(a) Location. Any proposed limited services rural hospital (LSRH) shall be easily accessible to the community and to service vehicles such as delivery trucks, ambulances, and fire protection apparatus. No building may be converted for use as an LSRH which, because of its location, physical condition, state of repair, or arrangement of facilities, would be hazardous to the health and safety of the patients.
  (1) Hazardous locations.
    (A) Underground and above ground hazards. New LSRHs or additions to existing LSRHs shall not be constructed within 150 feet of easement boundaries or setbacks of hazardous underground locations including liquid butane or propane, liquid petroleum or natural gas transmission lines, high pressure lines, and not within the easement of high voltage electrical lines.
    (B) Fire hazards. New LSRHs and additions to existing LSRHs shall not be built within 300 feet of above ground or underground storage tanks containing liquid petroleum or other flammable liquids used in connection with a bulk plant, marine terminal, aircraft refueling, bottling plant of a liquefied petroleum gas installation, or near other hazardous or hazard producing plants.
  (2) Undesirable locations.
    (A) Nuisance producing sites. New LSRHs shall not be located near nuisance producing industrial sites, feed lots, sanitary landfills, or manufacturing plants producing excessive noise or air pollution.
    (B) Cemeteries. New LSRHs shall not be located near a cemetery in a manner that allows direct view of the cemetery from patient windows.
    (C) Flood plains.
      (i) Previously licensed eligible general or special hospital. An existing building or a portion of an existing building located in a designated 100-year flood plain that was previously licensed as a general or special hospital but has been vacated or used for purposes other than a hospital, will not be licensed as an LSRH.
      (ii) Existing LSRH. Access and required functional LSRH components shall be constructed above the designated flood plain in a new addition to an existing LSRH located in a designated 100-year flood plain.
    (D) Airports. Construction of new LSRHs shall be avoided in close proximity to airports. When LSRHs are proposed to be located near airports, recommendations of the Texas Aviation Authority and the Federal Aviation Authority shall apply. An LSRH may not be constructed within a rectangular area formed by lines perpendicular to and two miles (10,560 feet) from each end of any runway and by lines parallel to and one-half mile (2,640 feet) from each side of any runway.
(b) Environmental considerations. Development of an LSRH site and LSRH construction shall be governed by state and local regulations and requirements with respect to the effect of noise and traffic on the community and the environmental impact on air and water.
(c) LSRH site.
  (1) Paved roads and walkways. Paved roads shall be provided within the lot lines to provide access from public roads to the main entrance, emergency entrance, entrances serving community activities, and to service entrances, including loading and unloading docks for delivery trucks.
    (A) Emergency entrance. An LSRH shall have its emergency entrance well-marked to facilitate entry from the public roads or streets serving the site.
    (B) Access to emergency department. Access to the emergency entrance shall not conflict with other vehicular traffic or pedestrian traffic and shall be located so as not to be compromised by floods.
    (C) Pedestrian traffic. Finished surface walkways shall be provided for pedestrians.
  (2) Parking. Off-street parking shall be available for visitors, employees, and staff. Parking structures directly accessible from an LSRH shall be separated with two-hour fire rated noncombustible construction. When used as required means of egress for LSRH occupants, parking structures shall comply with National Fire Protection Association (NFPA) 88A, Standard for Parking Structures, 2011 edition. This requirement does not apply to freestanding parking structures.
    (A) Number of parking places. In the absence of a formal parking study, one parking space shall be provided for each day shift employee plus one space for each patient station. This ratio may be reduced in an area convenient to a public transportation system or to public parking facilities on the basis of a formal parking study. Parking facilities shall be increased accordingly when the size of existing facilities is increased.
    (B) Additional parking. Additional parking shall be required to accommodate medical staff, outpatient and other services when such services are provided.
    (C) Emergency and delivery parking. Separate parking facilities shall be provided for ambulances and delivery vehicles.
(d) Building design and construction requirements. Every building and every portion thereof shall be designed and constructed to sustain all dead and live loads in accordance with accepted engineering practices and standards and the local governing building codes. Where there is no local governing building code, the LSRH shall be constructed in accordance with the International Building Code, 2003 edition.
  (1) General architectural requirements. All new construction, including conversion of an existing building to an LSRH, and establishing a separately licensed LSRH in a building with an existing licensed LSRH, shall comply with Chapter 18 of the NFPA 101, Life Safety Code, 2012 edition (NFPA 101), Subchapter F of this chapter (relating to Fire Prevention and Safety), and this subchapter. An LSRH shall submit construction documents to the Texas Health and Human Services Commission (HHSC) in accordance with §511.167 of this subchapter (relating to Preparation, Submittal, Review, and Approval of Plans, and Retention of Records).
    (A) Physical environment. A physical environment that protects the health and safety of patients, personnel, and the public shall be provided in each LSRH. The physical premises of the LSRH and those areas of the LSRH's physical structure that are used by the patients (including all stairwells, corridors, and passageways) shall meet the local building and fire safety codes, Subchapter F of this chapter, and this subchapter.
    (B) Construction type. An LSRH may occupy an entire building or a portion of a building, provided the LSRH portion of the building is separated from the rest of the building in accordance with subparagraph (C) of this paragraph and the entire building or the LSRH portion of the building complies with this subchapter's requirements (type of construction permitted for hospitals by NFPA 101 §18.1.6.2), and the entire building is protected with a fire sprinkler system conforming with requirements of NFPA 13, Standard for the Installation of Sprinkler Systems, 2010 edition.
    (C) Separate buildings. Portions of a building divided horizontally with two-hour fire rated walls that are continuous (without offsets) from the foundation to above the roof shall be considered as a separate building. Communicating openings in the two-hour wall shall be limited to public spaces such as lobbies and corridors. All such openings shall be protected with self-closing one and one-half hour, Class B fire door assemblies.
    (D) Design for the accessibility. Special considerations benefiting staff, visitors, and patients with disabilities shall be provided. An LSRH 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 (relating to Accessibility Guidelines for Buildings and Facilities) or 16 TAC Chapter 68 (relating to Elimination of Architectural Barriers), Texas Accessibility Standards (TAS), April 1, 1994 edition, issued by the Texas Department of Licensing and Regulation, under Texas Government Code Chapter 469 (relating to Elimination of Architectural Barriers).
    (E) Patient safety. In developing construction documents for submission to HHSC in accordance with §511.167 of this subchapter, the owner shall comply with the requirements of Texas Health and Safety Code Chapter 256 (relating to Safe Patient Handling and Movement Practices). Texas Health and Safety Code §256.002(b)(8) requires an LSRH's governing body to consider the feasibility of incorporating patient handling equipment or the physical space and construction design needed to incorporate that equipment at a later date.
    (F) Other regulations. The more stringent standard, code or requirement shall apply when a difference in requirements for construction exists.
    (G) Exceeding minimum requirements. Nothing in this subchapter shall be construed to prohibit a better type of building construction, more exits, or otherwise safer conditions than the minimum requirements specified in this subchapter.
Cont'd...
(H) Equivalency. Nothing in this subchapter is intended to prevent the use of systems, methods, or devices of equivalent or superior quality, strength, fire resistance, effectiveness, durability, and safety to those prescribed by this subchapter, providing technical documentation that demonstrates equivalency is submitted to HHSC for approval.
