Section 330.1243. Construction and equipment of nursing units generally.

(1) Each patient room in a nursing unit shall meet all of the following standards:

(a)  ) Maximum room capacity shall be 4 patients.

(b)    Patient room areas, exclusive of toilet rooms, closets, lockers, wardrobes, alcoves, or vestibules, shall be not less than 9.29 square meters (100 square feet) for single-bed rooms and 7.43 square meters (80 square feet) per bed for multiple-bed rooms. Minor encroachments, including columns and lavatories, that do not interfere with functions may be ignored when determining space requirements for patient rooms. In multiple-bed rooms, a clearance of 1.12 meters (3 feet 8 inches) shall be available at the foot of each bed to permit the passage of equipment and beds. The areas noted in this subdivision are intended  as  recognized minimums and do not prohibit the use of larger rooms  where required  for needs and functions.

(c)   Patient rooms intended for 24-hour occupancy or more shall have operable windows. Special tools for window operation may be used if these are available at all times for staff use.

(d)   Hand-washing facilities shall be provided in each patient room. The lavatory may be omitted from a bedroom if a water closet and lavatory are provided in a toilet room designed to serve 1 single-bed room or  1 2-bed room.

(e)    Each patient shall have access to a toilet room without entering the general corridor area. One toilet room shall serve not more than 4 beds and not more than 2 patient rooms. The toilet room shall contain a water closet and a lavatory. The lavatory may be omitted from a toilet room if each patient room  served  by  that  toilet contains  a lavatory   for hand-washing.

(f)   Each patient shall have within his or her room a separate wardrobe, locker, or closet  suitable for hanging full-length  garments  and  for storing personal effects.

(g)   In multiple-bed rooms, visual privacy shall be provided for each patient. The design for privacy shall not restrict patient access  to  the entrance, lavatory, or toilet.

(h)   Ceilings shall be monolithic from wall to wall without fissures.

(2)  Provisions for the services noted in this subrule shall be located in, or be readily available to, each nursing unit. The size and location of each service area will depend upon the numbers and types of beds served. Identifiable  spaces  are  required  for each of the indicated functions. Each service area may be arranged and located to serve more than 1 nursing unit, but, unless noted otherwise, at least 1 such service area shall be provided on each nursing floor. Where the word "room" or "office" is used, a separate, enclosed space for the 1 named function is intended; otherwise, the described area may be a specific space in another room or common area. Service areas shall include all of the following:

(a)  Administrative center or nurses' station.

(b)   Nurses' office for floor staff.

(c)   Administrative supplies storage.

(d)  Lavatories for hand-washing, conveniently accessible to the nurses' station, drug distribution station, and nourishment center. One lavatory may serve several areas if convenient to each area.

(e)   ) Charting facilities.

(f)  Toilet rooms for staff.

(g)    Staff lounge facilities. These facilities may be centrally located on another floor.

(h)   Securable closets or cabinet compartments for the personal effects of nursing personnel, conveniently located to the duty station. At a minimum, the closets or cabinets shall be large enough  for   purses  and billfolds. Coats may be stored in closets or cabinets on each floor  in  a central staff locker area.

(i)       Multipurpose rooms for staff and patient conferences, education, demonstrations, and consultation. These rooms shall be  conveniently accessible to each nursing unit. The rooms may be on other floors  if convenient for regular use. One such room may serve several nursing units or departments, or both.

(j)   Examination and treatment rooms. These rooms may be omitted if all beds in the facility are single-bed patient rooms. The examination and treatment rooms may serve several nursing units and may be on a different floor if conveniently located for routine use. Examination rooms shall have a minimum floor area of 11.2 square meters (120 square feet), excluding space for vestibules, toilets, and closets. The room shall contain a lavatory or sink equipped for hand-washing, storage  facilities, and a desk, counter, or shelf space for writing.

(k)   Clean workroom or clean holding room. If the room is used for preparing patient care items, it shall contain a counter and hand-washing and storage facilities. If the room is used only for storage and holding as part of a system for the distribution of clean and sterile supply materials, the work counter and hand-washing facilities may be omitted.

(l)   Soiled material  workroom.  This  room  shall  contain  all  of  the following:

(i)   A clinical sink or equivalent flushing rim fixture.

(ii)   A sink equipped for hand-washing.

(iii)   A work counter.

(iv)   Waste receptacles.

(v)   A linen receptacle.

Rooms used only for the temporary holding of soiled material need not contain hand-washing sinks or work counters. However, if a flushing rim sink is omitted, other provisions for the disposal of liquid waste at each unit shall be made if the program requirements so dictate.

(m)   Drug distribution station. Provision shall be made for the 24-hour distribution of medications. This may be from a medicine preparation room or unit, from a self- contained medicine dispensing unit, or by another  approved  system.  If  used,  a medicine preparation room or unit shall be under the visual control of nursing staff. A medical preparation room shall contain a work counter, sink, refrigerator, and locked storage for controlled drugs and shall have a minimum area of 4.65 square meters (50 square feet). A self-contained medicine dispensing unit may be located at the nurses' station, in the clean workroom, or in an alcove. As standard cup-sinks provided in many self-contained units are not  adequate  for hand-washing,  provision  shall   be  made for  convenient   access    to hand-washing facilities.

(n)   Clean linen storage. Each nursing unit shall contain a designated area for clean linen storage. This may be within    the   clean    workroom,   a separate closet, or an

approved distribution system on each  floor.  If  a closed cart system is used, storage may be in an alcove. Carts shall be out of the path of normal traffic.

(o)     Nourishment  station.  This  station  shall  contain  all  of  the following:

(i)   A sink.

(ii)   A work counter.

(iii)   A refrigerator.

(iv)   Storage cabinets.

(v)   Equipment for serving nourishment between scheduled meals.

Provisions and space shall be included for the separate temporary storage of unused and soiled dietary trays which are not picked up at mealtime. In place of a nourishment station, kitchen service may be provided within the unit. If kitchen service is used, this shall include a sink equipped for hand-washing, storage space, a refrigerator, and facilities  for meal preparation.

(p)     Ice machine. Each nursing unit shall have equipment to provide ice for treatments and nourishment. Ice-making equipment may be in the clean workroom or at the nourishment station under staff control. Ice intended for human consumption shall be from self-dispensing ice makers.

(q)   Equipment storage room. Storage space for stretchers and wheelchairs may be outside the psychiatric unit if provisions are made for convenient access as needed for handicapped patients.

(r)    Bathing facilities. A bathtub or shower shall be provided for each 6 beds not otherwise served by bathing facilities within the patient rooms.

(s)     Emergency equipment storage. Space shall be provided for emergency equipment, such as a cardiopulmonary resuscitation (CPR) cart, which is under direct control of the nursing staff, in close proximity to the nurses' station, but out of normal traffic.

(t)   Direct access to a janitor's closet for each nursing unit and not less than 1 janitor's closet for each floor. Each janitor's closet shall contain a service sink or receptor and provisions for the storage of supplies. This provision is in addition to separate janitor's closets that may otherwise be required for the exclusive use of specific services.

(u)   An electrical receptacle shall be a safety-type receptacle or be protected by 5 milliampere ground fault interrupters (GFI).

History: 1990 AACS.