) a separate enclosed space for the exclusive purpose of holding soiled disposable items and other medical waste;

(3) for each exam, diagnostic, treatment room or laboratory, provide a separate lavatory, equipped for hand washing, within the room or space; and

(4) privacy for patient. The planning of ambulatory medical facilities shall provide for the patient's privacy and dignity during interview, examination and treatment.

(f) Ventilation shall be provided in accordance with Section 7.31.D1 of the 1996-97 Guidelines for Design and Construction of Hospital and Health Care Facilities, 1996 edition, which is described in more detail in section 711.2(b)(6) of this Title.

(g) Freestanding renal dialysis centers shall comply with pertinent requirements in Section 7.14 of Chapter 7, "General Hospital", of the1996-97 Guidelines for Design and Construction of Hospital and Health Care Facilities, 1996 edition, which is described in more detail in section 711.2(b)(6) of this Title, and the provisions of Chapter 21, "Existing Ambulatory Health Care Occupancies" of NFPA 101, Life Safety Code, 2000 edition, which is described in more detail in section 711.2(a) of this Title. Patient areas and patient-related service areas shall also comply with the following:

(1) Individual cubicles for treatment shall be separated by non-inflammable curtains.

(2) A lavatory for hand washing, operable without the use of hands, shall be provided for each ten patients served.

(3) A sealed floor and floor drain shall be provided in each dialysis unit where hemodialysis is performed.

(h) Freestanding birthing center facilities shall include and comply with the following:

(1) Each birthing room shall have available oxygen, vacuum and medical air.

(2) An area for locked storage for drugs and refrigeration for biologicals (separate from the nourishment area refrigerator) shall be provided.

(3) A separate area for storing clean and sterile supplies shall be provided.

(4) Provisions shall be made for separate collection, storage and disposal of soiled materials. Fluid waste may be disposed of in the toilet adjacent to the birth room.

(5) Sterile supplies may be prepackaged disposables or processed off-site. If instruments and supplies are sterilized on-site, an area for accommodation of sterilizing equipment as appropriate shall be provided.

(6) As needed, the following elements shall be provided for clinical services to satisfy the functional program:

(i) birthing rooms shall be adequate in size, excluding vestibule, toilet and closets, to accommodate one patient, her family or other companion(s) and attending staff;

(ii) toilet, sink and bath/shower facilities with appropriately placed grab bars shall be adjacent to each birthing room. Bath/shower facilities shall be shared by not more than two birthing rooms;

(iii) hand washing fixtures operable without the use of hands, shall be located conveniently accessible to the birthing rooms; and

(iv) each birthing room shall be equipped with a system for communicating to other parts of the center and to an outside telephone line.

Effective Date: 
Wednesday, December 29, 2010
Doc Status: 
Complete

Section 715-1.5 - Ambulatory surgery facility construction projects approved or completed between October 14, 1998 and December 31, 2010

715-1.5 Ambulatory surgery facility construction projects approved or completed between October 14, 1998 and December 31, 2010.

This section applies to ambulatory surgery facility construction projects approved by the department or commissioner between October 14, 1998 and December 31, 2010 and to ambulatory surgery facility construction projects not requiring such approval that are completed between October 14, 1998 and December 31, 2010.

(a) Ambulatory surgery facilities shall comply with Chapter 21, "Existing Ambulatory Health Care Occupancies", of NFPA 101, Life Safety Code, 2000 edition, which is described in section 711.2(a) of this Title. Where an ambulatory surgery facility includes medical gas installations and clinical vacuum systems, and is part of a larger building that does not comply with or exceeds the fire safety requirements applicable to the installation of medical gases and clinical vacuum systems described in NFPA 101, Life Safety Code, 2000 edition, and NFPA 99, Standard for Health Care Facilities, 1999 edition, there shall be not less than one hour fire-related separation between the ambulatory surgery facility and other parts of the building. The ambulatory surgery facility shall have not less than two exits to the exterior. The documents referred to in this subdivision are described in more detail in section 711.2(a) of this Title.

(b) The extent (number and types) of the diagnostic, clinical, and administrative facilities to be provided will be determined by the services contemplated and the estimated patient load as described in the narrative program. Provisions shall be made for patient examination, interview, preparation testing, and obtaining vital signs of patient for ambulatory surgeries, in addition to the following:

(1) An area for locked storage for drugs and refrigeration for biologicals (separate from the nourishment area refrigerator) shall be provided.

(2) A separate area for storing clean and sterile supplies shall be provided.

(3) Provisions shall be made for separate collection, storage and disposal of soiled materials.

(4) Sterile supplies may be prepackaged disposables, or processed off-site. If instruments and supplies are sterilized on-site, an area for accommodation of sterilizing equipment as appropriate shall be provided.

(c) Clinical facilities shall include and comply with the following:

(1) At least one room shall be provided for examination and testing of patients prior to surgery.

(2) The operating room suite shall be arranged so as to preclude unrelated traffic, and the following shall be provided for:

(i) a control station located to permit visual surveillance of all traffic which enters the operating suite;

(ii) scrub facilities near the entrance of each operating room;

(iii) fluid waste disposable facilities;

(iv) clean workroom;

(v) central stored and piped medical gas and storage space for reserve nitrous oxide and oxygen cylinders;

(vi) at least one x-ray film illuminator for each operating room;

(vii) an emergency communication system;

(viii) a drug distribution center; and

(ix) a soiled holding room.

(3) Room(s) for post-operative recovery of surgical patients with at least one bed per operating room.

(4) All ceilings and walls shall be cleanable, readily washable and free of crevices that can retain dirt particles.

(5) Hand washing facilities for staff in patient care areas shall be trimmed with valves that are operable without the use of hands.

(6) Emergency lighting and power shall be provided for in accordance with NFPA 99: Standard for Health Care Facilities, 1999 edition, and NFPA 101, Life Safety Code, 2000 edition, and NFPA 110, Standard for Emergency and Standby Power Systems, 1999 edition, as described in section 711.2(a) of this Title.

Effective Date: 
Wednesday, December 29, 2010
Doc Status: 
Complete