248 CMR, § 10.18

Current through Register 1535, November 22, 2024

Section 10.18 - Hospital Fixtures

(1)General. In general, all plumbing installed in hospitals shall comply with the requirements of 248 CMR 3.00 through 10.00 and the Massachusetts Department of Environmental Protection (DEP).

(2)Definitions.

Aspirator. An aspirator is a fitting or device supplied with water or other fluid under positive pressure which passes through an integral orifice or "constriction" causing a vacuum. Aspirators are often referred to as "suction" apparatus and are similar in operation to an ejector.

Autopsy Table. An autopsy table is a fixture or table used for the post-mortem examination of a body.

Bedpan Hopper (Clinic Sink). A bedpan hopper is a fixture meeting the design requirements of fixture, sometimes called a clinic sink.

Bedpan Steamer. A bedpan steamer is a fixture used for scalding bedpans or urinals by direct application of steam.

Bedpan Washer. A bedpan washer is a fixture designed to wash bedpans and to flush the contents into the soil drainage system. It may also be provided for steaming the utensils with steam or hot water.

Bedpan Washer Hose. A bedpan washer hose is a device supplied with hot and/or cold water and located adjacent to a toilet or clinic sink to be used for cleansing bedpans.

Clinic Sink. See Bedpan Hopper and 248 CMR 10.18(3)(b).

Flushing Type Floor Drain. A flushing type floor drain is a floor drain which is equipped with an integral water supply, enabling flushing of the drain receptor and trap.

Local Vent Stack. A local vent stack is a vertical pipe to which connections are made from the fixture side of traps and through which vapor and/or foul air may be removed from the fixture or device used on bedpan washers.

Sterilizer, Boiling Type. A boiling type "sterilizer" is a fixture (non-pressure type) used for boiling instruments, utensils, and/or other equipment (used for disinfection). Some devices are portable, others are connected to the plumbing system.

Sterilizer Instrument. SeeSterilizer, Boiling Type.

Sterilizer, Pressure Instrument Washer-sterilizer. A pressure instrument washer-sterilizer is a fixture (pressure vessel) designed to both wash and sterilize instruments during the operating cycle of the fixture.

Sterilizer, Pressure (Autoclave). A pressure sterilizer is a fixture (pressure vessel) designed to use steam under pressure for sterilizing. A pressure sterilizer is also called an Autoclave.

Sterilizer, Utensil. SeeSterilizer, Boiling Type.

Sterilizer Vent. A sterilizer vent is a separate pipe or stack, indirectly connected to the building drainage system at the lower terminal, which receives the vapors from non-pressure sterilizers, or the exhaust vapors from pressure sterilizers, and conducts the vapors directly to the outer air, sometimes called vapor, steam, atmospheric or exhaust vent.

Sterilizer Water. A water sterilizer is a device for sterilizing water and storing sterile water.

Still. A still is a device used in distilling liquids.

(3)Fixtures.

(a)General. Product-accepted flush rim bedpan hoppers (clinic sinks), bedpan washers, and/or other acceptable fixtures and equipment shall be provided for:

1. the disposing of bedpan contents; and

2. the cleansing and disinfection of bedpans in soiled utility (hopper) rooms.

(b)Clinic Sink.

1. A clinic sink shall have an integral trap in which the upper portion of a visible trap seal provides a water surface.

2. The fixture shall be so designed as to permit complete removal of the contents by siphon and/or blowout action, and to reseal the trap.

3. A flushing rim shall provide water to cleanse the interior surface.

4. The fixtures shall have flushing and cleansing characteristics similar to a toilet.

(c)Prohibited Use of Clinic Sinks and Service Sinks.

1. A clinic sink serving a soiled utility room shall not be considered as a substitute for, nor shall it be used as a janitor's service sink.

2. A janitor's service sink shall not be used for the disposal of urine, fecal matter, or other human wastes.

(d)Ice Prohibited in Soiled Utility Rooms.

1. No machine for manufacturing ice, or any device for the handling or storage of ice shall be located in a soiled utility room.

2. Machines for manufacturing ice, or devices for handling or storage of ice intended for either human consumption or packs may be located in clean utility room, floor pantry, or diet kitchen.

(4)Sterilizer Equipment Requirements.

