Texas Administrative Code
Title 25 - HEALTH SERVICES
Part 1 - DEPARTMENT OF STATE HEALTH SERVICES
Chapter 133 - HOSPITAL LICENSING
Subchapter I - PHYSICAL PLANT AND CONSTRUCTION REQUIREMENTS
Section 133.165 - Building with Multiple Occupancies
Universal Citation: 25 TX Admin Code ยง 133.165
Current through Reg. 49, No. 38; September 20, 2024
(a) Multiple hospitals located within one building.
(1) Identifiable location. Each hospital
shall conform with all the requirements contained in Chapter 18 of the National
Fire Protection Association 101, Life Safety Code, 2003 edition (NFPA 101),
relating to New Health Care Occupancies. All documents published by NFPA as
referenced in this section may be obtained by writing or calling the NFPA at
the following address or telephone number: National Fire Protection
Association, 1 Batterymarch Park, Post Office Box 9101, Quincy, MA 02269-9101
or (800) 344-3555.
(A) The guest hospital
shall be in one separately contiguous location.
(B) In no case may a person leave the guest
hospital, traverse the host hospital, and then reenter the guest hospital to
access the remaining portion of the guest hospital.
(C) A connecting stair within the host
hospital may be used to connect the vertical contiguous areas of the guest
hospital.
(D) A guest hospital may
not occupy two or more noncontiguous areas of a host hospital which contain
intervening space of the host hospital even if on the same floor.
(E) Construction of the host hospital
building shall conform to the requirements of NFPA 101, Chapter 18, and the
building shall be fully sprinklered.
(2) Separate facilities. Each hospital shall
provide the following separate facilities:
(A) a nursing unit in accordance with the
requirements of §
133.163(t)
of this title (relating to Spatial Requirements for New
Construction);
(B) an
administration office with an adjacent waiting room or waiting area;
(C) a medical records room which conforms
with the requirements of §
133.163(p)
of this title;
(D) a pharmacy suite
in accordance with §
133.163(x)
of this title;
(E) employee locker
facilities which comply with requirements of §
133.163(g)(1)
of this title;
(F) a housekeeping
room in accordance with the requirements of §
133.162(d)(2)(A)(xxviii)
of this title (relating to New Construction Requirements);
(G) emergency facilities. Each hospital shall
provide emergency facilities as required by §
133.163(f)(1)(A)
of this title. When general hospitals share a building, each general hospital
shall provide emergency facilities as required by §
133.163(f)(1)(A)(i)
and (ii) of this title;
(H) imaging and other diagnostic services and
facilities, in accordance with §
133.41(s)
of this title (relating to Hospital Functions and Services) and §
133.163(l)
of this title respectively;
(I)
laboratory services and a laboratory suite which comply with §
133.41(h)
of this title, and §
133.163(n)(1)(B)
of this title respectively;
(J)
surgical or obstetrical facilities for each general hospital, in accordance
with §
133.163(u)
and §
133.163(ee)
of this title;
(K) dietary services
and dietary suite, including staff dining facilities, which comply with §
133.41(d)
of this title and §
133.163(e)
of this title respectively;
(L)
external signage at the building entrance which identifies each hospital;
and
(M) internal signage which
provides directions to each hospital.
(3) Means of egress. Means of egress from the
host or guest hospital shall not be through a psychiatric hospital or a crisis
stabilization unit or other area subject to locking. Means of egress may
traverse through a hospital which conforms with the requirements of §
133.161
of this title (relating to Requirements for Buildings in which Existing
Licensed Hospitals are Located) or §
133.162
of this title. Stairs must have guardrails from the floor of the guest hospital
to the level of exit discharge in accordance with NFPA 101,
§7.2.2.4.5.
(4) Additional
services and facilities. Additional services and facilities when required in
each licensed hospital may be provided by contractual agreement with the other
hospital when the services and facilities comply with the specific requirements
of §
133.41
of this title and §
133.163
of this title. Some services may be provided by contractual agreement with a
commercial contractor; however, the following minimal facilities shall be
provided on site by the host hospital and be located in one of the hospitals.
