(a) A facility that is operating before the effective date of this chapter is considered to be a pre-existing facility and shall meet the physical plant and construction requirements under this chapter.
(b) A pre-existing facility shall complete all major remodeling, renovations, additions, and alterations in accordance with the requirements for new construction in §131.143 of this title (relating to Construction Requirements for a New Facility). All areas of a pre-existing facility that are not part of a major remodel, renovation, addition or alteration to the facility, are not required to meet these new construction requirements as long as the existing portion met the codes that were in effect when it was originally constructed and licensed. When existing conditions make such changes impractical, the department may grant a conditional approval of minor deviations from the requirements of §131.143 of this title, if the intent of the requirements is met and if the care, safety and welfare of patients will not be jeopardized. The operation of the facility, accessibility of individuals with disabilities, and safety of the patients shall not be jeopardized by a condition(s) which is not in compliance with this subchapter.
  (1) Any alteration, modification, replacement, or installation of new building equipment (such as mechanical, electrical, emergency power equipment, energy/utility management, conveying systems, plumbing, fire protection, or other equipment), with a primary function of building service that affects life safety, infection control, functional operation, or the health, safety, and welfare of patients and staff shall comply with the requirements for new construction and shall not be replaced, materially altered, or extended in a pre-existing licensed facility until complete plans and specifications have been submitted to the department, and the department has reviewed and approved the plans and specifications in accordance with §131.146 of this title (relating to Preparation, Submittal, Review and Approval of Plans, and Retention of Records).
  (2) Minor remodeling or alterations within an existing facility which do not involve alterations to load-bearing members and partitions, change functional operation, affect fire safety, or involve any of the major changes listed in paragraph (1) of this subsection are considered to be minor projects and require evaluation and approval by the department. A pre-existing licensed facility shall submit by mail or fax a written request and floor plan for evaluation, a brief description of the proposed changes, floor plan, and sketches of the area being remodeled. Based on such submittal, the department shall evaluate and determine whether any additional submittals or inspections are required. The department shall notify the facility of its decision. The patching, restoration, or painting of materials, elements, equipment, or fixtures for the purpose of maintaining such materials, elements, equipment, or fixtures in good or sound condition would not require submission to the department for approval.
  (3) All remodeling or alterations which involve alterations to load-bearing members or partitions, change functional operation, or affect fire safety are considered major projects. A facility shall comply with this section before beginning construction of major projects.
    (A) Plans shall be submitted in accordance with this section for all major remodeling or alterations.
    (B) Construction projects involving alterations of or additions to existing buildings shall be programmed and phased so that on-site construction shall minimize disruptions of existing functions.
      (i) Access, exit access, and fire protection shall be maintained so that the safety of the occupants shall not be jeopardized during construction.
      (ii) A noncombustible or limited combustible dust and vapor barrier shall be provided to separate areas undergoing demolition and construction from occupied areas. When a fire retardant plastic material is used for temporary daily usage, it shall be removed at the end of each day.
      (iii) The air inside the construction area shall be protected by mechanical filtration that recirculates inside the space or is exhausted directly to the exterior.
      (iv) The area shall be properly ventilated and maintained. The area under construction shall have a negative air pressure differential to the adjoining areas and shall continue to operate as long as construction dust and odors are present.
      (v) Temporary sound barriers shall be provided where intense prolonged construction noises will disturb patients or staff in the occupied portions of the building during patient treatment times.
      (vi) When construction occurs after hours or on weekends, the facility shall thoroughly clean all areas of construction and provide a clean safe environment before treating patients. The facility shall ensure that all fire safety protection and building systems are in place and working properly.
(c) Pre-existing facilities shall be easily accessible to the community and to service vehicles such as delivery trucks, ambulances, and fire protection apparatus.
  (1) The facility site shall include paved roads, walkways, and parking in accordance with local building codes and ordinances.
  (2) Pre-existing licensed facilities shall comply with the Americans with Disabilities Act (ADA) of 1990, Public Law 101 - 336, 42 United States Code, Chapter 126, and Title 36, Code of Federal Regulations, Part 1191, Appendix A, Accessibility Guidelines for Buildings and Facilities or 16 TAC, §68.20 (relating to Buildings and Facilities Subject to Compliance with the Texas Accessibility Standards), Texas Accessibility Standards (TAS), April 1, 1994 edition, issued by the Texas Department of Licensing and Regulation, under the Texas Architectural Barriers Act, Government Code, Chapter 469.
(d) Spatial requirements.
  (1) Administration and public areas.
    (A) A primary entrance at grade level shall be accessible.
