(a) Multiple hospitals located within one building.
  (1) Identifiable location. Each hospital shall conform with all the requirements contained in Chapter 18 of the National Fire Protection Association 101, Life Safety Code, 2003 edition (NFPA 101), relating to New Health Care Occupancies. All documents published by NFPA as referenced in this section may be obtained by writing or calling the NFPA at the following address or telephone number: National Fire Protection Association, 1 Batterymarch Park, Post Office Box 9101, Quincy, MA 02269-9101 or (800) 344-3555.
    (A) The guest hospital shall be in one separately contiguous location.
    (B) In no case may a person leave the guest hospital, traverse the host hospital, and then reenter the guest hospital to access the remaining portion of the guest hospital.
    (C) A connecting stair within the host hospital may be used to connect the vertical contiguous areas of the guest hospital.
    (D) A guest hospital may not occupy two or more noncontiguous areas of a host hospital which contain intervening space of the host hospital even if on the same floor.
    (E) Construction of the host hospital building shall conform to the requirements of NFPA 101, Chapter 18, and the building shall be fully sprinklered.
  (2) Separate facilities. Each hospital shall provide the following separate facilities:
    (A) a nursing unit in accordance with the requirements of §133.163(t) of this title (relating to Spatial Requirements for New Construction);
    (B) an administration office with an adjacent waiting room or waiting area;
    (C) a medical records room which conforms with the requirements of §133.163(p) of this title;
    (D) a pharmacy suite in accordance with §133.163(x) of this title;
    (E) employee locker facilities which comply with requirements of §133.163(g)(1) of this title;
    (F) a housekeeping room in accordance with the requirements of §133.162(d)(2)(A)(xxviii) of this title (relating to New Construction Requirements);
    (G) emergency facilities. Each hospital shall provide emergency facilities as required by §133.163(f)(1)(A) of this title. When general hospitals share a building, each general hospital shall provide emergency facilities as required by §133.163(f)(1)(A)(i) and (ii) of this title;
    (H) imaging and other diagnostic services and facilities, in accordance with §133.41(s) of this title (relating to Hospital Functions and Services) and §133.163(l) of this title respectively;
    (I) laboratory services and a laboratory suite which comply with §133.41(h) of this title, and §133.163(n)(1)(B) of this title respectively;
    (J) surgical or obstetrical facilities for each general hospital, in accordance with §133.163(u) and §133.163(ee) of this title;
    (K) dietary services and dietary suite, including staff dining facilities, which comply with §133.41(d) of this title and §133.163(e) of this title respectively;
    (L) external signage at the building entrance which identifies each hospital; and
    (M) internal signage which provides directions to each hospital.
  (3) Means of egress. Means of egress from the host or guest hospital shall not be through a psychiatric hospital or a crisis stabilization unit or other area subject to locking. Means of egress may traverse through a hospital which conforms with the requirements of §133.161 of this title (relating to Requirements for Buildings in which Existing Licensed Hospitals are Located) or §133.162 of this title. Stairs must have guardrails from the floor of the guest hospital to the level of exit discharge in accordance with NFPA 101, §7.2.2.4.5.
  (4) Additional services and facilities. Additional services and facilities when required in each licensed hospital may be provided by contractual agreement with the other hospital when the services and facilities comply with the specific requirements of §133.41 of this title and §133.163 of this title. Some services may be provided by contractual agreement with a commercial contractor; however, the following minimal facilities shall be provided on site by the host hospital and be located in one of the hospitals. If the host hospital fails to provide the facilities and services, the guest hospital shall describe to the department how it plans to provide services:
    (A) cart cleaning and sanitizing services and facilities which comply with §133.163(b) of this title;
    (B) general stores services and facilities which comply with §133.163(i) of this title;
    (C) housekeeping rooms as required in §133.162(d)(2)(A)(xxviii) of this title;
    (D) parking facilities, in accordance with §133.162(c)(2) of this title;
    (E) physical and/or occupational therapy services and facilities, in accordance with §133.41(x) of this title, and §133.163(aa) of this title respectively;
    (F) patient activity facilities. The patient activity facilities shall comply with the requirements for the specific service in accordance with §133.163 of this title as follows: hospital-based skilled units §133.163(j)(1)(C); mental health and chemical dependency nursing units §133.163(q)(1)(B); pediatric and adolescent nursing unit §133.163(w)(1)(D)(i); and rehabilitation therapy suite §133.163(aa)(1)(A)(i) and (ii);
    (G) respiratory care services and respiratory therapy suite which comply with §133.41(u) of this title and §133.163(cc) of this title respectively;
    (H) body-holding room which complies with §133.163(r)(1)(D) of this title;
    (I) central sterile supply which complies with §133.41(v)(2)(L) of this title and §133.163(c) of this title respectively;
    (J) waste and waste disposal services, and waste processing and storage units shall comply with §133.41(y) of this title; and
    (K) emergency water storage requirement of §133.162(d)(4)(A)(i)(VIII) shall be required for each the hospital and be located in one of the hospitals.
