DEPARTMENT OF CONSUMER AND INDUSTRY SERVICES

                          BUREAU OF HEALTH SYSTEMS

                 DIVISION OF HEALTH FACILITIES AND SERVICES

                      MINIMUM STANDARDS FOR HOSPITALS


(By authority conferred on the department of  public  health  by  sections
2226(d), 2233, and 20171 of Act No. 368 of the Public  Acts  of  1978,  as
amended, and section 9 of Act No. 380 of  the  Public  Acts  of  1965,  as
amended, being SS333.2226(d),  333.2233,  333.20171,  and  16.109  of  the
Michigan Compiled Laws)


                PART 1. ADMINISTRATIVE RULES AND PROCEDURES

R  325.1001   Administration.
  Rule 1. The state  health  commissioner  shall  administer  his  several
responsibilities toward hospitals as an integral unit.

  History:  1954 AC; 1979 AC.


R  325.1002   Hospital committee.
  Rule 2. (1) The state health commissioner, in a manner hereafter stated,
shall appoint an advisory committee to  be  known  as  the  commissioner's
hospital committee which will serve to advise him  on  the  administrative
aspects of the responsibilities given under the above authority.
  (2) The functions of the hospital committee shall be:
  (a) To consider rules and regulations concerning  hospitals  promulgated
in accordance with the above authority and any proposed revisions thereof,
and to advise the state health commissioner regarding the same.
  (b) To review all provisional  licenses  granted  by  the  state  health
commissioner.
  (c) To sit with the state health commissioner during his conduct of  any
hearings concerned with the suspension, revocation, or denial of  licenses
or certification.
  (3) The state  health  commissioner  shall  appoint  9  persons  to  the
hospital committee in the following manner: Five persons from a list of 10
hospital administrators or trustees submitted by the board of trustees  of
the Michigan hospital association, 2 members from  the  list  of  hospital
administrators or trustees submitted by the Michigan osteopathic  hospital
association, and 2 members at large. In the case of appointments made upon
nomination of the Michigan hospital association, at least 1 shall be  that
of a licensed physician and 1 shall be that of a registered nurse. In  the
case of appointments made by the Michigan osteopathic hospital association
1 shall be a licensed physician. The members of the committee shall  serve
for 3-year terms, provided that, of those  first  appointed,  3  shall  be
appointed for 1 year, 3 for 2 years, and  3  for  3  years.  The  hospital
committee shall meet at least semiannually and otherwise at  the  call  of
the state health commissioner or upon petition  of  the  majority  of  the
members.

  History:  1954 AC; 1979 AC.


R  325.1003   Advice of state council of health.
  Rule 3. If there should be substantial disagreement  between  the  state
health  commissioner  and  the  hospital  committee,  the   state   health
commissioner, either upon his own initiative or  at  the  request  of  the
committee, shall present the matter to the state council  of  health,  his
statutory advisory body.

  History:  1954 AC; 1979 AC.


R  325.1004   Special technical consultants.
  Rule 4. The state health commissioner may appoint such special technical
committees or consultants as may from time to time be indicated.

  History:  1954 AC; 1979 AC.


R  325.1005   Hearings.
  Rule 5. (1) Any hospital aggrieved by any decision of the  state  health
commissioner shall upon request be granted a hearing.
  (2) Except in matters concerned with the spread of communicable disease,
the state health commissioner  shall,  in  cases  of  proposed  denial  or
revocation of a license, present  his  preliminary  decision  and  reasons
therefor to the parties  concerned,  and  provide  an  opportunity  for  a
hearing.
  (3) Hearings required or requested under the terms of these rules  shall
be held by the state health commissioner or his authorized representative.
  (4) The commissioner's hospital  committee  shall  be  notified  of  and
invited to attend all hearings.
  (5) The hearings will be informal, and full opportunity  will  be  given
all  concerned  to  question  the  state  health   commissioner   or   his
representative.
  (6) After the hearing, the state health commissioner will ask the advice
of his hospital committee as to the disposition of the case.
  (7) If the state health commissioner is unable to accept said advice, he
shall present a summary of all facts, together  with  the  advice  of  the
hospital committee, to the state council of health before making  a  final
decision.