    (B) A main lobby shall be located at the primary entrance and shall include a reception and information counter or desk, waiting space(s), public toilet facilities located convenient to the lobby/waiting area, and storage room or alcove for wheelchairs. Private interview area may be omitted if all interviews occur in treatment or exam rooms.
  (2) Emergency Entrance and Signage.
    (A) An ambulance entrance at grade level shall be well-illuminated.
    (B) Emergency entry signage. An emergency sign shall be provided at the entry from the public road(s) or street(s) serving the site.
    (C) A facility that is not in continuous operation 24 hours per day and 7 days per week shall display clearly visible signage at the main entry and ambulance entry points of the facility. The signage letter size shall be readable and not smaller than half an inch in height. The signage shall provide the information required under §131.22(c) of this title (relating to Classifications of Facilities).
    (D) A facility that is not in continuous operation shall comply with the requirements under §133.22(d) of this title.
  (3) Emergency suite.
    (A) Control station/nurse station shall be located to permit staff observation and control of access to treatment room(s), exam rooms, pedestrian and ambulance entrances, and public waiting area(s). The nurse station shall contain cabinets, work counter, and a hand washing fixture with hands-free operable controls.
    (B) A medical staff work area and charting area(s) shall be provided. The area may be combined with the control station/nurse station.
    (C) As a minimum requirement, all pre-existing facilities shall provide at least one emergency treatment room to handle emergencies. The emergency treatment room shall contain cabinets, work counter, examination light, and a hand washing fixture with hands-free operable controls.
    (D) As a minimum requirement, all pre-existing facilities shall provide at least one exam room. The examination room shall contain cabinets, work counter, examination light, and a hand washing fixture with hands-free operable controls.
    (E) Storage space shall be provided within the room or suite and be under staff control for general medical-surgical emergency supplies and medications. Adequate space shall be provided for emergency equipment such as emergency treatment trays, ventilator, defibrillator, splints, cardiac monitor, etc.
    (F) An area or alcove located out of traffic and convenient to the treatment and exam room(s) shall be provided for an emergency crash cart.
    (G) An alcove shall be provided for stretcher and wheelchair storage. The storage for stretchers and wheelchairs shall be located out of the line of traffic.
    (H) A nourishment station shall be provided containing a work counter with sink, microwave, refrigerator and storage cabinets and not located in the clean workroom. When the patient nourishment refrigerator is located in the staff lounge, the refrigerator shall be labeled "patient refrigerator."
Cont'd...
(I) An ice machine supplying ice for therapeutic purposes, when provided, shall be located in the clean utility room or similar clean space. A self-dispensing ice machine shall be provided for ice for human consumption.
    (J) Patient toilet room(s) shall be provided and shall be convenient to treatment rooms, examination rooms, and trauma rooms a hand washing fixture with hands-free operable controls.
    (K) Staff toilets shall be provided and may be outside the suite but shall be convenient for staff use and include hand washing fixtures with hands-free operable controls.
    (L) A clean storage room shall be provided for clean supplies, linens and medications as needed. A hand washing fixture shall be provided within the room with hands-free operable controls.
    (M) Soiled workroom shall be provided and contain a work counter, a clinical sink or equivalent flushing type fixture, hand washing fixture with hands-free operable controls, waste receptacles, and soiled linen receptacles.
  (4) Medication storage. A medication work room or alcove shall be provided and located separate from patient and public areas and under the direct supervision of staff. A work counter, refrigerator, medication storage, and locked storage for biologicals and drugs shall be provided. A hand washing fixture with hands-free operable controls shall be located in the medication storage room or alcove.
    (A) Functional space shall be provided and areas required for records, reports, and accounting activities.
    (B) Space for the poison control center shall be provided with storage facilities for reaction data and drug information centers.
  (5) Diagnostic radiographic (X-ray). A diagnostic radiographic (X-ray) room shall be provided and be readily available to the emergency suite.
    (A) Clearance and unobstructed space shall not be less than three feet around the diagnostic equipment.
    (B) When the facility is equipped with digital imaging system capabilities, a minimum of two X-ray film illuminators viewers shall be provided and mounted in a central location.
  (6) Computed tomography (CT) scanning. A CT room shall be provided and be readily available to the emergency suite. Clearance and unobstructed space shall be not less than three feet on each side of the diagnostic table.
    (A) A control room shall be provided with a view window permitting view of the patient. The control room shall be located to allow convenient film processing.
    (B) A patient toilet shall be provided convenient to the CT room. The toilet room shall have a hand washing fixture with hands-free operable controls.
