Section 1226 — [OSHPD 3]-CLINICS

The provisions of this section shall apply to primary care clinics, specialty clinics and psychology clinics, licensed by the California Department of Public Health. Primary care clinics include free clinics, community clinics, employee clinics and optometric clin- ics. Specialty clinics include surgical clinics, chronic dialysis clinics, rehabilitation clinics and alternative birth centers (ABC). This section shall also apply to outpatient clinical services of a hospital when provided in a freestanding building.

All new buildings and additions, alterations or repairs to existing buildings and conversion of space to a clinic use within existing buildings, subject to licensure by Licensing and Certification, California Department of Public Health, shall comply with applicable provisions of the California Electrical Code, California Mechanical Code, California Plumbing Code, California Fire Code, (Parts 3, 4, 5 and 9 of Title 24) and this section. OSHPD requirements apply to all facilities described above and are not dependent upon Occupancy Group designations.

Exception: See Section 1224.2.

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1226.2.1 Outpatient clinical services. Hospitals providing outpatient clinical services and clinics licensed under Health and Safety Code Section 1200 providing services that are not covered by this section shall meet the applicable requirements in Section 1224.

1226.2.2 Special services. A general acute care hospital referenced in Health and Safety Code Section 1255 (d) (3) (E), that provides special services in conformance with Health and Safety Code Section 1255, shall meet all the provisions of Section 1224.28.3 in addi- tion to Section 1226.2. The Office of Statewide Hospital Planning and Development (OSHPD) shall review any proposed construction or alteration for OSHPD compliance.

Clinics and outpatient clinical services under a hospital license shall comply with the provisions under Section 1224.4, General Construction, where applicable, except as supplemented, amended or modified below.

1226.4.1 Examination and treatment areas.

1226.4.1.1 Service spaces. Refer to Section 1224.4.2.

1226.4.1.2 Treatment spaces. Refer to Section 1224.4.3.

1226.4.1.3 Examination or treatment room. Refer to Section 1224.4.4.1.

1226.4.1.4 Airborne infection isolation exam/treatment room. Refer to Section 1224.4.4.1.3.

1226.4.2 Miscellaneous requirements.

1226.4.2.1 Station outlets. When provided, refer to Section 1224.4.6.1.

1226.4.2.2 Gas and vacuum systems. When provided refer to Section 1224.4.6.2.

1226.4.2.3 Hyberbaric facilities. When provided, refer to Section 1224.4.6.3.

1226.4.2.4 Laboratories. Refer to Section 1224.4.6.4.

1226.4.2.5 Nurse call systems. Refer to Section 1224.4.6.5.

1226.4.2.6 Noise reduction. The noise reduction criteria shown in Table 1224.4.19 shall apply to partitions, floors and ceiling construction in patient treatment areas.

1226.4.3 Corridors.

1226.4.3.1 Outpatient services. Refer to Section 1224.4.7.3

1226.4.3.2 Corridor width. For clinics with bed/gurney patient(s) refer to Section 1224.4.7.1.

1226.4.3.3 Light traffic. Refer Section 1224.4.7.2.

1226.4.3.4 Handrails. For rehabilitation services space, refer to Section 1224.4.7.4.

1226.4.3.5 Contiguous functions. Basic services of a single licensed clinic may be located in separate suites. Each clinic suite shall be contiguous and include internal circulation to access each of the required functions identified for that specific basic service.

Exceptions: 1. Various functions including but not limited to reception, waiting, staff support areas such as toilets, storage and lounge may be located outside of the clinic suite with approval from the California Department of Public Health. 2. If toilets and drinking fountain(s) serving the public are provided as part of the overall building features, they need not be provided within the clinic suite. 3. Shared services. Space for general storage, laundry, housekeeping and waste management may be shared with other tenants.

1226.4.4 Doors and door openings.

1226.4.4.1 Toilet room doors. Refer to Section 1224.4.8.1.

1226.4.4.2 Pocket doors. Refer to Section 1224.4.8.2.

1226.4.5 Windows.

1226.4.5.1 Window screens. Refer to Section 1224.4.9.4.

1226.4.5.2 Light and ventilation. Refer to Section 1224.4.9.5.

1226.4.6 Ceiling heights.

1226.4.6.1 Minimum height . For minimum ceiling height requirements, refer to Section 1224.4.10.1.

1226.4.6.2 Minimum height with fixed ceiling equipment. Refer to Section 1224.4.10.2.

1226.4.7 Interior finishes.

1226.4.7.1 Floor finishes. Refer to Section 1224.4.11.1 and Table 1224.4.11.

1226.4.7.1.1 Coved base. Refer to Section 1224.4.11.1.1.

1226.4.7.1.2 Wet cleaning. Refer to Section 1224.4.11.1.3.

1226.4.7.1.3 Airborne infection isolation exam/treatment room. Refer to Section 1224.11.1.4.

1226.4.7.2 Wall bases.

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1226.4.7.2.1 Material. Refer to Section 1224.4.11.2.1.

1226.4.7.2.2 Wet cleaning. Refer to Section 1224.4.11.2.2.

1226.4.7.3 Wall finishes. Refer to Section 1224.4.11.3.

1226.4.7.4 Ceilings. Ceiling finishes shall comply with Section 1224.4.11.4 and Table 1224.4.11.

1226.4.8 Elevators.

1226.4.8.1 Elevator cab requirements. Buildings over one story in height with accommodations or services for patients on floors without grade-level entrance shall provide at least one elevator in compliance with Section 3002.4.

1226.4.8.2 Dimensions. Elevators used for the routine transport of wheeled stretchers shall have minimum inside platform dimensions of 5 feet by 8 feet (1524 mm by 2438 mm) and a minimum clear door opening of 3 feet 8 inches (1118 mm).

1226.4.9 Garbage, solid waste, medical waste and trash storage. These facilities shall comply with the appropriate local health and environmental authorities’ requirements, California Department of Public Health requirements for medical waste management, and comply with the following minimum requirements:

1226.4.9.1 Location. A location shall be provided for waste collection and storage with sufficient space based upon the volume of projected waste and length of anticipated storage. The location of compactors, balers, sharps containers and recycling container staging at docks or other waste removal areas shall comply with Section 1224.4.2. 1226.4.9.2 Enclosure. A lockable room or screened enclosure of at least 25 square feet (2.32 m [2] ) shall be provided for the washing and cleaning of garbage containers and for the storage of garbage, trash and other solid wastes.

