Current through Register Vol. 47, No. 12, March 26, 2025
This section applies to ambulatory care facility
construction projects approved by the commissioner or department prior to
October 14,1998 and to ambulatory care facility construction projects not
requiring such approval that were completed prior to October 14, 1998.
(a) Ambulatory care facilities shall comply
with chapter 39, "Existing Business Occupancies," of NFPA 101, Life Safety
Code, 2000 edition, which is described in more detail in section
711.2(a) of this
Title.
(b) Ambulatory care
facilities shall include all pertinent elements described in this section. When
services are shared or purchased, the commissioner may approve appropriate
deletions and modifications in space and equipment requirements to avoid
duplication. With respect to ambulatory care facilities that provide
specialized services or a limited scope of services, the commissioner may, on
the basis of an approved program, waive compliance with the requirements of
this Subpart, provided that the granting of waiver would not adversely affect
the life safety, efficiency or function of the facility.
(c) An ambulatory care facility's
administration and public areas shall include and comply with the following:
(1) An entrance located at grade level,
sheltered from the weather, and able to accommodate wheelchairs.
(2) A lobby that shall include:
(i) wheelchair storage space(s);
(ii) a reception and information counter or
desk;
(iii) waiting space; however,
no corridor, sub corridor or passageway shall be used as waiting
space;
(iv) public toilet
facilities;
(v) public
telephone(s); and
(vi) drinking
fountain(s).
(3)
Interview space for private interviews relating to social services, credit and
admissions.
(4) General or
individual office for business transactions, records and administrative and
professional staffs. Adequate space for storage and processing medical records
shall be provided.
(5)
Multi-purpose rooms for conferences, meetings and health education
purposes.
(6) Special storage for
employees' personal effects.
(7)
General storage facilities for office supplies, sterile supplies,
pharmaceutical supplies, splints and other orthopedic supplies, housekeeping
supplies and equipment.
(d) An ambulatory care facility's clinical
areas shall include and comply with the following:
(1) One or more general purpose examination
rooms for medical, obstetrical and similar examinations, which shall include a
lavatory or sink equipped for handwashing and a counter or shelf space for
writing.
(2) Special purpose
examination rooms. The room sizes for special clinics such as eye, dental, and
ear, nose and throat examinations shall be determined by types of equipment
used. A lavatory or sink equipped for handwashing and a counter or shelf space
for writing shall be provided.
(3)
One or more treatment rooms for outpatient surgical procedures and cast
procedures which shall have a minimum floor area of approximately 120 square
feet, excluding such space as vestibule, toilet, closet and work counter
whether fixed or movable. A work counter, storage cabinets and lavatory or sink
equipped for handwashing with foot or knee control shall be provided. The
minimum room dimension shall be 10 feet.
(4) One or more observation rooms for
handling isolation, suspect, or disturbed patients which shall be conveniently
located to nurses' station or other control station to permit close observation
of patients and to minimize their hiding, escape, injury or suicide. Patients
shall have access to a toilet room without entering the general corridor area.
In facilities having an annual patient visit load of 15,000 or fewer, a
separate room is not required if an examination room is modified to accommodate
this function.
(5) Facilities for
charting and for clinical records or nurses' station(s) with work counter,
communication system, and space for supplies shall be provided. A separate
space may be omitted if these functions are accommodated in each examination
room and each treatment room.
(6) A
medicine preparation room or unit, a self-contained medicine dispensing unit,
or other approved system shall be provided. If used, a medicine preparation
room or unit shall be under nursing staff's visual control and contain a work
counter, refrigerator, and locked storage for biologicals and drugs. A medicine
dispensing unit may be located at the nurses' station, in the clean workroom,
or in an alcove or other space under direct control of nursing or pharmacy
staff.
(7) A pharmacy, close to the
reception area, shall be provided, if required by the operational program of
the facility. A pharmacy need not be provided in facilities performing only
termination of pregnancy procedures, if justified by the program, and if
approved by the commissioner. The pharmacy should include space for:
(i) administrative functions, including
requisitioning, recording, reporting, receiving, storage, including
refrigeration, and counting;
(ii)
quality control area if bulk compounding and/or packaging functions are
performed;
(iii) locked storage for
drugs and biologicals;
(v) handwashing
facilities;
(vi) drug information
area; and
(vii) sterile products
area.
(8) If procedures
for termination of pregnancy are performed, the facilities shall also have:
(i) procedure rooms with a minimum dimension
of 12 feet by 15 feet;
(ii)
scrub-up facilities adjacent to the procedure rooms;
(iii) separate male and female locker and
dressing rooms and toilet rooms;
(iv) recovery room, consisting of two
recovery beds for each procedure room, and lounge with sitting space for four
patients for each procedure room;
(v) stretcher parking area or
alcove;
(vi) patient dressing and
toilet facilities;
(vii) storage
space for oxygen and inhalation.
(9) A radiology suite with equipment for
diagnostic imaging and other radiology procedures shall be provided, if
required by the operational program of the facility. Radiology suites located
outside of New York City shall comply with applicable requirements of Part 16
of this Title. Radiology suites located in New York City shall comply with
applicable requirements of article 175 of the New York City Health Code. If
therapeutic radiology is provided, the suite shall contain:
(i) radiographic room(s);
(ii) file processing facilities;
(iii) viewing and administration
area(s);
(iv) file storage
facilities;
(v) toilet room with
handwashing facilities directly accessible from each fluoroscopy room without
entering the general corridor area; and
(vi) dressing area(s) with convenient access
to public toilets.