(a)De-scaling of Equipment Prohibited. It shall be unlawful to de-scale or otherwise submit the interior of water sterilizers, stills, or similar equipment to acid or other chemical solutions while the equipment is connected to the water and/or drainage system.

(b)ASME Standard. New pressure sterilizers and pressure instruments washer-sterilizers hereafter installed, shall always display in a location to be clearly visible, the ASME Standard symbol and data plate.

(c)Sterilizer Piping. All sterilizer piping and/or devices necessary for the operation of sterilizers shall be accessible for inspection and maintenance.

(d)Condensers.

1. Pressure sterilizers shall be equipped with an acceptable means of condensing and cooling the exhaust steam vapors.

2. Non-pressure sterilizers should be equipped with an acceptable device which shall automatically control the vapors in a manner to confine them within the vessel, or equipped with an acceptable means of condensing and cooling of vapors.

(e)Gas Fired Equipment. Gas fired equipment or apparatus shall be installed in accordance with the requirements of the Massachusetts Fuel Gas Code 248 CMR 4.00 through 7.00.

(f) Discharge from sterilizers into the sanitary drainage system shall be at a temperature of no more than 150 °F.

(5)Special Elevations.

(a) Control valves, vacuum outlets, and devices which protrude from a wall of an operating, emergency, recovery, examining, or delivery room, or a corridor and/or other locations where patients may be transported on a wheeled stretcher, shall be located at an elevation which will preclude bumping the patient or stretcher against the device.

(b) When necessary to install at a lower elevation, safety precautions should be taken to protect the personnel.

(6)Plumbing in Hospitals for the Psychologically Impaired.

(a) In hospitals/facilities for the psychologically impaired exceptional consideration should be given to piping, controls, and fittings of plumbing fixtures given the nature of the patients.

(b) No pipes or traps shall be exposed and fixtures shall be substantially secured to walls.

(7)Drainage and Venting.

(a)Ice Storage Chest Drains.

1. Any drain serving an ice chest or box shall discharge over an indirect waste receptor separate from all other fixture wastes.

2. Each terminal shall discharge through an air gap above the receptor.

3. The end shall be covered with a removable screen of not less than ten-mesh per inch, and if discharging vertically, the terminal shall be cut at an angle of 45°.

(b)Bedpan Washers and Clinic Sinks. Bedpan washers and clinic sinks shall be:

1. connected to the soil pipe system; and

2. vented following the requirements as applied to toilets, except that bedpan washers require additional local vents.

(8)Sterilizer Wastes.

(a)Indirect Wastes Required.

1. All sterilizers shall be provided with individual and separate indirect wastes, with air gaps of not less than two diameters of the waste tailpiece.

2. The upper rim of the receptor, funnel, or basket type waste fitting shall be not less than two inches below the vessel or piping, whichever is lower.

3. Except as provided in 248 CMR 10.18(8)(c) and (8)(e) a p-trap shall be installed on the discharge side of, and immediately below, the indirect waste connection serving each sterilizer.

(b)Floor Drain Required. In all recess rooms containing the recessed, or concealed portions of sterilizers, not less than one acceptable floor drain, connecting to the drainage system, shall be installed in a manner to drain the entire floor area.

(c)Recess Room Floor Drains, Trap Seal Maintenance.

1. The recess room floor drain waste and trap shall be a minimum diameter of three inches.

2. It shall receive the drainage from at least one sterilizer within the recess room to assure maintenance of the floor drain trap seal.

3. The sterilizer drain shall be installed on a branch taken off between the floor drain trap and the drain head.

4. No individual sterilizer waste trap shall be required on this type of installation.

(d)Prohibited Connections.

1. Branch funnel and branch basket type fittings, except as provided in 248 CMR 10.18(8)(e) are prohibited on any new installation or when relocating existing equipment.

2. Existing branch funnel or branch basket type installations shall be provided with an acceptable indirect waste below the branch connections.

(e)Battery Assemblies. A battery assembly of not more than three sterilizer wastes may drain to one trap, provided:

1. The trap and waste are sized according to the combined fixture unit rating.

2. The trap is located immediately below one of the indirect waste connections.

3. The developed distance of a branch does not exceed eight feet.

4. The branches change direction through a tee-wye or wye pattern fitting.

(f)Bedpan Steamers - Additional Trap Required. A trap with a minimum seal of three inches shall be provided in a bedpan steamer drain located between the fixture and the indirect waste connection.