Exception: This amount of space may not be required by the enforcing agency if there is a proposed method of handling and storage which requires a lesser amount of space. Additional space may be required by the enforcing agency when special oper- ations or collection and disposal methods result in greater than usual accumulation of solid wastes.

The room or screened enclosure shall include the following:

1. Floor and curb. A concrete floor with a curb and with a drain connected to the sewer.

2. Water. Steam or hot water and cold water supplies in accordance with the California Plumbing Code. 3. Size. A minimum floor area of not less than 25 square feet (2.32 m [2] ), the least dimension of which shall be 4 feet (1219 mm). This amount of space may not be required by the enforcing agency if there is proposed a method of handling, storage or cleaning of containers which requires a lesser amount of space. Additional space may be required by the enforcing agency when special operations or collection and disposal methods result in greater than usual accumula- tion of solid wastes.

1226.4.9.3 Waste holding room. As an alternative to the requirements in Section 1226.4.9.2, a holding room for medical waste and garbage may be provided.

Exception: This amount of space may not be required by the enforcing agency if there is a proposed method of handling and storage which requires a lesser amount of space. Additional space may be required by the enforcing agency when special oper- ations or collection and disposal methods result in greater than usual accumulation of solid wastes.

The waste holding room shall comply with the following: 1. The waste holding room shall be a minimum of 25 square feet, with the least dimension of which is 4 feet. 2. The waste holding room shall have 100 percent exhaust ventilation. 3. All finishes in the waste holding room shall comply with the requirements in Section 1224.4.11. 4. The waste holding room shall be immediately accessible to an exterior door.

1226.4.10 Compactors. Trash compactor systems shall meet the drainage and wash-down requirements under Section 1226.4.9.2, Items 1 and 2.

Exception: If a dumpster system is proposed, operational procedures for handling and storage must be specifically approved by the local health officials.

1226.4.11 Housekeeping room. Refer to Section 1224.4.15.

1226.4.12 Laundry and trash chutes. Gravity-type laundry and trash chutes shall comply with Section 1224.4.16.

1226.4.13 Support areas for examination and treatment rooms.

1226.4.13.1 Nurse station(s). If required, this area shall have space for counters and storage and shall have direct access to a handwashing stations (refer to Section 1224.3 for definition of handwashing station). It may be combined with or include centers for reception, charting and communication.

1226.4.13.2 Medication station. Provision shall be made for distribution of medications. This shall be done from a medicine preparation room or a self-contained medicine dispensing unit.

1226.4.13.2.1 Medication preparation room or area. When provided, the entry of the medication preparation room or area shall be under the visual control of the staff. This may be a part of the nurse station and shall include all of the following:

1. Work counter

2. Sink

3. Lockable refrigerator

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4. Immediate access to handwashing station 5. Locked storage for biologicals and drugs

When a medication preparation room or area is to be used to store self-contained medication dispensing units, the room shall be designed with adequate space to prepare medications with the self-contained medication-dispensing units present.

1226.4.13.2.2 Self-contained medicine-dispensing unit. When provided, the location of a self-contained medicine-dispensing unit shall be permitted in the clean workroom or at the administrative center or nurse station, provided there is adequate secu- rity for medications and adequate lighting to easily identify drugs. Immediate access to a handwashing station shall be provided.

1226.4.13.3 Clean utility room. A clean utility room shall be provided. If the room is used for preparing patient care items, it shall contain:

1. Work counter

2. Handwashing station 3. 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 materials from a central sterile supply, the work counter and handwashing station may be omitted. Soiled and clean utility rooms or holding rooms shall be separated and have no direct connection.

1226.4.13.4 Soiled workroom or soiled holding room. Soiled workroom or soiled holding room shall be provided and contain:

1. Clinic sink

Exception: For primary care clinics, a utility sink or patient toilet room equipped with a bedpan flushing device may be provided in lieu of a clinic sink. A utility sink may be used for soaking or rinsing and shall be provided as appropriate to the method of decontamination used.

2. Handwashing station

3. Work counter

4. Storage cabinets 5. A designated area for waste receptacle(s) 6. A designated area for soiled linen receptacle(s)

If the clinic includes a central sterile supply that complies with Section 1224.22 and the soiled holding room is used only for temporary holding of soiled materials, the clinic sink and work counter may be omitted. Where rooms are used for temporary hold- ing of materials, provisions shall be made for separate collection, storage and disposal of soiled materials. Soiled and clean utility rooms or holding rooms shall be separated and have no direct connection.

1226.4.13.5 Sterile and pharmaceutical supply storage. Separate storage for sterile supplies and pharmaceutical supplies shall be provided.

1226.4.13.6 Sterilization facilities. When provided, a sterilization facility shall meet the following applicable requirements:

1226.4.13.6.1 Storage. Each facility shall provide space for the storage of disposable sterile supplies or provide space for ster- ilization and disinfection equipment.

Exception: Facilities with contractual arrangements for outside autoclaving and sterilizing services.

1226.4.13.6.2 Central sterile supply and sterilizing area. When provided, rooms and spaces of the central supply and steriliz- ing area shall comply with the following: 1. Soiled work area. A receiving and gross cleaning area which shall contain work space and equipment for cleaning medical and surgical equipment and for disposal of or processing of soiled materials. 2. Clean work area. A clean work area which shall contain work space and equipment for sterilizing medical and surgi- cal equipment and supplies. 3. Sterilizing and equipment disinfection space. 4. Storage. Space for sterile supplies and unsterile supplies.

1226.4.13.6.3 Sterilizers. When provided, all sterilizers and autoclaves which emit system steam exhaust shall be vented to the outside of the building. Such vents shall be independent from the plumbing vent system.

Exception: Small instrument sterilizers.

1226.4.13.7 Nourishment room. When provided, the nourishment room or area shall have all of the following:

1. Sink

2. Work counter

3. Refrigerator 4. Storage cabinets 5. Equipment for serving nourishment 6. A handwashing station, as defined in Section 1224.3, shall be located in the nourishment room or be immediately acces- sible without going through a door.

