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007.05.10-50. Physical Facilities, Obstetrical Facilities.

AR ADC 007.05.10-50Arkansas Administrative CodeEffective: February 5, 2021

West's Arkansas Administrative Code
Title 007. Department of Health
Division 05. Health Facility Services
Rule 10. Rules for Critical Access Hospitals in Arkansas (Refs & Annos)
Effective: February 5, 2021
Ark. Admin. Code 007.05.10-50
007.05.10-50. Physical Facilities, Obstetrical Facilities.
General obstetrical unit shall be located and designated to prohibit non-related traffic through the unit. When delivery and operating rooms are in the same suite, access and service arrangements shall be such that neither staff nor patients need to travel through one area to reach the other. Except as permitted otherwise herein, existing facilities being renovated shall, as far as practicable, provide all the required support services.
A. Postpartum Unit.
1. Postpartum Room.
a. A postpartum room shall have a minimum of 100square [FN1] feet of clear floor area per bed in multi-bedded rooms and 120square [FN1] feet of clear floor area in single-bed rooms. These areas shall be exclusive of toilet rooms, closets, alcoves, or vestibules. Where renovation work is undertaken, every effort shall be made to meet the above minimum standards. If it is not possible to meet the above square -- foot standards, the authorities having jurisdiction may grant approval to deviate from this requirement. In such cases, existing postpartum patient rooms shall have no less than 80 square feet of clear floor area per bed in multiple-bed rooms and 100 square feet in single-bed rooms.
b. In multi-bedded rooms there shall be a minimum clear distance of four feet between the foot of the bed and the opposite wall, three feet between the side of the bed and nearest wall, and four feet between beds.
c. The maximum number of beds per room shall be two.
2. The following support services for this unit shall be provided.
a. Nurses' station.
b. Nurse office.
c. Charting facilities.
d. Toilet room for staff.
e. Staff lounge.
f. Lockable closets or cabinets for personal articles of staff.
g. Consultation/conference room(s).
h. Patients' lounge. The patients' lounge may be omitted if all rooms are single-bedded rooms
i. Clean workroom or clean supply room. A clean workroom is required if clean materials are assembled within the obstetrical suite prior to use. It shall contain a work counter, a handwashing fixture, and storage facilities for clean and sterile supplies. If the room is used only for storage and holding as part of a system for distribution of clean and sterile supply materials, the work counter and handwashing fixtures may be omitted. Soiled and clean workrooms or holding rooms shall be separated and have no direct connection.
j. Soiled workroom or soiled holding room for the exclusive use of the obstetrical suite. This room shall be separate from the clean workroom. The soiled workroom shall contain a clinical sink (or equivalent flushing-rim fixture) and a handwashing fixture. The above fixtures shall have a hot and cold mixing faucet. The room shall have work counter and space for separate covered containers for soiled linen and waste. Rooms used only for temporary holding of soiled material may omit the clinical sink and work counter. If the flushing-rim clinical sink is omitted, facilities for cleaning bedpans shall be provided elsewhere.
k. Medication station. Provision shall be made for storage and distribution of drugs and routine medications. This may be done 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 visual control of nursing staff. It shall contain a work counter, sink, refrigerator, and double-locked storage for controlled substances. Convenient access to handwashing stations shall be provided. (Standard cup-sinks provided in many self-contained units are not adequate for handwashing.)
l. Clean linen storage may be part of a clean workroom or a separate closet. When a closed cart system is used, the cart shall be stored out of the path of normal traffic.
m. Nourishment station shall contain sink, work counter, ice dispenser, refrigerator, cabinets, and equipment for serving hot or cold food. Space shall be included for temporary holding of unused or soiled dietary trays.
n. Equipment storage room. Each unit shall provide sufficient storage area(s) located on the patient floor to keep its required corridor width free of equipment and supplies, but not less than 10 square feet per postpartum room and 20 square feet per each LDR or LDRP outside of the patient room.
o. Storage space for stretchers and wheelchairs shall be provided in a strategic location, out of corridors and away from normal traffic.
p. When bathing facilities are not provided in patient rooms, there shall be at least one shower and/or bathtub for each six beds or fraction thereof.
q. A housekeeping room shall be provided for the exclusive use of the obstetrical suite. It shall be directly accessible from the suite and shall contain a service sink or floor receptor and provisions for storage of supplies and housekeeping equipment.
r. Examination/treatment room and/or multipurpose diagnostic testing room shall have a minimum clear floor area of 120square [FN1] feet. When utilized as a multipatient diagnostic testing room, a minimum clear floor area of 80square [FN1] feet per patient shall be provided. An adjoining toilet room shall be provided for patient use.
s. Emergency equipment storage shall be located in close proximity to the nurses' station.