(g)Pressure Sterilizer.

1. Except when an exhaust condenser is used a pressure sterilizer chamber drain may be connected to the exhaust drip tube before terminating at the indirect waste connection.

2. If a vapor trap is used, it shall be designed and installed to prevent moisture being aspirated into the sterilizer chamber.

3. The jacket steam condensate return, if not connected to a gravity steam condensate return, shall be separately and indirectly wasted.

4. If necessary, to cool a high temperature discharge, a cooling receiver, trapped on its discharge side may serve as the fixture trap.

(h)Pressure Sterilizer Exhaust Condensers.

1. The drain from the condenser shall be installed with an indirect waste as prescribed in 248 CMR 3.00 through 10.00.

2. If condensers are used on pressure sterilizers, the chamber drain shall have a separate indirect waste connection.

(i)Water Sterilizer. All water sterilizer drains, including tank, valve leakage, condenser, filter and cooling shall be installed with indirect waste or according to 248 CMR 10.18(8)(b).

(j)Pressure Instrument Washer-sterilizer.

1. The pressure instrument washer-sterilizer chamber drain, and overflow may be interconnected. They also may be interconnected with the condenser.

2. The indirect waste shall follow the provision set forth in 248 CMR 3.00 through 10.00.

(k)Aspirators.

1. In operating rooms, emergency rooms, recovery rooms, delivery rooms, examining rooms, autopsy rooms, and other locations except laboratories where aspirators are installed for removing blood, pus and/or other fluids, the discharge from any aspirator shall be indirectly connected to the drainage system.

2. The suction line of an aspirator shall be provided with a bottle or similar trap to protect the water supply.

(9)Central Vacuum and/or Disposal Systems.

(a)Wastes. The waste from a central vacuum (fluid suction) system of the disposal type and/or which is connected to the drainage system whether the disposal be by barometric leg, collecting tanks, or bottles shall be directly connected to the sanitary drainage system through a trapped waste.

(b)Piping.

1. The piping of a central vacuum (fluid suction) system shall be of corrosion resistant material having a smooth interior surface.

2. No branches shall be less than one inch for one outlet and sized according to the number of vacuum outlets, and no main shall be less than one inch.

3. The pipe sizing shall be increased according to the manufacturer's recommendation as stations are increased.

4. All piping shall be provided with adequate and accessible clean-out facilities on mains and branches, and shall be accessible for inspection, maintenance, and replacements.

(c)Water Systems for Space Cooling and Heating Condensate Drains.

1. The lowest point of a condensate riser or risers shall be trapped and discharged over an indirect waste sink.

2. The trap may be either "P" or a "running trap" with a clean-out.

3. A branch shall be installed upstream from the condensate drain trap for flushing and resealing purposes.

4. The condensate drain and trap shall be located above the lowest floor level of the building.

(10)Vent Material. Material for local vents serving bedpan washers and sterilizer vents serving sterilizers, shall be sufficiently rust proof, erosion and corrosion resistant to withstand:

(a) intermittent wetting and drying from steam vapors;

(b) the distilled water solvent action of the steam vapors; and

(c) frequent and immediate changes of temperatures.

(11)Vent Connections Prohibited.

(a) Connections between local vents serving bedpan washers, sterilizer vents serving sterilizing apparatus, and/or normal sanitary plumbing systems, are prohibited.

(b) Only one type of apparatus shall be served by a given vent.

(12)Local Vents and Stacks. Bedpan Washers.

(a) Bedpan washers shall be vented to the outer atmosphere above the roof by means of one or more local vents.

(b) The local vent for a bedpan washer shall be not less than a two-inch diameter pipe.

(c) A local vent serving a single bedpan washer may drain to the fixture served.

(13)Multiple Installations.

(a) Where bedpan washers are located above each other on more than one floor, a local vent stack may be installed to receive the local vent on the various floors.

(b) Not more than three bedpan washers shall be connected to a two-inch local vent stack, six to a three-inch local vent stack, and 12 to a four-inch local vent stack.

(c) In multiple installations, the connections between a bedpan washer local vent and local vent stack shall be made by use of the tee or tee-wye sanitary pattern drainage fittings, installed in an upright position.

(d)Trap Required.