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1226.4.14 Support areas for patients.

1226.4.14.1 Patient toilet room(s). Toilet room(s) with a lavatory shall be provided separate from public use toilet(s) and shall be located to permit access from patient care areas without passing through publicly accessible areas.

Exception: For primary care clinics where the facility contains no more than three examination and/or treatment rooms, the patient toilet room shall be permitted to serve outpatient waiting room(s).

1226.4.14.2 Specimen and/or blood collection facilities. When provided, refer to Section 1224.4.4.3. Use of patient toilet room(s) shall be permitted for specimen collection.

1226.4.15 General support services and facilities.

1226.4.15.1 Areas for off-site laundry services. If linen is to be processed off site, the following shall be provided: 1. Soiled linen holding area or designated and dedicated area for soiled laundry cart. 2. Clean linen storage area that protects linen from soil or damage.

1226.4.16 Public and administrative areas.

1226.4.16.1 Public.

1226.4.16.1.1 Reception. A reception and information counter or desk shall be provided.

1226.4.16.1.2 Outpatient waiting rooms. Refer to Section 1224.4.5.

1226.4.16.2 Administrative services.

1226.4.16.2.1 Medical records storage. Outpatient clinics shall provide a health record service which shall comply with the following: 1. Work area for sorting and recording records for either paper or electronic media. 2. Storage area for records for either paper or electronic media.

1226.4.16.2.2 Equipment and supply storage. General storage facilities for office supplies and equipment shall be provided.

1226.4.17 Support areas for staff.

1226.4.17.1 Staff toilet(s). Provide staff toilet(s) in addition to and separate from, public and patient facilities. The areas shall contain toilet(s) and handwashing stations pursuant to the California Plumbing Code, Table 4-2.

1226.4.17.2 Storage for employees. Provide storage for staff personal effects with locking drawers or cabinets (may be individ- ual desks or cabinets). Such storage shall be readily accessible to individual workstations and shall be staff controlled.

1226.4.17.3 Staff lounge. When provided, the lounge shall have adequate space to accommodate staff.

OUTPATIENT CLINICAL SERVICES OF A HOSPITAL.

A licensed hospital may elect to locate certain outpatient services in a free- standing building. To be considered a freestanding building, refer to the California Administrative Code Section 7-111. See Section 309A.5.1 of the California Existing Building Code for eligibility for jurisdiction of the local enforcement agency over freestanding buildings adjacent to hospital buildings.

Outpatient clinical services of a hospital provided in a freestanding building are regulated under the banner [OSHPD 3] instead of

[OSHPD 1]. These services shall comply with Sections 1226.4.2 through 1226.4.8 and the provisions of this section. Outpatient clinical services of a hospital that are not addressed in the provisions of Section 1226 shall comply with applicable provisions of Section 1224 and/or Section 1228 as if those provisions were repeated in Section 1226.5.

GENERAL SUPPORT AREAS FOR OUTPATIENT CLINICAL SERVICES - Requirements for all service types.

1226.5.1 Support areas for patients.

1226.5.1.1 Patient toilet room(s). Refer to Section 1226.4.14.1.

1226.5.1.2 Specimen and/or blood collection facilities. When provided, refer to Section 1224.4.4.2.

1226.5.2 General support services and facilities.

1226.5.2.1 Garbage, solid waste, medical waste and trash storage. Refer to Section 1226.4.9.

1226.5.2.2 Housekeeping room. Refer to Section 1224.4.15.

1226.5.3 Public and administrative areas.

1226.5.3.1 Public area.

1226.5.3.1.1 Reception. Refer to Section 1226.4.16.1.1.

1226.5.3.1.2 Outpatient waiting room. Refer to Section 1224.4.5.

1226.5.3.1.3 Public toilet(s). Refer to Section 1224.4.5.

1226.5.3.1.4 Public telephone access. Refer to Section 1224.4.5.

1226.5.3.1.5 Drinking fountain(s). Refer to Section 1224.4.5.

1226.5.3.2 Administrative services.

1226.5.3.2.1 Medical records storage. Refer to Section 1226.4.16.2.1.

1226.5.3.2.2 Equipment and supply storage. Refer to Section 1226.4.16.2.2.

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1226.5.4 Support areas for staff.

1226.5.4.1 Staff toilet(s). Refer to Section 1226.4.17.1.

1226.5.4.2 Storage for employees. Refer to Section 1226.4.17.2.

RADIOLOGICAL/IMAGING SERVICE SPACE.

1226.5.5 Radiological/imaging service space. When x-ray examination services, computerized tomography scanning, magnetic resonance imaging, ultrasound and/or mammography services are provided, the radiological/imaging services space shall comply with the provisions of this section.

1226.5.5.1 Support spaces for radiological/imaging services. The following spaces are common to the imaging service area and are minimum requirements:

1226.5.5.1.1 Patient toilet room(s). In service spaces with procedure rooms that do not require dedicated patient toilets, provide a minimum of one patient toilet room within the service space, refer to Section 1226.4.14.1.

1226.5.5.1.2 Outpatient change area. A separate space shall be provided where outpatients change from street clothing. This shall include provisions for clothing storage, space for clothing change and gowning area. Dressing rooms shall be readily accessible to the imaging rooms.

1226.5.5.1.3 Staff facilities. In service space of three or more procedure rooms, staff toilet room(s) internal to the service space.

1226.5.5.1.4 Handwashing stations. Handwashing stations shall be located within the unit.

1226.5.5.1.5 Imaging storage (active). If imaging storage systems are used, provide a means of sorting and filing patient film or electronic media for immediate retrieval shall be provided.

1226.5.5.1.6 Medication station. Provision shall be made for locked storage of medications and drugs. Refer to Section 1226.4.13.2.

1226.5.5.1.7 Areas for off-site laundry services. Refer to Section 1226.4.15.1.

1226.5.5.2 Radiation protection. Radiation protection requirements for equipment refer to Section 1224.18.1.1.

1226.5.6 X-ray examination services . When provided, x-ray examination services space shall comply with the following:

1. X-ray room. 2. When shielded control alcove with protective view windows is provided, refer to Section 1224.18.1.1. 3. Fluoroscopy room, when provided, shall have a toilet room directly accessible to the fluoroscopy room. This toilet room is in addition to common patient toilet room facilities located in the radiological/imaging service space. 4. Space for processing images. 5. An office or other suitable area for viewing and reporting radiographic examination.