  History:  1954 AC; 1979 AC.


           PART 2. LICENSURE AND REPORTS FOR MATERNITY HOSPITALS

R  325.1011   Original and renewal applications.
  Rule 11. As provided in section 3 of Act No. 231 of the Public  Acts  of
1951, applications to conduct a maternity hospital shall be  submitted  to
the state health commissioner. All  applications  shall  be  completed  in
full.

  History:  1954 AC; 1979 AC.



R  325.1012   Display of current license.
  Rule 12. The current license shall be displayed in a  conspicuous  place
in the hospital.

  History:  1954 AC; 1979 AC.


R  325.1013   Return of license.
  Rule 13. The maternity license remains the property of the state  health
commissioner and shall be returned  if  the  license  is  revoked  or  the
hospital closes.

  History:  1954 AC; 1979 AC.


R  325.1014  Rescinded.

  History:  1954 AC; rescinded 1954 ACS 24, Eff.
June 14, 1957.


R  325.1015   Monthly report.
  Rule 15. As provided in Act No. 231 of the Public  Acts  of  1951,  each
licensed maternity hospital shall make a monthly statistical report  on  a
prescribed form (H-205) to the state health commissioner.

  History:  1954 AC; 1979 AC.


R  325.1016   Confidential maternity report.
  Rule 16. Not later than 48 hours after such a child or its mother leaves
the hospital, the memorandum which is required by section 4 of Act No. 231
of the Public Acts of 1951, (MH-1) shall  be  sent  in  a  strong,  sealed
envelope  marked  "Confidential"  to  the   State   Health   Commissioner,
Attention: Maternal and Child Health Section, Lansing, Michigan.

  History:  1954 AC; 1979 AC.


 PART 3. OPERATIONAL RULES AND MINIMUM STANDARDS FOR ALL HOSPITAL PHYSICAL
               PLANT, FACILITIES, EQUIPMENT, AND OPERATIONS

R  325.1021   Compliance with law and regulations.
  Rule 21. (1) The hospital shall comply with the housing law of Michigan.
  (2) The hospital shall comply with the requirements of  the  state  fire
marshal.
  (3) The hospital shall comply with the state plumbing code.
  (4) The hospital shall comply  with  the  requirements  of  the  federal
department of health, education, and welfare as set forth  in  its  latest
publication  entitled  "Health  Insurance  for  the  Aged--Conditions   of
Participation for Hospitals," a copy of which  is  kept  on  file  in  the
bureau of medical care administration of the department of  public  health
at Lansing, Michigan.

  History:  1954 AC; 1979 AC.


R  325.1022   Water and ice supply.
  Rule 22. (1) A public water supply shall be used if available.
  (2) The location and construction of a well, and the  operation  of  the
system, shall comply with standards approved for public water supplies  by
local and state health departments.
  (3) The entire plumbing system and all plumbing facilities shall  be  so
designed  and  maintained   that   the   possibility   of   back-flow   or
back-siphonage shall be reduced to a minimum.
  (4) There shall be no physical  cross-connection  between  water  supply
systems that are safe for human use and those that are or may at any  time
become unsafe for human use.
  (5) All  ice  used  in  contact  with  food  or  drink  shall  be  clear
manufactured ice made from water from a source approved by the  state  and
local health departments and handled  in  such  a  manner  as  to  prevent
contamination.
  (6) All ice containers shall be kept clean.

  History:  1954 AC; 1979 AC.


R  325.1023   Sewage, garbage, and waste disposal.
  Rule 23. (1) All liquid waste shall be discharged into a  public  sewage
system whenever available.
  (2) When a private sewage disposal system is required, the  type,  size,
and construction shall meet with the  approval  of  the  local  and  state
health departments.
  (3) The collection, storage, and disposal of all garbage shall  be  done
in a manner that will  not  permit  the  transmission  of  a  communicable
disease, create a nuisance, or provide  a  breeding  place  for  flies  or
rodents.
  (4) Containers for  garbage  shall  be  watertight,  have  tight-fitting
covers to prevent the entrance of flies, and be rodent-proof.
  (5) Garbage containers  shall  be  emptied  at  frequent  intervals  and
thoroughly cleansed and aired before further use.
  (6)  Facilities  shall  be  provided  for  the  disposal  of  infectious
dressings, surgical and  obstetrical  wastes,  and  similar  materials  by
incineration or in a manner approved by the state health commissioner.