    (I) Freestanding buildings (not for patient use). Separate freestanding buildings for nonpatient use such as the heating plant, boiler plant, laundry, repair workshops, or general storage may be of unprotected noncombustible construction, protected noncombustible construction, or fire-resistive construction and be designed in accordance with other occupancy classifications requirements listed in NFPA 101.
    (J) Energy conservation. In new construction and in major alterations and additions to existing buildings and in new buildings, electrical and mechanical components shall be selected for efficient utilization of energy. LSRH construction shall be in accordance with the provisions of Texas Health and Safety Code Chapter 388 (relating to Texas Building Energy Performance Standards).
    (K) Heliports. Heliports located on LSRH buildings or land used or intended to be used for landing and takeoff of helicopters shall comply with National Fire Protection Association 418, Standard for Heliports, 2011 edition.
  (2) General detail and finish requirements. Details and finishes in new construction projects, including additions and alterations, shall be in compliance with this paragraph, with NFPA 101, Chapter 18, with local building codes, and with any specific detail and finish requirements for the particular unit as contained in §511.163 of this subchapter (relating to Spatial Requirements).
    (A) General detail requirements.
      (i) Fire safety. Fire safety features, including compartmentation, means of egress, automatic extinguishing systems, inspections, smoking regulations, and other details relating to fire prevention and fire protection shall comply with §511.161 of this subchapter (relating to Requirements for Buildings in Which Existing Licensed Hospitals Are Located), and NFPA 101, Chapter 18 requirements for hospitals. The Fire Safety Evaluation System for Health Care Occupancies contained in the NFPA 101A, Alternative Approaches to Life Safety, 2010 edition, Chapter 3, shall not be used in new building construction, renovations, or additions to existing LSRHs.
      (ii) Access to exits. Corridors providing access to all patient, diagnostic, treatment, and patient therapy rooms and exits shall be at least eight feet in clear and unobstructed width, not less than seven feet six inches in height, and constructed in accordance with requirements listed in NFPA 101 §18.3.6.
      (iii) Corridors in other occupancies. Public corridors in administrative and service areas that are designed to requirements other than LSRH requirements and are the required means of egress from the LSRH shall be not less than five feet in width.
      (iv) Encroachment into the means of egress. Items such as drinking fountains, telephone booths or stations, and vending machines shall be so located as to not project into and restrict exit corridor traffic or reduce the exit corridor width below the required minimum. Portable equipment shall not be stored so as to project into and restrict exit corridor traffic or reduce the exit corridor width below the required minimum.
      (v) Doors in means of egress. All door leaves in the means of egress shall be not less than 44 inches wide or as otherwise permitted for hospitals by NFPA 101 §18.2.3.6.
      (vi) Sliding doors. Horizontal sliding doors serving an occupant load of fewer than 10 shall be permitted. The area served by the door has no high hazard contents. The door is readily operable from either side without special knowledge or effort. The force required to operate the door in the direction of door travel is not more than 30 pounds per foot to set the door in motion and is not more than 15 pounds per foot to close the door or open in the minimum required width. The door assembly complies with any required fire protection rating, and, where rated, is self-closing or automatic closing. The sliding doors opening to the egress corridor doors shall have a latch or other mechanism that ensures that the doors will not rebound into a partially open position if forcefully closed. The sliding doors may have breakaway provisions and shall be installed to resist passage of smoke. The latching sliding panel shall have a minimum clear opening of 41.5 inches in the fully open position. The fixed panels may have recessed tracks.
      (vii) Control doors. Designs that include cross-corridor control doors should be avoided. When unavoidable, cross-corridor control doors shall consist of two 44-inch wide leaves that swing in a direction opposite from the other, or of the double acting type. Each door leaf shall be provided with a view window.
      (viii) Emergency access. Rooms containing bathtubs, showers, and water closets, intended for patient use shall be provided with at least one door having hardware that will permit access from the outside in any emergency. Door leaf width of such doors shall not be less than 36 inches.
      (ix) Obstruction of corridors. All doors that swing towards the corridor must be recessed. Corridor doors to rooms not subject to occupancy (any room that you can walk into and close the door behind you is considered occupiable) may swing into the corridor, provided that such doors comply with the requirements of NFPA 101 §7.2.1.4.4.
      (x) Stair landing. Doors shall not open immediately onto a stair without a landing. The landing shall be 44 inches deep or have a depth at least equal to the door width, whichever is greater.
      (xi) Doors to rooms subject to occupancy. All doors to rooms subject to occupancy shall be of the swing type except that horizontal sliding doors complying with the requirements of NFPA 101 §18.2.2.2.9 are permitted. Door leaves to rooms subject to occupancy shall not be less than 36 inches wide.
      (xii) Operable windows and exterior doors. Windows that can be opened without tools or keys and outer doors without automatic closing devices shall be provided with insect screens.
      (xiii) Glazing. 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 that 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 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.
      (xiv) Fire doors. All fire doors shall be listed by an independent testing laboratory and shall meet the construction requirements for fire doors in NFPA 80, Standard for Fire Doors and Fire Windows, 2010 edition. Reference to a labeled door shall be construed to include labeled frame and hardware.
      (xv) Grab bars. Grab bars shall be provided at patient toilets, showers and tubs. 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 are not permitted at bathing and toilet fixtures in mental health and chemical dependency units unless designed and installed to eliminate the possibility of patients harming themselves. Grab bars intended for use by the disabled shall also comply with Americans with Disabilities Act of 1990 (ADA) requirements.
      (xvi) Soap dishes. Soap dishes shall be provided at all showers and bathtubs.
      (xvii) Hand washing facilities. Location and arrangement of fittings for hand washing facilities shall permit their proper use and operation. Hand washing fixtures with hands-free operable controls shall be provided within each workroom, examination, and treatment room. Hands-free includes blade-type handles, and foot, knee, or sensor operated controls. 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 provided and conveniently located for staff use throughout the LSRH where patient care contact occurs and services are provided.
      (xviii) Soap dispensers. A liquid or foam soap dispenser shall be located at each hand washing facility.
      (xix) Alcohol-based hand rubs. Alcohol-based hand rubs (ABHRs) are considered flammable. When used, ABHRs shall meet the following requirements.
Cont'd...
(I) The dispensers may be installed in a corridor so long as the corridor width is six feet or greater. The dispensers shall be installed at least four feet apart.
        (II) The maximum individual dispenser fluid capacity is 1.2 liters for dispensers in rooms, corridors, and areas open to corridors, and 2.0 liters for dispensers in suites of rooms.
        (III) The dispensers shall not be installed over or directly adjacent to electrical outlets and switches.
        (IV) Dispensers installed directly over carpeted surfaces shall be permitted only in sprinklered smoke compartments.
        (V) Each smoke compartment may contain a maximum aggregate of 10 gallons of ABHR solution in dispensers and a maximum of five gallons in storage.
      (xx) Hand drying. Provisions for hand drying shall be included at all hand washing facilities except scrub sinks. There shall be hot air dryers or individual paper or cloth units enclosed in such a way as to provide protection against dust or soil and ensure single-unit dispensing.
      (xxi) Mirrors. Mirrors shall not be installed at hand washing fixtures where asepsis control and sanitation requirements would be lessened by hair combing. Mirrors may be installed in patient toilet rooms, lockers, and public toilet rooms.