1226.5.7 Computerized tomography (CT) scanning. When provided, CT services space shall comply with the requirements of Section 1224.18.3.

1226.5.8 Magnetic resonance imaging (MRI). When provided, MRI services space shall comply with the requirements of Section 1224.18.4.

1226.5.9 Ultrasound. When ultrasound is provided, refer to Section 1224.18.5.

1226.5.10 Mammography. When mammography is provided, refer to Section 1224.18.6.

GASTROINTESTINAL ENDOSCOPY.

1226.5.11 Gastrointestinal endoscopy. When provided, gastrointestinal endoscopy services space shall comply with Section 1224.39.3 and the provisions of this section:

1226.5.11.1 Procedure Room(s).

1226.5.11.1.1 Space requirements. Refer to Section 1224.39.3.1.1.

1226.5.11.1.2 Handwashing station. Refer to Section 1224.39.3.1.2.

1226.5.11.2 Processing room. Refer to Section 1224.39.3.2.

1226.5.11.3 Preoperative patient holding. Refer to Section 1224.16.2.

1226.5.11.4 Post-anesthesia recovery area. Refer to Section 1224.16.

1226.5.11.5 Communication system. Refer to Section 1224.39.3.5.

1226.5.11.6 Support areas for outpatient gastrointestinal endoscopy.

1226.5.11.6.1 Control station. Refer to Section 1224.15.3.1.

1226.5.11.6.2 Medication station. Refer to Section 1226.4.13.2.

1226.5.11.6.3 Soiled workroom. Refer to Section 1224.15.3.7.

1226.5.11.6.4 Clean utility room. Refer to Section 1224.15.3.8.

1226.5.11.6.5 Anesthesia workroom. Refer to Section 1224.15.3.9.

1226.5.11.6.6 Storage room(s) for equipment and supplies used in gastrointestinal endoscopy service space. Refer to Section 1224.15.3.10.

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1226.5.11.6.7 Staff clothing change areas. Refer to Section 1224.15.3.11.

1226.5.11.6.8 Housekeeping room. Refer to Section 1224.39.2.3.2.

1226.5.11.6.9 Sterile and pharmaceutical supply storage. Refer to Section 1226.4.13.5.

1226.5.11.7 Additional support areas for patients.

1226.5.11.7.1 Outpatient change area. A separate space shall be provided where patients change out of their street clothing and are prepared for the procedure. This space shall include provisions for clothing storage, toilet room(s), sink, space for cloth- ing change and gowning area.

NUCLEAR MEDICINE.

1226.5.12 Nuclear medicine. When provided, nuclear medicine services space shall comply with Section 1224.34 and the provisions of this section:

1226.5.12.1 Radiation protection. When provided, refer to Section 1224.34.1.1.

1226.5.12.2 Nuclear medicine room. Refer to Section 1224.34.1.2.

1226.5.12.3 Radiopharmacy. When provided, refer to Section 1224.34.1.3.

1226.5.12.4 Support areas for nuclear medicine services.

1226.5.12.4.1 Cleanup. Refer to Section 1224.34.2.2.

1226.5.12.4.2 Dose administration area. Refer to Section 1224.34.2.5.

1226.5.12.4.3 Holding. Refer to Section 1224.34.2.6.

1226.5.12.4.4 Patient dressing rooms. Refer to Section 1224.34.2.7.

1226.5.12.4.5 Patient toilet room(s). Refer to Section 1224.34.2.8.

1226.5.12.4.6 Staff toilet room(s). Refer to Section 1224.34.2.9.

1226.5.12.4.7 Handwashing stations. Refer to Section 1224.34.2.10.

1226.5.12.4.8 Control desk and reception. Refer to Section 1226.5.3.

1226.5.12.4.9 Clean linen storage. A storage area for clean linen shall be provided.

1226.5.12.4.10 Soiled and contaminated material. Refer to Section 1224.34.2.13.

1226.5.12.5 Radiotherapy service space. When provided, radiotherapy service space shall comply with the following provisions of this section:

1226.5.12.5.1 Radiation protection. Refer to Section 1224.34.3.2.

1226.5.12.5.2 Room sizes. Refer to Section 1224.34.3.3.

1226.5.12.5.3 General support area. Refer to Section 1224.34.3.4.

1226.5.12.6 Additional support areas for linear accelerator.

1226.5.12.6.1 Mold room. Refer to Section 1224.34.4.1.

1226.5.12.6.2 Block room. Refer to Section 1224.34.4.2.

1226.5.12.7 Additional support areas for cobalt room.

1226.5.12.7.1 Hot lab.

1226.5.12.8 High dose rate brachytherapy room.

CANCER TREATMENT/INFUSION THERAPY.

1226.5.13 Cancer treatment/infusion therapy service space. When provided, cancer treatment/infusion therapy service space shall comply with the provisions of this section:

1226.5.13.1 Treatment area.

1226.5.13.1.1 Location. Refer to Section 1224.39.4.2.1.

1226.5.13.1.2 Nurse station(s). Refer to Section 1224.39.4.2.2.

1226.5.13.1.3 Individual patient treatment areas. Refer to Section 1224.39.4.2.3.

1226.5.13.1.4 Handwashing stations. Refer to Section 1224.39.4.2.4.

1226.5.13.1.5 Privacy. Refer to Section 1224.39.4.2.5.

1226.5.13.1.6 Medication dispensing. Refer to Section 1224.39.4.2.6.

1226.5.13.1.7 Examination room. Refer to Section 1224.39.4.2.7.

1226.5.13.1.8 Clean utility room. Refer to Section 1224.39.4.2.8.

1226.5.13.1.9 Soiled utility room. Refer to Section 1224.39.4.2.9.

1226.5.13.1.10 Nourishment station. Refer to Section 1224.39.4.2.10.

1226.5.13.1.11 Housekeeping room. Refer to Section 1224.39.4.2.11.

1226.5.13.1.12 Supplies. Refer to Section 1224.39.4.2.12.

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1226.5.13.1.13 Storage. Refer to Section 1224.39.4.2.13.