  History:  1954 AC; 1979 AC.


R  325.1024   Laundering and sterilization  of  linens;  sterilization  of
  instruments and utensils.
  Rule 24. (1) The hospital shall make arrangements for the laundering  of
linens and other washable goods.
  (2) There  shall  be  provision  for  the  sterilization  of  dressings,
utensils, instruments, and water.
  (3) The hospital shall maintain  a  check  on  the  performance  of  all
sterilizing equipment.
  (4) Special precautions shall be taken so that sterile supplies may  not
be mixed with unsterile supplies.

  History:  1954 AC; 1979 AC.


R  325.1025   Heating and ventilating.
  Rule 25. (1) The temperature in patients' rooms shall be  maintained  at
approximately 72 degrees Fahrenheit throughout the heating season.
  (2) A minimum temperature of 75 degrees Fahrenheit shall  be  maintained
in all hospital nurseries.
  (3)  The  hospital  ventilating  system  shall  be  regulated  so   that
objectionable drafts shall not be created.

  History:  1954 AC; 1979 AC.


R  325.1026   General maintenance.
  Rule 26. (1) Equipment, floors, walls, and ceilings shall be kept clean.
  (2) Food service areas, all equipment, and work surfaces shall  be  kept
clean.
  (3) Handwashing facilities shall be convenient to each food  preparation
or serving area:
  (a) Tempered running water, soap, and towels shall be available  in  all
kitchens, including diet kitchens, and in washrooms used by food handlers.
  (b) The use of a common towel is prohibited.
  (4) Food storage areas and refrigeration shall be provided:
  (a) Storerooms shall be clean and well ventilated.
  (b) Stored food shall be protected from dust,  flies,  rodents,  vermin,
unnecessary handling,  droplet  infection,  overhead  leakage,  and  other
sources of contamination.
  (c) Refrigerated storage space shall be kept at approximately 40 degrees
Fahrenheit.
  (d) A reliable thermometer shall be installed in each refrigerator.
  (e) Refrigerators shall be kept clean.
  (f) Prepared foods shall be kept covered.
  (5) All dishes and utensils used in storage, preparation, or serving  of
food and drink shall be sanitized and kept clean:
  (a) The use of dish towels for drying dishes is forbidden.
  (b) Kitchens and utility rooms shall be provided as needed.
  (6) Whenever insects are prevalent all  used  openings  to  the  outside
shall be screened with wire screen or its equal  with  not  less  than  16
meshes per lineal inch.
  (7) Insects, such as flies, roaches, and mosquitoes, shall  be  properly
controlled.  All  breeding  places  for  flies  and  mosquitoes  shall  be
eliminated from the premises.
  (8) All openings where rats or mice may gain entrance  to  the  building
shall be screened or safely guarded to prevent entrance of  such  rodents.
All rodent control programs shall be carried on in a safe manner.

  History:  1954 AC; 1979 AC.


