Current through Register Vol. 51, No. 3, September 1, 2024
RELATES TO: KRS 216B.010-216B.130,
216B.990(1),
(2)
NECESSITY, FUNCTION, AND CONFORMITY:
KRS
216B.042 and
216B.105
mandate that the Kentucky Cabinet for Human Resources regulate health
facilities and health services. This administrative regulation provides the
licensure requirements for the structural specifications and physical plant
requirements for new construction, alteration and maintenance of psychiatric
hospital facilities. Psychiatric hospital facilities licensed prior to the
effective date of this administrative regulation shall meet the facility
specifications in force on the date of their most recent licensure
inspection.
Section 1. Definitions.
(1) "Board" means the Commission for Health
Economics Control in Kentucky.
(2)
"License" means an authorization issued by the board for the purpose of
operating a psychiatric hospital facility.
(3) "Licensure agency" means the Division for
Licensing and Regulation in the office of the Inspector General, Cabinet for
Human Resources.
Section
2. Preparation and Approval of Plans and Specifications. After
receiving a certificate of need from the board, plans and specifications shall
be submitted to the licensure agency and required approvals shall be obtained
pursuant to the requirements of
902 KAR
20:009, Sections 2 and 3.
Section 3. Compliance with Building Codes,
Ordinances and Regulations.
(1) This section
of this administrative regulation may be administered independently from other
sections of this administrative regulation.
(2) Nothing stated herein shall relieve the
sponsor from compliance with building codes, ordinances, and regulations which
are enforced by city, county, or state jurisdictions.
(3) The following requirements shall apply
where applicable and as adopted by the respective agency authority:
(a) Requirements of the Kentucky Building
Code pursuant to 815 KAR 7:010 through 815 KAR 7:060;
(b) Requirements for safety pursuant to 815
KAR 10:020, as amended;
(c)
Requirements for plumbing pursuant to
815 KAR
20:010 through
815 KAR
20:191, as amended;
(d) Requirements for air contaminants for
incinerators pursuant to
401 KAR 59:020
and
401 KAR
61:010;
(e) Requirements for elevators pursuant to
815 KAR
4:010;
(f)
Requirements for making buildings and facilities accessible to and usable by
the physically handicapped pursuant to
KRS
198B.260 and administrative regulations
promulgated thereunder;
(g) Review
of x-ray installation, construction and modification plans pursuant to
902 KAR
100:160;
(h) Food Service Establishment Act
(KRS
219.011 to
219.081) and State
Food Service Code (902 KAR
45:005) , as amended; and
(i) Requirements for boilers pursuant to
815 KAR
15:010 through 815 KAR 15:070.
(4) Prior to occupancy the facility shall
have final approval from appropriate agencies.
(5) All facilities shall be currently
approved by the Fire Marshal's Office before relicensure is granted by the
licensing agency.
Section
4. Facility Requirements and Special Conditions.
(1) A copy of the narrative program as
submitted in the certificate of need application for each project shall be
provided to the licensure agency by the sponsor which describes the functional
space requirements, staffing patterns, departmental relationships, and other
basic information relating to the fulfillment of the objectives of the
facility.
(2) The extent (number
and types of rooms) of the diagnostic, clinical, and administrative facilities
to be provided shall be determined by the services to be provided and the
estimated patient load as described in the narrative program.
Section 5. Nursing Unit.
(1) Patient room. Each patient room shall
meet the following requirements:
(a) Minimum
floor area of 100 square feet in one (1) bed rooms and eighty (80) square feet
per patient in multibed rooms with a maximum of two (2) patients per
room.
(b) Patient toilet rooms. A
toilet room shall be directly accessible from each patient room without going
through the general corridor. One (1) toilet room may serve two (2) patient
rooms.
(c) Lavatory. A lavatory
shall be provided in each patient room. If the patient room is served by its
own private toilet room the lavatory may be located in the toilet
room.
(d) Window. Sill height shall
not be higher than three (3) feet above the floor. Windows in psychiatric units
shall be of security type or a type that can only be opened by keys or tools
that are under the control of staff. Degree of security required shall be as
determined by the program. Operation of the sash shall be restricted to inhibit
possible tendency for escape or suicide. Where glass fragments may create a
hazard, safety glazing and/or other appropriate security features shall be
incorporated.
