Support Service Areas

Section 205 TITLE 77: PUBLIC HEALTH CHAPTER I: DEPARTMENT OF PUBLIC HEALTH SUBCHAPTER b: HEALTH CARE FACILITIES PART 205 AMBULATORY SURGICAL TREATMENT CENTER LICENSING REQUIREMENTS SECTION 205.1370 SUPPORT SERVICE AREAS Section 205.1370  Support Service Areas a)         Controls shall be in place to prohibit unauthorized traffic in the surgical area.  Personnel who have a communicable disease shall be excluded from the surgical area. b)         The ASTC shall provide sterilizing facilities with high-speed autoclaves conveniently located in a clean workroom to serve all procedure rooms. Alternate provisions, approved by the governing body, may be made for replacement of sterile instruments during surgery. c)         A drug distribution workroom shall be provided for storage and preparation of medication to be administered to patients. d)         Scrub stations with knee, foot or elbow actuated faucets or with automatic electronic actuated faucets shall be provided near the entrances to, but outside of, the procedure rooms.  Scrub facilities shall be arranged to minimize splatter on nearby personnel or supply carts. e)         A soiled workroom for the exclusive use of the surgical suite staff shall be provided.  The soiled workroom shall contain a work counter, a sink equipped for hand washing, a waste receptacle, and a linen receptacle.  This room may be used for cleaning anesthesia equipment. f)         Fluid waste disposal facilities shall be conveniently located with respect to the general procedure rooms. g)         A clean workroom or a clean supply room is required when clean materials are assembled within the surgical suite prior to use.  A clean workroom shall contain a work counter, sink equipped for hand washing, and space for clean and sterile supplies.  A clean supply room shall be provided when the narrative program defines a system for the storage and distribution of clean and sterile supplies that would not require the use of a clean workroom. h)         Anesthesia storage facilities shall be provided.  Flammable anesthetics are prohibited. i)          Medical gas supply storage with space for reserve nitrous oxide and oxygen cylinders shall be provided, with all tanks properly secured. j)          A storage area for equipment and supplies used in the surgical suite shall be provided.  The area shall provide protection against dust, moisture, insects, vermin, and temperature and humidity extremes. k)         Separate facilities for staff and personnel shall be provided for male and female personnel (orderlies, technicians, nurses, and doctors) working within the surgical suite.  Each area shall contain separate lockers, toilets, lavatories equipped for hand washing, and space for changing clothes, and a combined lounge area. These areas shall be arranged to provide a one-way traffic pattern so that personnel entering from outside the surgical area can change and move directly into the sterile area in facility-laundered surgical attire. l)          The ASTC shall provide change areas where patients can change from street clothes into hospital gowns in privacy and be prepared for surgery.  This shall include lockers, toilets, clothing change or gowning areas, and space for the administration of medications. m)        The stretcher storage area shall be out of the direct line of traffic. n)         A janitor's closet containing a floor receptor or service sink and storage space for housekeeping supplies and equipment shall be provided exclusively for the surgical area. o)         Traffic patterns in the surgical area shall be designed to facilities movement of the patients and personnel into, through and out of defined areas, including restricted and semi-restricted areas.  Traffic flow shall be tailored to the types of procedures offered in the ASTC. 1)         Restricted area: traffic is restricted to authorized personnel and patients.  No street clothing shall be worn in the restricted area.  Health care workers shall wear facility-laundered surgical attire.  Head and facial hair shall be contained within a protective covering.  Cloth head coverings shall be laundered by the facility and changed daily.  Additional garments shall be completely contained or covered within the surgical attire.  Masks shall be worn in restricted areas where open sterile supplies or equipment are present or scrubbed persons are located. 2)         Semi-restricted area:  traffic is restricted to authorized personnel and patients.  No street clothing shall be worn in the semi-restricted area.  Health care workers shall wear facility-laundered surgical attire.  Head and facial hair shall be contained within a protective covering.  Cloth head coverings shall be laundered by the facility and changed daily.  Additional undergarments shall be completely contained or covered within the surgical attire. Masks are not required in this area.  Patients shall wear attire appropriate for their surgical procedure and shall wear hair covering if applicable. p)         Signage shall clearly delineate the traffic flow and surgical attire requirements. q)         The movement of clean and sterile items shall be separated from contaminated or dirty items by space or traffic patterns. r)          All jewelry shall be removed prior to the surgical scrub. Jewelry shall not be worn in the operating room, except that anesthesia personnel may wear a watch. s)         Additional personal protective equipment shall be worn when exposure to blood or other potentially infectious material is anticipated. t)          Whenever surgical attire or personal protective equipment is soiled, it shall be removed and discarded prior to leaving the surgical area. u)         The sterile gown and gloves used when participating in surgical procedures shall be removed and discarded. v)         The unsterile gloves worn when participating in surgical procedures shall be removed and discarded prior to leaving the operating room. w)        The use of single-use coverall suits shall be determined by ASTC written policy. x)         Shoe covers shall be worn when it can reasonably be anticipated that splashes or spills may occur.  If shoe covers are worn, they shall be changed whenever they become torn, wet or soiled; or daily, whichever comes first.  They shall be removed and discarded before leaving the surgical area. y)         The use of cover gowns for covering the surgical attire when outside of the surgical area shall be determined by ASTC written policy.  Surgical attire worn into the facility from outside shall be changed before entering the operating room.  Persons exiting the facility shall don facility-laundered surgical attire upon return to the surgical area.