4. [FN1] Airborne infection isolation room(s). An airborne infection isolation room is not required for the obstetrical unit. Provisions for the care of the perinatal patient with an airborne infection shall be determined by the Infection Prevention and Control Risk Assessment.
B. Cesarean/Delivery Suite.
1. Caesarean/delivery room(s) shall have a minimum clear floor area of 360 square feet with a minimum dimension of 16 feet exclusive of built-in shelves or cabinets. There shall be a minimum of one such room in every obstetrical unit.
2. Delivery room(s) shall have minimum clear area of 300 square feet exclusive of fixed cabinets and built-in shelves. An emergency communication system shall be connected with the obstetrical suite control station.
3. Infant resuscitation shall be provided within the cesarean/delivery room(s) and delivery rooms with a minimum clear floor are of 40 square feet in addition to the required area of each room or may be provided in a separate but immediately accessible room with a clear floor area of 150 square feet. Six single or three duplex electrical outlets shall be provided for the infant in addition to the facilities required for the mother.
4. Labor room(s) (LDR or LDRP rooms may be substituted). In renovation projects, existing labor rooms may have a minimum clear area of 100 square feet per bed.
Where LDRs or LDRPs are not provided, a minimum of two labor beds shall be provided for each Caesarean room and/or delivery room. In facilities that have only one Caesarean delivery room, two labor rooms shall be provided. Each room shall be designed for either one or two beds with a minimum clear area of 120square [FN1] feet per bed. Each labor room shall contain a handwashing fixture and have access to a private toilet room. One toilet room may serve two labor rooms. Labor rooms shall have controlled access with doors that are arranged for observation from a nurses' station. At least one shower (which may be separate from the labor room if under staff control) for use of patients in labor shall be provided. Windows in labor rooms, if provided, shall be located, draped, or otherwise arranged to preserve patient privacy from causal observation from outside the labor room.
5. Recovery room(s). (LDR or LDRP rooms may be substituted.) Each recovery room shall contain at least two beds and have a nurses' station with charting facilities located to permit visual control of all beds. Each room shall include stations for handwashing and dispensing medicine. A clinical sink with bedpan flushing device shall be available, as shall storage for supplies and equipment. There shall be enough space for baby and crib and a chair for the support person. There shall be the ability to maintain visual privacy of the new family.
6. Service Areas.
a. Individual rooms shall be provided as indicated in the following standards; otherwise, alcoves or other open spaces that do not interfere with traffic may be used.
b. The following services shall be provided:
1) A control/nurse station located to restrict unauthorized traffic into the suite.
2) Soiled workroom or soiled holding room. This room shall be separate from the clean workroom. The soiled workroom shall contain a clinical sink (or equivalent flushing-rim fixture). The room shall contain a handwashing fixture. The above fixtures shall have a hot and cold mixing faucet. The room shall have a work counter and space for separate covered containers for soiled linen and waste. Rooms used only for temporary holding of soiled material may omit the clinical sink and work counter. If the flushing-rim clinical sink is eliminated, facilities for cleaning bedpans shall be provided elsewhere.
3) Fluid waste disposal.
c. The following services may be shared with the surgical facilities if the functional program reflects this concern. Where shared, areas shall be arranged to avoid direct traffic between the delivery and operating rooms.
1) A supervisor's office or station.
2) A waiting room, with toilets, telephones, and drinking fountains conveniently located. The toilet room shall contain handwashing stations.
