3701-7-06 General facilities and equipment requirements.

(A) This rule shall not be construed to require any maternity unit licensed on or before March 20, 1997, to alter, upgrade, or otherwise improve the structure or fixtures of the maternity unit in order to comply with the requirements of this rule, unless one of the following applies:

(1) The maternity unit initiates or has, after March 20, 1997, initiated a construction, renovation, or a reconstruction project that involves a capital expenditure of at least fifty thousand dollars, not including expenditures for equipment or staffing or operational costs, and that directly involves the area in which the existing maternity unit is located;

(2) The maternity unit initiates or has, after March 20, 1997, initiated a service level designation change under rule 3701-7-07 of the Administrative Code or prior Chapter 3701-84 of the Administrative Code; or

(3) The director determines or has determined, by clear and convincing evidence, that failure to comply would create an imminent risk to the health and welfare of any patient.

(B) Each maternity unit, newborn care nursery, or maternity home shall ensure that the building or structure where the maternity unit, newborn care nursery, or maternity home is located:

(1) Has a certificate of use from a local, certified building department or from the Ohio department of commerce as meeting applicable requirements of Chapters 3781. and 3791. of the Revised Code and any rules adopted thereunder;

(2) Complies with the state fire code; and

(3) Complies with the applicable provisions of Chapter 3737. of the Revised Code and the rules adopted under it.

(C) The maternity unit, newborn care nursery, or maternity home shall develop and follow a disaster preparedness plan including evacuation in the event of a fire. Evacuation procedures shall be reviewed at least annually, and practice drills shall be conducted quarterly on each shift.

(D) The maternity unit, newborn care nursery, or maternity home shall develop and follow policies for ensuring the safety and security of all patients, including infant security drills for locating missing newborns. The policies shall be reviewed at least annually, and practice infant security drills shall be conducted on each shift at least once every six months.

(E) Each maternity unit, newborn care nursery, or maternity home shall label, store and dispose all poisons, hazardous wastes and flammable materials in a safe manner that does not jeopardize patient or resident health or safety, and in accordance with state and federal laws and regulations.

(F) Minimum space or square footage requirements specified in this chapter are of clear floor space and exclusive of fixed or wall mounted cabinets, desks, wardrobes, and closets that are floor based.

(G) Each maternity unit constructed on or after the effective date of this rule that utilizes separate antepartum areas shall provide space for the provision of services and shall provide:

(1) Single occupancy rooms with a minimum of one hundred twenty square feet of open floor space. Each room shall provide space for the mother and a support person;

(2) A private toilet and shower or tub for each room; and

(3) Two medical gas, medical air, and vacuum outlets available in each room.

(H) Each maternity unit's labor-delivery-recovery or labor-delivery-recovery-postpartum area shall provide space for the provision of services and the following:

(1) Single occupancy rooms with a minimum of two hundred fifty square feet of open floor space and a minimum room width or length of thirteen feet. Each room shall provide space for the mother, newborn and a support person;

(2) A private toilet and shower or tub for each room;

(3) A distinct area within the room for newborn resuscitation and stabilization. The distinct area shall be equipped with one medical gas, medical air, and vacuum outlet available to each mother and one medical gas, medical air, and vacuum outlet available to each newborn;

(4) A minimum of six total air changes per hour with the ability to provide fifteen air changes per hour during the performance of a cesarean delivery where that room is designated as such. Maternity units constructed on or after the effective date of this rule shall provide a minimum of six total air changes per hour with the ability to provide twenty air changes per hour during the performance of a cesarean delivery where that room is designated as such; and

(5) Immediately accessible examination lights.

(I) Each maternity unit that utilizes separate labor rooms shall provide space for the provision of services and shall provide:

(1) A minimum area of one hundred square feet per bed. Each maternity unit constructed on or after the effective date of this rule shall have private occupancy labor rooms. Maternity units constructed on or after the effective date of this rule shall provide a minimum area of two hundred square feet perbed;

(2) One medical gas, one medical air and one vacuum outlet accessible to each mother's bed; and

(3) A minimum of two total air changes per hour with the ability to provide twenty air changes per hour during the performance of a cesarean delivery where that room is designated as such. Maternity units constructed on or after the effective date of this rule shall provide a minimum of six total air changes per hour with the ability to provide twenty air changes per hour during the performance of a cesarean delivery where that room is designated as such.

(J) Each maternity unit that utilizes separate recovery rooms shall provide space for the provision of services and shall provide:

(1) A minimum of two recovery room beds;

(2) Space for the newborn, mother and support person; and

(3) A minimum of six total air changes per hour per recovery room.

