Section 22-B2035. ENVIRONMENT

 

2035.1All facilities shall comply with the following applicable codes and standards to provide a safe environment:

 

(a)Life Safety Code (National Fire Protection Association 101); and

 

(b)The Food Code, Title 25 of the District of Columbia Municipal Regulations

 

2035.2Existing and new facilities shall comply with the physical plant standards contained in § 2031 of this chapter. The hospital shall maintain all building materials and structural components so that total loads imposed do not stress materials and components more than one and one-half times the working stresses allowed in the building code for new buildings of similar structure, purpose, or location.

 

2035.3Interpretations: All dimension, sizes, and quantities; noted herein will be determined by rounding fractions to the nearest whole number.

 

2035.4Floor area is the space with ceilings at least seven feet in height and does not include areas such as enclosed storage, toilets, and bathing rooms, corridors and halls. The space beyond the first two feet of vestibules and alcoves less than five feet in width will not be included in the required floor area. In rooms with sloped ceilings, at least half of the ceiling shall be at least seven feet in height with areas less than five feet in height not included in the required floor area.

 

2035.5Dining Areas: If provided, dining areas for patients shall have an outside wall with windows for natural light and ventilation. In addition:

 

(a)Dining areas shall be furnished with tables and chairs that accommodate or conform to patient needs.

 

(b)Dining areas shall have a floor area of fifteen (15) square feet per patient in existing facilities and twenty (20) square feet per patient in new construction.

 

(c)Dining areas shall allow for group dining at the same time in either separate dining areas or a single dining area, or dining in two (2) shifts, or dining during open dining hours.

 

(d)Dining areas shall not be used for sleeping, offices or corridors.

 

2035.6Activity Areas: If provided, activity areas shall have space for patient socialization and leisure time activities. In addition:

 

(a)Activity areas shall have furnishings to accommodate group and individual activities.

 

(b)Activity areas shall have a floor area of at least fifteen (15) square feet per patient residing in bedrooms and may be combined with dining areas.

 

(c)Activity areas shall not be used for sleeping, offices, or as a corridor.

 

(d)The hospital shall make activity areas available to all patients.

 

2035.7Bathing Rooms: A hospital shall provide a bathing room consisting of a tub and/or shower adjacent to each bedroom or provide a central bathing room on each floor with patient rooms. Tubs and showers regardless of location shall be equipped with hand grips or other assistive devices as needed or desired by the bathing patient.

 

(a)In new construction a central bathing room shall open off the corridor and contain a toilet and sink or have an adjoining toilet room, and not open directly in food preparation or dining area.

 

(b)Bathing Fixtures: Existing and new facilities shall have at least one bathing fixture per twenty (20) licensed beds. New construction shall have at least one bathing fixture per twelve (12) licensed beds.

 

2035.8Toilet Rooms: The hospital shall provide toilet rooms with hand-washing sinks for patient use.

 

(a)Existing facilities shall have a toilet and sink adjoining each bedroom or shared toilet rooms may provide one fixture per four licensed beds.

 

(b)New construction and new facilities shall have a toilet and sink fixture provided adjoining each patient room.

 

2035.9Patient Rooms: The hospital shall provide patient rooms which allow for sleeping, afford privacy, provide access to furniture and belongings, and accommodate inpatient care and treatment.

 

2035.10Patient Rooms:

 

(a)Shall not be located in any garage, storage area, shed or similar detached buildings;

 

(b)Shall not be accessed through a bathroom, food preparation area, laundry or another bedroom;

 

(c)Shall be located on an outside wall with a window with a minimum glass size of 8 square feet per patient. The window shall provide an unobstructed view of at least ten (10) feet;

 

(d)Shall contain at least twenty-five (25) cubic feet of storage volume per patient in dressers, closets or wardrobes; and

 

(e)If they have multiple beds, shall allow for an accessible arrangement of furniture, which provides a minimum of three (3) feet between beds.

 

2035.11Existing or New Facility: Patient rooms in existing and new facilities shall have at least the following floor areas:

 

(a)Floor areas for single patient rooms shall be one hundred (100) square feet.

 

(b)Floor areas for multiple bed patient rooms shall be eighty (80) square feet per bed with maximum of four (4) beds.

 

2035.12New Construction: Patient rooms in new construction shall have at least the following floor areas.

 

(a)Floor areas for single patient rooms shall be one hundred and twenty (120) square feet.

 

(b)Floor areas for multiple bed patient rooms shall be one hundred (100) square feet per bed with a maximum of two (2) beds.

 

2035.13Isolation Rooms: The number and type of isolation rooms in a hospital shall be determined by the hospital and based upon an infection control risk assessment. In addition:

 

(a)Facilities shall make provisions for isolating patients with infectious diseases.