      (xxii) Ceiling heights. The minimum ceiling height shall be seven feet six inches with the following exceptions.
        (I) Boiler rooms. Boiler rooms shall have ceiling clearances not less than two feet six inches above the main boiler header and connecting piping.
        (II) Rooms with ceiling-mounted equipment. Rooms containing ceiling-mounted equipment shall have the ceiling height clearance increased to accommodate the equipment or fixtures.
        (III) Overhead clearance. 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.
      (xxiii) Areas producing impact noises. Recreation rooms, exercise rooms, and similar spaces where impact noises may be generated shall not be located directly over patient bed area or operating rooms unless special provisions are made to minimize noise.
      (xxiv) Noise reduction. Noise reduction criteria in accordance with the Table 1 in §511.169(a) of this subchapter (relating to Tables) shall apply to partitions, floor, and ceiling construction in patient areas.
      (xxv) Rooms with heat-producing equipment. Rooms containing heat-producing equipment such as heater rooms, laundries, etc. shall be insulated and ventilated to prevent any occupied floor surface above from exceeding a temperature differential of 10 degrees Fahrenheit above the ambient room temperature.
      (xxvi) Chutes. Linen and refuse chutes shall comply with the requirements of NFPA 82, Standard on Incinerators, Waste and Linen Handling Systems and Equipment, 2009 edition, and NFPA 101 §18.5.4.
      (xxvii) Thresholds and expansion joint covers. Thresholds and expansion joint covers shall be flush or not more than one-half inch above the floor surface to facilitate the use of wheelchairs and carts. Expansion and seismic joints shall be constructed to restrict the passage of smoke and fire and shall be listed by a nationally recognized testing laboratory.
      (xxviii) Housekeeping room.
        (I) In addition to any housekeeping rooms required in certain departments, sufficient housekeeping rooms shall be provided throughout the LSRH as required to maintain a clean and sanitary environment.
        (II) Each housekeeping room shall contain a floor receptor or service sink and storage space for housekeeping equipment and supplies.
    (B) General finish requirements.
      (i) Cubicle curtains and draperies.
        (I) Cubicle curtains, draperies, and other hanging fabrics shall be noncombustible or flame retardant and shall pass both the small scale and the large-scale tests of NFPA 701, Standard Methods of Fire Tests for Flame-Resistant Textiles and Films, 2010 edition. Copies of laboratory test reports for installed materials shall be submitted to HHSC at the time of the final construction inspection.
        (II) Cubicle curtains shall be provided to assure patient privacy.
      (ii) Flame spread, smoke development, and noxious gases. Flame spread and smoke developed limitations of interior finishes shall comply with Table 2 of §511.169(b) of this subchapter and NFPA 101 §10.2. The use of materials known to produce large or concentrated amounts of noxious or toxic gases shall not be used in exit accesses or in patient areas. Copies of laboratory test reports for installed materials tested in accordance with NFPA 255, Standard Method of Test of Surface Burning Characteristics of Building Materials, 2000 edition, and NFPA 258, Standard Research Test Method for Determining Smoke Generation of Solid Materials, 2001 edition, shall be provided.
      (iii) Floor finishes. Flooring shall be easy to clean and have wear resistance appropriate for the location involved. Floors that are subject to traffic while wet (such as shower and bath areas, kitchens, and similar work areas) shall have a nonslip surface. In all areas frequently subject to wet cleaning methods, floor materials shall not be physically affected by germicidal and cleaning solutions. The following are acceptable floor finishes:
        (I) painted concrete;
        (II) vinyl and vinyl composition tiles and sheets;
        (III) monolithic or seamless flooring. Where required, seamless flooring shall be impervious to water, coved and installed integral with the base, tightly sealed to the wall, and without voids that can harbor insects or retain dirt particles. The base shall not be less than six inches in height. Welded joint flooring is acceptable;
        (IV) ceramic and quarry tile;
        (V) wood floors. Wood floors subject to frequent cleaning methods shall be avoided. When wood floors are used, the floor shall be tightly sealed, without voids and the joints shall be impervious to water;
        (VI) carpet flooring. Carpeting installed in patient care areas shall be treated to prevent bacterial and fungal growth;
        (VII) terrazzo; and
        (VIII) poured in place floors.
      (iv) Wall finishes. Wall finishes shall be smooth, washable, moisture resistant, and cleanable by standard housekeeping practices. Wall finishes shall comply with requirements contained in Table 2 of §511.169(b) of this subchapter, and NFPA 101 §18.3.3.
        (I) Wall finishes shall be water-resistant in the immediate area of plumbing fixtures.
        (II) Wall finishes subject to frequent wet cleaning methods shall be impervious to water, tightly sealed, and without voids.
      (v) 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.
      (vi) Ceiling types. Ceilings that 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. The following subclauses describe three types of ceilings that are required in various areas of the LSRH.
        (I) Ordinary ceilings. Ceilings such as acoustical tiles installed in a metal grid that are dry cleanable with equipment used in daily housekeeping activities such as dusters and vacuum cleaners.
        (II) Washable ceilings. Ceilings that are made of washable, smooth, moisture impervious materials such as painted lay-in gypsum wallboard or vinyl faced acoustic tile in a metal grid.
        (III) Monolithic ceilings. Ceilings that are monolithic from wall to wall (painted solid gypsum wallboard), smooth and without fissures, open joints, or crevices and with a washable and moisture impervious finish.
      (vii) Special construction. Special conditions may require special wall and ceiling construction for security in areas such as storage of controlled substances and areas where patients are likely to attempt suicide or escape.
      (viii) Flammable anesthetizing locations. Flammable anesthetic locations in which flammable anesthetic agents are stored or administered shall comply with Annex E of NFPA 99, Health Facilities Code, 2012 edition.
      (ix) Materials finishes. Materials known to produce noxious gases when burned shall not be used for mattresses, upholstery, and wall finishes.
Cont'd...
(x) Signage. A sign shall be posted at the entrance to each toilet or restroom to identify the facility for public, staff, or patient use. A sign is not required for patient room bathrooms.
  (3) General mechanical requirements. This paragraph contains common requirements for mechanical systems; steam and hot and cold water systems; air conditioning, heating and ventilating systems; plumbing fixtures; piping systems; and thermal and acoustical insulation. An LSRH shall comply with the requirements of this paragraph and any specific mechanical requirements for the particular unit of the LSRH as described in §511.163 of this subchapter.
    (A) Equipment location. When mechanical equipment is exposed to weather, it shall be weather protected or protected by weatherproof construction.
    (B) Vibration isolation. Mechanical equipment shall be mounted on vibration isolators as required to prevent unacceptable structure-borne vibration. Ducts, pipes, etc. connected to mechanical equipment that is a source of vibration shall be isolated from the equipment with vibration isolators.
    (C) Performance and acceptance. Before completion and acceptance of the facility, all mechanical systems shall be tested, balanced, and operated to demonstrate to the design engineer or their representative that the installation and performance of these systems conform to the requirements of the plans and specifications.
      (i) Material lists. On completion of the contract, the owner shall be provided with parts lists and procurement information with numbers and description for each piece of equipment.
      (ii) Instructions. On completion of the contract, the owner shall be provided with instructions in the operational use of systems and equipment as required.
