Compilation of Rules and Regulations of the State of Georgia
Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH
Chapter 111-8 - HEALTHCARE FACILITY REGULATION
Subject 111-8-22 - END STAGE RENAL DISEASE FACILITIES
Rule 111-8-22-.15 - Environment of Care
Universal Citation: GA Rules and Regs r 111-8-22-.15
Current through Rules and Regulations filed through September 23, 2024
(1) Safety. The facility shall have sufficient staff, systems and equipment in place to provide a safe environment for patients, staff, and visitors, to include at least:
(a) A system for patients and staff to summon assistance, when needed, from treatment areas and bathrooms;
(b) An incident reporting and monitoring system that promptly identifies, investigates, and takes corrective action regarding all incidents that involve injury to patients or visitors, that involve damage to property, or which have the potential to cause such injury or damage if not corrected;
(c) Policies and procedures to prohibit and prevent verbal or physical abuse or neglect of patients while they are receiving services from the facility;
(d) A program which requires and documents the inspection, monitoring, and maintenance of biomedical equipment, electrical equipment, and any emergency power systems;
(e) An environment free of physical hazards such as broken or torn furniture, loose floors or wet flooring, or holes in walls, windows, or ceilings;
(f) Procedures, supplies, and equipment for the management of biomedical waste and the disposal of sharps in accordance with current accepted standards of practice;
(g) Adequate supplies of protective equipment for staff involved with patient care; and
(h) A working telephone on the premises accessible to the patients.
(2) Cleanliness and Sanitation. The facility premises and equipment shall be maintained in a clean and orderly condition. There must be evidence that the facility has systems that satisfactorily address at least the following:
(a) The description and performance of effective daily, interim, and terminal cleaning routines for all areas;
(b) Procedures, supplies, and facilities for the management of linens which include separate storage areas and separate transport containers for clean and dirty linens, separate storage areas for patient property if permitted by facility policy, and the requirement that no dirty linens or sanitation equipment shall be stored in a water treatment room or reuse room;
(c) Clean and orderly storage areas for supplies;
(d) Facilities and supplies for convenient and effective handwashing throughout the facility, including but not limited to:
1. For facilities newly constructed or undergoing major renovation after the effective date of these rules, at least one handwashing sink in the dialysis area for each eight dialysis stations;
2. If the facility conducts reuse hemodialysis, a separate handwashing sink in the reuse room;
3. If the facility provides on-site peritoneal dialysis, a handwashing sink in the room used for peritoneal dialysis which is separate from any facilities for disposal of effluent (peritoneal dialysis drainage); and
4. Hot and cold running water at each sink, with soap or sanitizing solution for washing hands, and clean disposable materials or air dryers for drying hands.
(e) Sufficient equipment and systems for prevention of infestation by insects, rodents, or other vermin or vectors;
(f) Systems for the storage and disposal of trash, garbage, and waste in a manner that will not permit the transmission of disease, create a nuisance, or provide a breeding place for insects or rodents; and
(g) Floor coverings that are intact, with no reservoirs or cracks in the surface where pathogens and standing water may accumulate.
(3) Space and Equipment. The facility shall provide adequate space and equipment to provide the scope of services offered, while ensuring the health and safety of patients and staff.
(a) For a facility constructed or undergoing renovation after the effective date of these rules, the facility shall have a minimum of 70 square feet of floor space at each treatment station, with the smallest dimension being 7 feet.
1. The 70 square feet may include counters, sinks, and aisles.
2. There shall be access to both sides of the patient bed/chair at each treatment station, with ease of passage for staff or a wheelchair.
(b) Public hallways, doorways, and elevators should be of sufficient size so as to accommodate passage of a wheelchair or ambulance gurney or stretcher.
(c) If the facility provides on-site peritoneal dialysis, there shall be a separate room for the peritoneal dialysis treatment.
(d) The facility shall have a private area for meetings with patients or family members, separate from the treatment areas.
(e) The facility shall have an examination room, equipped with a door that closes, an examining table, a readily accessible handwashing sink, and adequate floor space to accommodate the patient's treatment needs.
(f) If the facility offers services to patients with infectious diseases, the facility shall provide treatment for those patients in accordance with recommendations from the Centers for Disease Control. Some infectious diseases will require the use of isolation rooms and separate dialyzer equipment.
(g) There shall be sufficient office space for physicians, nurses, social services, administration, and dietetic and other ancillary services to work and meet, physically separated from the patient treatment area(s).
(h) The facility shall have at least one toilet facility with handwashing sink for patient use, which is accessible for a patient in a wheelchair.
(4) Water Treatment System.
(a) The facility shall operate a system for the analysis and treatment of water to ensure a continuous water supply sufficient in quantity and quality to conduct dialysis in accordance with accepted standards of practice.
1. Responsibility for the effective operation of the water treatment system shall be assigned to the medical director of the facility.
2. Policies and procedures shall be developed and implemented to govern all staff actions relative to water treatment; and
3. Systems for water treatment, water monitoring, water delivery, and water disposal shall adhere to the current standards for water treatment as described in the American National Standard,"Hemodialysis Systems", published by the Association for the Advancement of Medical Instrumentation (AAMI), herein incorporated by reference.
(b) The area used for water treatment shall be separate from the area(s) used for dialysis treatment, dialyzer reprocessing, or other activities and purposes at the facility. Mixing of dialysate may be performed in the area used or water treatment, if there is sufficient space for both functions.
(c) The facility's water treatment system shall be continuously monitored during patient treatment, and shall be equipped with a functional audible and visible alarm system to alert staff if there is a failure of the system.
(d) Staff assigned to the operation and monitoring of the water treatment system shall meet the training and competency qualifications for water treatment technicians required under this chapter.
(e) Staff shall maintain a written log of the operation of the water treatment system throughout each treatment day. Entries into the log shall be current and legible, and shall indicate that each component of the system is operating within required parameters or shall describe actions taken when operation is outside required parameters.
(f) Monthly testing of product water from selected sample sites within the system shall be conducted to assess compliance with AAMI water quality standards. In addition, a sample of product water shall be submitted for chemical analysis every six months, or sooner if there have been changes to the system or if the monthly results indicate there may have been a significant change in quality. Reports of all water testing shall be reviewed and signed by the medical director.
O.C.G.A. § 31-44-3.
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