Alabama Administrative Code
Title 420 - ALABAMA STATE BOARD OF HEALTH
Chapter 420-5-5 - END STAGE RENAL DISEASE TREATMENT AND TRANSPLANT CENTERS
Section 420-5-5-.04 - Physical Environment

(a) Scope. A facility constructed or renovated after the effective date of these rules shall be classified as Ambulatory Health Care Occupancy of the Life Safety Code, and Business Occupancy of the Standard Building Code, and shall comply with the codes and standards adopted by the State Board of Health at the time of plan submission.

(b) New Construction, Additions, and Major Alterations. When construction is contemplated, either for new buildings, conversions, additions, or major alterations to existing buildings coming within the scope of these Rules, plans and specifications shall be submitted for review and approval to the Alabama Department of Public Health, in accordance with Alabama Administrative Code Rule 420-5-22, "Submission of Plans and Specifications for Health Care Facilities."

(c) Minor Alterations and Remodeling. Minor alterations and remodeling which do not affect the structural integrity of the building, which do not change functional operation, which do not affect fire safety, and which do not add beds or facilities over those for which the dialysis and/or transplant facility is licensed, need not be submitted for approval.

(d) Inspections. The Alabama Department of Public Health and its authorized representatives shall have access to the work for inspection wherever it is in preparation or progress.

(a) Location. The facility shall provided sufficient parking space for patients, visitors and staff. The facility and its services shall be accessible to disabled individuals as required by federal law.

(b) Local Restrictions. The dialysis center shall comply with local zoning, building, and fire ordinances.

(c) Structural Soundness. The building shall be structurally sound, free from leaks and excessive moisture, in good repair, and painted at intervals to be reasonably attractive inside and out.

(d) Fire Extinguisher. An all purpose fire extinguisher shall be provided at each exit and special hazard areas and located so a person would not have to travel more than 75 feet to reach an extinguisher.

(e) Ventilation. The building shall be well ventilated at all times with a comfortable temperature maintained. Portable and window air circulating fans are prohibited.

(f) Garbage Disposal. Space and facilities shall be provided for the sanitary storage and disposal of all waste. Infectious and potential waste material shall be rendered non-infectious on the premises either by autoclaving, incineration or immersion in formaldehyde, or shall be delivered by employees of the ESRD Facility directly to an incinerator. In the latter case, the ESRD Facility must complete an Agreement with the owner of said incinerator delineating appropriate measures for the proper disposal of such waste. During transportation, such waste must be labeled, placed in double bags and sharp objects placed within rigid-walled containers. Removal of such waste shall not be through patient use areas.

(g) Elevators. Multi-story facilities shall be equipped with at least one automatic elevator of a size sufficient to carry a patient on a stretcher.

(h) Doors. All doors to Treatment Rooms and Patient Use Areas shall be no less than 36 inches wide.

(i) Pest Control. The premises must be kept free from rodent and insect infestation.

(j) Corridors. Corridors required for exit access shall be as a minimum 5 feet wide.

(k) Occupancy. No part of a dialysis center may be rented, leased or used for any commercial purpose, or for any purpose not necessary or in conjunction with the operation of the center. Food and drink machines may be maintained or a diet kitchen provided.

(l) Lighting. All areas of the center shall have sufficient artificial lighting to prevent accidents and provide proper illumination for all services.

(m) Exit Doors. Exit doors shall meet the following criteria:

(n) Floors. All floors in treatment areas shall be smooth resilient tile or seamless flooring, and be free from cracks and finished so that they can be easily cleaned. All other floors shall be covered with hard tile, resilient tile or carpet or the equivalent.

(o) Curtains. All draperies and cubicle curtains shall be rendered and maintained flame retardant.

(p) Handicap Facilities. The facility shall be accessible to the physically handicapped and shall comply with ADA Accessibility Guidelines.

(q) Reuse Rooms. Reuse Rooms shall be separated from the rest of the facility by one hour fire resistive construction. Rooms shall be of adequate size and design to prevent co-mingling of dirty and clean dializers. Ventilation for Reuse rooms shall comply with AAMI requirements.

(a) Admission Office. There shall be a room designated as the admission office where patients may discuss personal matters in private. The admission office may be combined with the business office and medical record room if privacy can be maintained when confidential matters are being discussed.

(b) Preventive Maintenance. There shall be a preventive maintenance program to ensure that all mechanical, electrical and patient care equipment is maintained in safe operating condition. Also, records shall be maintained as to the calibration and maintenance of equipment in accordance with the manufacturers recommendation. Cleaning of dialysis equipment shall be carried out with appropriate disinfecting agents. Air-conditioning and heating filters must be inspected monthly to ensure and maintain their effectiveness. Filter inspections shall be recorded.

(c) Dialysis Station. The treatment area shall contain a minimum of 70 square feet per dialysis station and be so arranged as to facilitate both routine and emergency care of the patient, and emergency evacuation.

(d) Waiting Room. A waiting room in the administrative section shall be provided with sufficient seating for the maximum number of persons that may be present at any time. Waiting room shall be separated from the Treatment Area by a wall and door with locking capability. Public toilet(s) shall be available in the waiting room.

(e) Storage Facilities. Storage rooms will be provided in order that ample space be available for storage of supplies and equipment. Storage Rooms of more than 50 square feet in area shall be enclosed with one hour fire rated construction, with 45 minute fire rated, self closing doors.

Authors: Tigner Zorn, L. O'Neal Green, Cecil Barnes, Victor Hunt