    (D) Heating, ventilating and air conditioning (HVAC) systems. All HVAC systems shall comply with and shall be installed in accordance with the requirements of NFPA 90A, Standard for the Installation of Air Conditioning and Ventilating Systems, 2012 edition, NFPA 99, Chapter 6, the requirements contained in this subparagraph, and the specific requirements for a particular unit in accordance with §511.163 of this subchapter.
      (i) General ventilation requirements. All rooms and areas in the LSRH listed in Table 3 of §511.169(c) of this subchapter shall have provision for positive ventilation. Fans serving exhaust systems shall be located at the discharge end and shall be conveniently accessible for service. Exhaust systems may be combined, unless otherwise noted, for efficient use of recovery devices required for energy conservation. The ventilation rates shown in Table 3 of §511.169(c) of this subchapter shall be used only as minimum requirements since they do not preclude the use of higher rates that may be appropriate. Supply air to the building and exhaust air from the building shall be regulated to provide a positive pressure within the building with respect to the exterior.
        (I) Cost reduction methods. To reduce utility costs, facility design may utilize energy conserving procedures including recovery devices, variable air volume, load shedding, systems shutdown or reduction of ventilation rates (when specifically permitted) in certain areas when unoccupied. In no case shall patient care be jeopardized.
        (II) Economizer cycle. Mechanical systems shall be arranged to take advantage of outside air conditions by using an economizer cycle when appropriate to reduce heating and cooling systems loads. An LSRH may present to HHSC for consideration an innovative design that provides for additional energy conservation while meeting the intent of this section for acceptable patient care.
        (III) Outside air intake locations. Outside air intakes shall be located at least 25 feet from exhaust outlets of ventilating systems, combustion equipment stacks, medical-surgical vacuum systems, plumbing vents, or areas that may collect vehicular exhaust or other noxious fumes. (Prevailing winds and proximity to other structures may require more stringent requirements). Plumbing and vacuum vents that terminate five feet above the level of the top of the air intake may be located as close as 10 feet.
        (IV) Low air intake location limit. The bottom of outside air intakes serving central systems shall be located as high as practical but at least six feet above ground level, or if installed above the roof, three feet above the roof level.
        (V) Contaminated air exhaust outlets. Exhaust outlets from areas (kitchen hoods, etc.) that exhaust contaminated air shall be above the roof and be arranged to exhaust upward unless the air has been treated by an appropriate means where sidewall exhaust will be allowed. Ethylene oxide sterilizers shall be terminated above the roof and be arranged to exhaust upward. Each patient room bathroom shall be exhausted continuously to the exterior in accordance with Table 3 of §511.169(c) of this subchapter.
        (VI) Directional air flow. Ventilation systems shall be designed and balanced to provide directional flow as shown in Table 3 of §511.169(c) of this subchapter. For reductions and shutdown of ventilation systems when a room is unoccupied, the provisions in Note 4 of Table 3 of §511.169(c) of this subchapter shall be followed.
        (VII) Areas requiring fully ducted systems. Fully ducted supply, return and exhaust air for HVAC systems shall be provided for all critical care areas, sensitive care areas, all patient care areas, all areas requiring a sterile regimen, storage rooms, food preparation areas, and where required for fire safety purposes. Combination systems, utilizing both ducts and plenums for movement of air in these areas shall not be permitted.
        (VIII) Ventilation start-up requirements. Air handling systems shall not be started or operated without the filters installed in place. This includes the 90 percent and 99.97 percent efficiency filters where required. Ducts shall be cleaned thoroughly and throughout by a certified air duct cleaning contractor when the air handling systems have been operating without the required filters in place. When ducts are determined to be dirty or dusty, HHSC will require a written report assuring cleanliness of duct and clean air quality.
        (IX) Humidifier location. When duct humidifiers are located upstream of the final filters, they shall be located at least 15 feet from the filters. Ductwork with duct-mounted humidifiers shall be provided with a means of removing water accumulation. An adjustable high-limit humidistat shall be located downstream of the humidifier to reduce the potential of condensation inside the duct. All duct take-offs should be sufficiently downstream of the humidifier to ensure complete moisture absorption. Reservoir-type water spray or evaporative pan humidifiers shall not be used.
      (ii) Filtration requirements. All central air handling systems serving patient care areas, including corridors, shall be equipped with filters having efficiencies equal to, or greater than, those specified in Table 4 of §511.169(d) of this subchapter. Filter efficiencies shall be average efficiencies tested in accordance with 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. Air handlers serving more than one room shall be considered as central air handlers.
        (I) Filtration requirements for air handling units serving single rooms requiring asepsis control. Dedicated air handlers serving only one room where asepsis control is required, including operating rooms and special procedure rooms shall be equipped with filters having efficiencies equal to, or greater than, those specified for patient care areas in Table 4 of §511.169(d) of this subchapter.
        (II) Filtration requirements for air handling units serving other single rooms. Dedicated air handlers serving all other single rooms shall be equipped with nominal filters installed at the return air system.
        (III) Location of multiple filters. Where two filter beds are required by Table 4 of §511.169(d) of this subchapter, filter bed number one shall be located upstream of the air conditioning equipment, and filter bed number two shall be downstream of the supply air blowers and cooling and heating coils.
        (IV) Location of single filters. Where only one filter bed is required by Table 4 of §511.169(d) of this subchapter, it shall be located upstream of the supply fan. Filter frames shall be durable and constructed to provide an airtight fit with the enclosing ductwork.
        (V) Pressure monitoring devices. A manometer or draft gauge shall be installed across each filter bed having a required efficiency of 75 percent or more including hoods requiring high efficiency particulate air (HEPA) filters.
      (iii) Thermal and acoustical insulation for air handling systems. Asbestos insulation shall not be used.
Cont'd...
(I) Thermal duct insulation. Air ducts and casings with outside surface temperature below ambient dew point or temperature above 80 degrees Fahrenheit shall be provided with thermal insulation.
        (II) Insulation in air plenums and ducts. Linings in air ducts and equipment shall meet the Erosion Test Method described in Underwriters Laboratories (UL), Inc., Standard Number 181 (relating to Factory-Made Duct Materials and Air Duct Connectors), April 4, 1996 edition.
        (III) Insulation flame spread and smoke developed ratings. Interior and exterior insulation, including finishes and adhesives on the exterior surfaces of ducts and equipment, shall have a flame spread rating of 25 or less and a smoke developed rating of 50 or less as required by NFPA 90A Chapters 4 and 5.
        (IV) Linings and acoustical traps. Duct lining and acoustical traps exposed to air movement shall not be used in ducts serving critical care areas. This requirement shall not apply to mixing boxes and acoustical traps that have approved nonabrasive coverings over such linings.
        (V) Frangible insulation. Insulation of soft and spray-on types shall not be used where it is subject to air currents or mechanical erosion or where loose particles may create a maintenance problem.
        (VI) Existing duct linings. Internal linings shall not be used in ducts, terminal boxes, or other air system components supplying operating rooms, delivery rooms, birthing rooms, labor rooms, recovery rooms, nurseries, trauma rooms, isolation rooms, and intensive care units unless terminal filters of at least 90 percent efficiency are installed downstream of linings.
      (iv) Ventilation for anesthetizing locations. Ventilation for anesthetizing locations, as defined in NFPA 99 §3.3, shall comply with NFPA 99 §13.4.1.2, and any specific ventilation requirements for the particular unit in accordance with §511.163 of this subchapter.