  (7) Laboratory services. Laboratory room or work area shall be provided with the following minimum facilities.
    (A) The laboratory work room(s) shall include counter(s), space appropriately designed for laboratory equipment, and sink(s) with hands-free operable controls.
    (B) Each laboratory room or work area shall be provided with a hand washing fixture(s) with hands-free operable controls.
    (C) General storage, including refrigeration for reagents, standards, supplies, and stained specimen microscope slides, etc. shall be provided. Separate facilities shall be provided for such incompatible materials as acids and bases, and vented storage shall be provided for volatile solvents.
    (D) A refrigerator and other necessary equipment shall be provided for specimen storage waiting for transfer to off-site testing.
    (E) Specimen room/area for blood collection shall be provided with a counter, space for seating, and hand washing fixture with hands-free operable controls. A toilet and lavatory with hands-free operable controls shall be provided for specimen collection. This facility may be outside the laboratory area if conveniently located.
    (F) When chemical safety is a requirement, an emergency shower and eye flushing devices shall be provided.
    (G) Flammable or combustible liquids, when used, shall be stored in approved containers, in accordance with National Fire Protection Association 30, Flammable and Combustible Liquids Code, 2003 edition.
    (H) Radioactive materials, when employed, shall be stored in safe storage facilities.
    (I) Each laboratory unit shall meet the requirements of Chapter 11 of NFPA 99 (relating to Laboratories), and Chapter 20 of NFPA 101 (relating to New Ambulatory Health Care Occupancies).
  (8) Housekeeping room. A sufficient number of janitor's closets shall be provided throughout the facility to maintain a clean and sanitary environment. The closet shall contain a floor receptor or service sink and storage space for housekeeping supplies and equipment. When there is only one housekeeping room for the entire facility there shall be policies and procedures in place, as described in §131.55 of this title (relating to Sanitary Conditions and Hygienic Practices) for proper use of cleaning body fluids versus general cleaning, and the use of separate equipment and supplies.
  (9) Medical waste. Space and facilities shall be provided for the safe storage and disposal of medical waste as appropriate for the material being handled and in compliance with all applicable federal, state, or local laws, codes, rules, regulations and ordinances.
  (10) Supply rooms.
    (A) A storage room/area for breakdown of supplies shall be provided. The storage room/area shall have adequate space for breakdown of prepackaged supplies to be loaded on cart(s) to transport to the appropriate storage spaces. The breakdown area shall not reduce the clear unobstructive width in the egress corridor.
    (B) Sterile/clean supply room. A sterile/clean supply room shall be provided. Storage of sterile/clean supplies shall not occur within the breakdown room.
    (C) An equipment storage room shall be provided. The equipment room may be in the emergency suite.
  (11) Employee facilities. A lounge, lockers and staff toilets shall be provided for employees and volunteers. The toilet room(s) may be unisex.
  (12) Engineering suite and equipment areas shall be provided.
    (A) Provisions shall be made for protected storage of facility drawings, records, manuals, etc.
    (B) All mechanical and electrical equipment rooms shall provide sufficient space for proper maintenance of equipment. Provisions shall be made for removal and replacement of equipment.
    (C) Additional areas or room(s) for mechanical and electrical equipment shall be provided within the physical plant or installed in separate buildings or weatherproof enclosures with the following exceptions.
      (i) An area shall be provided for cooling towers and heat rejection equipment when such equipment is used.
      (ii) Medical gas systems shall be housed in accordance with National Fire Protection Association 99, Standard for Health Care Facilities, 2002 edition (NFPA 99), Chapters 4 and 8.
      (iii) When provided, compactors, dumpsters, and incinerators shall be located in an area remote from public entrances.
(e) General detail requirements. Details in pre-existing facilities shall comply with this subsection, local building codes, and local ordinances.
  (1) Exits, corridors and doors.
    (A) A facility shall provide two exits remote from each other. At least one exit door shall be accessible by an ambulance from the outside.
    (B) Encroachment into the means of egress. Such items as drinking fountains, telephone booths or stations, and vending machines shall not project into or restrict exit corridor traffic or reduce the exit corridor width below the required minimum. Portable equipment, when stored, shall not project into and restrict exit corridor traffic or reduce the exit corridor width below the required minimum.
    (C) The unobstructed width of a corridor shall be at least four feet.
    (D) Doors at all openings between corridors and rooms or spaces subject to occupancy shall be swing type. Elevator doors are excluded from this requirement.
    (E) The minimum width of doors for patient access to treatment, examination, diagnostic, and imaging rooms requiring access for beds and gurneys shall be three feet.