1226.5.13.1.14 Clean linen storage. Refer to Section 1224.39.4.2.14.

1226.5.13.1.15 Patient storage. Refer to Section 1224.39.4.3.2.

HYPERBARIC THERAPY.

1226.5.14 Hyperbaric therapy service space. When provided, hyperbaric therapy service space shall comply with Section 1224.39.5 and the provisions of this section:

1226.5.14.1 General. Refer to Section 1224.39.5.1.

1226.5.14.2 Hyperbaric chambers. Refer to Section 1224.39.5.2.

1226.5.14.3 Pre-procedure patient holding area(s). Refer to Section 1224.39.5.3.

1226.5.14.4 Medical gas station outlets. Refer to Section 1224.39.5.4.

1226.5.14.5 Support areas for the hyperbaric suite.

1226.5.14.5.1 Reception/control desk. Refer to Section 1224.39.5.5.1.

1226.5.14.5.2 Examination/treatment room(s). Refer to Section 1224.39.5.5.2.

1226.5.14.5.3 Clean linen storage. Refer to Section 1224.39.5.5.3.

1226.5.14.5.4 Clean supply room. Refer to Section 1224.39.5.5.4.

1226.5.14.5.5 Gas cylinder room. Refer to Section 1224.39.5.5.5

1226.5.14.5.6 Gurney and wheelchair storage. Refer to Section 1224.39.5.5.6.

1226.5.14.5.7 Housekeeping room. Refer to Section 1224.39.5.5.7.

1226.5.14.5.8 Compressor room. Refer to Section 1224.39.5.5.8.

1226.5.14.6 Support areas for staff. Refer to Section 1224.39.5.6.

1226.5.14.7 Support areas for patients.

1226.5.14.7.1 Patient waiting area. Refer to Section 1224.39.5.7.1.

1226.5.14.7.2 Patient changing area. Refer to Section 1224.39.5.7.2.

1226.5.14.7.3 Patient toilet room. Refer to Section 1224.39.5.7.3.

PRIMARY CARE CLINICS.

Primary care clinics and outpatient clinical services of a hospital providing services equivalent to a primary care clinic shall comply with Sections 1226.4.3 through 1226.4.8 and the provisions of this section.

1226.6.1 Examination and treatment areas.

1226.6.1.1 Examination room(s). Refer to Section 1224.4.4.1.

1226.6.1.2 Treatment room(s). Treatment room(s) for minor procedures (e.g., minor surgical procedures, casting), if provided, shall have a minimum area of 120 square feet (11.15 m [2] ), the least dimension of which shall be a minimum of 10 feet (3048 mm), excluding such spaces as vestibules and work counters, and shall meet the requirements in Section 1224.4.4.1.

1226.6.1.3 Dental examination and treatment areas. When provided, the examination and treatment space shall be permitted to be a room or a patient care station in an open treatment area. 1226.6.1.3.1 Area. The treatment space shall have a minimum clear floor area of 80 square feet (7.4 m [2] ). This space is required for each station in an open operatory or treatment area. A minimum of 3 feet (915 mm) clearance shall be provided along the full length of one side of the chair, the head of the chair, and between the cuspidor and the head of the chair on the other side for assisting dental staff.

1226.6.1.3.2 Pediatric patients. At least one private consultation/treatment room shall be provided when pediatric patients are treated in a facility.

1226.6.1.3.3 Handwashing. Each treatment room shall include a handwashing station. If treatment is provided at stations in an open operatory, a handwashing station may be permitted to serve two treatment stations.

1226.6.1.3.4 Imaging. If provided, the space for a dental panographic x-ray system and printer shall comply with shielding requirements in Section 1226.5.5.2 and alcove requirements in Section 1224.18.1.1.

1226.6.1.4 Oral surgery. When provided, treatment areas for procedures for which general anesthesia is used on more than five patients at a time shall comply with the requirements in Section 1226.8.

1226.6.2 Support areas for examination rooms.

1226.6.2.1 Nurse station. Refer to Section 1226.4.13.1.

1226.6.2.2 Medication station. Refer to Section 1226.4.13.2.

1226.6.2.3 Clean utility room. Refer to Section 1226.4.13.3.

1226.6.2.4 Soiled workroom or soiled linen holding. Refer to Section 1226.4.13.4.

1226.6.2.5 Consultation room. Dental facilities must provide a consultation room for private conferences with patients.

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1226.6.2.6 Sterilization facilities. If sterile processing and/or high level disinfection is provided, the sterile processing room shall consist of a decontamination area and a clean work area. The sterile processing/high level disinfection room shall be designed to provide one-way flow of contaminated materials/instruments to the sterilizer/high level disinfection equipment. Sterile/high level disinfected instruments should be distributed from the area in such a manner that processed items do not pass through the decon- tamination area.

1226.6.2.6.1 Decontamination area. The decontamination area shall be equipped with the following: 1. Countertop, separated from clean countertop by 4 feet minimum distance. 2. Handwashing station separate from the instrument washing sink. 3. Sink for washing instruments. To avoid splash, the decontamination sink shall be separated from the clean work area by either a 4-foot distance from the edge of the sink or a separating wall or screen. If a screen is used, it shall extend a minimum of 4 feet (1220 mm) above the sink rim. 4. Storage for supplies.

1226.6.2.6.2 Clean work area. The clean work area shall be equipped with the following: 1. Countertop, separated from decontamination countertop by 4 feet minimum distance. 2. Sterilizer/high level disinfection equipment, as required for the services provided. 3. Handwashing station, may share with decontamination area handwashing station. 4. Built-in storage for supplies.

1226.6.2.7 Laboratory. Facilities for laboratory services shall be provided in dental facilities or through a contract arrangement with a laboratory service.