        (I) Smoke removal systems for windowless anesthetizing locations. Smoke removal systems shall be provided in all windowless anesthetizing locations in accordance with NFPA 99 §6.4.1.2.
        (II) Smoke removal systems for surgical suites. Smoke removal systems shall be provided in all surgical suites in accordance with NFPA 99 §6.4.1.3.
        (III) Smoke exhaust grilles. Exhaust grilles for smoke evacuation systems shall be ceiling-mounted or wall-mounted within 12 inches of the ceiling.
      (v) Location of return and exhaust air devices. The bottoms of wall-mounted return and exhaust air openings shall be at least four inches above the floor. Return air openings located less than six inches above the floor shall be provided with nominal filters. All exhaust air openings and return air openings located higher than six inches but less than seven feet above the floor shall be protected with grilles or screens having openings through which a one-half inch sphere will not pass.
      (vi) Ray protection. Ducts that penetrate construction intended for X-ray or other ray protection shall not impair the effectiveness of the protection.
      (vii) 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.
      (viii) Smoke damper requirements. Smoke dampers shall be located and installed in accordance with the requirements of NFPA 101 §18.3.7.3 and NFPA 90A Chapter 5.
        (I) Fail-safe installation. Smoke dampers shall close on activation of the fire alarm system by smoke detectors installed and located as required by NFPA 72, National Fire Alarm Code, 2010 edition, Chapter 8; NFPA 90A Chapter 6; and NFPA 101 §18.3.7; the fire sprinkler system; and on loss of power. Smoke dampers shall not close by fan shutdown alone unless it is a part of an engineered smoke removal system.
        (II) Interconnection of air handling fans and smoke dampers. Air handling fans and smoke damper controls may be interconnected so that closing of smoke dampers will not damage the ducts.
        (III) Frangible devices. Use of frangible devices for shutting smoke dampers is not permitted.
      (ix) Acceptable damper assemblies. Only fire damper and smoke damper assemblies integral with sleeves and listed for the intended purpose is acceptable.
      (x) Duct access doors. Unobstructed access to duct openings in accordance with NFPA 90A §4.3.4 shall be provided in ducts within reach and sight of every fire damper, smoke damper, and smoke detector. Each opening shall be protected by an internally insulated door that shall be labeled externally to indicate the fire protection device located within.
      (xi) Restarting controls. Controls for restarting fans may be installed for convenient fire department use to assist in evacuation of smoke after a fire is controlled, provided provisions are made to avoid possible damage to the system because of closed dampers. To accomplish this, smoke dampers shall be equipped with remote control devices.
      (xii) Make-up air. If air supply requirements in Table 3 of §511.169(c) of this subchapter do not provide sufficient air for use by exhaust hoods and safety cabinets, filtered make-up air shall be ducted to maintain the required air flow direction in that room. Make-up systems for hoods shall be arranged to minimize short circuiting of air and to avoid reduction in air velocity at the point of contaminant capture.
      (xiii) Isolation room exhaust. An isolation room exhaust shall be a dedicated system that exhausts all air continuously to the exterior in accordance with Table 3 of §511.169(c) of this subchapter. Multiple isolation rooms may be interconnected to the same exhaust system.
  (4) General piping systems and plumbing fixture requirements. All piping systems and plumbing fixtures shall be designed and installed in accordance with the requirements of the National Standard Plumbing Code Illustrated published by the National Association of Plumbing-Heating-Cooling Contractors (PHCC), 2003 edition, and this paragraph.
    (A) Piping systems.
      (i) Water supply systems. Water service pipe to point of entrance to the building shall be brass pipe, copper tube (not less than type M when buried directly), copper pipe, cast iron water pipe, galvanized steel pipe, or approved plastic pipe. Domestic water distribution system piping within buildings shall be brass pipe, copper pipe, copper tube, or galvanized steel pipe. Piping systems shall be designed to supply water at sufficient pressure to operate all fixtures and equipment during maximum demand.
        (I) Valves. 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. Backflow preventers (vacuum breakers) shall be installed on hose bibbs, laboratory sinks, janitor sinks, bedpan-flushing attachments, autopsy tables, and on all other fixtures to which hoses or tubing can be attached.
        (III) Flushing valves. Flush valves installed on plumbing fixtures shall be of a quiet operating type, equipped with silencers.
        (IV) Capacity of water heating equipment. Water heating equipment shall have sufficient capacity to supply water for clinical, dietary and laundry use at the temperatures and amounts specified in Table 5 of §511.169(e) of this subchapter.
        (V) Water temperature measurements. Water temperatures shall be measured at hot water point of use or at the inlet to processing equipment.
        (VI) Water storage tanks. Any domestic water storage tanks shall be fabricated of corrosion-resistant metal or lined with noncorrosive material. When potable water storage tanks (hot and cold) are used, the water shall be used and replenished. Water shall not be stored in tanks for future use unless the water is tested weekly for contaminates and bacteria.
        (VII) Hot water distribution. Water distribution systems shall be arranged to provide hot water at each hot water outlet at all times.
        (VIII) Purified water supply system. Purified water distribution system piping shall be task specific and include Polypropylene (PP), Polyvinylidene fluoride (PVDF) or Polyvinyl Chloride (PVC) pipe. Final installed purified water system piping assemblies shall be UL approved and fully comply with applicable American Society for Testing and Materials (ASTM) Fire Resistant/Smoke Density requirements.
        (IX) Dead-end piping. Dead-end piping (risers with no flow, branches with no fixture) shall not be installed. In any renovation work, dead-end piping shall be removed. Empty risers, mains and branches installed for future use are permitted.
Cont'd...
(ii) Fire sprinkler systems. Fire sprinkler systems shall be provided in an LSRH as required by NFPA 101 §18.3.5. All fire sprinkler systems shall be designed, installed, and maintained in accordance with the requirements of NFPA 13, and shall be certified as required by §511.168(c)(1)(C) of this subchapter (relating to Construction, Inspections, and Approval of Project).
      (iii) Nonflammable medical gas and clinical vacuum systems. Nonflammable medical gas and clinical vacuum system installations shall be designed, installed, and certified in accordance with the requirements of NFPA 99 §5.1 for Level I systems and the requirements of this clause.
        (I) Outlets. Nonflammable medical gas and clinical vacuum outlets shall be provided in accordance with Table 6 of §511.169(f) of this subchapter.
        (II) Installer qualifications. All installations of the medical gas piping systems shall be done only by, or under the direct supervision of, a holder of a master plumber license or a journeyman plumber license with a medical gas piping installation endorsement issued by the Texas State Board of Plumbing Examiners.
        (III) Installer tests. Prior to closing of walls, the installer shall perform an initial pressure test, a blowdown test, a secondary pressure test, a cross-connection test, and a purge of the piping system as required by NFPA 99.
        (IV) Qualifications for conducting verification tests and inspections. Verification testing shall be performed and inspected by a party, other than the installer, installing contractor, or material vendor. Testing shall be conducted by a registered medical gas system verifier and technically competent and experienced in the field of medical gas and vacuum pipeline testing and meeting the requirements of the American Society of Safety Engineers (ASSE) Personnel Standard 6030, Professional Qualifications Standard for Medical Gas Systems.