    (F) All fire doors shall be listed by an independent testing laboratory and shall meet the construction requirements for fire doors in National Fire Protection Association 80, Standard for Fire Doors and Fire Windows, 1999 Edition. Reference to a labeled door shall be construed to include labeled frame and hardware.
  (2) Glazing for glass doors, lights, sidelights, borrowed lights, and windows located within 12 inches of a door jamb or with a bottom-frame height of less than 18 inches and a top-frame height of more than 36 inches above the finished floor which may be broken accidentally by pedestrian traffic shall be glazed with safety glass or plastic glazing material that will resist breaking and will not create dangerous cutting edges when broken. Similar materials shall be used for wall openings in Cont'd...
activity areas such as recreation and exercise rooms, unless otherwise required for fire safety. Safety glass, tempered or plastic glazing materials shall be used for shower doors and bath enclosures, interior windows and doors. Plastic and similar materials used for glazing shall comply with the flame spread ratings of NFPA 101, §18.3.3.
  (3) Grab bars shall be provided at patient toilets and showers. The bars shall be one and one-half inches in diameter, shall have either one and one-fourth or one and one-half inches clearance to walls, and shall have sufficient strength and anchorage to sustain a concentrated vertical or horizontal load of 250 pounds. Grab bars intended for use by the disabled shall also comply with ADA requirements.
  (4) Location and arrangement of fittings for hand washing facilities shall permit their proper use and operation. Hand washing fixtures with hands-free controls shall be provided in each examination, treatment, trauma, diagnostic, imaging, holding/observation room/area, soiled utility room, clean work room, and toilet room. Particular care shall be given to the clearances required for blade-type operating handles. Lavatories and hand washing facilities shall be securely anchored to withstand an applied vertical load of not less than 250 pounds on the front of the fixture. In addition to the specific areas noted, hand washing facilities shall be conveniently located for staff use in rooms and areas noted under spatial requirements in subsection (c) of this section and throughout the center where patient care services are provided.
  (5) A liquid or foam soap dispenser shall be located at each hand washing facility.
  (6) Provisions for hand drying shall be included at all hand washing facilities. Hot air dryers or individual paper or cloth units shall be enclosed to provide protection against dust or soil and shall provide single-unit dispensing.
  (7) A sign shall be posted at the entrance to each toilet/restroom to identify the facility for public, staff, or patient use.
  (8) Emergency eyewash shall be provided conveniently located within the emergency suite for staff use and comply with ANSI Z358.1.
  (9) The minimum ceiling height shall be eight feet six inches with the following exceptions.
    (A) Ceilings in storage rooms, toilet rooms, and other minor rooms shall be not less than seven feet six inches.
    (B) Boiler rooms shall have ceiling clearances not less than two feet six inches above the main boiler header and connecting piping.
    (C) Overhead clearance for suspended tracks, rails, pipes, signs, lights, door closers, exit signs, and other fixtures that protrude into the path of normal traffic shall not be less than six feet eight inches above the finished floor.
  (10) Radiation shielding shall be designed, tested, and approved by a medical physicist licensed under the Medical Physics Practice Act, Occupations Code, Chapter 602. The facility shall obtain a certificate of registration issued by the Radiation Safety Licensing Branch to use radiation machines.
(f) General finish requirements. Finishes in pre-existing facilities shall comply with this subsection, local building codes, and local ordinances.
  (1) Privacy screens, cubicle curtains, and draperies.
    (A) Cubicle curtains or privacy screens shall be provided to assure patient privacy when required or requested by a patient.
    (B) Cubicle curtains, draperies and other hanging fabrics shall be noncombustible or flame retardant.
  (2) Floor finishes.
    (A) Flooring shall be easy to clean and have wear resistance appropriate for the location involved. In all areas frequently subjected to wet cleaning methods, floor materials shall not be physically affected by germicidal and cleaning solutions.
    (B) Existing flooring in patient treatment/exam rooms in a pre-existing facility that has jointed or seamed flooring material may continue to be used provided there is assurance that no bodily fluids or moisture can harbor in the joints, seams or under the flooring material. If assurance of fluids harboring under the flooring material cannot be made, the flooring material must be sealed with a covering sealant material to prevent fluids from entering the seams and joints. When the existing flooring is replaced, the new flooring shall meet the requirements of §131.143(f)(3)(A)(iii) of this title (relating to Construction Requirements for a New Facility).
