Texas Register, Volume 23, Number 49, Part III, Pages 12311-12450, December 4, 1998 Page: 12,330
12311-12450 p. ; 28 cm.View a full description of this periodical.
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need to be established (i.e., State of California) if this is to be
an enforceable provision.
15. RESPONSE: The department agrees The department
believes that "efficient utilization of energy" should be deter-
mined by overall efficiency, operational cost, and life cycle cost-
ing. All recognized engneering practices should be followed to
achieve the most economical and effective results. To reduce
utility costs, facility design shall utilize energy conserving pro-
cedures including recovery devices, variable air volume, load
shedding, systems shut down or reduction of ventilation rates
(when specifically permitted) in certain areas when unoccupied
insofar as patient care is not jeopardized. Mechanical ventila-
tion shall be arranged to take advantage of outside air supply
by using an economizer cycle when appropriate to reduce heat-
ing and cooling system loads. Innovative design that provides
for additional energy conservation while meeting the intent of
this section for acceptable patient care will be considered. The
department has clarified the language to reflect this.
16. COMMENT: Concerning 135.52(d)(1)(A), entrance (con-
struction requirements for new ASCs), a commenter stated that
the requirement for drive under canopy will be met with dis-
dain by many building owners. The commenter further stated
that this requirement will make building an ASC in an existing
structure very difficult to retrofit and exceedingy costly. An-
other commenter stated "The intricacies regarding accessibility
should be left to the TAS. A drive-through canopy for loading
and unloading passengers may be excessive and an encum-
brance on many office building or medical facilities. This may
be impractical in many locations. Although the goal is to have
an accessible entrance, a covered accessible entrance should
not be a requirement Of the numerous licensed ASC facilities
that our firm has designed, none would be able to meet this
requirement"
16. RESPONSE: The department agrees and has deleted the
requirement for a drive under canopy. However, the requirement
for protection from inclement weather remains.
17. COMMENT: Concerning 135.52(d)(6), pharmacy (con-
struction requirements for new ASCs), a commenter stated that
since the pharmacy is used only for drug storage, it should not
be required to have a hand washing sink.
17. RESPONSE: The department disagrees on the basis that
other functions beyond the storage of medication may occur
in the pharmacy area. Other duties might include distribution,
compounding, preparation of parental and enteral products,
and other procedures requiring asepsis control. The language
has been revised to clarify that a sink may be located in or
convenient to the pharmacy room or alcove.
18. COMMENT: Concerning 135.52(d)(7)(A) and (9)(A),
preoperative patient holding room and the recovery room
(construction requirements for new ASCs), a commenter stated
that the requirement to have these areas separate and distinct
from each other is a very costly requirement in terms of
space, circulation, and support. The commenter believes that
this is appropriate for hospitals, but would be overkill in an
ambulatory setting and that it greatly penalizes the owner by
not allowing any economics of dual use of space or employees.
The commenter further believes that this could not help but
double the amount of support spaces provides, thus adcding
unnecessary costs to the building. By keeping these areas
separate the ability to "swing" a Holding Area to Recovery is lostThe commenter also noted that these two spaces are basically
set up the same as far as physical attributes are provided.
18. RESPONSE: The department disagrees and considers the
standard reasonable. The requirement for separate preop and
postop patient holding areas is an existing standard. No change
was made as a result of the comment
19. COMMENT: Concerning 135.52(d)(7)(B)(iii), preoperative
patient holding room (construction requirements for new ASCs),
a commenter asked if the patients' belongings can be placed
in a bag (furnished by the ASC) and kept beneath the patients
stretcher or in an area near recovery or second stage recovery.
19. RESPONSE: The department requires that space be made
available to secure patients' personal effects. Placing a patients
personal belonging beneath the patients stretcher or in an area
near recovery or second stage recovery does not ensure that
the patients personal belongings are secure. The method
Implemented by a facility to secure personal effects shall be
the decision of the facility. Designated space (patient lockers)
reduces the chances of misplacing a patients personal effects
and provides one secure area that can be monitored. No
change was made as a result of the comment.
20. COMMENT: Concerning 135.52(d)(7)(B) and (9)(B), pre-
operative patient holding room and the recovery room (con-
struction requirements for new ASCs), a commenter believes
that a minimum of two patient stations per operating room for
the recovery room is excessive. The commenter's facility has
two operating rooms which are usually operated by a singe sur-
geon, and that just like the requirements for preoperative patient
holding room, one patient station per operating room is more
than sufficient The commenter stated "The time that a pa-
tient spends in preop usually matches the time that the patient
spends in postop, so it only makes sense that the same number
of stations should be required." The commenter expressed con-
cern that this new requirement would be impossible to comply
with short of major construction without knocking out exterior
walls into space he does not have. Another commenter also
believes that the requirement for two patient stations is exces-
sive for an ASC setting and expensive unless the preop holding
areas could double for these uses when needed.
20. RESPONSE: The department disagrees and considers the
rule reasonable. The requirement for two recovery beds per
operating room is an existing requirement No change was
made as a result of the comment.
21. COMMENT: Concerning 135.52(d)(7)(B)(ii), patient sta-
tion/preoperative patient holding room (construction require-
ments for new ASCs), a commenter stated that a minimum
clearance of 6 feet- 0 inches between gurneys and beds seems
to be excessive. The commenter believes the old requirement
of 3 feet - 0 inches should be adequate particularly in multi-
gurney situations and that this requirement will result in preop
and postop rooms being much larger. The commenter further
stated that "Although we see the value in providing plenty of
clearance around the bed, this room will not have patients oo-
cupying it for long periods of time, such as a hospital room
with an extended stay." Another commenter stated "T'he 6 feet
- 0 inches minimum requirement between patient beds in the
postop recovery room is probably excessive. Although the pa-
tient will be recovering, other arrangements might be able to
be accommodated to give flexibility to the room arrangement.
The result of 6 feet - 0 inches between beds will dramatically
increase the size of the recovery room "23 TexReg 12330 December 4, 1998 Texas Register
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Texas. Secretary of State. Texas Register, Volume 23, Number 49, Part III, Pages 12311-12450, December 4, 1998, periodical, December 4, 1998; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth379980/m1/30/: accessed May 7, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.