        (V) Verification tests. On completion of the installer inspections and tests and after closing of walls, verification tests of the medical gas piping systems, the warning system, and the gas supply source shall be conducted. The verification tests shall include a cross-connection test, valve test, flow test, piping purge test, piping purity test, final tie-in test, operational pressure tests, and medical gas concentration test.
        (VI) Verification test requirements. Verification tests of the medical gas piping system and the warning system shall be performed on all new piped medical gas systems, additions, renovations, or repaired portions of an existing system. All systems that are breached and components that are added, renovated, or replaced shall be inspected and appropriately tested. The breached portions of the systems subject to inspection and testing shall be all of the new and existing components in the immediate zone or area located upstream of the point or area of intrusion and downstream to the end of the system or a properly installed isolation valve.
        (VII) Warning system verification tests. Verification tests of piped medical gas systems shall include tests of the source alarms and monitoring safeguards, master alarm systems, and the area alarm systems.
        (VIII) Source equipment verification tests. Source equipment verification tests shall include medical gas supply sources (bulk and manifold) and the compressed air source systems (compressors, dryers, filters, and regulators).
        (IX) LSRH responsibility. Before new piped medical gas systems, additions, renovations, or repaired portions of an existing system are put into use, the LSRH is responsible for ensuring the gas delivered at the outlet is the gas shown on the outlet label and the proper connecting fittings are checked against their labels.
        (X) Written certification. On successful completion of all verification tests, written certification for affected piped medical gas systems and piped medical vacuum systems including the supply sources and warning systems shall be provided by a party technically competent and experienced in the field of medical gas pipeline testing stating the provisions of NFPA 99 have been adhered to and systems integrity has been achieved. The written certification shall be submitted directly to the LSRH and the installer. The LSRH shall forward a copy to HHSC.
        (XI) Documentation of medical gas and clinical vacuum outlets. The same party certifying the piped medical gas systems shall submit to HHSC documentation of the installed, modified, extended or repaired medical gas piping system. The number and type of medical gas outlets (oxygen, vacuum, medical air, nitrogen, nitrous oxide, etc.) shall be documented and arranged tabularly by room numbers and room types.
      (iv) Medical gas storage facilities. Main storage of medical gases may be outside or inside the LSRH 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.
      (v) Multiple gas outlets on one medical gas outlet. Y-connections, "twinning," or other similar devices shall not be used on any medical gas outlet.
      (vi) Waste anesthetic gas disposal (WAGD) systems. Each space routinely used for administering inhalation anesthesia shall be provided with a WAGD system as required by NFPA 99 §5.1.3.7.
      (vii) Steam and hot water systems.
        (I) Boilers. Boilers shall have the capacity, based on the net ratings as published in the I-B-R Ratings Book for Boilers, Baseboard Radiation and Finned Tube (commercial) by the Hydronics Institute Division of Gas Appliance Manufacturers Association, to supply the normal requirements of all systems and equipment. The number and arrangement of boilers shall be such that, when one boiler breaks down or routine maintenance requires that one boiler be temporarily taken out of service, the capacity of the remaining boiler or boilers shall be sufficient to provide hot water service for clinical, dietary, and patient use, steam for sterilization and dietary purposes, and heating for operating, emergency, recovery, treatment, and general patient care rooms. However, reserve capacity for space heating of noncritical care areas (e.g., general patient care rooms and administrative areas) is not required in geographical areas where a design dry bulb temperature equals 25 degrees Fahrenheit or higher as based on the 99 percent design value shown in the Handbook of Fundamentals, 2005 edition, published by ASHRAE, Inc.
        (II) Boiler accessories. Boiler feed pumps, heating circulating pumps, condensate return pumps, and fuel oil pumps shall be connected and installed to provide normal and standby service.
        (III) Valves. Supply and return mains and risers of cooling, heating, and process steam systems shall be valved to isolate the various sections of each system. Each piece of equipment shall be valved at the supply and return ends except that vacuum condensate returns need not be valved at each piece of equipment.
        (IV) Hot water distribution systems. Hot water distribution systems for patient care areas shall be under constant recirculation to provide continuous hot water at each hot water outlet. Nonrecirculated fixtures branch piping shall not exceed 25 feet in length. Water temperature is measured at the point of use or inlet to the equipment. Tankless water system may be used at point of use.
        (V) Domestic hot water system. The domestic hot water system shall make provisions to limit the amount of Legionella bacteria and opportunistic waterborne pathogens.
      (viii) Drainage systems.
        (I) Above ground piping. Soil stacks, drains, vents, waste lines, and leaders installed above ground within buildings shall be drain-waste-vent (DWV) weight or heavier and shall be copper pipe, copper tube, cast iron pipe, or galvanized iron pipe.
        (II) Underground piping. All underground building drains shall be cast iron soil pipe, hard temper copper tube (DWV or heavier), acrylonitrile-butodiene-styrene (ABS) plastic pipe (DWV Schedule 40 or heavier), polyvinyl chloride (PVC) plastic pipe (DWV Schedule 40 or heavier), or extra strength vitrified clay pipe (VCP) with compression joints or couplings with at least 12 inches of earth cover.
        (III) Drains for chemical wastes. Separate drainage systems for chemical wastes (acids and other corrosive materials) shall be provided. Materials acceptable for chemical waste drainage systems shall include chemically resistant glass pipe, high silicone content cast iron pipe, VCP, plastic pipe, or plastic lined pipe.
      (ix) Thermal insulation for piping systems and equipment. Insulation shall be provided for the following:
        (I) boilers, smoke breeching, and stacks;
        (II) steam supply and condensate return piping;
        (III) hot water piping and all hot water heaters, generators, converters, and storage tanks;
Cont'd...
(IV) chilled water, refrigerant, other process piping, equipment operating with fluid temperatures below ambient dew point, and water supply and drainage piping on which condensation may occur. Insulation on cold surfaces shall include an exterior vapor barrier; and
        (V) other piping, ducts, and equipment as necessary to maintain the efficiency of the system.
      (x) Pipe and equipment insulation rating. Flame spread shall not exceed 25 and smoke development rating shall not exceed 150 for pipe insulation as determined by an independent testing laboratory in accordance with NFPA 255, Standard Method of Test of Surface Burning Characteristics of Building Materials, 2000 edition. Smoke development rating for pipe insulation located in environmental air areas shall not exceed 50.
      (xi) Asbestos insulation. Asbestos insulation shall not be used.
    (B) Plumbing fixtures. Plumbing fixtures shall be made of nonabsorptive acid-resistant materials and shall comply with the recommendations of the National Standard Plumbing Code and this paragraph.
      (i) Sink and lavatory controls. All fixtures used by medical and nursing staff and all lavatories used by patients and food handlers shall be trimmed with valves that 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 be used.
      (ii) Clinical sink traps. Clinical sinks shall have an integral trap in which the upper portion of a visible trap seal provides a water surface.
      (iii) Sinks for disposal of plaster of paris. Sinks used for the disposal of plaster of paris shall have a plaster trap.
      (iv) 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.
      (v) Drinking fountain. Each drinking fountain shall be designed so that the water issues at an angle from the vertical, the end of the water orifice is above the rim of the bowl, and a guard is located over the orifice to protect it from lip contamination.
      (vi) Sterilizing equipment. All sterilizing equipment shall be designed and installed to prevent not only the contamination of the water supply but also the entrance of contaminating materials into the sterilizing units.