    (C) Thresholds at doorways shall not exceed 3/4 inch in height for exterior sliding doors or 1/2 inch for other type doors. Raised thresholds and floor level changes at accessible doorways shall be beveled with a slope no greater than 1:2. Expansion joint covers shall not exceed 1/2 inch in height and shall have beveled edges with a slope no greater than 1:2.
  (3) Wall finishes. Wall finishes shall be washable, moisture resistant, and cleanable by standard housekeeping practices.
    (A) Wall finishes shall be water-resistant in the immediate area of plumbing fixtures.
    (B) Wall finishes in areas subject to frequent, wet cleaning methods shall be impervious to water, tightly sealed, and without voids.
  (4) Ceiling finishes. All occupied rooms and spaces shall be provided with finished ceilings, unless otherwise noted. Ceilings which are a part of a rated roof/ceiling assembly or a floor/ceiling assembly shall be constructed of listed components and installed in accordance with the listing.
  (5) Floor, wall, and ceiling penetrations. Floor, wall, and ceiling penetrations by pipes, ducts, and conduits, or any direct openings shall be tightly sealed to minimize entry of dirt particles, rodents, and insects. Joints of structural elements shall be similarly sealed.
  (6) Material finishes. Materials known to produce noxious gases when burned shall not be used for mattresses, upholstery, and wall finishes.
(g) General mechanical requirements. Mechanical systems, air conditioning, heating, and ventilating systems shall meet the requirements of the local building codes, ordinances and this section.
  (1) Equipment location. Mechanical equipment may be located indoors, outdoors in a weatherproof enclosure, or in a separate building(s).
  (2) Vibration isolation. Mechanical equipment shall be mounted on vibration isolators to prevent unacceptable structure-borne vibration. Ducts, pipes, etc. connected to mechanical equipment which is a source of vibration shall be isolated from the equipment with vibration isolators.
  (3) Heating, ventilating, and air conditioning (HVAC) systems.
    (A) All central HVAC systems shall comply with and shall be installed in accordance with required building codes, ordinances and NFPA 90A, Standard for the Installation of Air Conditioning and Ventilating Systems, 2002 Edition, or NFPA 90B, Standard for the Installation of Warm Air Heating and Air-Conditioning Systems, 2002 Edition, as applicable, and the requirements contained in this paragraph. Air handling units serving two or more rooms are considered to be central units.
    (B) Noncentral air handling systems, i.e., individual room units that are used for heating and cooling purposes (e.g., fan-coil units, heat pump units, and packaged terminal air conditioning units) shall be equipped with permanent (cleanable) or replaceable filters. The filters shall have an average efficiency of 25 - 30% and an average arrestance of 85% based on American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE), Inc., Standard 52.2, 1999 edition, Method of Testing General Ventilation Air Cleaning Devices for Removal Efficiency by Particle Size. These units shall be used as air recirculating units only.
    (C) General ventilation requirements. All rooms and areas in the facility shall have provision for positive ventilation.
      (i) All toilet exhaust ventilation shall be exhausted.
      (ii) Air distribution devices. Design shall consider turbulence and other factors of air movement to minimize airborne particulate matter.
        (I) All supply diffusers grilles shall be located on the ceiling or on a wall within four inches from the ceiling.
        (II) Air supply for the treatment rooms/areas, exam rooms/areas, and trauma rooms/areas shall be from ceiling outlets.
      (iii) Air handling units shall be equipped with filters having efficiencies of 25 - 30% and an average arrestance of 85% or greater based on American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE), Inc., Standard 52.2, 1999 edition, Method of Testing General Ventilation Air Cleaning Devices for Removal Efficiency by Particle Size. All joints between filter segments, and between filter segments and the enclosing ductwork, shall have gaskets and seals to provide a positive seal against air leakage.
      (iv) Existing return air plenums in pre-existing facility may continue to be used as long as the following conditions are provided.
        (I) Final filters providing 90% efficiency shall be located downstream of the supply air blowers, cooling and heating coils.
Cont'd...
(II) The facility shall at all times have constant air changes throughout the facility and meet the ventilation requirements of Table 2 of §131.148(b) of this title (relating to Tables) during operational hours.
        (III) Provide Ultraviolet (UV) lighting apparatus in the central air handling unit.
    (D) Ray protection. Ducts which penetrate construction intended for X-ray or other ray protection shall not impair the effectiveness of the protection.
    (E) Fire damper requirements. Fire dampers shall be located and installed in all ducts at the point of penetration of a required two-hour or higher fire-rated wall or floor in accordance with the requirements of NFPA 101, §18.5.2.