If the host hospital fails to provide the facilities and services, the guest
hospital shall describe to the department how it plans to provide services:
(A) cart cleaning and sanitizing services and
facilities which comply with §
133.163(b)
of this title;
(B) general stores
services and facilities which comply with §
133.163(i)
of this title;
(C) housekeeping
rooms as required in §
133.162(d)(2)(A)(xxviii)
of this title;
(D) parking
facilities, in accordance with §
133.162(c)(2)
of this title;
(E) physical and/or
occupational therapy services and facilities, in accordance with §
133.41(x)
of this title, and §
133.163(aa)
of this title respectively;
(F)
patient activity facilities. The patient activity facilities shall comply with
the requirements for the specific service in accordance with §
133.163
of this title as follows: hospital-based skilled units §133.163(j)(1)(C);
mental health and chemical dependency nursing units §133.163(q)(1)(B);
pediatric and adolescent nursing unit §133.163(w)(1)(D)(i); and
rehabilitation therapy suite §133.163(aa)(1)(A)(i) and (ii);
(G) respiratory care services and respiratory
therapy suite which comply with §
133.41(u)
of this title and §
133.163(cc)
of this title respectively;
(H)
body-holding room which complies with §
133.163(r)(1)(D)
of this title;
(I) central sterile
supply which complies with §
133.41(v)(2)(L)
of this title and §
133.163(c)
of this title respectively;
(J)
waste and waste disposal services, and waste processing and storage units shall
comply with §
133.41(y)
of this title; and
(K) emergency
water storage requirement of §133.162(d)(4)(A)(i)(VIII) shall be required
for each the hospital and be located in one of the hospitals.
(5) Building systems and
equipment.
(A) The following systems shall be
provided separately in each hospital at a 24-hour staffed location.
(i) Nurses calling systems shall be provided
separately in each hospital in accordance with §133.162(d)(5)(L) and Table
7 of §
133.169(g)
of this title (relating to Tables).
(ii) Medical gas alarms shall be provided in
each hospital.
(iii) Fire alarm
annunciator panels shall be provided in each hospital so that each hospital can
monitor the other.
(iv) An
emergency generator annunciator panel shall be provided in each
hospital.
(B) Where
applicable, the following systems may serve more than one hospital provided the
systems meet the new construction requirements of §
133.162
of this title:
(i) air conditioning, heating
and ventilating systems;
(ii)
drainage systems;
(iii)
elevators;
(iv) fire sprinkler
systems. The guest hospital may not be constructed in a host hospital when the
host hospital is not fully sprinklered. The host and guest hospitals shall be
fully sprinklered;
(v) medical
piping systems;
(vi) stand pipe
systems;
(vii) steam
systems;
(viii) water supply
systems, hot and cold (including emergency water storage); and
(ix) electrical service and equipment.
(I) Where applicable, the building electrical
service, lighting, essential electrical system, and fire alarm system, may be a
part of or extension of those in the existing hospital, provided the existing
systems meet these requirements. The host hospital shall be responsible for
maintenance, testing and upkeep of the essential electrical system. Power and
lighting distribution panels shall be within each hospital served and comply
with the requirements of §133.162(d)(5)(E). Electrical installation
details shall conform with all requirements contained in
§133.162(d)(5)(A).
(II) When
the existing essential electrical system is nonconforming, the following
options are available:
(-a-) a separate
conforming essential electrical system shall be provided in the guest hospital;
or
(-b-) separate transfer switches
connected to the existing on-site generator(s) shall be provided when adequate
capacity is available and the host hospital existing nonconforming system shall
be corrected. Corrections shall be made in accordance with a plan of correction
approved by the department.
(b)
Hospitals located in buildings with licensed health care facilities other than
hospitals.
(1) Before a hospital is licensed
in a building containing other licensed health care facilities, all the
requirements of this chapter and the following requirements shall be met.
(A) Construction of the building shall
conform to the requirements of NFPA 101, Chapter 18, and the building shall be
fully sprinklered.
(B) The hospital
shall be in one identifiable contiguous location and shall be separated
(vertically and horizontally) with two-hour fire rated noncombustible
construction from the other licensed health care facility and comply with the
requirements of this chapter.
(i) In no case
may a person leave the hospital, traverse other licensed healthcare facilities,
and then reenter the hospital to access the remaining portion of the
hospital.
(ii) A connecting
stair(s) and elevator(s) within the building shall be provided to connect the
vertical contiguous areas of the hospital.
(iii) A hospital may not occupy two or more
noncontiguous areas of other licensed healthcare facilities which contain
intervening space of the other licensed healthcare facilities even if on the
same floor.
(iv) Access to the
hospital shall be directly from a main lobby or an elevator lobby, if on an
upper floor. The required means of egress from the hospital may be through the
other licensed health care facility except not through a psychiatric hospital
or a crisis stabilization unit or other area subject to locking.
(I) Each licensed facility shall be
identified with external signage at the building entrance.
(II) Internal signage shall provide direction
to the hospital.