      (vii) Hose attachment. No hose shall be affixed to any faucet if the end of the hose can become submerged in contaminated liquid unless the faucet is equipped with an approved, properly installed vacuum breaker.
      (viii) Bedpan washers and sterilizers. 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.
      (ix) Flood level rim clearance. The water supply spout for lavatories and sinks required in patient care areas shall be mounted so that its discharge point is a minimum of five inches above the rim of the fixture.
      (x) Scrub sink controls. Scrub sinks and lavatories used for scrubbing in procedure rooms shall be trimmed with foot, knee, or ultrasonic controls. Single lever wrist blades are not acceptable at scrub sinks.
      (xi) 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 grilled drain cover to prevent entry of large particles of waste that might cause stoppages.
      (xii) Under-counter piping. Under-counter piping and above floor drains shall be arranged (raised) so as not to interfere with cleaning of floor below the equipment.
      (xiii) 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.
      (xiv) Food disposal units. A food disposal unit shall only be permitted in the dietary department in accordance with §511.163(d) of this subchapter.
  (5) General electrical requirements. This paragraph contains common electrical requirements. The LSRH shall comply with the requirements of this paragraph and with any specific electrical requirements for the particular unit of the LSRH in accordance with §511.163 of this subchapter.
    (A) Electrical installations. All new electrical material and equipment, including conductors, controls, and signaling devices, shall be installed in compliance with applicable sections of NFPA 70, National Electrical Code, 2011 edition, and NFPA 99 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 manufacturers' instructions.
      (i) All fixtures, switches, sockets, and other pieces of apparatus shall be maintained in a safe and working condition.
      (ii) Extension cords and cables shall not be used for permanent wiring.
      (iii) 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.
      (iv) All equipment, fixtures, and appliances shall be properly grounded in accordance with NFPA 70.
      (v) Under-counter receptacles and conduits shall be arranged (raised) to not interfere with cleaning of floor below the equipment.
    (B) Installation testing and certification.
      (i) Installation testing. The electrical installations, including alarm, nurses calling system and communication systems, shall be tested to demonstrate that equipment installation and operation is appropriate and functional.
      (ii) Grounding system testing. The grounding system shall be tested as described in NFPA 99 4.3.3, for patient care areas in new or renovated work. A qualified electrician or their qualified electrical testing agent shall perform the testing. The electrical contractor shall provide a letter stating the grounding system has been tested in accordance with NFPA 99, the testing device use complies with NFPA 99, and whether the grounding system passed the test. The qualified electrical contractor or their designated qualified electrical testing agent shall sign the letter, certifying the system has been tested and the results of the test are indicated.
    (C) 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.
    (D) Services and switchboards. Electrical service and switchboards serving the required LSRH components shall be installed above the designated 100-year flood plain. 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.
    (E) Panelboards. Panelboards serving normal lighting and appliance circuits shall be located on the same floor as the circuits they serve. Panelboards serving critical branch emergency circuits shall be located on each floor that has major users (operating rooms, emergency department, etc.) and may also serve the floor above and the floor below. Panelboards serving life safety branch circuits may serve three floors, the floor where the panelboard is located and the floors above and below.
    (F) Wiring. All conductors for controls, equipment, lighting and power operating at 100 volts or higher shall be installed 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.
    (G) Lighting.
      (i) Lighting intensity for staff and patient needs shall comply with guidelines for health care facilities set forth in the Illuminating Engineering Society of North America (IESNA) Handbook, 2000 edition, published by the IESNA.
        (I) Consideration should be given to controlling intensity and wavelength to prevent harm to the patient's eyes (i.e., cataracts due to ultraviolet light).
Cont'd...
(II) Approaches to buildings and parking lots shall be illuminated. All rooms including storerooms, electrical and mechanical equipment rooms, and all attics shall have sufficient artificial lighting so all parts of these spaces are clearly visible.
        (III) Consideration should be given to the special needs of the elderly. Excessive contrast in lighting levels that makes effective sight adaptation difficult shall be minimized.
      (ii) Means of egress and exit sign lighting intensity shall comply with NFPA 101 §§7.8 - 7.10.
      (iii) Electric lamps that may be subject to breakage or that 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.
      (iv) Ceiling-mounted surgical and examination light fixtures shall be suspended from rigid support structures mounted above the ceiling.
    (H) Receptacles. Only listed hospital grade single-grounding or duplex-grounding receptacles shall be used in all patient care areas. This does not apply to special purpose receptacles.
      (i) Installations of multiple-ganged receptacles shall not be permitted in patient care areas.
      (ii) Electrical outlets powered from the critical branch shall be provided in all patient care, procedure and treatment locations in accordance with NFPA 99 §4.4.2.2.2.3. At least one receptacle at each patient treatment or procedure location shall be powered from the normal power panel.
      (iii) Replacement of malfunctioning receptacles and installation of new receptacles powered from the critical branch in existing facilities shall be accomplished with receptacles of the same distinct color as the existing receptacles.
      (iv) 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.
      (v) Each receptacle shall be grounded to the reference grounding point by means of a green insulated copper equipment grounding conductor.
      (vi) All critical care area receptacles shall be identified. The face plate for the receptacle or receptacles shall have a nonremovable label or be engraved indicating the panel and circuit number.
    (I) Equipment.
      (i) Equipment required for safe operation of the LSRH shall be powered from the equipment system in accordance with the requirements contained in NFPA 99 §4.4.2.2.3.
      (ii) Boiler accessories including feed pumps, heat-circulating pumps, condensate return pumps, fuel oil pumps, and waste heat boilers shall be connected and installed to provide both normal and standby service.
      (iii) Laser equipment shall be installed according to manufacturer recommendations and shall be registered with the Texas Department of State Health Services Radiation Control Program.
    (J) Ground fault circuit interrupters (GFCI). 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. Receptacles connected to the critical branch that may be used for equipment that should not be interrupted do not have to be GFCI protected. Receptacles in wet locations, as defined by NFPA 70 §517.20 and §517.21, shall be GFCI protected regardless of the branch of the electrical system serving the receptacle.
    (K) Grounding requirements. In areas such as a critical care unit where a patient may be treated with an internal probe or catheter connected to the heart, the ground system shall comply with applicable sections of NFPA 99 and NFPA 70.
    (L) Nurses calling systems. Three different types of nurses calling systems are required to be installed in an LSRH: a nurses regular calling system; a nurses emergency calling system; and a staff emergency assistance calling system. The LSRH shall comply with the requirements of this subparagraph in addition to any specific requirements for nurses calling systems for the particular unit of the LSRH in accordance with §511.163 and Table 7 of §511.169(g) of this subchapter. When required in this subparagraph, when a colored dome light lamp or particular combination of colored lamps is used for only one type of call, a distinct visible signal shall be (used or provided). Different flash rates do not meet this requirement.
      (i) A nurses regular calling system is intended for routine communication between each patient and the nursing staff. Activation of the system at a patient's regular calling station will sound a repeating (every 20 seconds or less) distinct audible signal at the nurse station, indicate type and location of call on the system monitor, and activate a distinct visible signal in the corridor at the patient suites door. In multi-corridor nursing units, additional visible signals shall be installed at corridor intersections. The audible signal shall be canceled and two-way voice communication between the patient room and the nursing staff shall be established at the unit's nursing station when the call is answered by the nursing staff. The visible signal or signals in the corridor shall be canceled upon termination of the call. Calls shall activate visible signals in accordance with Table 7 of §511.169(g) of this subchapter. An alarm shall activate at the nurse station when the call cable is unplugged.