(e) If a nurses' call
system is included, provisions shall be made to permit removal of call buttons
and/or use of blank plates as appropriate.
(f) Visual privacy shall be provided to each
patient as needed which isolates patients from one another but not from
observation by staff.
(g) No
patient room shall be located more than 120 feet from the nurses'
station.
(h) No room shall be used
as a patient room where the access is through another patient's room.
(2) Service areas. Each
nursing unit shall include:
(a) A separate
space for occupational therapy at the rate of fifteen (15) square feet per
patient and a minimum area of 400 square feet. This space may be outside the
nursing unit.
(b) A minimum of two
(2) separate social spaces, one (1) appropriate for noisy activities and the
other for quiet activities shall be provided. The combined area shall not be
less than thirty (30) square feet per patient or not less than 120 square feet
for each of the two (2) spaces, whichever is greater. This space may be shared
by dining activities and may be outside of the nursing unit.
(c) Storage for patients'
belongings.
(d) Bathing facilities.
Bathtubs or showers shall be provided at the rate of one (1) for each four (4)
beds which are not individually served. At least one (1) bathing facility shall
have space for a wheelchair patient with an assisting attendant.
(e) Nurses' station for charting,
communications, and storage for supplies with a sink equipped for
handwashing.
(f) Clean workroom or
clean holding area. There shall be a clean workroom with a work counter,
handwashing and storage facilities or a clean holding room which is part of a
central system for storage and distribution of clean and sterile
supplies.
(g) Soiled workroom or
soiled holding room. There shall be a soiled workroom with a clinical sink or
equivalent flushing rim fixture, sink equipped for handwashing, work counter,
waste receptacle, and linen receptacle or a soiled holding room which is a part
of a central system for collection and disposal of soiled materials.
(h) Medicine area. Provision shall be made
for twenty-four (24) hour distribution of medicine to patients. This may be
from a medicine preparation room or unit, a self-contained medicine dispensing
unit, or by another approved system. If a medicine preparation room or unit is
used it shall be under the nursing staff's visual control and contain a work
counter, refrigerator, and locked storage for biologicals and drugs. If a
medicine dispensing unit is used it may be located at the nurses' station, in
the clean workroom, or in an alcove or other space under direct control of the
nursing or pharmacy staff. The controlled substances locker must have a double
lock.
(i) Clean linen storage in an
enclosed space (may be a designated area within the clean workroom). If a
closed cart system is used, storage may be in an alcove.
(3) Seclusion room(s). A seclusion room shall
be provided for patients requiring security and protection from either himself
or others. The room shall be located in a manner affording direct observation
of the patient by the nursing staff. It shall be a single room and be
constructed to minimize the patient's hiding, escape, injury or suicide. There
shall be a minimum of one (1) seclusion room for every twenty-four (24) beds.
The seclusion room(s) is intended for short term occupancies by patients who
may have become violent or suicidal. Therefore, special fixtures, hardware,
etc., including ground fault interrupters for electrical circuits and tamper
proof screws, shall be used. Doors shall have provisions for staff observation
while maintaining privacy from public and other patients.
Section 6. Outpatient Services. Outpatient
department. If outpatient services are provided outpatient facilities shall
provide for the privacy and dignity of the patient during interview,
examination, and treatment. Facilities shall be located so that outpatients do
not transverse areas being used by inpatients.
Section 7. Laboratory Facilities. Facilities
for laboratory services shall be provided directly within the psychiatric
hospital or through a contract with a hospital or laboratory service for
hematology, clinical chemistry, urinalysis, cytology, and bacteriology. If the
psychiatric hospital has a full medical laboratory providing these services it
shall comply with the applicable requirements of
902 KAR
20:009 concerning laboratories. If these services are
provided through a contract, the following shall be provided in the psychiatric
hospital:
(1) Laboratory work counter(s) with
sink, gas and electric service;
(2)
Lavatory(ies) with handwashing facility;
(3) Storage cabinet(s) or closet(s);
and
(4) Specimen collection
facilities. Urine collection rooms shall be equipped with a water closet and
lavatory. Blood collection facilities shall have space for a chair and work
counter.
Section 8.
Pharmacy or Drug Room. There shall be adequate facilities for the safe storage
and handling of pharmaceuticals including double locking of controlled
substances and refrigeration for biologicals and drugs which require
refrigeration.