(v) The
hospital shall have services and facilities separate from the other licensed
health care facility. The required facilities shall be located within the
proposed hospital proper.
(vi)
Common use of facilities using time-sharing concepts may be permitted on a case
by case basis when the other health care facilities comply with the
requirements contained in NFPA 101, Chapter 18, and §
133.163
of this title, and provided this chapter and the other health care facility
licensing regulations allow.
(C) The equipment and systems required in
each new hospital may be provided exclusively for the hospital or by
contractual agreement with a licensed health care facility. The equipment and
systems shall be in accordance with §
133.162
of this title.
(i) The following equipment
and systems shall be provided for the exclusive use of the hospital, except
where noted otherwise:
(I) breaker serving
the hospital. Where the hospital is served by the building's normal electrical
system, the breaker serving the hospital shall originate in the main
switchboard and shall be labeled, "Hospital Service - Contact Hospital
Representative Prior to Opening Breaker";
(II) electrical service for power and
lighting. The hospital distribution panel board(s) shall be within the
hospital;
(III) type I essential
electrical system. An electrical room for the distribution of type I essential
electrical system shall be provided separate from the building electrical room.
The hospital staff shall have access at all times to the essential electrical
system room and the building's electrical room(s). The hospital shall be
responsible for maintenance, testing and upkeep of the essential electrical
system. When the existing essential electrical system owned and operated by the
other licensed health care facility is nonconforming, the following options are
available:
(-a-) a separate conforming
essential electrical system shall be provided in the new hospital; or
(-b-) separate transfer switches connected to
the existing on-site generator(s) shall be provided when adequate capacity is
available and the other health care facility existing nonconforming system
shall be corrected. Corrections shall be made in accordance with a plan of
correction approved by the department;
(IV) an emergency generator. An emergency
generator may be shared when adequate capacity is available. Separate transfer
switches shall be provided to serve the hospital and other licensed health care
facilities. The hospital shall be the owner of the generator, have access to
the generator at all times, and shall be responsible for maintenance, testing
and upkeep of the generator;
(V)
emergency water storage requirement of §
133.162(d)(4)(A)(i)(VIII)
of this title shall be located within the hospital;
(VI) a fire alarm system. When the other
licensed health care facilities have a fire alarm control center or a main
building alarm panel at the main lobby entrance, the hospital shall have an
annunciator panel at a 24-hour staffed location. The hospital staff shall have
access at all times to the main building fire alarm system panels and shall be
responsible for verifying the maintenance and upkeep of such system;
(VII) fireman's test valve for the fire
sprinkler system;
(VIII) air
conditioning, heating and ventilating systems;
(IX) medical piping systems with alarm. The
medical gas supply sources may be shared provided the hospital is owner of the
medical gas system source and is responsible for maintenance, testing and
upkeep of the supply sources. The hospital and other occupancies shall have
separate main supply shutoff valves. The hospital shall be provided with an
alarm panel within the hospital that monitors the medical gas system supply
source serving the other licensed health care facilities;
(X) medical vacuum and medical air;
and
(XI) nurses calling
systems.
(ii) Where
applicable, the following systems may be a part or extension of those in the
existing licensed health care facility, provided the existing systems meet the
requirements of this chapter for new construction:
(I) drainage systems;
(II) elevators. The hospital shall be served
by the number and size of elevators cabs in accordance with §
133.164
of this title (relating to Elevators, Escalators, and Conveyors). The elevators
cab lighting, control, communication, and signal systems shall be connected to
the life safety panel of the essential electrical system;
(III) fire sprinkler systems. The new
hospital may not be constructed in the other health care facility when the
other health care facility is not fully sprinklered. The new hospital and the
other health care facility shall be fully sprinklered;
(IV) stand pipe systems;
(V) steam systems. The hospital is
responsible for providing all backup systems (such as boilers) as required in
this chapter;
(VI) domestic water
supply systems, hot and cold; and
(VII) mechanical chilled and hot water
systems.
(2) When hospitals and psychiatric hospitals
share one building, the building systems and equipment may be shared in
accordance with subsection (a)(5)(B) of this section, or be provided
separately.
(c)
Hospitals in buildings with nonhealth care occupancies.
(1) General. Before a hospital is licensed in
a building also containing occupancies other than health care occupancies, all
requirements of this chapter and the following requirements shall be met.
(A) Construction of the building shall
conform to the requirements of NFPA 101, Chapter 18, and the building shall be
fully sprinklered.
(B) The hospital
shall be in one identifiable contiguous location and shall be separated
(vertically and horizontally) with two-hour fire rated noncombustible
construction from the other occupancies.
