(a) Flammable germicides. If flammable germicides, including alcohol-based products, are used for preoperative surgical skin preparation in a limited services rural hospital (LSRH), the LSRH must:
  (1) use only self-contained, single-use, pre-measured applicators to apply the surgical skin preparations;
  (2) follow all manufacturer product safety warnings and guidelines;
  (3) develop, implement, and enforce written policies and procedures outlining the safety precautions required related to the use of the products, which, at a minimum, must include minimum drying times, prevention and management of product pooling, parameters related to draping and the use of ignition sources, staff responsibilities related to ensuring safe use of the product, and documentation requirements sufficient to evaluate compliance with the written policies and procedures;
  (4) ensure that all staff working in the surgical environment where flammable surgical skin preparation products are in use have received training on product safety and the facility policies and procedures related to the use of the product;
  (5) develop, implement, and enforce an interdisciplinary team process for the investigation and analysis of all surgical suite fires and alleged violations of the policies; and
  (6) report all occurrences of surgical suite fires to the Texas Health and Human Services Commission as soon as possible but not later than 10 calendar days after the occurrence, and complete an investigation of the occurrence and develop and implement a corrective action plan within 30 days after a surgical suite fire.
(b) Flammable and nonflammable gases and liquids. Flammability of liquids and gases shall be determined by National Fire Protection Association (NFPA) 329, Recommended Practice for Handling Releases of Flammable and Combustible Liquids and Gases, 2010 edition.
  (1) Nonflammable gases (examples including oxygen and nitrous oxide) shall be stored and distributed in accordance with Chapter 5 of the NFPA 99, Standard for Health Care Facilities, 2012 edition.
    (A) Medical gases and liquefied medical gases shall be handled in accordance with the requirements of NFPA 99 Chapter 9.
    (B) Oxygen shall be administered in accordance with NFPA 99 §9.6.
  (2) Piped flammable gas systems intended for use in laboratories and piping systems for fuel gases shall comply with requirements of NFPA 99 §11.11.
  (3) Flammable gases shall be stored in accordance with NFPA 99 §11.10.
  (4) Flammable and combustible liquids used in laboratories shall be handled and stored in accordance with NFPA 99 §11.7, and National Fire Protection Association 101, Life Safety Code, 2012 edition, §18.3.2.2.
  (5) Other flammable agents shall be stored in accordance with NFPA 99 Chapter 7.
(c) Gasoline and gasoline powered equipment. No motor vehicles including gasoline powered standby generators or any amount of gasoline shall be located within the LSRH building. Other devices that may cause or communicate fire, and that are not necessary for patient treatment or care, shall not be stored within the LSRH building. All such devices and materials when necessary shall be used within the building only with precautions ensuring a reasonable degree of safety from fire.
(d) Gas-fired appliances. The installation, use, and maintenance of gas-fired appliances and gas piping installations shall comply with the National Fire Protection Association 54, National Fuel Gas Code, 2012 edition. The use of portable gas heaters and unvented open flame heaters is specifically prohibited.

Source Note: The provisions of this §511.143 adopted to be effective October 5, 2023, 48 TexReg 5668