  (5) Building systems and equipment.
    (A) The following systems shall be provided separately in each hospital at a 24-hour staffed location.
      (i) Nurses calling systems shall be provided separately in each hospital in accordance with §133.162(d)(5)(L) and Table 7 of §133.169(g) of this title (relating to Tables).
      (ii) Medical gas alarms shall be provided in each hospital.
      (iii) Fire alarm annunciator panels shall be provided in each hospital so that each hospital can monitor the other.
      (iv) An emergency generator annunciator panel shall be provided in each hospital.
    (B) Where applicable, the following systems may serve more than one hospital provided the systems meet the new construction requirements of §133.162 of this title:
      (i) air conditioning, heating and ventilating systems;
      (ii) drainage systems;
      (iii) elevators;
      (iv) fire sprinkler systems. The guest hospital may not be constructed in a host hospital when the host hospital is not fully sprinklered. The host and guest hospitals shall be fully sprinklered;
      (v) medical piping systems;
      (vi) stand pipe systems;
      (vii) steam systems;
      (viii) water supply systems, hot and cold (including emergency water storage); and
      (ix) electrical service and equipment.
        (I) Where applicable, the building electrical service, lighting, essential electrical system, and fire alarm system, may be a part of or extension of those in the existing hospital, provided the existing systems meet these requirements. The host hospital shall be responsible for maintenance, testing and upkeep of the essential electrical system. Power and lighting distribution panels shall be within each hospital served and comply with the requirements of §133.162(d)(5)(E). Electrical installation details shall conform with all requirements contained in §133.162(d)(5)(A).
        (II) When the existing essential electrical system is nonconforming, the following options are available:
          (-a-) a separate conforming essential electrical system shall be provided in the guest hospital; or
          (-b-) separate transfer switches connected to the existing on-site generator(s) shall be provided when adequate capacity is available and the host hospital existing nonconforming system shall be corrected. Corrections shall be made in accordance with a plan of correction approved by the department.
(b) Hospitals located in buildings with licensed health care facilities other than hospitals.
Cont'd...
(1) Before a hospital is licensed in a building containing other licensed health care facilities, all the requirements of this chapter and the following requirements shall be met.
    (A) Construction of the building shall conform to the requirements of NFPA 101, Chapter 18, and the building shall be fully sprinklered.
    (B) The hospital shall be in one identifiable contiguous location and shall be separated (vertically and horizontally) with two-hour fire rated noncombustible construction from the other licensed health care facility and comply with the requirements of this chapter.
      (i) In no case may a person leave the hospital, traverse other licensed healthcare facilities, and then reenter the hospital to access the remaining portion of the hospital.
      (ii) A connecting stair(s) and elevator(s) within the building shall be provided to connect the vertical contiguous areas of the hospital.
      (iii) A hospital may not occupy two or more noncontiguous areas of other licensed healthcare facilities which contain intervening space of the other licensed healthcare facilities even if on the same floor.
      (iv) Access to the hospital shall be directly from a main lobby or an elevator lobby, if on an upper floor. The required means of egress from the hospital may be through the other licensed health care facility except not through a psychiatric hospital or a crisis stabilization unit or other area subject to locking.
        (I) Each licensed facility shall be identified with external signage at the building entrance.
        (II) Internal signage shall provide direction to the hospital.
      (v) The hospital shall have services and facilities separate from the other licensed health care facility. The required facilities shall be located within the proposed hospital proper.
      (vi) Common use of facilities using time-sharing concepts may be permitted on a case by case basis when the other health care facilities comply with the requirements contained in NFPA 101, Chapter 18, and §133.163 of this title, and provided this chapter and the other health care facility licensing regulations allow.