Section 9. Other
Medical Services. If the psychiatric hospital provides radiologic, physical
therapy, surgical services or other medical services not addressed by this
administrative regulation the facility shall comply with the applicable
requirements of
902 KAR
20:009, Facility specifications, hospitals.
Section 10. Dietary Department. Food service
facilities shall be designed and equipped for sanitary storage, processing, and
handling of food. The facilities shall include refrigerated storage and dry
storage to accommodate a three (3) day minimum supply and dining space for
ambulatory patients, staff and visitors.
Section
11. Administrative and Public Areas. The facility shall have
adequate administrative, public, and staff facilities (e.g., offices, lobby,
toilet facilities) to accommodate the needs of the public, patients, and staff
without interfering with the provision of medical care services.
Section 12. Medical Records Unit. This unit
shall include adequate space for record storage, record review and dictating,
record sorting and recording.
Section
13. Laundry.
(1) The arrangement
of facilities and equipment shall assure an orderly work flow with a minimum of
cross traffic that might mix clean and soiled operations.
(2) If linen is to be processed in the
hospital, the following shall be provided:
(a)
Soiled linen receiving, holding, and sorting room with handwashing
facilities;
(b) Laundry processing
room with commercial-type equipment which can process seven (7) days of linen
needs within a regularly scheduled work week. Handwashing facilities shall be
provided;
(c) Clean linen storage,
inspection, and issuing room or area; and
(d) Cart storage and cart sanitizing
facilities.
(3) If linen
is to be processed off the hospital site there shall be a soiled linen holding
room with a handwashing facility conveniently accessible and a room or rooms
for receiving, inspection and storage of clean linen.
Section 14. Waste Processing Services. Space
and facilities shall be provided for the sanitary storage and disposal of waste
by incineration, mechanical destruction, compaction, containerization, removal,
or by a combination of these techniques.
Section
15. Details and Finishes. All details and finishes shall meet the
following requirements:
(1) Doors to patient
toilet rooms and other rooms needing access for wheelchairs shall have a
minimum width of two (2) feet and ten (10) inches.
(2) All doors to patient-room toilets and
patient-room bathrooms shall swing outward or be equipped with hardware that
will permit access in an emergency.
(3) Grab bars provided at patients' toilets,
showers, or tubs shall have one and one-half (1 1/2) inches clearance to walls
and shall be of sufficient strength and anchorage to sustain a concentrated
load of 250 pounds for a period of five (5) minutes.
(4) Recreation rooms, exercise rooms, and
similar spaces where impact noises may be generated shall not be located
directly over patient bed areas unless special provisions are made to minimize
such noise.
(5) Rooms containing
heat-producing equipment such as boiler rooms, laundries, and food preparation
areas shall be insulated and ventilated to prevent any floor surface from
exceeding a temperature of ten (10) degrees Fahrenheit above the ambient room
temperature.
(6) Noise reduction
criteria. Partition, floor, and ceiling construction in patient areas shall
comply with Section 19, Table 1 of this administrative regulation.
(7) Floors that are subject to traffic while
wet, such as shower and bath areas shall have a nonslip finish.
Section 16. Elevators.
(1) Number of elevators. All hospitals having
patients' facilities, such as patient rooms, dining rooms or recreation areas,
or diagnostic or therapy areas, located other than on the main entrance floor
shall have elevators.
(a) At least one (1)
hospital-type elevator shall be installed where one (1) to fifty-nine (59)
patient beds are located on any floor other than the main entrance
floor.
(b) At least two (2)
hospital-type elevators shall be installed where sixty (60) to 200 patient beds
are located on floors other than the main entrance floor, or where the major
inpatient services are located on a floor other than those containing patient
beds.
(c) At least three (3)
hospital-type elevators shall be installed where 201 to 350 patient beds are
located on floors other than the main entrance floor, or where the inpatient
services are located on a floor other than those containing patient
beds.
(d) For hospitals with more
than 350 beds the number of elevators shall be determined from a study of the
hospital plan and the estimated vertical transportation requirements.
