Title: Rules Governing the Sanitation of Hospitals, Nursing Homes, Rest Homes and Other Institutions 2002 A
1Rules Governing the Sanitation of Hospitals,
Nursing Homes, Rest Homes and Other
Institutions2002 Amendments Jim Hayes
2Current Status (Sept 12, 2002)
- Delayed by pending House Bill 1777
- HB 1777 was approved by the House of
Representatives on August 20, 2002 and referred
to the Senate - Senate Health Care Committee Substitute adopted
September 20, 2002
3House Bill 1777
- Delay effective date until March 1, 2003
- Field test new grading system Oct 1 - Feb 1
- DEH to train staff of facilities
- DEH to review rules for duplication
- DEH to report results to CHS and ERC
- CHS to have fast track for amending rule changes
to eliminate unanticipated costs
4Institutions Subject to The Rules
- House or feed 13 or more patients or residents
- Obtain a license or certificate from the NC Dept
of Health and Human Services - These rules do not apply to adult day services
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6Approval of Plans
- Approved by the licensing agency
- Approved by the local health department
- Construction must comply with the .1300
sanitation rules
7Inspections
- Institutions are inspected once every 6 months
and will receive a sanitation grade separate from
the food service area - Food services will be inspected quarterly and
receive sanitation grades based on the same
standards as restaurants
8Reinspections
- Administrator may request a reinspection to raise
the posted sanitation grade - An unannounced reinspection of an institution
must be made within 30 days of the request - An unannounced reinspection of the food service
area must be made within 15 days
9Approved Institutions
- Sanitation grades are posted separately in the
resident care and food service areas - Grade A 90 percent or better
- Grade B 80 to 89.5 percent
- Grade C 70 to 79.5 percent
10Disapproved Institutions
- Institution or food service sanitation scores
below 70 percent are disapproved - Conditions dangerous to the health of residents
- Licensing agency is notified within 24 hours
11Inspection Form
- DENR 1213 Inspection of Hospitals, Nursing and
Rest Homes and Other Institution - 48 items each count 1 to 4 of score
- Non-compliant items can be deducted half credit
or full credit
12Items 1 and 2 Floors
- Smooth, non-absorbent, easy to clean
- in intensive care units, bathrooms, showers,
hydrotherapy areas, operating rooms, soiled
utility rooms, and laundry areas - in areas subjected to flooding-type cleaning
- Carpeting shall be maintained clean, odor free,
dry and in good repair
134 Lighting
- Sufficient Illumination
- 10 foot candles 30 inches above the floor in all
areas - Food service areas shall meet 15A NCAC 18A .2600
145 Ventilation
- Clean and good repair
- Ambient air temperature 65º F. to 85º F.
156 Moisture Control
- Moisture shall be controlled such that there is
no evidence of microbial growth on interior
surfaces and objects
167 Smoke Exposure
- Indoor smoking restricted to dedicated smoking
rooms - Smoking rooms shall be ventilated to prevent
smoke from moving into other occupied portions of
the building - No obligation to establish smoking rooms
178 Handwashing Facilities
- Accessible
- Where personnel can be exposed to bodily
excretions or secretions - Sterile supply processing areas
- Medication rooms
- Laundry areas
- Nutrition stations
- Soiled and Clean utility rooms
- Food preparation areas
1811 Lavatories
- Hot and cold running water
- Mixing faucet or tempered warm water
- Soap
- Sanitary towels or approved hand-drying device
- Handwashing lavatories used only for handwashing
1911 Lavatories Provided for Use of Patients or
Residents
- Use only for
- Handwashing
- Personal Hygiene
- Rinsing Feeding Tubes
- Obtaining Water
- Shall not be used for disposal of bodily fluids
or cleaning soiled linens
2013 Water Heaters
- Shall Provide Hot Water Within the Temperature
Range Of 100º F. to 116º F. at all lavatories and
bathing facilities
2114 Shared Bathing Equipment
- Skin contact bathing equipment cleaned and
disinfected after each patients use - Clean with Detergent
- Disinfect with EPA registered hospital
disinfectant - Follow manufacturers instructions for
disinfecting equipment with pumps
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2614 Disinfectant
- EPA Registered Hospital Disinfectant
- Accessible To Bathing Areas
- Disinfectants Mixed On Site
- Concentration Assured By
- Metering Pump
- Measuring Device Or
- Chemical Test Kit
2716 Water Supply Interruption
- Notify local health department if water supply is
interrupted for more than 4 hours - Have backup water supply plan to provide 25
gallons per day per patient or resident for up to
3 days - Label or hood water sources if water is
determined to be unsafe for drinking
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2919 Handling of Ice
- Protect against contamination
- Ice machines, buckets, other containers, scoops
- Cleaned on a regular schedule and kept free of
scum, rust, mold or other contamination - Maintained and located where protected from the
elements and use by unauthorized personnel - Stored Ice accessible to patients or the public
provided through dispensing equipment
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3222-23 Solid Waste
- Stored in leak-proof, covered containers or in a
vermin-proof room - Adequate for storage of all solid waste
- Kept clean, facilities for cleaning
- Disposed of frequently
- Medical waste handled and disposed of in
according to 15A NCAC 13B .1200
33Types of Medical Wastes
- Non-regulated medical waste
- Sharps - needles, syringes with needles,
capillary tubes, slides and cover slips, scalpel
blades - Regulated Medical Waste - blood and body fluids
in containers gt 20 ml, microbiological waste,
pathological waste
3423 Requirements for Sharps
- Sharps placed in container which is rigid,
leak-proof when in upright position and puncture
resistant - Not compacted prior to disposal
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3723 Requirements for Regulated Medical Waste
- Stored in an area accessible only to authorized
personnel - Treated prior to disposal by incineration or
sterilization or - Packaged in impervious, leak-proof, impact
resistant bag in a rigid container, labeled and
picked up by a medical waste hauler within seven
days
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3927 Animal Maintenance
- Animal areas cleaned to minimize accumulation of
- Animal Waste
- Pet Dander
- Allergens
- Veterinary records kept on premises
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4530 Medication Carts
- Cleaned when visibly soiled
- Food utensils handled in a sanitary manner
- Unused cups covered or inverted
- Sharps containers secured
46Can you see anything wrong here?
