Current through Register Vol. 49, No. 6, March 15, 2024
PURPOSE: Section
197.225,
RSMo authorizes the Department of Health to establish physical standards for
birthing centers in order to provide care in a safe environment. Birthing
centers are considered ambulatory surgical centers as defined by section
197.200(1),
RSMo and are subject to licensure as
required by 197.205, RSMo. This rule establishes physical plant requirements
for licensing existing birthing centers. Existing birthing centers are those
birthing facilities already in operation at the time these rules are
adopted.
PUBLISHER'S NOTE: The publication of the full text of
the material that the adopting agency has incorporated by reference in this
rule would be unduly cumbersome or expensive. Therefore, the full text of that
material will be made available to any interested person at both the Office of
the Secretary of State and the office of the adopting agency, pursuant to
section 536.031.4, RSMo. Such material will be provided at the cost established
by state law.
(1) General
Standards.
(A) Any birthing center existing
and in continuous operation prior to the date of the adoption of this rule will
be inspected by the Department of Health to determine compliance with this
rule. Existing birthing centers shall comply with all applicable local
regulations and codes and shall hold a certificate of occupancy from the local
building authority.
(B) Requests
for deviations from requirements on physical facilities shall be requested in
writing to the Department of Health and must contain information which
determines that the respective intent or objectives of this rule have been met.
Approvals for deviations shall be requested in writing and both requests and
approvals shall be made a part of the permanent Department of Health records
for the birthing center.
(C)
References in this rule to, National Fire Protection Association (NFPA),
publications are those contained in the twelve (12)-volume 1994 compilation of
National Fire Codes. Where there are discrepancies between
referenced NFPA publication requirements and this rule, the requirements of
this rule shall apply.
(2) Access for the Physically Handicapped.
Existing birthing centers are required by the United States Department of
Justice to currently comply with the federal requirements for accessible design
established under the Americans With Disabilities Act. Evidence of compliance
as determined by a local authority or other independent third party shall be
provided to the department by the owner of the facility.
(3) Site.
(A) Adequate vehicular and pedestrian access
shall be provided to the main entrance, emergency vehicular entrance and
service entrance.
(B) Adequate
parking shall be available in proportion to the number of patients and staff
normally occupying the facility.
(C) Means of immediate access to the building
for fire fighting and ambulance service personnel and equipment shall be
provided.
(4)
Administrative/public areas shall include business office with staff telephone
and administrator's office, medical records storage for at least two (2) years
of active patient records, public lobby and waiting room, telephone, toilet, at
least one (1) room for education and training and at least one (1) examination
room. In existing birthing centers having only one (1) regular birthing room,
one (1) examination room shall be sized and equipped to serve as a stand-by
birthing room.
(5) Birthing rooms
shall include at least one (1) birthing room sized to accommodate the
equipment, personnel and circulation area necessary to accomplish infant
delivery; each birthing room door shall be ample in width and conformation to
accommodate ambulance stretchers or infant transport warmer.
(A) Hand washing facilities operable without
the use of hands shall be accessible within each birthing room and each
examination room.
(B) Each birthing
room shall be equipped with a bed or delivery chair, storage facilities for
supplies, and sufficient tables to hold emergency and other necessary
equipment.
(C) A toilet with
lavatory and shower shall be easily accessible from the birthing rooms without
traversing public areas.
(D)
Piped-in or portable oxygen and vacuum service shall be available to each
birthing room.
(6)
Service and Staff Support Facilities for the Birthing Suite. These facilities
shall include:
(A) A clean work and sterile
storage area, and storage space for clean supplies;
(B) A separate soiled/decontamination utility
area equipped with a counter and sink;
(C) A separate toilet with lavatory for
staff;
(D) An area shall be
provided for the preparation and storage of medication; and
(E) A staff work area for charting located to
permit visual supervision of the birthing suite.
(7) General Support Facilities. These
facilities shall include:
(A) Adequate space
for the housing and maintenance of mechanical, plumbing and electrical
equipment;
(B) Medical gas shall be
stored and distributed in accordance with "NFPA 99, Standard for Health Care
Facilities, 1993 Edition," in 1994 National Fire Code, Volume
5; and
(C) Housekeeping supply and
general storage areas appropriate to fulfill the needs of the
facility.
(8) Details
and Finishes.
(A) A continuous system of
unobstructed corridors and aisles shall extend through the enclosed portion of
each story of the birthing facility, connecting all rooms and spaces with each
other and with all entrances, exitways and elevators. Mechanical equipment
space need not be connected to the corridor system. Corridors shall be
separated from all other areas by partitions constructed to resist the passage
of smoke.
(B) At least two (2)
remote exits shall be provided for each patient floor. Each exit shall
discharge to the outside or through an enclosed stairway or passageway to the
outside.
(C) Required exit stairs
shall discharge directly to the outside or into an enclosed corridor which
extends from the stair discharge to the outside. The fire-resistance rating of
the enclosure of a corridor extension of a stair shall be not less than the
rating required for the stair enclosure as stated in subsection (9)(D) of this
rule.