(2) Cars and platforms. Cars of
hospital elevators shall have inside dimensions that will accommodate a
hospital bed and attendant and shall be at least five (5) feet wide by seven
(7) feet and six (6) inches deep. The car door shall have a minimum clear
opening of not less than three (3) feet and eight (8) inches.
Section 17. Mechanical
Requirements.
(1) General. Prior to completion
of the contract and final acceptance of the facility, the architect and/or
engineer shall obtain from the contractor certification in writing that all
mechanical systems have been tested and that the installation and performance
of these systems conform with the final plans and specifications.
(2) Steam and hot water systems.
(a) Boilers. If boilers are used, a minimum
of two (2) shall be provided and the combined capacity of the boilers, based
upon the published Steel Boiler Institute or Institute of Boiler and Radiation
Manufacturer's net rating, must be able to supply 150 percent of the normal
requirements for all systems and equipment in the facility.
(b) Boiler accessories. Boiler feed pumps,
condensate return pumps, fuel oil pumps, and circulation pumps shall be
connected and installed to provide normal and standby service.
(3) Air-conditioning, heating and
ventilation systems.
(a) Temperatures. For all
areas occupied by inpatients, the indoor winter design temperature shall be
seventy-two (72) degrees Fahrenheit and the indoor summer design temperature
shall be seventy-five (75) degrees Fahrenheit.
(b) Ventilation system details. All
air-supply and air-exhaust systems shall be mechanically operated. All fans
serving exhaust systems shall be located at the discharge end of the system.
The ventilation rates as shown in Section 19, Table 2 of this administrative
regulation, shall be considered as minimum acceptable rates and shall not be
construed as precluding the use of higher ventilation rates.
1. Outdoor air intakes shall be located as
far as practical but not less than twenty-five (25) feet from exhaust outlets
of ventilation systems, combustion equipment stacks, plumbing vent stacks, or
from areas which may collect vehicular or other noxious fumes. The bottom of
outside air intakes serving central air systems shall be located as high as
practical but not less than six (6) feet above ground level or if installed
above the roof, three (3) feet above roof level.
2. The ventilation systems shall be designed
and balanced in accordance with the pressure relationships as shown in Section
19, Table 2 of this administrative regulation.
3. All room supply, return and exhaust
outlets shall be located not less than three (3) inches above the finished
floor.
4. Corridors shall not be
used to supply air to or exhaust air from any room, except that exhaust air
from corridors may be used to ventilate rooms such as bathrooms, toilet rooms,
or janitor's closets which open directly on corridors.
(4) Plumbing systems.
(a) Lavatories and sinks required in patient
care areas shall have the water supply spout mounted so that its discharge
point is a minimum of five (5) inches above the rim of the fixture. All
fixtures in medical and nursing staff work areas and all lavatories used by
food handlers shall be equipped with valves which can be operated without the
use of hands. Where blade handles are used for this purpose, they shall not
exceed four and one-half (4 1/2) inches in length, except that handles on scrub
sinks and clinical sinks shall be not less than six (6) inches long. These
special fixtures are not required on lavatories in patient rooms or patient
toilet rooms.
(b) Clinical sinks
shall have an integral trap in which the upper portion of a visible trap seal
provides a water surface.
(c) Hot
water heating systems. The hot water heating equipment shall have a sufficient
capacity to supply water at the temperature and amounts indicated below:
|
Hot Water Use
|
|
Clinical
|
Dishwasher
|
Laundry
|
|
Gal/hr/bed
|
6 1/2
|
4
|
41/2
|
|
Temp. F.
|
100-110
|
180*
|
140- 180**
|
*Temperature may be reduced to 160 degrees Fahrenheit if a
chloritizer is used. Required temperature must be maintained throughout the
wash and rinse cycles.
**If the temperature used is below 180 degrees Fahrenheit, the
facility shall utilize detergents and other additives to insure that the linens
will be adequately cleaned.
Section 18. Electrical Requirements.
(1) General. All material including
equipment, conductors, controls, and signaling devices shall be installed to
provide a complete electrical system with the necessary characteristics and
capacity to supply the electrical facilities shown in the specifications or
indicated on the plans. All materials shall be listed as complying with
applicable standards of Underwriters' Laboratories, Inc., or other similarly
established standards.
(2) Panel
boards. Lighting and appliance panel boards shall be located on the same floor
as the circuits they serve.