(10)
Laboratory facilities shall be provided directly within the ambulatory care
facility or through an effective contract arrangement with a clinical
laboratory. If clinical laboratory services are provided through such a
contract, then at least the following minimum laboratory facilities shall be
provided in the ambulatory care facility:
(i)
Laboratory work counter(s), with sink and vacuum, gas and electric
services.
(ii) Lavatory(ies) or
counter sink(s) equipped for handwashing.
(iii) Storage cabinet(s) or
closet(s).
(iv) 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.
(e)
An ambulatory care facility's service areas shall include and comply with the
following:
(1) At least one janitor's closet
shall be included on each floor, which shall contain a floor receptor or
service sink and storage for housekeeping supplies and equipment.
(2) A clean workroom or clean holding room
with a work counter, handwashing and storage facilities. The clean holding room
shall be part of a system for storage and distribution of clean and sterile
supply materials and shall be similar to the clean workroom except that the
work counter and handwashing facilities may be omitted.
(3) A soiled workroom or soiled holding room.
The soiled workroom shall contain a clinical sink or equivalent flushing rim
fixture, sink equipped for handwashing, work counter, waste receptacle and
linen receptacle. A soiled holding room shall be part of a system for the
collection and disposal of soiled materials and shall be similar to the soiled
workroom except that the clinical sink and the work counter may be
omitted.
(4) Sterilizing facilities
used for the sterilization of equipment and supplies shall be provided, which
may be in the clean workroom.
(5)
Stretcher storage space.
(6)
Employees' facilities, consisting of locker rooms, lounges, toilets or shower
facilities, as required, shall be provided to accommodate the needs of all
personnel and volunteers.
(f) Ambulatory care facility engineering
service and equipment areas shall include and comply with the following:
(1) Equipment room(s) for boilers, mechanical
equipment and electrical equipment.
(2) Storage room(s). General storage areas
for bulk office and janitor's supplies, clinical supplies, educational
materials.
(3) Waste processing
services, consisting of:
(i) Space and
facilities for the sanitary storage and disposal of waste by incineration,
mechanical destruction, compaction, containerization, removal, or by a
combination of these techniques.
(ii) If provided, design and construction of
incinerators and trash chutes shall be in accordance with the requirements of
NFPA 82, Standard on Incinerators and Waste and Linen Handling Systems and
Equipment, 1999 edition, as described in more detail in section
711.2(a) of this
Title.
(iii) If provided, the
incinerator shall be in a separate room or placed outdoors and be designed and
equipped to conform to the requirements prescribed by air pollution regulations
in the area.
(g) Ambulatory care facility details and
finishes shall include and comply with the following:
(1) Minimum widths of public corridors shall
be four feet. In facilities where terminations of pregnancy are performed,
these corridors shall be five feet.
(2) Minimum widths of doors for patient
access to examination, consultation and treatment rooms shall be two feet six
inches. In facilities where terminations of pregnancy are performed, these
doors shall be three feet two inches.
(3) Toilet rooms, which may be used by
patients, shall be equipped with doors and hardware which will permit access
from the outside in any emergency. When such rooms have only one opening, or
are small, the doors shall be capable of opening outward, or be otherwise
designed to be opened without need to push against a patient who may have
collapsed within the room.
(4)
Doors on all openings between corridors and rooms or space subject to
occupancy, except elevator doors, shall be swing type.
(5) Doors, except doors to spaces such as
small closets, which are not subject to occupancy, shall not swing into
corridors in a manner that might obstruct traffic flow or reduce the required
corridor width. Large walk-in type closets are considered subject to
occupancy.
(6) Doors, sidelights,
borrowed lights, and windows in which the glazing extends down to within 18
inches of the floor thereby creating possibility of accidental breakage by
pedestrian traffic, shall be glazed with safety glass, wire glass, or plastic
glazing material that will resist breaking and will not create dangerous
cutting edges when broken. Similar materials shall be used in wall openings of
playrooms and exercise rooms unless required otherwise for fire safety. Safety
glass or plastic glazing materials shall be used for shower doors and bath
enclosures.
(7) Thresholds and
expansion joint covers shall be made flush with the floor surface to facilitate
use of wheelchairs and carts.
(8)
The location and arrangement of handwashing facilities shall permit their
proper use and operation. Particular care shall be given to the clearances
required for blade-type operating handles.
(9) Paper towel dispensers and waste
receptacles shall be provided at all handwashing fixtures.
(10) In facilities where procedures for
termination of pregnancy are performed, the arrangement of corridor doors,
elevators and other passages shall be adequate to allow a stretcher-borne
patient to be moved from each procedure room and recovery room to a street
level exit.
(11) All buildings
having examination rooms, treatment rooms or diagnostic services located on
other than the main entrance floor shall have an elevator.
(12) Mechanical facilities shall conform to
Subpart 712-1 of this Title, where applicable.
(13) Electrical facilities shall conform to
Subpart 712-1 of this Title, where applicable.