(h) Piping systems and plumbing fixture requirements. All piping systems and plumbing fixtures shall meet the requirements of the local building codes, ordinances and this subchapter.
  (1) Piping systems.
    (A) Water supply piping systems. Piping systems shall be designed to supply water at sufficient pressure to operate all fixtures and equipment during maximum demand.
      (i) Each water service main, branch main, riser, and branch to a group of fixtures shall be equipped with accessible and readily identifiable shutoff valves. Stop valves shall be provided at each fixture.
      (ii) Backflow preventers (vacuum breakers) shall be installed on hose bibs, laboratory sinks, janitor sinks, bedpan flushing attachments, and all other fixtures to which hoses or tubing can be attached. Connections to high hazard sources, e.g., X-ray film processors, shall be from a cold water hose bib through a reduced pressure principle type backflow preventer (RPBFP).
      (iii) Flush valves installed on plumbing fixtures shall be a quiet operating type, equipped with silencers.
      (iv) Water heating equipment shall have sufficient capacity to supply water for all clinical needs based on accepted engineering practices using actual number and type of fixtures and for heating, when applicable.
      (v) Water temperatures shall be measured at hot water point of use or at the inlet to processing equipment. Hot water temperature at point of use for patients, staff, and visitors shall be in the range of 105 to 120 degrees Fahrenheit.
      (vi) Dead-end piping (risers with no flow, branches with no fixture) shall not be allowed.
    (B) Fire sprinkler systems. When provided, fire sprinkler systems shall comply with the requirements of NFPA 101, §9.7, Automatic Sprinklers and Other Extinguishing Equipment, and the requirements of this subparagraph. All fire sprinkler systems shall be designed, installed, and maintained in accordance with the requirements of NFPA 13, Standard for the Installation of Sprinkler Systems, 2002 Edition, and shall be certified as required by §131.147(c)(1)(C) of this title (relating to Construction, Inspection, and Approval of Project).
    (C) Piped nonflammable medical gas and clinical vacuum systems. Existing piped nonflammable medical gas and clinical vacuum systems shall be in accordance with NFPA 99, §5.1 for Level 1 Piped Systems.
    (D) Main storage of medical gases may be outside or inside the facility in accordance with NFPA 99, §5.1. Provision shall be made for additional separate storage of reserve gas cylinders necessary to complete at least one day's procedures.
  (2) Building sewers shall discharge into a community sewage system. Where such a system is not available, a facility providing sewage treatment shall conform to applicable local and state regulations.
  (3) Plumbing fixtures. Plumbing fixtures shall be made of nonabsorptive, acid-resistant materials and shall comply with the requirements of the National Standard Plumbing Code, and this paragraph.
    (A) Sink and lavatory controls. All lavatories used by medical and nursing staff and by patients shall be trimmed with valves or electronic controls which can be operated without the use of hands. Blade handles used for this purpose shall not be less than four inches in length. Single lever or wrist blade devices may also be used.
    (B) Back-flow or siphoning. All plumbing fixtures and equipment shall be designed and installed to prevent the back-flow or back-siphonage of any material into the water supply. The over-the-rim type water inlet shall be used wherever possible. Vacuum-breaking devices shall be properly installed when an over-the-rim type water inlet cannot be utilized.
    (C) Sterilizing equipment. All sterilizing equipment shall be designed and installed to prevent the contamination of the water supply, and the entrance of contaminating materials into the sterilizing units.
    (D) Hose attachment. No hose shall be affixed to any faucet if the end of the hose may become submerged in contaminated liquid unless the faucet is equipped with an approved, properly installed vacuum breaker.
    (E) Bedpan washers and sterilizers. When provided, bedpan washers and sterilizers shall be designed and installed so that both hot and cold water inlets shall be protected against back-siphonage at maximum water level.
    (F) Flood level rim clearance. The water supply spouts for lavatories and sinks required in patient care areas shall be mounted so that their discharge points are a minimum of five inches above the rim of the fixture.
    (G) Scrub sink controls. Freestanding scrub sinks and lavatories used for scrubbing in procedure rooms shall be trimmed with foot, knee, or electronic hands-free controls. Single lever wrist blades are not acceptable at scrub sinks.
    (H) Floor drains or floor sinks. Where floor drains or floor sinks are installed, they shall be of a type that can be easily cleaned by removal of the cover. Removable stainless steel mesh shall be provided in addition to a grilled drain cover to prevent entry of large particles of waste which might cause stoppages.
    (I) Under counter piping. Under counter piping and above floor drains shall be arranged (raised) so as not to interfere with cleaning of the floor below the equipment.