    (C) The equipment and systems required in each new hospital may be provided exclusively for the hospital or by contractual agreement with a licensed health care facility. The equipment and systems shall be in accordance with §133.162 of this title.
      (i) The following equipment and systems shall be provided for the exclusive use of the hospital, except where noted otherwise:
        (I) breaker serving the hospital. Where the hospital is served by the building's normal electrical system, the breaker serving the hospital shall originate in the main switchboard and shall be labeled, "Hospital Service - Contact Hospital Representative Prior to Opening Breaker";
        (II) electrical service for power and lighting. The hospital distribution panel board(s) shall be within the hospital;
        (III) type I essential electrical system. An electrical room for the distribution of type I essential electrical system shall be provided separate from the building electrical room. The hospital staff shall have access at all times to the essential electrical system room and the building's electrical room(s). The hospital shall be responsible for maintenance, testing and upkeep of the essential electrical system. When the existing essential electrical system owned and operated by the other licensed health care facility is nonconforming, the following options are available:
          (-a-) a separate conforming essential electrical system shall be provided in the new hospital; or
          (-b-) separate transfer switches connected to the existing on-site generator(s) shall be provided when adequate capacity is available and the other health care facility existing nonconforming system shall be corrected. Corrections shall be made in accordance with a plan of correction approved by the department;
        (IV) an emergency generator. An emergency generator may be shared when adequate capacity is available. Separate transfer switches shall be provided to serve the hospital and other licensed health care facilities. The hospital shall be the owner of the generator, have access to the generator at all times, and shall be responsible for maintenance, testing and upkeep of the generator;
        (V) emergency water storage requirement of §133.162(d)(4)(A)(i)(VIII) of this title shall be located within the hospital;
        (VI) a fire alarm system. When the other licensed health care facilities have a fire alarm control center or a main building alarm panel at the main lobby entrance, the hospital shall have an annunciator panel at a 24-hour staffed location. The hospital staff shall have access at all times to the main building fire alarm system panels and shall be responsible for verifying the maintenance and upkeep of such system;
        (VII) fireman's test valve for the fire sprinkler system;
        (VIII) air conditioning, heating and ventilating systems;
        (IX) medical piping systems with alarm. The medical gas supply sources may be shared provided the hospital is owner of the medical gas system source and is responsible for maintenance, testing and upkeep of the supply sources. The hospital and other occupancies shall have separate main supply shutoff valves. The hospital shall be provided with an alarm panel within the hospital that monitors the medical gas system supply source serving the other licensed health care facilities;
        (X) medical vacuum and medical air; and
        (XI) nurses calling systems.
      (ii) Where applicable, the following systems may be a part or extension of those in the existing licensed health care facility, provided the existing systems meet the requirements of this chapter for new construction:
        (I) drainage systems;
        (II) elevators. The hospital shall be served by the number and size of elevators cabs in accordance with §133.164 of this title (relating to Elevators, Escalators, and Conveyors). The elevators cab lighting, control, communication, and signal systems shall be connected to the life safety panel of the essential electrical system;
        (III) fire sprinkler systems. The new hospital may not be constructed in the other health care facility when the other health care facility is not fully sprinklered. The new hospital and the other health care facility shall be fully sprinklered;
        (IV) stand pipe systems;
        (V) steam systems. The hospital is responsible for providing all backup systems (such as boilers) as required in this chapter;
        (VI) domestic water supply systems, hot and cold; and
        (VII) mechanical chilled and hot water systems.
  (2) When hospitals and psychiatric hospitals share one building, the building systems and equipment may be shared in accordance with subsection (a)(5)(B) of this section, or be provided separately.
(c) Hospitals in buildings with nonhealth care occupancies.
  (1) General. Before a hospital is licensed in a building also containing occupancies other than health care occupancies, all requirements of this chapter and the following requirements shall be met.
    (A) Construction of the building shall conform to the requirements of NFPA 101, Chapter 18, and the building shall be fully sprinklered.
    (B) The hospital shall be in one identifiable contiguous location and shall be separated (vertically and horizontally) with two-hour fire rated noncombustible construction from the other occupancies.
      (i) In no case may a person leave the hospital, traverse other occupancies, and then reenter the hospital to access the remaining portion of the hospital.