R  325.1027   Patient care.
  Rule 27. (1) All persons admitted to  a  hospital  shall  be  under  the
continuing daily care of a physician licensed to practice in Michigan.
  (a) The hospital shall require that an admitting diagnosis  be  recorded
promptly on each patient.
  (b) There shall be a written hospital policy denoting when  consultation
should be held. Consultation shall be recorded.
  (c) No medication or treatment shall be given to any patient  except  on
the written order of a physician.
  (d) Verbal orders for medication, whether given over  the  telephone  or
otherwise, shall be written into the record as such.
  (e) Verbal orders, whether given over the telephone or otherwise,  shall
be received only by a person or persons approved  and  authorized  by  the
administrator and by the medical staff, and shall be indicated  as  verbal
orders, initialed by the physician's initials per the receiver's  initials
and countersigned by the physician at the time of the next visit.
  (2) The hospital shall provide personnel, space, equipment, and supplies
for routine laboratory analyses. It shall utilize regularly  the  services
of an experienced pathologist for the examination of tissue  suspected  of
being diseased, except tonsils, removed at operations.
  (3)  Equipment   shall   be   provided   for   diagnostic   radiographic
examinations. The hospital shall require that the responsibility for  film
interpretation and  the  proper  protection  against  radiation,  electric
shock, and combustion of stored film shall  be  assigned  to  the  general
supervision of  a  licensed  physician  with  training  or  experience  in
radiology.
  (4) The hospital shall employ professional and  auxiliary  personnel  to
give patients necessary services.
  (a) The nursing service shall be in  the  charge  of  a  graduate  nurse
registered to practice in Michigan.
  (b) Each nursing shift shall be  personally  supervised  by  a  graduate
nurse registered to practice in Michigan.
  (c) Personnel assigned to the maternity service, including  the  formula
room, and all food handlers shall have a written record of  pre-employment
and annual physical examination.
  (i) Persons found upon  examination  to  have  conditions  dangerous  to
patients shall be removed from assignment until recovery.
  (ii) All persons with  respiratory,  skin,  gastrointestinal,  or  other
communicable infection shall be excluded from working on  these  services.
  (d) Duty in the nursery or in food handling areas shall not  be  resumed
until the administrator or his agent has  a  medical  statement  based  on
appropriate physical examination and tests to the effect  that  return  to
duty is safe.
  (5) Meals provided for the various types of patients shall be planned in
accordance with the recommended daily allowances of the national  research
council.
  (a) Only pasteurized milk and milk products or evaporated or dried  milk
shall be used.
  (b) Meals shall be prepared and served in a sanitary manner.
  (c) Food returned from patients' trays is  considered  contaminated  and
shall not be re-served.
  (6) Rooms for adult patients shall provide a minimum of 80  square  feet
of floor space per bed. In multiple bedrooms, beds shall  be  at  least  3
feet apart.
  (7) There shall be sufficient equipment for care according to  the  type
of patients accepted by the hospital.
  (a) Individual linens shall be provided each patient.
  (b) A wash basin, emesis basin, bedpan, and  when  indicated,  a  urinal
shall be immediately available for each patient. Bedside  equipment  shall
be sterilized or sanitized between patients in a manner  approved  by  the
state health commissioner.
  (c) There shall be at least as many thermometers available as there  are
patients.
  (d) Autoclaves and other sterilizers shall be provided as needed.
  (e) Each hospital shall have facilities for blood transfusions.
  (f) Each  hospital  shall  have  facilities  for  immediate  intravenous
therapy and for the administration of parenteral fluids,  including  blood
substitutes.
  (8) Rules governing visitors shall be posted in a conspicuous place.
  (9) Hospitals shall isolate patients with communicable disease, carriers
of communicable  diseases,  or  those  suspected  of  having  communicable
diseases.
  (a) A lavatory and a toilet shall be provided within the isolation area.
  (b) The  hospital  shall  make  written  policies  concerning  isolation
techniques available to all personnel concerned.

  History:  1954 AC; 1979 AC.


R  325.1028   Records.
  Rule 28. (1) The hospital  shall  require  that  accurate  and  complete
medical records be kept on all patients admitted.
  (2) Patients' records shall include the following:
  (a) Admission date.
  (b) Admitting diagnosis.
  (c) History and physical examination.
  (d) Physician's progress notes.
  (e) Operation and treatment notes and consultations.
  (f) The physician's orders.
  (g) Nurse's notes including temperature, pulse, respiration,  conditions
observed and medication given.
  (h) Record of discharge or death.
  (i) Final diagnosis.
  (3) Additional records of patients  having  surgery  shall  include  the
following:
  (a) Details of the preoperative study and diagnosis.
  (b) The preoperative medication.
  (c) The name of the surgeon and his assistants.
  (d) The method of anesthesia.
  (e) The amount of anesthetic when measurable.
  (f) The name of the anesthetist.
  (g) The postoperative diagnosis, including pathological findings.
  (4) The report of special examinations, such as  laboratory,  x-ray  and
pathology, shall be kept in the patient's record.
  (5) Medical records shall be preserved as original  records,  abstracts,
microfilms or otherwise and shall be such as  to  afford  a  basis  for  a
complete audit of professional information.
  (6) The administrative records  of  the  hospital  shall  include  as  a
minimum:
  (a) Records of admissions and discharges.
  (b) Patient's records.
  (c) Daily census records.
  (d) Narcotic register.
  (e) Statistics regarding number of deaths.
  (f) Statistics regarding number of autopsies.