    (J) Ice machines. All ice-making machines used for human consumption shall be of the self-dispensing type. Copper tubing shall be provided for supply connections to ice machines.
(i) General electrical requirements. This subsection contains common electrical and essential emergency system requirements. All electrical installation and equipment shall meet the requirements of the local building codes, ordinances and this subsection.
  (1) Electrical requirements. All electrical material and equipment, including conductors, controls, and signaling devices, shall be installed in compliance with applicable sections of the NFPA 70, National Electrical Code, 2002 Edition, §517; NFPA 99, Chapter 14; the requirements of this subsection; and as necessary to provide a complete electrical system. Electrical systems and components shall be listed by nationally recognized listing agencies as complying with available standards and shall be installed in accordance with the listings and manufacturer's instructions.
    (A) All fixtures, switches, sockets, and other pieces of apparatus shall be maintained in a safe and working condition.
    (B) Extension cords and cables shall not be used for permanent wiring.
    (C) All electrical heating devices shall be equipped with a pilot light to indicate when the device is in service, unless equipped with a temperature limiting device integral with the heater.
    (D) All equipment, fixtures, and appliances shall be properly grounded in accordance with NFPA 70.
    (E) Under counter electrical installations shall be arranged (raised) to not interfere with cleaning the floor below the equipment.
  (2) Electrical safeguards. Shielded isolation transformers, voltage regulators, filters, surge suppressors, and other safeguards shall be provided as required where power line disturbances are likely to affect fire alarm components, data processing, equipment used for treatment, and automated laboratory diagnostic equipment.
  (3) Services and switchboards. Main switchboards shall be located in separate rooms, separated from adjacent areas with one-hour fire-rated enclosures containing only electrical switchgear and distribution panels and shall be accessible to authorized persons only. These rooms shall be ventilated to provide an environment free of corrosive or explosive fumes and gases, or any flammable and combustible materials. Switchboards shall be located convenient for use and readily accessible for maintenance as required by NFPA 70, Article 384. Overload protective devices shall operate properly in ambient temperatures.
  (4) Wiring. All conductors for controls, equipment, lighting and power operating at 100 volts or higher shall be installed in metal or metallic raceways in accordance with the requirements of NFPA 70, Article 517. All surface mounted wiring operating at less than 100 volts shall be protected from mechanical injury with metal raceways to a height of seven feet above the floor. Conduits and cables shall be supported in accordance with NFPA 70, Article 300.
Cont'd...
(5) Lighting.
    (A) Consideration shall be given to controlling light intensity and wavelength to prevent harm to the patient's eyes.
    (B) Approaches to buildings and parking lots, and all spaces within buildings shall have fixtures that can be illuminated as necessary. All rooms including storerooms, electrical and mechanical equipment rooms, and all attics shall have sufficient artificial lighting so that all spaces are clearly visible.
    (C) The special needs of the elderly shall be considered. The facility shall minimize excessive contrast in lighting levels that makes effective sight adaptation difficult.
    (D) Electric lamps, which may be subject to breakage or which are installed in fixtures in confined locations when near woodwork, paper, clothing, or other combustible materials, shall be protected by wire guards, or plastic shields.
    (E) Ceiling mounted surgical and examination light fixtures shall be suspended from rigid support structures mounted above the ceiling.
  (6) Receptacles. Only listed hospital grade single-grounding or duplex-grounding receptacles shall be used in the trauma, treatment, exam, diagnostic, imaging rooms, and all patient care areas. This does not apply to special purpose receptacles.
    (A) Electrical receptacles powered from the emergency generator shall be colored red.
    (B) Replacement of malfunctioning receptacles and installation of new receptacles powered from the critical branch in existing facilities shall be installed or replaced with receptacles of the same distinct color as the existing receptacles.
    (C) In locations where mobile X-ray or other equipment requiring special electrical configuration is used, the additional receptacles shall be distinctively marked for the special use.
    (D) Each receptacle shall be grounded to the reference grounding point by means of a green insulated copper equipment grounding conductor in accordance with NFPA 70, §517-13.
    (E) Ground fault circuit interrupters (GFCI) receptacles shall be provided for all general use receptacles located within three feet of a wash basin or sink. When GFCI receptacles are used, they shall be connected to not affect other devices connected to the circuit in the event of a trip.
  (7) Nurse's calling systems.