      (ii) A nurses emergency calling system shall be installed in all toilets used by patients to summon nursing staff in an emergency. Activation of the system shall sound a repeating (every 5 seconds or less) a distinct audible signal at the nurse station, indicate type and location of call on the system monitor, and activate a distinct visible signal in the corridor at the patient suites door. In multi-corridor nursing units, additional visible signals shall be installed at corridor intersections. The visible and audible signals shall be cancelable only at the patient calling station. Calls shall activate visible signals in accordance with Table 7 of §511.169(g) of this subchapter. When conveniently located and accessible from both the bathing and toilet fixtures, one emergency call station may serve one bathroom. A nurses emergency call system shall be accessible to a collapsed patient lying on the floor. Inclusion of a pull cord extending to within six inches of the floor will satisfy this requirement.
      (iii) A staff emergency assistance calling system (code blue) is intended to be used by staff to summon additional help in an emergency. In open suites, an emergency assistant call system device shall be located at the head of each patient station and in each individual room. The emergency assistance calling device can be shared between two patient stations if conveniently located. Activation of the system will sound a distinct audible signal at the nursing unit's nurse station or at a staffed control station of a suite, department or unit, indicate type and location of call on the system monitor and activate a distinct visible signal in the corridor at the patient suites door. In multi-corridor nursing units, additional visible signals shall be installed at corridor intersections. Calls shall activate audible and visible signals in accordance with Table 7 of §511.169(g) of this subchapter. A visible system shall clearly define the alarm location to a continuously staffed back up area (other than the nurse station or an administrative center) from which assistance can be summoned. Alternatively, back up may be provided by automatic annunciation from the staff emergency assistance calling system through wireless phones or pagers. The system shall have voice communication capability so that the type of emergency or help required may be specified between the point of alarm and the unit's nurse station.
    (M) Emergency electric service. A type I essential electrical system shall be provided in each LSRH in accordance with requirements of NFPA 99; NFPA 101; and NFPA 110, Standard for Emergency and Standby Power Systems, 2010 edition.
      (i) When the emergency and standby power systems require a fuel source with tank, the fuel storage capacity tank shall have enough fuel for a 24-hour period.
      (ii) When a vapor liquefied petroleum gas (LPG) systems (natural gas) system is used, the 24-hour fuel capacity on-site is not required. The vapor withdrawal LPG system shall require a dedicated fuel supply.
      (iii) When the emergency generator or generators and electrical transformer or transformers are located within the same area, they shall be located at least 10 feet apart.
    (N) Fire alarm system. A fire alarm system that complies with NFPA 101 §18.3.4, and with NFPA 72 Chapter 6 requirements shall be provided in each LSRH. The required fire alarm system components are as follows.
Cont'd...
(i) A fire alarm control panel (FACP) shall be installed at a continuously attended (24 hour) location. A remote fire alarm annunciator listed for fire alarm service and installed at a continuously attended location and is 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.
      (ii) Manual fire alarm pull stations shall be installed in accordance with NFPA 101 §18.3.4.
      (iii) Smoke detectors for door release service shall be installed on the ceiling at each door opening in the smoke partition in accordance with NFPA 72 §6.15.6, where the doors are held open with electromagnetic devices conforming with NFPA 101 §18.2.2.6.
      (iv) Ceiling-mounted smoke detector or detectors shall be installed in room containing the FACP when this room is not attended continuously by staff as required by NFPA 72 §4.4.5.
      (v) Smoke detectors shall be installed in air ducts in accordance with NFPA 72 §5.14.4.2 and §5.14.5 and NFPA 90A §6.4.2.
      (vi) Smoke detectors shall be installed in 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.
      (vii) Fire sprinkler system water flow switches shall be installed in accordance with requirements of NFPA 101 §9.6.2; NFPA 13 §6.9; and NFPA 72 §8.5.3.3.3.4.
      (viii) Sprinkler system valve supervisory switches shall be installed in accordance with the requirements of NFPA 72 §6.8.5.5.
      (ix) Audible alarm indicating devices shall be installed in accordance with the requirements of NFPA 101 §18.3.4 and NFPA 72 §7.4.
      (x) Visual fire alarm indicating devices that comply with the requirements of paragraph (1)(D) of this subsection and NFPA 72 §7.5 shall be provided.
      (xi) Devices for transmitting alarm for alerting the local fire brigade or municipal fire department of fire or other emergency shall be provided. 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.
      (xii) A smoke detection system for spaces open to a corridor shall be provided when required by NFPA 101 §18.3.6.1.
      (xiii) A fire alarm signal notification that complies with NFPA 101 §9.6.3 shall be provided to alert occupants of fire or other emergency.
      (xiv) Wiring for fire alarm detection circuits and fire alarm notification circuits shall comply with requirements of NFPA 70 Article 760.
      (xv) A smoke detection system for elevator recall shall be located in elevator lobbies, elevator machine rooms and at the top of elevator hoist ways as required by NFPA 72 §6.15.3.10.
        (I) The elevator recall smoke detection system in new construction shall comply with requirements of American Society of Mechanical Engineers/American National Standards Institute (ASME/ANSI) A17.1, Safety Code for Elevators and Escalators, 2000 edition.
        (II) The elevator recall smoke detection system in existing hospitals shall comply with requirements of ASME/ANSI A17.3, Safety Code for Existing Elevators and Escalators, 2002 edition.
      (xvi) Smoke detectors for initiating smoke removal from windowless anesthetizing areas shall be provided in accordance with NFPA 99 §6.4.1.2.
      (xvii) Smoke detectors for initiating smoke removal from surgical suites shall be provided in accordance with NFPA 99 §6.4.1.3.
      (xviii) A smoke detection system for initiating smoke removal from atriums shall be located above the highest floor level of the atrium and at return intakes from the atrium in accordance with NFPA 92B, Guide for Smoke Management Systems in Malls, Atria, and Large Areas, 2000 edition.
      (xix) A smoke detector or detectors for shutdown of air handling units shall be provided. The detectors shall be installed in accordance with NFPA 90A §6.4.3.
    (O) Telecommunications and information systems. Telecommunications and information systems central equipment shall be installed in a separate location designed for the intended purpose. Special air conditioning and voltage regulation shall be provided as recommended by the manufacturer.
    (P) Lightning protection systems. When installed, lightning protection systems shall comply with NFPA 780, Standard for the Installation of Lightning Protection Systems, 2000 edition.
  (6) General design requirements. Services that the LSRH provides to patients under the LSRH license shall be within the LSRH. The services may be provided throughout the LSRH within identifiable suites, departments or units within the LSRH however all required units in this chapter shall be in one identifiable contiguous location. To be included in the LSRH license, a required patient care unit or support areas shall be physically connected to the LSRH and become contiguous to the LSRH. In no case may one leave the LSRH, traverse the other occupancies, and then reenter the LSRH to access the remaining portion of the LSRH. An LSRH may not occupy two or more noncontiguous areas of non-LSRH occupancies that contain intervening space of the non-LSRH occupancies even if on the same floor or other floors.

Source Note: The provisions of this §511.162 adopted to be effective October 5, 2023, 48 TexReg 5668