(D) Corridors serving as a
means of access to exit for patients in the birthing suite shall be arranged
and of sufficient width to facilitate the movement of patients on
stretchers.
(E) Exit doors shall
swing in the direction of exit travel.
(F) All doors through which birthing patients
pass to access birthing rooms and exits shall be of ample width to accommodate
ambulance stretchers and warmers.
(G) Where outside windows exist in the
birthing room, washable window treatments shall be installed to control light
and glare.
(H) Where outside
windows are provided in other areas of the facility, window treatments shall be
installed to control light and glare.
(I) At least one (1) ABC-type fire,
extinguisher, compliant with "NFPA 10, Standard for Portable Fire
Extinguishers, 1990 Edition" 1994 National Fire Code, Volume
1, shall be located on each floor occupied by the birthing center, including
the basement.
(J) A paper towel
dispenser and soap dispenser shall be provided at all lavatories used for hand
washing.
(K) Ceiling, wall and
floor finishes in toilets, bath facilities and utility and storage rooms
designed for washing, sterilizing and storage shall be easily
cleanable.
(L) Finish materials
installed on the walls, floors, and ceilings in the birthing rooms shall be
washable. The floors shall not be physically affected by frequent wet cleaning
with cleaning and germicidal cleaning agents.
(M) Floor and wall penetrations by pipes,
ducts and conduits shall be tightly sealed to minimize entry of rodents and
insects. Joints of structural elements shall be similarly sealed.
(9) Construction, Including
Fire-Resistive Requirements.
(A) Construction
of freestanding birthing centers shall comply with "NFPA 101, Section 13-6,
Existing Ambulatory Health Care Centers, 1994 Edition," in 1994
National Fire Codes, Volume 5 and to the minimum requirements of this
rule.
(B) Multistoried buildings
rated combustible Type V shall be protected throughout by an approved automatic
sprinkler system.
(C) Birthing
centers shall be separated from other tenants and occupancies by walls having
at least a one (1)-hour fire-resistance rating. These walls shall extend from
the floor slab below to the floor or roof slab above.
(D) The number of stories in a building
housing a birthing center shall be determined by counting all patient care
areas in the building.
(E) Every
stairway, elevator shaft, light and ventilation shaft, chute and other openings
between stories shall be enclosed or protected to prevent the spread of fire or
smoke from one (1) floor to another. The fire-resistance rating of the
enclosure or protection shall be not less than the structural floor separation
requirements of "NFPA 220, Standard on Types of Building Construction, 1992
Edition," in 1994 National Fire Codes, Volume 5 for the
fire-resistive building type classification required by subsection (9)(A) of
this section.
(10)
Elevators.
(A) Multistory buildings shall
have at least one (1) elevator if patient services are located on any floor
other than the grade level (birthing center's main entrance) floor.
(B) The elevator cab and door opening shall
be of sufficient size to facilitate the movement of a patient on an ambulance
stretcher.
(11)
Mechanical Requirements.
(A) Heating,
ventilating and cooling equipment shall be provided, maintained and operated to
provide ambient temperatures of sixty-eight to eighty-five degrees Fahrenheit
(68-85oF).
(B) All toilets and soiled materials
holding/workrooms shall be exhausted to the outside by exhaust fans.
(12) Plumbing and Other Piping
Systems.
(A) Systems shall be designed to
supply water to the fixtures and equipment on every floor at an adequate
pressure for their practical use.
(B) Reduced pressure backflow preventers
shall be installed where the water service enters the building and on hose
bibbs and on all fixtures, such as janitors' sinks and laboratory fixtures, to
which hoses or tubing can be attached.
(C) Hot water distribution systems shall be
delivered to each fixture at a temperature which precludes the hazard of
scalding.
(13)
Electrical Requirements.
(A) Every room,
including storage rooms, corridor and all other areas shall be sufficiently
illuminated to facilitate efficient performance of all necessary
tasks.
(B) Trickle charge battery
pack units, complying with the standards of "Article 700, NFPA 70,
National Electrical Code, 1994 Edition," in National
Fire Codes, Volume 3 shall be located to provide emergency lighting in
the birthing rooms, exit corridors, exit signs, electrical branch panel rooms
and exit stairs to point of discharge at grade. These fixtures shall be tested
at least quarterly with the tests documented in writing. An emergency stand-by
power system is not required in birthing centers.
(C) There shall be one (1) electrical outlet
for the emergency light and at least two (2) additional duplex outlets in each
birthing room.
(D) The fire alarm
system in existing birthing rooms may consist of the local alarms from the
required smoke detectors provided the alarm from any one (1) of the detectors
may be heard throughout the occupied areas of the birthing center. Existing
birthing centers with building configurations which preclude a local alarm from
alerting all birthing center occupants must have an electrically powered fire
alarm system which will alert all areas of the facility when
activated.
(E) Existing birthing
centers shall have smoke detectors installed at thirty-foot (30') intervals in
all rooms and in corridors. All required smoke detectors in existing birthing
centers may be battery powered. Battery-powered smoke detectors shall be tested
at least quarterly with the tests documented in writing.
*Original authority 1975, amended
1986.