1. The bottom of the local vent stack, except when serving only one bedpan washer, shall be drained by means of a trapped and vented waste connection to the plumbing sanitary drainage system.

2. The trap and waste shall be the same size as the local vent stack.

(14)Trap Seal Maintenance.

(a) A water supply of not less than A-inch minimum tubing shall be taken from the flush supply of each bedpan washer on the discharge or fixture side of the vacuum breaker, trapped to form not less than a three-inch seal and connected to the local vent stack on each floor.

(b) The water supply shall be so installed as to provide a supply of water to the local vent stack for cleansing and drain trap seal maintenance each time a bedpan washer is flushed.

(15)Sterilizer, Vents and Stacks.

(a)Connections.

1. Multiple installations of pressure and non-pressure sterilizers shall have their vent connections to the sterilizer vent stack made by means of inverted wye fittings.

2. Such vent connections shall be accessible for inspection and maintenance.

(b)Drainage.

1. The connection between the sterilizer vent stack shall be designed and installed to drain to the funnel or basket-type waste fitting.

2. In multiple installations, the sterilizer vent stack shall be drained separately to the lowest sterilizer funnel or basket-type waste fitting or receptor.

(16)Sterilizer Vent Stack Sizes.

(a)Bedpan Steamers.

1. The minimum size of a sterilizer vent serving a bedpan steamer shall be 1A inches in diameter.

2. Multiple installations shall be sized according to 248 CMR 10.18(16): Table 1: Stack Sizes for Bedpan Steamers and Boiling Type Sterilizers, (number of connections of various sizes sterilizer vent stacks).

Table 1

Stack Sizes for Bedpan Steamers and Boiling Type Sterilizers

Stack Size	Connection Size
1A inches	2 inches
11/2 - inch1	1 or 0
2 - inch1	2 or 1
2 - inch2	1 and 1
3 - inch1	4 or 2
3 - inch2	2 and 2
4 - inch1	8 or 4
4 - inch2	4 and 4

Note 1: Total of each size

Note 2: Combination of sizes

(b)Boiling Type Sterilizers.

1. The minimum size of a sterilizer vent stack shall be two inches in diameter when serving a utensil sterilizer, and one inch in diameter when serving an instrument sterilizer.

2. Combinations of building type sterilizer vent connections shall be based on 248 CMR 10.18(16): Table 1: Stack Sizes for Bedpan Steamers and Boiling Type Sterilizers.

(c)Pressure Sterilizers. Sterilizer vent stacks shall be 21/2 inches minimum; those serving combinations of pressure sterilizer exhaust connections shall be sized according to 248 CMR 10.18(16): Table 2: Stack Sizes for Pressure Sterilizers.

(d)Pressure Instrument Washer-sterilizer Sizes.

1. The minimum size of a sterilizer vent stack serving an instrument washer-sterilizer, shall be two inches in diameter.

2. Not more than two sterilizers shall be installed on a two-inch stack, and not more than four on a three-inch stack.

Table 2

Stack Sizes for Pressure Sterilizers

Number of Connections of Various Sizes Permitted to Various Size Vent Stacks
	Stack Size			Connection Size
	3/4	1 inch	11/4 inch	11/2 inch
11/2 - inch1	3	or	2	or	1
11/2 - inch2	2	and	1
2 - inch1	6	or	3	or	2	or	1
2 - Inch2	3	and	2
2 - inch2	2	and	1	and	1
2 - inch2	1	and	1	and	1
3 - inch1	15	or	7	or	5	or	3
3 - inch2	1	and	2	and	2
3 - inch2	1	and	5	and	1

Note 1: Combination of sizes

Note 2: Total of each size

(17)Radioactive Materials.

(a) All radioactive materials shall be disposed of in a manner so as to create no hazard to operation and maintenance personnel of the institution or to the public.

(b) Specific permission shall be secured from the State Department of Public Health to dispose of any radioactive material to the drainage system.

(18)Water Supply.

(a)Water Service. All hospitals shall have dual services installed in a manner to provide an uninterrupted supply of water in case of a water main break.

(b)Hot Water Heater and Tanks.

1. The hot water equipment shall have enough capacity to supply water at 125 °F for hospital fixtures; water at 180°F for kitchens and laundries.