(K) Each maternity unit that utilizes separate postpartum areas shall provide space for the provision of services and shall provide:

(1) A minimum of one hundred square feet of clear floor space per bed in semiprivate rooms and one hundred and twenty square feet of clear floor space in private rooms. Postpartum rooms existing on or before March 20,1997 shall provide at least eighty square feet of clear space per bed in semiprivate rooms and one hundred square feet in private rooms; and

(2) Patient access to a bathroom with toilet and shower or tub, without entering the main corridor. Bathrooms in postpartum rooms existing before the effective date of this rule may serve no more than two postpartum beds. Postpartum rooms constructed on or after the effective date of this rule shall have one bathroom with toilet and shower or tub for each patient in that room.

(L) Each maternity unit shall provide at least one cesarean delivery room in every obstetrical area. Each cesarean delivery area shall provide space for services and shall provide:

(1) Cesarean delivery rooms with a minimum of three hundred and sixty square feet of open floor space and a minimum room width or length of sixteen feet. Any additional delivery rooms without cesarean delivery capability shall have a minimum open floor area of three hundred square feet;

(2) Space for newborn resuscitation that meets one of the following:

(a) A minimum of an additional forty square feet of open floor space within the cesarean delivery room. Cesarean delivery areas rooms constructed on or after the effective date of this rule shall provide a minimum an additional eighty square feet of open floor space within the cesarean delivery room; or

(b) An area of one hundred and fifty square feet in a separate room immediately accessible to the cesarean delivery room; and

(3) A minimum of twenty air changes per hour per cesarean delivery area.

(M) Each maternity unit shall provide the necessary equipment and supplies for the complete care of the newborn in the location where the physiologic transition period occurs. Equipment shall include:

(1) Heat source equipment;

(2) Oxygen, suction, and air outlets;

(3) Oxygen blender available for delivery;

(4) Resuscitation equipment;

(5) Equipment necessary for physiologic monitoring; and

(6) Transport conveyance.

(N) Each maternity unit shall provide at least one airborne infection isolation room in or near each nursery. The room shall be enclosed and separated from the nursery with the ability to observe the infant from adjacent nurseries or control area and shall be consistent with current infection control guidelines, issued by the United States centers for disease control and prevention.

(O) The maternity unit shall provide separate areas as necessary to support the services provided including:

(1) The consultation, or demonstration of breast feeding or breast pumping; and

(2) Family waiting.

(P) Each newborn nursery room shall provide a floor area of twenty-four square feet for each newborn station with a minimum of two feet between newborn stations. Maternity units providing care to newborns requiring close observation shall conform to the requirements for the level designation and classification of that newborn service, and shall, at a minimum provide a floor area of fifty square feet with a distance of four feet between and at all sides of newborn stations. Maternity units constructed on or after the effective date of this rule that provide care to newborns requiring close observation shall conform to the requirements for the level designation and classification of that newborn service and shall provide a minimum of one hundred twenty square feet of open floor space for each newborn station with additional space based on the acuity level of the newborn.

(Q) Each newborn nursery room or newborn care nursery shall conform to the requirements for the level designation and classification of that newborn service and provide space for procedures, equipment, and staff functions and shall provide:

(1) Medical gas, medical air, and vacuum outlets accessible to each newborn;

(2) At least one door capable of being locked in each newborn nursery room that exits to the main corridor;

(3) At least one sink, capable of hands free operation, for each eight newborn stations;

(4) Observation windows to permit the viewing of newborns from public areas, workrooms and adjacent nursery rooms;

(5) A system for storage and distribution of emergency drugs and routine medications;

(6) A minimum of six total air changes per hour in all newborn nursery rooms or newborn care units; and

(7) Lighting capable of varying from indirect to high intensity.

(R) Maternity units may replace newborn nursery rooms with baby holding nurseries in postpartum and labor-delivery-recovery-postpartum areas. The holding nursery shall meet the requirements of paragraphs (P) and (Q) of this rule.