(3)
Lighting. Patients' bedrooms shall have general lighting and night lighting. A
reading light shall be available for each patient. Patients' reading lights and
other fixed lights not switched at the door shall have switch controls located
convenient to the luminaire. A fixed type night light shall be provided in each
patient room.
(4) Receptacles
(convenience outlets).
(a) Patient room. Each
patient room shall have duplex receptacles as follows: one (1) on each side of
the head of the bed; and one (1) on another wall. Receptacles shall be of the
safety type or shall be protected by five (5) milliampere ground fault
interrupters.
(b) Corridors. Duplex
receptacles for general use shall be installed approximately fifty (50) feet
apart and within twenty-five (25) feet of ends of corridors. Receptacles shall
be of the safety type or shall be protected by five (5) milliampere ground
fault interrupters.
(5)
Nurses' emergency calling system. An emergency calling system, which may be
used by nurses to summon assistance, shall be provided in each nursing
unit.
(6) Emergency electrical.
(a) To provide electricity during
interruption of the normal electric supply, an emergency source of electricity
shall be provided and connected to certain circuits for lighting and
power.
(b) The source of this
emergency electric service shall be as follows:
1. An emergency generating set, when the
normal service is supplied by one (1) or more central station transmission
lines.
2. An emergency generating
set or a central station transmission line, when the normal electric supply is
generated on the premises.
(c) Emergency generating set. The required
emergency generating set, including the prime mover and generator, shall be
located on the premises and shall be reserved exclusively for supplying the
emergency electrical system. Generator sets shall be self-sufficient insofar as
possible without dependency on public utilities that may be subject to cutoff
or outages. Exception: A system of prime movers which are ordinarily used to
operate other equipment and alternately used to operate the emergency
generator(s) will be permitted provided that the number and arrangement of the
prime movers are such that when one (1) of them is out of service (due to
breakdown or for routine maintenance), the remaining prime mover(s) can operate
the required emergency generator(s) and provided that the connection time
requirements as listed in Section 19 of this administrative regulation are met.
The emergency generator set shall be of sufficient kilowatt capacity to supply
all lighting and power load demands of the emergency electrical system. The
power factor rating of the generator shall be not less than eighty (80)
percent.
(d) Emergency electrical
connections. Emergency electric service shall be provided to circuits as
follows:
1. Lighting.
a. Exitways and all necessary ways of
approach thereto including exterior of exits, exit doorways, stairways, and
corridors.
b. Nursing station and
medication preparation areas.
c.
Generator set location, switch-gear location, mechanical room and boiler
room;
d. Elevator cabs.
e. Night light in patient rooms.
f. Dining and recreational areas,
occupational therapy and physical therapy.
2. Equipment. Essential to life safety and
for protection of important equipment or vital materials:
a. Nurses' calling system.
b. Paging or speaker systems, if intended for
issuing instructions during emergency conditions.
c. Fire pump and jockey pump, if
installed.
d. Sewerage or sump lift
pump, if installed.
e. Selected
receptacles at the nurses' stations; medicine dispensing area; and basic
laboratory functions, if provided.
f. Duplex receptacles in patient
corridors.
g. Equipment necessary
for maintaining telephone service.
3. Heating. Equipment for heating patient
rooms; except that service for heating of patient rooms will not be required
if:
a. The hospital is supplied by two (2) or
more electrical services supplied from separate generating sources, or a
utility distribution network having multiple power input sources and arranged
to provide mechanical and electrical separation; so that a fault between the
hospital and generating sources will not likely cause an interruption of the
hospital service feeders;
b. The
hospital has an alternate emergency heating system for the heating of
corridors; or
c. The hospital has
a written plan approved by the licensure agency for the transfer of patients
within a reasonable time to other facilities.
(e) Details. The emergency electrical system
shall be so controlled that after interruption of the normal electric power
supply, the generator is brought to full voltage and frequency and it must be
connected within ten (10) seconds through one (1) or more primary automatic
transfer switches to all emergency lighting systems; alarms systems; nurses'
calling systems; equipment necessary for maintaining telephone service; and
task illumination and receptacles in patient corridors. All other lighting and
equipment required to be connected to the emergency system shall either be
connected through the above described primary automatic transfer switching or
shall be subsequently connected through other automatic or manual transfer
switching. Receptacles connected to the emergency system shall be distinctively
marked for identification. Storage-battery-powered lights, provided to augment
the emergency lighting or for continuity of lighting during the interim of
transfer switching immediately following an interruption of the normal service
supply, shall not be used as a substitute for the requirement of a generator.