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4831 Miscellaneous
- Reused Feeding Syringes
- Labeled with patients name date opened
- Rinsed after each use stored in a clean
container - Disposed of within 24 hours of first use
- Tube Feeding Bags
- Changed According to Manufacturer Instructions
- Reused Oral Suction Catheters
- Flushed After Each Use Stored in a Clean
Container - Disposed of Within 24 Hours of First Use
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50 32 Furnishings
- Furniture, bed springs, mattresses, sleeping
mats, curtains, shades, venetian blinds, or other
furnishings kept clean and in good repair - Mattresses shall have non-absorbent cleanable
covers
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5233 Linen
- Clean Bed Linen
- Provided for each individual
- Changed when soiled
- Soiled Linen
- Placed in covered container at point of use
- Handled and stored separately from clean linen
- Soiled laundry carts labeled
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5434 Linen
- Hot water - at least 160º F
- Wash with a detergent
- Low Temperature Less than 160º F.
- Use chemical laundry disinfectants
- Clean Linen Storage
- Stored to prevent contamination
- Laundry Area and Equipment Kept Clean
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5735 Patient Contact Items
- Kept clean and in good repair
- Soiled items stored separately from clean items
- Room or area provided for cleaning
- Contaminated items cleaned disinfected after
each use - Shared toys subject to mouthing cleaned and
disinfected with 70 alcohol or 100 ppm chlorine
after each days use - Soiled non-washable items gas sterilized or
disposed of
5837 Rehabilitation Activity Kitchens
- Can use domestic utensils and equipment
- Can be used to prepare meals for groups of 12 or
less people - Can be used as a serving area for meals catered
from the main kitchen for groups of 13 or more
people for planned events from which the public
is excluded
5938 Activity Kitchens and Nutrition Stations
- Provisions shall be made for cleaning and
sanitizing equipment and utensils - Return to central kitchen for cleaning or
- Provide at least a two-compartment sink with
counter space at each end - Any area where food is portioned, served or
handled shall be equipped with a separate
handwash lavatory
6039 Food Service (for 13 or more)
- Shall comply with Rules Governing Restaurants and
other Foodhandling Establishments (15A NCAC 18A
.2600) - Facilities serving food to the public or catering
food to events outside the facility population
are already covered under the restaurant rules
6140 Food Supplies
- Free from spoilage, adulteration misbranding
- Safe for human consumption
- Food from home
- Stored separately from institution food supply
- Labeled with persons name and date
- Kept only as long as it is clean free from
spoilage
6242 Food Protection
- Protected from contamination while being stored,
prepared transported, displayed and served - Maintained at safe temperatures (45º F or below,
or 140º F or above - Potentially hazardous foods served shall be
consumed or discarded within 2 hours - Medications shall be stored in a manner which
will not contaminate food
6345 Food Protection
- No live animals in food prep or storage area
- Animals are allowed in dining areas
- In tanks, terrariums or enclosed aviaries
- Patrol dogs support animals
- Pets are allowed in dining areas of group
residences except during meals if - Kept out of food storage prep areas
- Condiments, equipment utensils are protected
- Surfaces are cleaned before meals
6447 Employees
- Wear visibly clean outer clothing
- No tobacco use while preparing or handling food
- Wash or decontaminate hands
- Before beginning work
- After using the toilet
- Before after patient contact
- After contact with a source of microorganisms
- After removing gloves
65 47 Employee Handwashing
- When hands are visibly soiled
- Vigorously lather for at least 10 seconds and
rinse - Dry with disposable towel or drying device
- When hands are not visibly soiled it is
acceptable to use alcohol-based hand antiseptics - When water is not available, hand antisepsis can
be achieved by using detergent containing
toweletts alcohol-based hand rubs
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