(S) In addition to the requirements of paragraphs (N) and (P) of this rule, each maternity unit or newborn care nursery licensed as a level IIA, level IIB, level IIIA, level IIIB, or level IIIC neonatal care service shall provide:

(1) A group patient or open bay area with a clearly identified entrance large enough to accommodate portable x-ray equipment, and a reception area for families. The reception area shall permit visual observation and contact by the staff of all individuals entering the unit. A hand washing area shall be provided at each family entrance to the newborn care area;

(2) At least one door to each nursery room shall be large enough to accommodate portable x-ray equipment;

(3) A system to provide efficient and controlled access to the nursery from the labor and delivery area, the emergency room, and other referral entry points as may be applicable;

(4) Work areas, in addition to newborn care space;

(5) A minimum of one hundred square feet of open floor space for each newbornstation. Additional space shall be provided based on acuity level of the newborn. There shall be an aisle adjacent to each newborn station with a minimum width of three feet to accommodate movement through the nursery without disturbing newborn care. Newborn care nurseries constructed on or after the effective date of this rule shall provide a minimum of one hundredtwenty square feet of open floor space for each newborn station with additional space based on the acuity level of the newborn. An aisle adjacent to each newborn station with a minimum width of four feet to accommodate movement through the nursery without disturbing newborn care shall also be provided;

(6) A minimum of three medical gas, three medical air, three vacuum outlets, and seven duplex-grounded electrical receptacles organized in an accessible and safe manner for each newborn station. Fifty per cent of electrical outlets must be connected to the emergency system power and be so labeled. Newborn care nurseries constructed on or after the effective date of this rule shall provide sixteen single or duplex-grounded electrical receptacles organized in an accessible and safe manner for each newborn station. Fifty per cent of electrical outlets must be connected to the emergency system power and be so labeled;

(7) A respiratory therapy work area and storage area within the newborn care area or in close proximity;

(8) A transition room that allows parents and infant extended private time together in close proximity to the nursery. The room shall have a sink and toilet fixtures, a bed for parents, sufficient space for an infant bed and equipment, communication linkage with newborn intensive care nursery staff, and electric, air, vacuum, and medical gas outlets. The transition room may be used for other purposes when not required for use by parents and infant orinfants; and

(9) Newborn care nurseries that utilize single patient private or semi-private rooms within the nursery shall meet the requirements of paragraphs (R)(5) and (R)(6) of this rule.

(T) Equipment and technology required under this rule may be replaced by newer technology and equipment with equivalent or superior capability. In assessing new equipment and technology, consideration shall be given to the recommendations of recognized professional societies and accrediting bodies.

(U) Each maternity unit or newborn care nursery shall provide hands-free hand washing fixtures in all areas for staff use where patient care is provided.

(V) Each maternity unit or newborn care nursery shall provide a system of communication that interconnects all areas in which patient care is provided and that effectively alerts staff members of emergencies or patient needs. Each toilet, or shower, or both, used by patients shall have an emergency communications system capable of alerting staff of emergencies or patient needs.

(W) Each maternity unit or newborn care nursery shall provide appropriate safety features including handrails, emergency power, and electrical outlets for the services provided.

(X) Maternity home facilities and equipment shall include at least the following:

(1) Equipment, lighting, and means of regulating indoor temperature and indoor air quality to provide a safe and comfortable living environment and working conditions in the maternity home;

(2) Adequate facilities for the delivery of housekeeping and other supportive services;

(3) Handrails in all stairwells, and grab bars in bathrooms and showers;

(4) Secure office space for maintenance, preparation, and storage of resident medical records and medications;

(5) Separate toilet facilities for personnel;

(6) A dining area;

(7) Adequate storage areas;

(8) A means for the sanitary disposal of waste and soiled linen;

(9) A relaxation area not readily accessible to the casual visitor;

(10) Private office space for resident consultation;

(11) Laundry facilities for residents;

(12) At least one separate, private room for the examination and treatment of residents;

(13) Equipment and supplies necessary for routine and emergency care of residents;

(14) Each resident bedroom shall house no more than four beds and have at least one attached toilet room.

(Y) Each maternity home that offers newborn services shall maintain a newborn nursery appropriate to the number of newborns to be cared for at any one time. Each newborn nursery room shall be equipped with the following:

(1) A floor area of twenty-four square feet for each newborn station with a minimum of two feet between newborn stations;

(2) Maternity homes providing care to newborns requiring close observation shall provide a minimum floor area of fifty square feet with a minimum of four feet between and at all sides of newborn stations;

(3) At least one door capable of being locked that exits to a main corridor; and

(4) At least one sink capable of hands-free operation.

(Z) Each maternity home that offers newborn services shall develop and follow policies and procedures to ensure the safety and security of all patients, including infant security drills for locating missing newborns. The policies shall be reviewed at least annually, and practice infant security drills shall be conducted on each shift at least once every six months.

Replaces: 3701-7-04, 3701-7-05, 3701-7-11, 3701-7-12

Effective: 01/01/2012
R.C. 119.032 review dates: 01/01/2017
Promulgated Under: 119.03
Statutory Authority: 3711.12
Rule Amplifies: 3711.05 , 3711.12
Prior Effective Dates: 7/15/1976, 4/30/03, 8/1/08