Code Application Notice (CAN) 2-11B, 09-09-2014

DIVISION 8: SPECIAL ROOMS, SPACES, AND ELEMENTS

INTERPRETATION

Examination, diagnostic and treatment rooms refer to all patient care areas and include but are not limited to: exam rooms, treatment rooms, imaging rooms, operating rooms, emergency rooms, post anesthesia recovery rooms/units, dialysis rooms/units, infusion rooms/units, labor/delivery/recovery rooms and observation rooms/units. All examination, diagnostic and treatment rooms shall be accessible. Toilet rooms that are accessed from an examination, diagnostic or treatment room shall also be accessible. Note that all patient toilet rooms, other than those specifically exempted (i.e. non-accessible patient rooms and ICU patient rooms), must comply with Section 11B-603.

INTERPRETATION

Required to provide mobility features means those patient bedrooms intended to meet the requirements of Section 11B-223.2 or 11B-223.3. Accessible patient amenities such as the turning radius, door maneuvering areas, their toilet/bathing room and their wardrobe are dependent upon whether it is an "accessible room" required to provide mobility features, or not. The 18 inch strike-side clearance and 5 feet deep maneuvering clearance are not required at the patient room door in a "non-accessible room," as one not required to provide mobility features. Handwashing fixtures located in non-accessible rooms must still comply with Section 11B-805.6. These are primarily for staff use. Staff access to both sides of the patient is a functional requirement of Section 1224.14.1.2, and not dependent upon Section 11B-805.4.1.

Patient toilet and bathing rooms that are accessed from patient bedrooms that are not required to provide mobility features are not subject to the accessibility requirements of Section 11B-805.2.4 or Section 11B-603. Although these rooms are not required to comply with Section 11B-603, CBC Section 1224.4.18 requires that "each toilet, bathtub and shower serving patients shall have conveniently placed grab bars." These non-accessible grab bars are only required to be compliant with Section 11B-609. Also note that patient toilet rooms that are part of Intensive Care Unit (ICU) rooms are not required to comply with Section 11B-603. Section 11B-223.1, Exception states: "Toilet rooms that are part of critical or intensive care patient sleeping rooms shall not be required to comply with Section 11B-603."

Modular (cabinet) toilets allowed under CBC Section 1224.29.1.4 for ICUs are not required to have grab bars. These units are not intended as normal patient toileting facilities but as equipment in support of patient care assessment within an ICU setting.

All doors to patient toilet rooms "shall be equipped with hardware which will permit the door to swing outward or in a manner to negate the need to push against a patient who may have collapsed within the toilet room" per CBC Section 1224.4.8.1. The operable parts requirements in Section 11B-309 and the maneuvering clearances and clear space requirements in Section 11B-404.2.4 apply only to the normal use of doors required to be accessible and not to the emergency breakaway function.

INTERPRETATION

All patient care areas must provide access to the area and to the bed, exam table, procedure table, gurney, lounge chair and/or equipment/apparatus associated with the delivery of care, exam, diagnosis or treatment performed in the space. Access includes compliance with Division 4 of Chapter 11B for travel to, and circulation within, the patient care area; and turning space in compliance with Section 11B-304. A minimum of a 36-inch wide access shall be provided to and along each side of the bed, exam table, procedure table, gurney, lounge chair and/or equipment/apparatus. "Each side" includes both sides and the foot, but does not include the head unless the provision of care requires it. Refer to the following examples:

Exam room - Exam rooms are required to provide a turning space, accessible handwashing fixture, and 36-inch wide access along the full length of each side and the foot of the exam table. The exception is in reference to general exam rooms only. These are restricted to those meeting the definition of exam room in CBC Section 1224.3. Specific exam rooms required to be larger than 80 square feet are not considered "general exam rooms" and are not eligible for the exception.

Treatment room - Treatment rooms are required to provide a turning space, accessible handwashing fixture, accessible counter and writing surface, and 36-inch wide access along the full length of each side and foot of the treatment table. If the treatment room is intended to accommodate procedures requiring access to the head (e.g. minor surgery, etc.), all four sides of the table require 36-inch wide access.

Equipment - Exam or treatment rooms with equipment such as imaging must provide a turning space, accessible handwashing fixture if required, and 36-inch wide access to both sides and the foot of the table. The head of the equipment does not require the 36-inch access if only used for servicing.

INTERPRETATION

The requirements of Section 11B-606 apply to all lavatories, sinks, and handwashing fixtures for public use, patient use, and employee use, unless otherwise specifically exempted by the code. Lavatories, sinks, and handwashing fixtures are common use areas and therefore, require accessibility.

Exceptions:

• Scrub sinks (due to impracticality)

• Specific workstations (see Section 11B-203.9). This applies only where the sink is the actual workstation.

Knee clearance requirement - All accessibility requirements of Section 11B-606 apply to lavatories, sinks, and handwashing fixtures required to be accessible. Lavatories are subject to Section 11B-306.3.3, Exception 1 which states: "At lavatories required to be accessible by Section 11B-213.3.4, the knee clearance shall be 27 inches (686 mm) high minimum above the finish floor or ground at a depth of 8 inches (203 mm) minimum increasing to 29 inches (737 mm) high minimum above the finish floor or ground at the front edge of a counter with a built-in lavatory or at the front edge of a wall-mounted lavatory fixture."

This requirement applies to all lavatories. "Handwashing fixtures" are special application "sinks" and not subject to the exception. Handwashing fixtures, as sinks, are subject to Section 11B- 306.2.3, Exception 1 which states: "The toe clearance shall extend 19 inches minimum under sinks required to be accessible by Section 11B-212.3."

Consequently, handwashing fixtures must have a minimum depth of 19 inches in order to comply with the minimum toe clearance. They shall also have a minimum knee clearance of 27 inches at the depth and reduction described in Sections 11B-306.3.3 and 11B-306.3.4. 

INTERPRETATION

Built-in equipment consoles include recessed or wall mounted Electronic Medical Record (EMR) systems. These units must also comply with US Access Board Section 508 Standards for Electronic and Information Technology. A 30-inch by 48-inch clear floor space, in compliance with Section 11B-305, shall be centered in front of the display screen. Wall-mounted units shall comply with protrusion limits prescribed in Section 11B-307.2. Touch screen units shall be allowed to be vertically mounted with the centerline of the display screen no more than 52 inches above the floor in compliance with Section

11B-707.7.1.1. These units will need the capability of an alternate input method such as a wireless keyboard made available to those who would need it.

Original signed     9/914

Paul Coleman      Date