Title: 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.
VOLUME D (Title 10)