2. Where direct fired hot water heaters are used, they shall be of an accepted high-pressure type.

3. Submerged steam heating coils should be of copper. Storage tanks shall be fabricated of non-corrosive metal or be lined with non-corrosive material.

(c)Hot Water Supply System.

1. Hot water circulating mains and risers should be run from the hot water storage tank to a point directly below the highest fixture at the end of each branch main.

2. Where the building is higher than three stories, each riser shall be circulated.

3. Each main, branch main, riser and branch to a group of fixtures of the water system shall be provided with valves.

(19)Vacuum Breaker Installation.

(a)Hose Connections. For ordinary hose connections the maximum height at which any hose is to be used shall be treated at its flood level.

(b)Low Volume Flows.

1. Where low volume flows might cause leaking or spitting at the vacuum breaker parts, back pressure may be developed by installing an acceptable minimum orifice valve on the discharge side of the vacuum breaker. This shall be in addition to the regular control valve.

2. Low volume flow installation shall be subject to review and acceptance by the Inspector.

(c)Prohibited Toilet and Clinic Sink Supply.

1. No jet or water supplied orifices, except those supplied by the flush connection, shall be located in and/or connected with a toilet bowl or clinic sink.

2.248 CMR 10.18 shall not prohibit an acceptable bidet installation.

(d)Special Equipment, Water Supply Protection. 248 CMR 10.18(19): Table 3: Hospital Fixtures and Their Water Supply Protection, sets forth the requirements which shall be followed in protecting the water supply for hospital fixtures against backflow or back siphonage.

Table 3

Hospital Fixtures and Their Water Supply Protection

Fixtures	Type of Protection1	Remarks
Aspirators:
Laboratory	Vacuum breaker
Portable	Vacuum breaker
Vacuum system	Vacuum breaker
Bedpan:
Washers	Vacuum breaker
Washer hose	Vacuum breaker	Locate five feet above floor.
Boiling type sterilizer	Air gap	Not less than twice the effective opening of the water supply.
Exhaust condenser	Vacuum breaker
Flush floor drain	Vacuum breaker
Hose connection	Vacuum breaker	Locate six feet above floor.
Pressure instrument washersterilizer	Vacuum breaker
Pressure Sterilizer	Vacuum breaker
(rubber Tube Testers-Washers)	Vacuum breaker
Vacuum systems
Cleaning	Air gap or vacuum breaker
Fluid suction	Air gap or vacuum breaker

Note 1: Where vacuum breakers are used, they shall be installed after the last control valve.

(20)Clinical, Hydrotherapeutic and Radiological Equipment. All clinical, hydrotherapeutic, radiological, or any equipment, whether mentioned or not, which is water supplied and/or discharges to the waste system, shall meet the requirements of 248 CMR 10.18 and the regulations covering cross-connections, air gaps, vacuum breakers, and check valves.

Special Equipment and Devices Found under These Classes Include:

Clinical	Hydrotherapeutic	Radiological
Dental cuspidors	Control units	Violet X-Ray
Surgical cuspidors	Arm bath	Diagnostic X-Ray
Dental (flush rim) lavatories	Leg bath	Therapy X-Ray
Colonic irrigation	Foot bath	X-Ray target
Sitz bath	Tub bath	X-Ray transformers
Emergency bath	Immersion bath	X-Ray oil tank
Receiving bath	Shower bath	Diffraction
Prenatal bath	Needle bath	X-Ray developing
Infant bath	Tank	Photographic developing
Prophylaxis	Pool	Film developing
Shampoo	Hose	Microscopic
Massage	Syringe
Douche

(21)Condensate Drain Trap Seal.

(a) A water supply shall be provided for cleaning, flushing, and resealing the condensate trap.

(b) The source of the water supply shall be a refrigerator condenser discharge, a drinking water station waste, or other acceptable method of flushing and resealing the trap.

(c) The water supply shall be not less than A inch diameter pipe.

(d) The water supply shall discharge through an air gap not less than twice the diameter of the supply pipe.

(22)Valve Leakage Diverter. Each water sterilizer which may be filled with water through directly connected piping, shall be equipped with an acceptable leakage diverter and/or bleed-line on the water supply control valve to indicate and conduct any leakage of unsterile water away from the sterile zone.

248 CMR, § 10.18

Amended by Mass Register Issue 1510, eff. 12/8/2023.