 

(b)A hospital shall have a minimum of one isolation room with an adjoining toilet room.

 

(c)In new construction, facilities shall equip isolation rooms with hand-washing and gown changing facilities at the entrance of the room.

 

2035.14Observation Areas: If the hospital provides medical observation, extended recovery or behavior intervention methods, the hospital shall provide one or more appropriately equipped rooms for patients needing close supervision. Each room shall:

 

(a)Have appropriate temperature control, ventilation and lighting;

 

(b)Be void of unsafe wall or ceiling fixtures and sharp edges;

 

(c)Have a way to observe the patient, such as an observation window or if necessary, flat wall mirrors so that all areas of the room are observable by staff from outside of the room;

 

(d)Have a way to assure that the door cannot be held closed by the patient in the room which could deny staff immediate access to the room; and

 

(e)Be equipped to minimize the potential of the patient's escape, injury, suicide or hiding of restricted substances.

 

2035.15Critical Care Rooms: If monitored complex nursing care is provided, the hospital shall provide one or more rooms for patients needing the care. Each room shall be appropriately located and equipped to promote staff observation of patients. Rooms with a single occupant shall have a minimum floor area of no less than one hundred and thirty (130) square feet. Multiple bed locations shall contain at least one hundred and ten (110) square feet per bed with a minimum of four (4) feet between beds. The room shall include provision for life support, medical gas, sleeping, and convenient bathing and toileting facilities.

 

2035.16Bassinets: Each bassinet shall have a minimum floor area of forty (40) square feet with at least three (3) feet between bassinets.

 

2035.17Cubicles: Patient care and treatment cubicles shall have a minimum floor area of sixty (60) square feet with at least three (3) feet between bedsides and adjacent side walls.

 

2035.18Examination Rooms: Each examination room shall have a minimum floor area of eighty (80) square feet and a minimum of three (3) feet clear dimension around three (3) sides of the examination table or chair.

 

2035.19Treatment Rooms: Treatment room for procedures performed under topical, local, or regional anesthesia without pre-operative sedation shall have a minimum floor area of one hundred and twenty (120) square feet and a minimum of ten (10) feet clear dimension.

 

2035.20Procedure Rooms: Procedure rooms for invasive and minor surgical procedures performed in conjunction with oral, parenteral, or intravenous sedation or under analgesic or dissociative drugs shall have a minimum floor area of two hundred (200) square feet and a minimum of fourteen (14) feet clear dimension.

 

2035.21Operating Rooms: Operating rooms for major surgical procedures that require general or regional block anesthesia and support of vital bodily functions shall have a minimum floor area of three hundred (300) square feet and a minimum of sixteen (16) feet clear dimension.

 

2035.22Corridors: The hospital corridors shall be wide enough to allow passage and be equipped as needed by the patient with safety and assistive devices to minimize injury. All stairways and ramps shall have handrails.

 

2035.23Doors: The hospital doors shall be wide enough to allow passage and be equipped for privacy, safety, and with assistive devices to minimize patient injury.

 

2035.24All patient room, toilet, and bathing room doors shall provide privacy yet not create seclusion or prohibit staff access for routine or emergency care.

 

(a)In new construction all toilet and bathing rooms used by patients with less than fifty (50) square feet of clear floor area shall not have doors that solely swing inward.

 

(b)Doors may prevent escape and create seclusion where therapeutically required, such as emergency protective custody, detoxification and psychiatric locations.

 

2035.25Outdoor Areas: Any outdoor area for patient usage provided by the hospital shall be equipped and situated to allow for patient safety and abilities.

 

2035.26Hand-washing Sinks: The hospital shall provide a hand-washing sink equipped with towels and a soap dispenser in all examination, treatment, isolation and procedure rooms and which shall also be available for every four care and treatment cubicle locations. Two scrub sinks shall be available near the entrance of each operating room.

 

2035.27Privacy: In multiple bed patient rooms, visual privacy, and window curtains shall be provided for each patient. In new facilities and new construction the curtain layout shall totally surround each care and treatment location which will not restrict access to the entrance to the room, lavatory, toilet, or enclosed storage facilities.

 

2035.28Finishes: A hospital shall provide the following special room finishes:

 

(a)Washable room finishes should be provided in procedure rooms, existing isolation rooms, sterile processing rooms, workroom, laundry, and food-preparation areas shall have smooth, non- adsorptive, surfaces which are not physically affected by routine housekeeping cleaning solutions and methods. Acoustic lay-in ceilings, if used, shall be non-perforated.

 

(b)Scrubbable room finishes provided in operating rooms and new isolation rooms shall have smooth, non-adsorptive, non-perforated surfaces that are not physically affected by harsh germicidal cleaning solutions and methods.

 

source

Notice of Final Rulemaking published at 55 DCR 8813 (August 15, 2008).