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Air Pressure Relationships WAC 246-320-405 (9)(c)(ii)

In order to minimize or eliminate infectious or chemical/physical agents from entering a patient care area, hospitals are required to manage air pressure relationships within the facility. The most frequently cited environmental deficiency in hospitals is improper air pressure relationships. Commonly, operating rooms, catheterization-labs, sub-sterile cores, lithotripsy and IV mixing rooms have negative pressure to adjacent areas rather then the required positive pressure. Conversely decontamination areas, laboratories, nuclear hot labs, dark rooms and soiled utility rooms have positive pressures to adjacent areas rather then the required negative pressure. Hospital facility conditions that lead to these improper pressure relationships are:

• Dampering air flow;

• Closing/altering a doorway; and

• Alterations/repairs to the ventilation system.

Tamper Resistant Receptacles WAC 246-320-405 (9)(e)(ii)

Tamper resistant receptacles, or safety receptacles, are electrical outlets designed to prevent injury or death.  Such devices are required in areas where patients or visitors would be at risk. 

Tamper resistant receptacles are required in the following areas per the requirements of WAC 246-320-405 (9)(e) (ii) and as noted in Table 525-5:

• Pediatric areas;

• Alcoholism and Substance Abuse units;

• Psychiatric units;

• Exam rooms; and

• Waiting areas.

Acceptable receptacles are constructed with:

• A shutter system that prevents or greatly limits an individual from inserting paper clips, pins and similar objects into the slots containing the energized contacts of the device; or they

• Only allow the contacts to be energized when two similar objects are inserted into both slots at the same time.

It is important to note that there are receptacles on the market that the Department of Health does not recognize as being tamper resistant. One such model is fitted with a slide plate that covers the receptacle slots but does not afford the level of protection present on the aforementioned receptacles.

Having tamper resistant receptacles installed in a facility is a crucial element of a hospital's safety program. It is important that hospitals actively seek out locations where at risk patients and visitors may be left unattended or receive limited supervision. Age and mental condition define at risk individuals as does the hospital unit in which they are located.

Plant Cross Connections WAC 246-320-405 (9)(b)(iii)

In order to assure that the potable water supply system is safe, hospitals are required to prevent improper or incorrect connections of equipment, piping and materials.  Whenever equipment is connected directly or indirectly to a potable water supply a backflow prevention device needs to be installed when or if:

• The equipment contains or might contain a contaminated or contaminating water, liquid, gas or mixture;

• The equipment has the potential to contaminate other equipment; and or

• The equipment is connected to a non-potable water supply, sewer or drain.

Examples of such equipment include:

The type of backflow prevention device required depends on the level of risk or hazard posed by the connected equipment and the equipment's design. For instance, a janitor sink or hose bib could be served by an atmospheric vacuum breaker or similar device as the risk posed is considered low level. An autoclave or a film processor would need to be served by a reduced pressure backflow assembly (RPBA) as the risk posed is considered high level.

Hospitals should have a program for actively conducting facility wide cross connection control self surveys of the plumbing system(s) and equipment. They need to:

• Identify and inventory all equipment or fixtures connected directly or indirectly to the potable water supply;

• Identify where the potable water supply may be inter-connected to an industrial water supply or loop;

• Evaluate the potential risk posed by the equipment, fixtures and or inter-connections;

• Install the appropriate backflow prevention device or devices; and

• Service the devices as needed.

Safety WAC 246-320-405(2)(a)

In order to safeguard patients, staff and visitors, hospitals need to maintain a physical environment that is free of hazards. Department of Health staff frequently identify the following unsafe conditions:

• Unsecured gas cylinders;
• Electrical receptacles in wet areas that are not protected by ground fault circuit interrupters (GFCI's);
• Lights over patient beds or in work areas that lack shields or shatterproof bulbs, unsecured windows;
• Electrical panels in patient areas that are left unlocked; and
• Plumbing and accessory fixtures installed in certain patient treatment areas that allow for self harm.

Hospitals should establish a program to identify safety hazards that incorporates regular, frequent "safety rounds".  One proven method is an individual or team of individuals who walk through the facility looking for obvious, common sense hazards.  Increased success of a safety round program occurs in hospitals that vary or rotate personnel responsible to visit/tour the facility. This approach ensures that a new “eyes” are available to see or perceive the existence of a problem. Many problems go unnoticed because hospital staff working in an area do not perceive a harmful or unsafe condition.

Nutrition - Food Service WAC 246-320-305 (6)

Hospitals are required to adopt and implement policies and procedures that will assure patient nutritional needs are met and that food borne illness is prevented. In part, this is accomplished through compliance with Food Service Code, WAC 246-215.

Department of Health staff have identified non-compliance with the Food Service Code for the following items of concern as well as others:

• Food preparation sinks lacking indirect drains;
• Potential cross-contamination of food products;
• Improper food holding temperatures, both hot and cold; and
• Improper dishwashing and sanitizing temperatures.

To help prevent being cited for any of the above items, hospitals are encouraged to implement a "Hazard Analysis Critical Control Point" (HACCP) program. HACCP is a safety system used by the food service industry that is based on the identification and control of potential or actual threats to food products. It is a system that deals with all threats be they biological, chemical or physical; and at a minimum it is employed from the point where food is delivered to the facility, during preparation and storage up to its being served or discarded.

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Washington State Department of Health
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Phone: (360) 236-2905
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Last Update : 11/20/2006 04:18 PM
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