1226.6.3 Support areas for patients.

1226.6.3.1 Patient toilet room(s). Refer to Section 1226.4.14.1.

1226.6.3.2 Specimen collection and/or blood collection facilities. When provided, refer to Section 1224.4.4.2.

1226.6.4 General support services and facilities.

1226.6.4.1 Garbage, solid waste, medical waste and trash storage. Refer to Section 1226.4.9.

1226.6.4.2 Housekeeping room. Refer to Section 1224.4.15.

1226.6.5 Public and administrative areas.

1226.6.5.1 Public area.

1226.6.5.1.1 Reception. Refer to Section 1226.4.16.1.1.

1226.6.5.1.2 Outpatient waiting room. Refer to Section 1224.4.5.

1226.6.5.1.3 Public toilet(s). Refer to Section 1224.4.5.

1226.6.5.1.4 Public telephone access. Refer to Section 1224.4.5.

1226.6.5.1.5 Drinking fountain(s). Refer to Section 1224.4.5.

1226.6.5.2 Administrative services

1226.6.5.2.1 Medical records storage. Refer to Section 1226.4.16.2.1.

1226.6.5.2.2 Equipment and supply storage. Refer to Section 1226.4.16.2.2.

1226.6.6 Support areas for staff.

1226.6.6.1 Staff toilet(s). Refer to Section 1226.4.17.1.

1226.6.6.2 Storage for employees. Refer to Section 1226.4.17.2.

Outpatient surgical clinics, and outpatient clinical services of a hospital providing services equivalent to a surgical clinic, shall comply with Sections 1226.4.2 through 1226.4.8 and the provisions of this section.

1226.8.1 Outpatient surgical service space.

1226.8.1.1 Operating room(s). Refer to Section 1224.39.2, Item 1.

1226.8.1.2 Perioperative services. Provide preoperative patient holding and post-anesthesia recovery area. Refer to Section 1224.16.

1226.8.1.3 Procedure room(s). Procedure rooms are optional. When provided, they shall comply with Section 1224.4.4.1.4.

1226.8.2 Support areas for outpatient surgery.

1226.8.2.1 Control station. Refer to Section 1224.15.3.1.

1226.8.2.2 Supervisor’s office or station. Refer to Section 1224.15.3.2.

1226.8.2.3 Substerile areas. When provided, refer to Section 1224.15.3.3.

1226.8.2.4 Medication station. Refer to Section 1226.4.13.2.

1226.8.2.5 Scrub facilities . Refer to Section 1224.15.3.5.

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1226.8.2.6 Clock. Refer to Section 1224.15.3.6.

1226.8.2.7 Soiled workroom. Refer to Section 1224.15.3.7.

1226.8.2.8 Clean utility room. Refer to Section 1224.15.3.8.

1226.8.2.9 Anesthesia workroom. Refer to Section 1224.15.3.9.

1226.8.2.10 Equipment storage room(s) for equipment and supplies used in outpatient surgery. Refer to Section 1224.15.3.10.

1226.8.2.11 Staff clothing change areas. Refer to Section 1224.15.3.11.

1226.8.2.12 Housekeeping room. Refer to Section 1224.39.2.3.2.

1226.8.2.13 Sterile and pharmaceutical supply storage. Refer to Section 1226.4.13.5.

1226.8.2.14 Sterilization facilities. Refer to Section 1226.4.13.6.

1226.8.3 Support areas for patients.

1226.8.3.1 Patient toilet room(s). Refer to Section 1226.4.14.1.

1226.8.3.2 Outpatient change area. A separate space shall be provided where patients change out of their street clothing and are prepared for the procedure. This space shall include provisions for clothing storage, toilet room(s), sink, space for clothing change and gowning area.

1226.8.4 General support services and facilities.

1226.8.4.1 Garbage, solid waste, medical waste and trash storage. Refer to Section 1226.4.9.

1226.8.4.2 Areas for off-site laundry services. Refer to Section 1226.4.15.1.

1226.8.5 Public and administrative areas.

1226.8.5.1 Public area.

1226.8.5.1.1 Reception. Refer to Section 1226.4.16.1.1.

1226.8.5.1.2 Outpatient waiting room. Refer to Section 1224.4.5.

1226.8.5.1.3 Public toilet(s). Refer to Section 1224.4.5.

1226.8.5.1.4 Public telephone access. Refer to Section 1224.4.5.

1226.8.5.1.5 Drinking fountain(s). Refer to Section 1224.4.5.

1226.8.5.2 Administrative services

1226.8.5.2.1 Medical records storage. Refer to Section 1226.4.16.2.1.

1226.8.6 Support areas for staff.

1226.8.6.1 Staff toilet(s). Refer to Section 1226.4.17.1.

1226.8.6.2 Storage for employees. Refer to Section 1226.4.17.2.

CHRONIC DIALYSIS CLINICS.

Chronic dialysis clinics and outpatient clinical services of a hospital providing services equivalent to a chronic dialysis clinic shall comply with Sections 1226.4.3 through 1226.4.8 and the provisions of this section.

1226.9.1 Examination and treatment rooms.

1226.9.1.1 Examination room(s). An examination room with a handwashing fixture shall be provided with a minimum clear floor area of 100 square feet (9.29 m [2] ).

1226.9.1.2 Treatment room(s) . When provided, refer to Section 1224.4.4.1. 1226.9.1.3 Individual patient treatment areas. Individual patient treatment areas shall contain at least 80 square feet (7.44 m [2] ). There shall be at least a 4-foot (1219 mm) space around and between beds and/or lounge chairs. In addition, the following shall be provided: 1. Location. The treatment area may be an open area and shall be separate from administrative area and outpatient wait- ing room. 2. Privacy. An open unit shall be designed to provide visual privacy for each patient.

1226.9.1.4 Reception. Refer to Section 1226.4.16.1.1.

1226.9.1.5 Outpatient waiting room. Refer to Section 1224.4.5.

1226.9.1.6 Bloodborne infection isolation room. A minimum of one bloodborne infection isolation room of at least 120 square feet (11.15 m [2] ) of clear floor space shall be provided for patients. This room shall contain a counter and handwashing station.

1226.9.1.7 Airborne infection isolation exam/treatment room. When provided, refer to Section 1224.4.4.1.3. 1226.9.1.8 Home training. When provided in the unit, a private treatment area of at least 120 square feet (11.15 m [2] ) shall be provided for patients who are being trained to use dialysis equipment at home. This room shall contain a counter, a handwashing station and a separate drain for fluid disposal.