    (A) A nurse's emergency calling system shall be installed in all treatment room/area station(s), exam rooms/area station(s), isolation room(s), patient holding stations, imaging, diagnostic and patient toilet room(s) to summon nursing staff in an emergency. Activation of the system shall sound a distinct audible signal which repeats every five seconds or less at the nurse station, indicate the type and location of call on the system monitor, and activate a distinct visible signal in all areas. The activation of the system shall also activate distinct visible signals in the clean workroom, soiled workroom, and if provided, in the nourishment station. The visible and audible signals shall be cancelable only at the patient calling station. A nurse's emergency call system shall be accessible to a collapsed patient lying on the floor. Inclusion of a pull cord extending to within 6 inches of the floor will satisfy this requirement.
    (B) A staff emergency assistance calling system station shall be located in each treatment room/area, examination room/area, trauma room/area, and holding room/area to be used by staff to summon additional help in an emergency. Activation of the system shall sound an audible signal at a staffed location, indicate type and location of call on the system monitor, and activate a distinct visible signal in the corridor at the door. Additional visible signals shall be installed at corridor intersections in multi-corridor facilities. Distinct visible and audible signals shall be activated in the clean workroom, in soiled workroom, equipment storage, and if provided, in the nourishment station.
  (8) The pre-existing facility shall have an emergency contingency plan for the continuity of emergency essential building systems. The emergency contingency plan shall consist of one of the two options in this paragraph.
    (A) An onsite emergency generator shall be provided with a Type II essential electrical distribution system in accordance with requirements of NFPA 99, §4.5 (2), and National Fire Protection Association 110, Standard for Emergency and Standby Power Systems, 2002 Edition.
      (i) An emergency generator standby power system(s) shall require an onsite fuel source and enough fuel capacity in the tank for a period of 24 hours or more. The facility shall execute a contract with an outside supplier/vendor(s) that will provide fuel on demand. When a vapor liquefied petroleum gas (LPG) (natural gas) system is used, the twenty-four hour fuel capacity on site is not required. The vapor withdrawal LPG system shall require a dedicated fuel supply.
      (ii) The emergency generator shall be installed, tested and maintained in accordance with the National Fire Protection Association 99, §4.5.4, and National Fire Protection Association 110, Standard for Emergency and Standby Power Systems, 2002 Edition.
    (B) An executed contract with an outside supplier/vendor(s) to provide a portable emergency generator(s) and fuel on demand.
      (i) An electrical transfer switch with plug-in device sized to provide emergency power for the patient care areas and the provisions in NFPA 99, §4.5.2.2.2.
      (ii) An alternate source of power (battery power lighting) shall be provided separate and independent from the normal electrical power source that will be effective for a minimum of one and one-half hours after loss of electrical power. The emergency lighting system shall be capable of providing sufficient illumination to allow safe evacuation from the building. The battery pack systems shall be maintained and tested quarterly.
      (iii) The facility shall implement the emergency contingency plan upon the loss of electrical power following a natural weather or man-made event when the electrical power may not be restored within 24 hours. The facility shall exercise the contract(s) with the supplier/vendor(s) in order to have portable emergency generator(s) available within 36 hours after the loss of electrical power.
  (9) Fire alarm system. A fire alarm system which complies with NFPA 101, §20.3.4, and with NFPA 72, Chapter 6 requirements, shall be provided in pre-existing facilities. The required fire alarm system components are as follows.
    (A) A fire alarm control panel (FACP) shall be installed at a visual location such as the main lobby. A remote fire alarm annunciator listed for fire alarm service and installed at a continuously attended location and capable of indicating both visual and audible alarm, trouble, and supervisory signals in accordance with the requirements of NFPA 72 may be substituted for the FACP.
    (B) Manual fire alarm pull stations shall be installed in accordance with NFPA 101, §20.3.4.
    (C) Smoke detectors shall be installed in supply and return air ducts in accordance with requirements of NFPA 72 §5.14.4.2.2 and §5.14.5 and NFPA 90A, §6.4.2.2.
    (D) A fire alarm signal notification which complies with NFPA 101, §9.6.3, shall be provided to alert occupants of fire or other emergency.
    (E) Audible alarm indicating devices shall be installed in accordance with the requirements of NFPA 101, §20.3.4, and NFPA 72, §7.4.
    (F) Visual fire alarm indicating devices which comply with the requirements of NFPA 72, §7.5, shall be provided.
    (G) Devices for transmitting an alarm shall be provided to alert the local fire brigade or municipal fire department of a fire or other emergency. The devices shall be listed for the fire alarm service by a nationally recognized laboratory, and be installed in accordance with such listing and the requirements of NFPA 72.

Source Note: The provisions of this §131.141 adopted to be effective June 1, 2010, 35 TexReg 4400