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007.05.10-45. Physical Facilities, Critical Care Unit.

AR ADC 007.05.10-45Arkansas 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 007.05.10-45
007.05.10-45. Physical Facilities, Critical Care Unit.
The Critical care units require special space and equipment considerations for effective staff functions. In addition, space arrangement shall include provisions for immediate access of emergency equipment from other departments. Critical care units shall comply in size, number and type with these standards and with the functional program. The following standards are intended for the more common types of critical care services and shall be appropriate to needs defined in functional programs. Where specialized services are required, additions and/or modifications shall be made as necessary for efficient, safe, and effective patient care.
A. Critical Care (General). The following shall apply to all types of critical care units unless otherwise noted. Each unit shall comply with the following provisions:
1. The location shall offer direct access by the emergency, respiratory care, laboratory, radiology, surgery, and other essential departments and services as defined by the functional program. It shall be located so that the medical emergency resuscitation teams may be able to respond promptly to emergency calls within minimum travel time. The location shall be arranged to eliminate the need for through traffic.
2. In new construction, where elevator transport is required for critically ill patients, the size of the cab and mechanisms and controls shall meet the specialized needs.
3. In new construction, each patient room (or multiple bed space for neonatal or pediatric units) shall have a minimum of 200 square feet of clear floor area with a minimum headwall width of 113 feet per bed, exclusive of anterooms, vestibules, toilet rooms, closets, lockers, wardrobes, and/or alcoves. In renovation of existing critical care units, every effort shall be made to meet the above minimum standards. If it is not possible to meet the above square foot standards, the Entity having jurisdiction may grant approval to deviate from this requirement. In such cases, rooms shall be no less than 130square feet.
4. View panels to the corridor shall be required and shall have means to provide visual privacy. Where only one door is provided to a bed space, it shall be at least four feet wide and arranged to minimize interference with movement of beds and large equipment. Sliding doors shall not have floor tracks and shall have hardware that minimizes jamming possibilities. Where sliding doors are used for access to cubicles within a suite, a three-foot-wide swinging door may also be provided for personnel communication. The sliding doors shall swing out.
5. Each patient bed area shall have space at each bedside for visitors and provisions for visual privacy from casual observation by other patients and visitors. For both adult and pediatric units, there shall be a minimum of eight feet between beds.
6. Each patient bed shall have visual access, other than skylights, to the outside environment with not less than one outside window in each patient bed area. In renovation projects, clerestory windows with windowsills above the heights of adjacent ceilings may be used, provided they afford patients a view of the exterior and are equipped with appropriate forms of glare and sun control. Distance from the patient bed to the outside window shall not exceed 50 feet. When partitioned cubicles are used, patients' view to outside windows may be through no more than two separate clear vision panels.
7. Nurse/patient communication shall be provided in accordance with item G. of Section72, Physical Facilities, Electrical Standards. The communication station for the unit shall include provisions for an emergency code resuscitation alarm to summon assistance from outside the critical care unit.
8. Handwashing fixtures shall be convenient to nurse stations and patient bed areas. There shall be at least one handwashing fixture for every three beds in open plan areas, and one in each patient room. The handwashing fixture or sanitizing station shall be located near the entrance to the patient cubicle or room, shall be sized to minimize splashing water onto the floor, and shall be equipped with hands-free operable controls.
9. Nurses' station shall have space for counters and storage. It may be combined with or include centers for reception and communication. There shall be direct or remote visual observation between the nurses' station and all patient beds in the critical care unit.
10. Each unit shall contain equipment for continuous monitoring, with visual displays for each patient at the bedside and at the nurses' station. Monitors shall be located to permit easy viewing and access but not interfere with access to the patient.
11. Emergency equipment storage space that is easily accessible to the staff shall be provided for emergency equipment such as a emergency cart.