1226.9.2 Support areas for examination and treatment rooms.

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1226.9.2.1 Administrative center or nurse station. Administrative center or nurse station shall be located within the dialysis treatment area and designed to provide visual observation of all patient stations. In addition, refer to Section 1226.4.13.1 for nurse station(s) requirements.

1226.9.2.1.1 Handwashing stations. Handwashing stations shall be directly accessible to the administrative center or nurse station and to patient treatment areas. Handwashing stations shall be provided for each four patient stations and for each major fraction thereof. These shall be uniformly distributed to provide equal access from each patient station. Refer to Section 1224.3 for the definition of a handwashing station.

1226.9.2.2 Medication station. Refer to Section 1226.4.13.2.

1226.9.2.3 Clean utility room. Refer to Section 1226.4.13.3.

1226.9.2.4 Soiled workroom or soiled linen holding. Refer to Section 1226.4.13.4.

1226.9.2.5 Housekeeping room. Provide a housekeeping room that is immediately accessible to, and for the exclusive use of, the unit. This room shall have a minimum floor area of 15 square feet (1.4 m [2] ) and shall include the following: 1. Service sink or floor receptor 2. Supply storage 3. Housekeeping equipment storage

1226.9.2.6 Nourishment room. When provided, refer to Section 1226.4.13.7.

1226.9.2.7 Sterilization facilities. When provided, refer to Section 1226.4.13.6.

1226.9.3 Administrative services. Provide office and clinical work space including the following:

1226.9.3.1. Medical records storage. Refer to Section 1226.4.16.2.1.

1226.9.3.2 Equipment and supply storage. Refer to Section 1226.4.16.2.2.

1226.9.4 Support areas for patients.

1226.9.4.1 Patient toilet room(s). Provide patient toilet room(s) directly accessible from treatment area. The toilet shall be equipped with bedpan flushing attachment(s). Refer to Section 1226.4.14.1.

1226.9.4.2 Patient storage. Provide space for storage of patient clothing and personal items.

1226.9.4.3 Specimen collection facilities. When provided, refer to Section 1224.4.4.2.

1226.9.5 General support services and facilities.

1226.9.5.1 Garbage, solid waste, medical waste and trash storage. Refer to Section 1226.4.9.

1226.9.5.2 Areas for off-site laundry services. Refer to Section 1226.4.15.1.

1226.9.5.3 Reprocessing room. When dialyzers are reused, a reprocessing room is required and sized to perform the functions required and include one-way flow of materials from soiled to clean with provisions for a refrigerator for temporary storage of dialyzer, decontamination/cleaning areas, sinks, processors, computer processors and label printers, packaging area, dialyzer storage and disinfectants storage.

1226.9.5.4 Repair room. When required, an equipment repair and breakdown room shall be equipped with a handwashing fixture, deep service sink, work counter and storage cabinet. Provide water supply and drain connection for testing machines.

1226.9.5.5 Mixing room. Each facility using a central batch delivery system shall provide, either on the premises or through writ- ten arrangements, individual delivery systems for the treatment of any patient requiring special dialysis solutions. The mixing room shall also include a sink, storage space and holding tanks.

1226.9.5.6 Water treatment room. The water treatment equipment shall be located in an enclosed room.

1226.9.6 Support areas for staff.

1226.9.6.1 Staff toilet(s). Refer to Section 1226.4.17.1.

1226.9.6.2 Storage for employees. Refer to 1226.4.17.2.

REHABILITATION CLINICS.

Rehabilitation clinics and outpatient clinical services of a hospital providing services equivalent to a rehabilitation clinic shall comply with Sections 1226.4.3 through 1226.4.8 and the provisions of this section.

SUPPORT AREAS FOR THERAPY SERVICES.

1226.10.1 Support area for patients.

1226.10.1.1 Patient toilet room(s). Refer to Section 1226.4.14.1.

1226.10.2 General support.

1226.10.2.1 Garbage. Refer to Section 1226.4.9.

1226.10.2.2 Housekeeping. Refer to Section 1224.4.15.

1226.10.2.3 Areas for off-site laundry services. Refer to Section 1226.4.15.1.

1226.10.3 Public and administrative.

1226.10.3.1 Public area.

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1226.10.3.1.1 Reception. Refer to Section 1226.4.16.1.1.

1226.10.3.1.2 Outpatient waiting room. Refer to Section 1224.4.5.

1226.10.3.1.3 Toilets. Refer to Section 1224.4.5.

1226.10.3.1.4 Drinking fountain. Refer to Section 1224.4.5.

1226.10.3.1.5 Telephone. Refer to Section 1224.4.5.

1226.10.3.2 Administrative services. Provide office and clinical work space including the following:

1226.10.3.2.1 Medical records storage. Refer to Section 1226.4.16.2.1.

1226.10.3.2.2 Equipment and supply storage. Refer to Section 1226.4.16.2.2.

1226.10.4. Support areas for staff.

1226.10.4.1 Staff toilet(s). Refer to Section 1226.4.17.1.

1226.10.4.2 Storage for employees. Refer to Section 1226.4.17.2.

REHABILITATION THERAPY SERVICE SPACES.

1226.10.5 Physical therapy service space. A physical therapy service space shall be provided. The service space shall comply with the following provisions: 1. Individual treatment area(s). Refer to Section 1224.35.2, Item 1. 2. Handwashing station(s). Refer to Section 1224.35.2, Item 2. 3. Exercise area. Refer to Section 1224.35.2, Item 3.

4. Clean linen and towel storage. Refer to Section 1224.35.2, Item 4. 5. Storage for equipment and supplies. Refer to Section 1224.35.2, Item 5 6. Separate storage for soiled linen, towels and supplies. Refer to Section 1224.35.2, Item 6.

1226.10.6 Occupational therapy service space. When an occupational therapy service is provided, the service space shall comply with following provisions: 1. Work areas and counters. Refer to Section 1224.35.3, Item 1.

2. Handwashing station(s). Refer to Section 1224.35.3, Item 2. 3. Storage for supplies and equipment. Refer to Section 1224.35.3, Item 3. 4. Area for teaching daily living activities. Refer to Section 1224.35.3, Item 4.