(i)
In no case may a person leave the hospital, traverse other occupancies, and
then reenter the hospital to access the remaining portion of the
hospital.
(ii) A connecting
stair(s) and elevator(s) within the building shall be provided to connect the
vertical contiguous areas of the hospital.
(iii) A hospital may not occupy two or more
noncontiguous areas of other occupancies which contain intervening space of the
other occupancies even if on the same floor.
(C) Access to the hospital shall be through a
dedicated hospital lobby or from the building's main lobby. The building's main
lobby shall be part of the hospital and shall comply with the requirements of
§
133.162
of this title.
(i) External signage shall be
provided at the building entrance which identifies the hospital.
(ii) Internal signage shall be provided to
give directions to the hospital.
(D) The required means of egress from the
hospital shall be independent of and shall not traverse through the other
occupancies.
(E) Stairs shall have
guardrails and handrails from the floor of the hospital to the level of exit
discharge in accordance with NFPA 101, §7.2.2.4.5.
(2) Services and facilities. Services and
facilities shall be provided exclusively for the hospital in accordance with
subchapters C, H, and I of this title (relating to Operational Requirements,
Fire Prevention and Safety Requirements, and Physical Plant and Construction
Requirements, respectively). Required services and facilities shall not be
shared with the other occupancies except as noted in paragraph (3) of this
subsection.
(3) Building equipment
and facilities. The equipment and systems shall be in accordance with §
133.162
of this title.
(A) The following equipment
and systems shall be provided for the exclusive use of the hospital except
where noted otherwise:
(i) type I essential
electrical system. An electrical room for the distribution of type I essential
electrical system shall be provided separate from the building electrical room.
The hospital staff shall have access at all times to the essential electrical
system room and the building's electrical room(s). The hospital shall be
responsible for maintenance, testing and upkeep of the essential electrical
system;
(ii) emergency generator.
An emergency generator may be shared when adequate capacity is available.
Separate transfer switches shall be provided to serve the hospital and other
building occupancies. The hospital shall be the owner of the generator, have
access to the generator at all times, and shall be responsible for maintenance,
testing and upkeep of the generator;
(iii) emergency water storage located within
the hospital;
(iv) fire alarm
system. When the building has a fire alarm control center or a main building
alarm panel at the main lobby entrance, the hospital shall have an annunciator
panel at a 24-hour staffed location. The hospital staff shall have access at
all times to the main building fire alarm system panels and shall be
responsible for verifying the maintenance and upkeep of such system;
(v) fireman's test valve for the fire
sprinkler system;
(vi) medical gas
systems. The medical gas supply sources may be shared provided the hospital is
owner of the medical gas system supply source and is responsible for
maintenance, testing and upkeep of the supply sources. The hospital and other
occupancies shall have separate main supply shutoff valves. The hospital shall
be provided with an alarm panel within the hospital that monitors the medical
gas system serving the other occupancies;
(vii) medical vacuum and medical
air;
(viii) air conditioning,
heating and ventilating systems. Air handling units of other occupancies may
not be used for the hospital. The hospital air handling units may share the
supply source for other occupancies but shall not return air from the other
occupancies back to the air handling unit(s); and
(ix) nurses calling systems.
(B) Where applicable, the
following systems may be a part or extension of those in the existing building
occupancies provided the existing systems meet the requirements of this chapter
for new construction:
(i) breaker serving the
hospital. Where the hospital is served by the building's normal electrical
system, the breaker serving the hospital shall originate in the main
switchboard and shall be labeled, "Hospital Service - Contact Hospital
Representative Prior to Opening Breaker";
(ii) electrical service for power and
lighting. The hospital's distribution panelboard(s) shall be within the
hospital;
(iii) drainage
systems;
(iv) elevators. The
hospital shall be served by the number and size of elevators cabs in accordance
with §
133.164
of this title. The elevators cab lighting, control, communication, and signal
systems shall be connected to the life safety panel of the essential electrical
system;
(v) fire sprinkler systems.
The hospital may not be constructed in the other type of building occupancies
when the other types of occupancies are not fully sprinklered. The hospital and
the other occupancies shall be fully sprinklered;
(vi) stand pipe systems;
(vii) fire pump, where applicable; The
hospital staff shall have access at all times to the location of the fire pump
to verify compliance and maintenance;
(viii) steam systems. The hospital is
responsible for providing all backup systems (such as boilers) that are
required in this chapter; and
(ix)
domestic water supply systems, hot and cold.
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