12. Medication Station. Provisions shall be made for distribution of medications. This may be done from a medicine preparation room or unit, from a self-contained medicine dispensing unit, or by another approved system:
a. Medicine preparation room. This room shall be designed to allow for visual supervision by the nursing staff. It shall contain a work counter, a sink adequate for handwashing, refrigerator, and locked storage for controlled drugs. When a medicine preparation room is to be used to store one or more self-contained medicine dispensing units, the room shall be designed with adequate space to prepare medicines with the self-contained medicine dispensing unit(s) present.
b. Self-contained medicine dispensing unit. A self-contained medicine dispensing unit may be located at the nurses' station, in the clean workroom, or in an alcove, provided the unit has adequate security for controlled drugs and adequate lighting to easily identify drugs. Convenient access to handwashing stations shall be provided. (Standard cup-sinks provided in many self-contained units are not adequate for handwashing.)
13. At least one airborne infection isolation room with anteroom shall be provided. The number of airborne infection isolation rooms shall be determined based on an infection control risk assessment; as per the primary catchment area by the facility. Each room shall contain only one bed and shall comply with the requirements of item C. of Section 44, Physical Facilities, Patient Accommodations (Adult Medical, Surgical, Communicable or Pulmonary Disease). However, the requirement for the bathtub (or shower) may be eliminated. Compact, modular toilet/sink combination units may replace the requirement for a “toilet room.” Special ventilation requirements are found in Table 4.
14. The following additional service spaces shall be immediately available within each critical care area (Note: These additional spaces may be shared by more than one critical care unit provided that direct access is available from each unit.):
a. Securable closets or cabinet compartments for the unit personnel;
b. Clean workroom or clean supply room. If the room is used for preparing patient care items, 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 fixture may be omitted. Soiled and clean workrooms or holding rooms shall be separated and have no direct connection;
c. Clean linen storage. There shall be 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. It shall be out of the path of normal traffic and under staff control;
d. 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 lavatory or 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 a variety of waste types. 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;
e. Nourishment Station. There shall be a nourishment station with sink, work counter, refrigerator, storage cabinets, and equipment for hot and cold nourishments between scheduled meals. The nourishment station shall include space for trays and dishes used for nonscheduled meal service. Provisions and space shall be included for separate temporary storage of unused and soiled dietary trays not picked up at meal time. Handwashing stations shall be in or immediately accessible from the nourishment station;
f. Ice machine. There shall be available equipment to provide ice for treatments and nourishment. Ice-making equipment may be in the clean work room or at the nourishment station. Ice intended for human consumption shall be from self-dispensing ice makers;
g. Equipment storage room or alcove. Appropriate room(s) or alcove(s) shall be provided for storage of large items of equipment necessary for patient care and as required by the functional program. Its location shall not interfere with the flow of traffic; and
h. X-ray viewing equipment.
15. The following shall be provided and may be located outside the unit if conveniently accessible.
a. A visitors' waiting room shall be provided with access to telephones and toilets. One waiting room may serve several critical care units.
b. Staff lounge(s) and toilet(s) shall be located so that staff may be recalled quickly to the patient area in emergencies. The lounge shall have telephone or intercom and emergency code alarm connections to the critical care unit it serves. One lounge may serve adjacent critical care areas.
c. A special procedures room shall be provided if required by the functional program.
d. Multipurpose room(s) for staff, patients, and patients' families for patient conferences, reports, education, training sessions, and consultation shall be provided. These rooms shall be accessible to each nursing unit.
e. A housekeeping room shall be provided within or immediately adjacent to the critical care unit. It shall not be shared with other nursing units or departments. It shall contain a service sink or floor receptor and provisions for storage of supplies and housekeeping equipment.
f. Storage space for stretchers and wheelchairs shall be provided in a strategic location, without restricting normal traffic.
g. Laboratory, radiology, respiratory care, and pharmacy services shall be available. These services may be provided from the central departments or from satellite facilities as required by the functional program.
B. Coronary Critical Care Unit. In addition to the standards set forth in Section 45, Physical Facilities, Critical Care Unit, the following standards apply to the coronary critical care unit:
1. Each coronary patient shall have a separate room for acoustical and visual privacy.
2. Each coronary patient shall have access to a toilet in the room. (Portable commodes may be used in lieu of individual toilets, but provisions shall be made for their storage, servicing, and odor control.)