Where stored fuel is required for emergency generator operation, the storage
capacity shall be sufficient for not less than twenty-four (24) hours of
continuous operation.
Section 19. Table 1 - Sound Transmission
Limitations in Psychiatric Hospitals. Table 2 - Pressure Relationships and
Ventilation of Certain Psychiatric Hospital Areas.
|
Table 1. Sound Transmission
Limitations in Psychiatric Hospitals
|
|
Location
|
Airborne Sound Transmission Class (STC)a*
|
Impact Insulation Class (IIC)b*
|
|
Parti-tions
|
Floors
|
Floors
|
|
Patients' room to patients' room
|
45
|
45
|
45
|
|
Corridor to patients' room
|
40
|
45
|
45c*
|
|
Public space to patients' room d*
|
50
|
50
|
50c*
|
|
Service areas to patients' room e*
|
55
|
55
|
55c*
|
a* - Sound transmission class (STC) shall be determined by
tests in accordance with the methods set forth in ASTM Standard E-90 and ASTM
Standard E-413.
b* - Impact insulation class (IIC) shall be determined in
accordance with criteria set forth in HUD FT/TS-24, "A guide to Airborne,
Impact and Structure Borne Noise - Control in Multifamily Dwellings."
c* - Impact noise limitation applicable only when corridor,
public space, or service area is over patients' room.
d* - Public space includes lobbies, dining rooms, recreation
rooms, treatment rooms, and similar spaces.
e* - Service areas include kitchens, elevators, elevator
machine rooms, laundries, garages, maintenance rooms, boiler and mechanical
equipment rooms, and similar spaces of high noise. Mechanical equipment located
on the same floor or above patients' rooms, offices, nurses' stations and
similar occupied spaces shall be effectively isolated relating to noise
transmission.
Note: The requirements set forth in this table assume
installation methods which will not appreciably reduce the efficiency of the
assembly as tested.
|
TABLE 2. PRESSURE RELATIONSHIPS AND
VENTILATION OF CERTAIN PSYCHIATRIC HOSPITAL AREAS
|
|
Area Designation
|
Pressure Relationship to Adjacent Areas
|
All Supply Air From Outdoors
|
Minimum Air Changes of Outdoor Air per Hour
|
Minimum total Air Changes Per Hour
|
All Air Exhausted Directly to Outdoors
|
|
Patient room
|
O
|
--
|
1
|
4
|
--
|
|
Patient area corridor
|
O
|
--
|
2
|
4
|
--
|
|
Treatment room
|
O
|
--
|
2
|
6
|
--
|
|
Physical therapy and hydrothera-py if
applicable
|
N
|
--
|
2
|
6
|
--
|
|
Dining and recreation areas
|
O
|
--
|
2
|
4
|
--
|
|
Soiled workroom
|
N
|
--
|
2
|
4
|
Yes
|
|
Clean workroom
|
P
|
Yes
|
2
|
4
|
--
|
|
Toilet room
|
N
|
--
|
--
|
10
|
Yes
|
|
Bedpan room if applicable
|
N
|
--
|
--
|
10
|
Yes
|
|
Bathroom
|
N
|
--
|
--
|
10
|
Yes
|
|
Janitor's closet
|
N
|
--
|
--
|
10
|
Yes
|
|
Linen and trash chute rooms
|
N
|
--
|
--
|
10
|
Yes
|
|
Food preparation center
|
O
|
Yes
|
2
|
10
|
Yes
|
|
Dishwashing area
|
N
|
--
|
--
|
10
|
Yes
|
|
Dietary day storage
|
O
|
--
|
--
|
2
|
--
|
|
Laundry, general
|
O
|
Yes
|
2
|
10
|
Yes
|
|
Soiled linen sorting and storage
|
N
|
--
|
2
|
10
|
Yes
|
|
Clean linen storage
|
P
|
--
|
1
|
4
|
--
|
P=Positive N=Negative O=Equal --= Optional
STATUTORY AUTHORITY:
KRS
216B.042,
216B.105