      (ii) A connecting stair(s) and elevator(s) within the building shall be provided to connect the vertical contiguous areas of the hospital.
      (iii) A hospital may not occupy two or more noncontiguous areas of other occupancies which contain intervening space of the other occupancies even if on the same floor.
    (C) Access to the hospital shall be through a dedicated hospital lobby or from the building's main lobby. The building's main lobby shall be part of the hospital and shall comply with the requirements of §133.162 of this title.
      (i) External signage shall be provided at the building entrance which identifies the hospital.
      (ii) Internal signage shall be provided to give directions to the hospital.
    (D) The required means of egress from the hospital shall be independent of and shall not traverse through the other occupancies.
Cont'd...
(E) Stairs shall have guardrails and handrails from the floor of the hospital to the level of exit discharge in accordance with NFPA 101, §7.2.2.4.5.
  (2) Services and facilities. Services and facilities shall be provided exclusively for the hospital in accordance with subchapters C, H, and I of this title (relating to Operational Requirements, Fire Prevention and Safety Requirements, and Physical Plant and Construction Requirements, respectively). Required services and facilities shall not be shared with the other occupancies except as noted in paragraph (3) of this subsection.
  (3) Building equipment and facilities. The equipment and systems shall be in accordance with §133.162 of this title.
    (A) The following equipment and systems shall be provided for the exclusive use of the hospital except where noted otherwise:
      (i) type I essential electrical system. An electrical room for the distribution of type I essential electrical system shall be provided separate from the building electrical room. The hospital staff shall have access at all times to the essential electrical system room and the building's electrical room(s). The hospital shall be responsible for maintenance, testing and upkeep of the essential electrical system;
      (ii) emergency generator. An emergency generator may be shared when adequate capacity is available. Separate transfer switches shall be provided to serve the hospital and other building occupancies. The hospital shall be the owner of the generator, have access to the generator at all times, and shall be responsible for maintenance, testing and upkeep of the generator;
      (iii) emergency water storage located within the hospital;
      (iv) fire alarm system. When the building has a fire alarm control center or a main building alarm panel at the main lobby entrance, the hospital shall have an annunciator panel at a 24-hour staffed location. The hospital staff shall have access at all times to the main building fire alarm system panels and shall be responsible for verifying the maintenance and upkeep of such system;
      (v) fireman's test valve for the fire sprinkler system;
      (vi) medical gas systems. The medical gas supply sources may be shared provided the hospital is owner of the medical gas system supply source and is responsible for maintenance, testing and upkeep of the supply sources. The hospital and other occupancies shall have separate main supply shutoff valves. The hospital shall be provided with an alarm panel within the hospital that monitors the medical gas system serving the other occupancies;
      (vii) medical vacuum and medical air;
      (viii) air conditioning, heating and ventilating systems. Air handling units of other occupancies may not be used for the hospital. The hospital air handling units may share the supply source for other occupancies but shall not return air from the other occupancies back to the air handling unit(s); and
      (ix) nurses calling systems.
    (B) Where applicable, the following systems may be a part or extension of those in the existing building occupancies provided the existing systems meet the requirements of this chapter for new construction:
      (i) breaker serving the hospital. Where the hospital is served by the building's normal electrical system, the breaker serving the hospital shall originate in the main switchboard and shall be labeled, "Hospital Service - Contact Hospital Representative Prior to Opening Breaker";
      (ii) electrical service for power and lighting. The hospital's distribution panelboard(s) shall be within the hospital;
      (iii) drainage systems;
      (iv) elevators. The hospital shall be served by the number and size of elevators cabs in accordance with §133.164 of this title. The elevators cab lighting, control, communication, and signal systems shall be connected to the life safety panel of the essential electrical system;
      (v) fire sprinkler systems. The hospital may not be constructed in the other type of building occupancies when the other types of occupancies are not fully sprinklered. The hospital and the other occupancies shall be fully sprinklered;
      (vi) stand pipe systems;
      (vii) fire pump, where applicable; The hospital staff shall have access at all times to the location of the fire pump to verify compliance and maintenance;
      (viii) steam systems. The hospital is responsible for providing all backup systems (such as boilers) that are required in this chapter; and
      (ix) domestic water supply systems, hot and cold.

Source Note: The provisions of this §133.165 adopted to be effective June 21, 2007, 32 TexReg 3587