C. Pediatric Critical Care. If a facility has a specific pediatric critical care unit, the functional program shall include consideration for staffing, isolation, and the safe transportation of critically ill pediatric patients, along with life support and environmental systems, from other areas. In addition to the standards previously listed for critical care units, each pediatric critical care unit shall include:
1. Space at each bedside for family, visitors and nursing staff;
2. In new construction, each patient space (whether separate rooms, cubicles, or multiple bed space) shall have a minimum of 200 square feet of clear floor area with a minimum headwall width of 13 feet per bed, exclusive of anterooms, vestibules, toilet rooms, closets, lockers, wardrobes, and/or alcoves;
3. Consultation/demonstration room within, or convenient to, the pediatric critical care unit for private discussions;
4. Provisions for formula storage. These may be outside the pediatric critical care unit but shall be available for use at all times;
5. Separate storage cabinets or closets for toys and games for use by the pediatric patients; and
6. Examination and treatment room(s).
D. Newborn Intensive Care Units. Each Newborn Intensive Care Unit (NICU) shall include or comply with the following:
1. The NICU shall have a clearly identified entrance and reception area for families. The area shall permit visual observation and contact with all traffic entering the unit. A scrub area shall be provided at each public entrance to the patient care area(s) of the NICU. All sinks shall be hands-free operable and large enough to contain splashing;
2. At least one door (44inches minimum) to each room in the unit to accommodate portable X-ray equipment;
3. There shall be controlled access systems to the unit from the Labor and Delivery area, the Emergency Room or other referral entry points;
4. When viewing windows are provided, provision shall be made to control casual viewing of infants;
5. Noise control shall be a design factor;
6. Provisions shall be made for indirect lighting in all nurseries. Provisions shall be made for multiple lighting levels;
7. A central area shall serve as a nurses' station, shall have space for counters and storage, and shall have convenient access to handwashing stations. It may be combined with or include centers for reception and communication and patient monitoring;
8. Each patient care space shall contain a minimum of 120 square feet per bassinette excluding sinks and aisles. There shall be an aisle for circulation adjacent to each patient care space with a minimum width of three feet;
9. An airborne infection isolation room is required in at least one level of nursery care. The room shall be enclosed and separated from the nursery unit with provisions for observation of the infant from adjacent nurseries or control area(s);
10. Blood gas lab facilities shall be immediately accessible;
11. A respiratory care work area and storage room shall be provided;
12. A consultation/demonstration/breast feeding room shall be provided convenient to the unit;
13. Charting and dictation space for physicians shall be provided;
14. Medication station shall be provided;
15. Clean workroom or clean supply room shall be provided. See Section 44.B.8, Physical Facilities, Patient Accommodations (Adult Medical, Surgical, Communicable or Pulmonary Disease);
16. Soiled workroom or soiled holding room shall be provided. See Section 44.B.9, Physical Facilities, Patient Accommodations (Adult Medical, Surgical, Communicable or Pulmonary Disease);
17. A lounge, locker room and staff toilet within or adjacent to the unit suite for staff use shall be provided;
18. Space shall be provided for emergency equipment that is under direct control of the nursing staff, such as a emergency cart. This space shall be located in an area appropriate to the functional program, but out of normal traffic;
19. One environmental services closet shall be provided for the unit. It shall be directly accessible from the unit and be dedicated for the exclusive use of the neonatal critical care unit. It shall contain a service sink or floor receptor and provisions for storage of supplies and housekeeping equipment; and
20. Space shall be provided for the following:
a. A visitors' waiting room;
b. Nurses' station; and
c. Multipurpose room(s) for staff, patients and patients' families for patient conferences, reports, education, training sessions, and consultation. These rooms shall be accessible to each nursing unit. They may be on other floors if convenient for regular use. One such room may serve several nursing units and/or departments.

Credits

Amended Jan. 1, 2016; Feb. 5, 2021.
<Statutory authority: Promulgated under the Authority of Ark. Code Ann. § 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 007.05.10-45, AR ADC 007.05.10-45
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