1226.10.7 Speech pathology and/or audiology service space. When speech pathology and/ or audiology service(s) is provided, the service space shall comply with the following provisions: 1. Interview, consultation and treatment space. Refer to Section 1224.35.4, Item 1. 2. Waiting area. Refer to Section 1224.35.4, Item 2. 3. Handwashing station(s). Refer to Section 1224.35.4, Item 3. 4. Testing unit. If an audiology service is provided. Refer to Section 1224.35.4, Item 4.

ALTERNATIVE BIRTHING CLINICS.

Alternative birthing clinics and outpatient clinical services of a hospital providing services equivalent to alternative birthing clinics shall comply with Sections 1226.4.3 through 1226.4.8 and the provisions of this section:

1226.11.1 Birthing service space.

1226.11.1.1 Birthing room. A birthing room shall have a minimum clear floor area of 200 square feet (18.58 square meters), including the newborn care area. A birthing room shall have a minimum clear dimension of 12 feet (3658 mm). The maximum number of beds per room shall be one.

1226.11.1.2 Location. Birthing rooms shall be located out of the path of unrelated traffic and under direct supervision of the facil- ity staff.

1226.11.1.3 Nurse call system. A nurse call system shall be located in the birthing room which will alert the nearest continually staffed administrative center or nurse station. Refer to Section 1224.4.6.5 for requirements.

1226.11.1.4 Hand-washing stations. A handwashing fixture, as defined in Section 1224.3, shall be located within or directly outside the room. If the fixture is located within the room, the fixture may be screened or within openable casework.

1226.11.1.5 Lighting. Lighting capable of 1076 lux (100 footcandles) at working surfaces shall be provided. Dimmer switches may be used.

1226.11.1.6 Window. Each birthing room shall have an outside window. Refer to Sections 1224.4.9.4 and 1224.4.9.5.

1226.11.1.7 Privacy. Windows or doors within a normal sightline that would permit observation into the room shall be arranged or draped, as necessary, for mother and newborn privacy.

1226.11.1.8 Newborn care area. When provided, a separate newborn care area shall be provided that is in addition to the birth- ing room.

1226.11.1.9 Examination room. When provided, the examination room shall meet the requirements of Section 1224.4.4.

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1226.11.2 Support areas for birthing services.

1226.11.2.1 Nurse station. Refer to Section 1226.4.13.1.

1226.11.2.2 Medication station. Refer to Section 1226.4.13.2.

1226.11.2.3 Clean utility room. Refer to Section 1226.4.13.3.

1226.11.2.4 Soiled utility or soiled holding room. Refer to Section 1226.4.13.4.

1226.11.2.5 Crash cart space. Space for storing crash cart shall be provided.

1226.11.2.6 Clean-up room. Each birthing room shall have immediate access to a clean-up room with a handwashing station and work space which is separate from any sterilizing facilities. The clean-up room shall provide 24 square feet (2.23 m [2] ) per birth- ing room up to eight rooms, with no dimensions less than 6 feet (1829 mm).

1226.11.2.7 Ice-making equipment. Each facility shall have equipment to provide ice for treatments and nourishment. Ice- making equipment shall be permitted in the clean utility or the nourishment room/area. Ice intended for human consumption shall be provided in the nourishment station and shall be served from self-dispensing ice-makers.

1226.11.2.8 Nourishment room or area. When provided, refer to Section 1226.4.13.7.

1226.11.2.9 Medical gas outlets. When provided, oxygen and suction capabilities may be portable or piped.

1226.11.3 Support areas for mother and newborn.

1226.11.3.1 Patient toilet room(s). Each birthing room shall have direct access to a private toilet room with lavatory, shower or tub and nurse call system. Facilities for cleaning bedpans shall be provided in the toilet room.

1226.11.4 General support services and facilities.

1226.11.4.1 Housekeeping room. Refer to Section 1224.4.15.

1226.11.4.2 Garbage, solid waste, medical waste and trash storage. Refer to Section 1226.4.9.

1226.11.4.3 Areas for off-site laundry services. Refer to Section 1226.4.15.1.

1226.11.5 Public and administrative areas.

1226.11.5.1 Public area.

1226.11.5.1.1 Reception. Refer to Section 1226.4.16.1.1.

1226.11.5.1.2 Outpatient waiting room. Refer to Section 1224.4.5.

1226.11.5.1.3 Public toilet(s). Refer to Section 1224.4.5.

1226.11.5.1.4 Public telephone. Refer to Section 1224.4.5.

1226.11.5.1.5 Drinking fountain. Refer to Section 1224.4.5.

1226.11.5.2 Administrative services.

1226.11.5.2.1 Medical records storage. Refer to Section 1226.4.16.2.1.

1226.11.5.2.2 Equipment and supply storage. Refer to 1226.4.16.2.2.

1226.11.6 Support areas for staff.

1226.11.6.1 Staff toilet(s). Refer to Section 1226.4.17.1.

1226.11.6.2 Storage for employees. Refer to Section 1226.4.17.2.

1226.11.6.3 Staff lounge. Refer to Section 1226.4.17.3.

1226.11.6.4 Staff clothing change area. When provided, a changing room with shower shall be provided for staff to change into work attire.

PSYCHOLOGY CLINICS.

Psychology clinics and outpatient clinical services of a hospital providing services equivalent to a psychology clinic shall comply with Sections 1226.4.3 through 1226.4.8 and the provisions of this section.

Psychology clinics shall provide at least an interview room, consulting room and group therapy room.

1226.12.1 Public and administrative area.

1226.12.1.1 Public area.

1226.12.1.1.1 Reception. Refer to Section 1226.4.16.1.1.

1226.12.1.1.2 Outpatient waiting room. Refer to Section 1224.4.5.

1226.12.1.1.3 Public toilet(s). Refer to Section 1224.4.5.

1226.12.1.1.4 Drinking fountain. Refer to Section 1224.4.5.

1226.12.1.1.5 Public telephone. Refer to Section 1224.4.5.

1226.12.1.2 Administrative Area.

1226.12.1.2.1 Medical Records storage. Refer to Section 1226.4.16.2.1.

1226.12.1.2.2 Equipment and supply storage. Refer to Section 1226.4.16.2.2.

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