3) Sterilizing facilities with high-speed sterilizers convenient to all Caesarean/delivery rooms. Sterilization facilities shall be separate from the delivery area and adjacent to clean assembly. High-speed autoclaves shall only be used in an emergency situation (i.e., a dropped instrument and no sterile replacement readily available). Sterilization facilities would not be necessary if the flow of materials were handled from a central service department based on the usage of the delivery room (DR).
4) A drug distribution station with handwashing stations and provisions for controlled storage, preparation, and distribution of medication.
5) Scrub facilities for Caesarean and delivery rooms. Two scrub stations shall be provided adjacent to entrance to each Caesarean/delivery room. Scrub facilities should be arranged to minimize any splatter on nearby personnel or supply carts. In new construction, view windows at scrub stations to permit the observation of room interiors.
6) Clean workroom or clean supply room. A clean workroom shall be provided if clean materials are assembled within the obstetrical suite prior to use. If a clean workroom is provided it shall contain a work counter, sink equipped for handwashing and space for storage of supplies. A clean supply room may be provided when the narrative program defines a system for the storage and distribution of clean and sterile supplies.
7) Medical gas storage facilities. Main storage of medical gases may be outside or inside the facility in accordance with NFPA99. Provision shall be made for additional separate storage of reserve gas cylinders necessary to complete at least one day's procedures.
8) A clean sterile storage area readily available to the delivery room: size to be determined on level of usage, functions provided, and supplies from the hospital central distribution area.
9) An anesthesia workroom for cleaning, testing, and storing anesthesia equipment. It shall contain a work counter, sink, and provisions for separation of clean and soiled items.
10) Equipment storage room(s) for equipment and supplies used in the obstetrical suite.
11) Staff clothing change areas. The clothing change area shall be designed to encourage one-way traffic and cross-traffic between clean and contaminated personnel. The area shall contain lockers, showers, toilets, handwashing stations, and space for donning and disposing scrub suits and booties.
12) Male and female support persons change area (designed as described above).
13) Lounge and toilet facilities for obstetrical staff convenient to delivery, labor, and recovery areas. The toilet room shall contain handwashing stations.
14) An on-call room(s) for physician and/or staff may be located elsewhere in the facility.
15) Environmental Services Closet. See Section 65, Physical Facilities, Cleaning Sanitizing Carts and Environmental Services for detailed requirements.
16) An area for storing stretchers out of the path of normal traffic.
C. LDR and LDRP Facilities. When provided by the narrative program, delivery procedures in accordance with birthing concepts may be performed in the LDR or LDRP rooms. LDR room(s) may be located in a separate LDR suite or as part of the Caesarean/Delivery suite. The postpartum unit may contain LDRP rooms. These rooms shall have a minimum of 250square [FN1] feet of clear floor area with a minimum dimension of 13feet [FN1], exclusive of toilet room, closet, alcove, or vestibules. There should be enough space for crib and reclining chair for support person. An area within the room but distinct from the mothers area shall be provided for infant stabilization and resuscitation. See Table 4 of the Appendix for medical gas outlets. These outlets shall be located in the room so that they are accessible to the mother's delivery area and infant resuscitation area. When renovation work is undertaken, every effort shall be made to meet the above minimum standards. If it is not possible to meet the above square-foot standards, the authorities having jurisdiction may grant approval to deviate from this requirement. In such cases, existing LDR or LDRP rooms may have a minimum clear area of 200 square feet.
Each LDR or LDRP room shall be for single occupancy and have direct access to a private toilet with shower or tub. Each room shall be equipped with handwashing facilities (handwashing stations with hands-free operation area acceptable for scrubbing). Examination lights may be portable, but shall be immediately accessible.
Finishes shall be selected to facilitate cleaning and with resistance to strong detergents. Window(s) shall be provided for LDRP room(s). Windows or doors within a normal sightline that would permit observation into the room shall be arranged or draped as necessary for patient privacy. Additional requirements for windows are provided above in A2.a.

Credits

Amended Jan. 1, 2016; Feb. 5, 2021.
[FN1]
So in original.
<Statutory authority: Promulgated under the Authority of Ark. Code Ann. ยง 20-7-123, 20-9-201 et seq.>
Current with amendments received through May 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 007.05.10-50, AR ADC 007.05.10-50
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