  History:  1954 AC; 1979 AC.


      ADDITIONAL REQUIREMENTS FOR MATERNITY HOSPITALS AND DEPARTMENTS

R  325.1051   Physical plant.
  Rule 51. The physical plant shall provide the following in  addition  to
the requirements of R 325.1021, R 325.1022,  R 325.1023,  R 325.1025,  and
R 325.1026:
  (a) A hospital providing maternity care shall provide for segregation of
maternity patients from other patients by section, wing, or floor,  except
when the director, upon the application of a hospital,  grants  permission
to  use  surplus  maternity  beds  in  the  postpartum  suite  for   clean
gynecological patients. Such permission shall be subject to the  following
restrictions:
  (i) The hospital shall  have  registered  500  or  more  births  in  the
preceding calendar year.
  (ii) The hospital shall have 3 or more postpartum  maternity  beds  over
and above the number required to provide  adequately  for  all  postpartum
patients as determined by the director.
  (iii) The hospital shall have maintained a minimum 85% average occupancy
in its medical or surgical beds in the preceding year.
  (iv) The average length of stay for all patients shall  not  exceed  9.0
days in the preceding calendar year, except that a hospital with a  higher
average length of stay shall be given an opportunity to justify its longer
average length of stay when a denial is based on this standard.
  (v) The hospital shall be free from major physical plant or  operational
deficiencies and items of noncompliance as determined by the director.
  (vi) The hospital shall have submitted a written plan, acceptable to the
director, which demonstrates to his satisfaction that  alternatives,  such
as consolidation of hospital  obstetrical  and  newborn  services  in  the
community or the reduction of postpartum maternity beds by  assignment  of
surplus beds to another nursing unit, are not feasible or  practical.  The
plan  shall  designate  the  rooms  and  beds  to  be  utilized  by  clean
gynecological patients, and indicate that such patients  admitted  to  the
surplus postpartum beds will not be patients with active infection, either
acute or chronic; frank malignancy other than carcinoma in situ;  patients
admitted for radiotherapy; or patients already in the hospital who are  on
any other service, including the gynecological service.
  (vii) The written plan submitted by a hospital shall  be  acceptable  to
the director from the standpoint of protecting the health of  mothers  and
babies, as well as other hospitalized patients, and shall demonstrate  the
development and implementation of  effective  medical  and  administrative
controls to carry out the plan.
  (viii) The plan, if approved by the director, shall be in effect  during
the license year in which it is issued.  Requests  for  extension  of  the
plan, or any modification thereof, shall  be  submitted  annually  to  the
director with a  hospital's  application  for  renewal  of  licensure  and
certification.
  (b) Separate toilet facilities shall be provided for maternity patients.
  (c) There shall be a separate delivery room.
  (d) Separate nurseries shall be provided unless complete facilities  for
"rooming-in" are available.
  (e) Each nursery shall have a minimum floor space of 24 square feet  per
bassinet. Bassinets shall be placed not less  than  2 feet  apart  with  a
minimum of 3 feet between rows.
  (f) A private room with a lavatory and a toilet shall be  available  for
the isolation of any mothers with infection, fever, or diarrhea.
  (g) There shall be an isolation nursery or a private room  with  running
water available for the isolation of infants.

  History:  1954 AC; 1979 AC.


R  325.1052   Minimum policies.
  Rule 52.  The  following  minimum  policies  shall  be  established  and
observed:
  (a) The hospital shall require that there be  staff  policies  regarding
the use and administration of analgesics and anesthetics, and the policies
shall be posted in all delivery units.
  (b) The hospital shall require that there be staff  policies  concerning
the use of pituitrin extracts and other oxytocics during  each  of  the  3
stages of labor, and the policies shall be posted in all  delivery  units.
  (c) The use of analgesics, anesthetics, pressure on the fetal  head,  or
holding the mother's legs together to prevent birth before the arrival  of
the doctor is prohibited.
  (d)  All  newborn  infants  born  outside  the  hospital,  infants  with
infection, or infants with conditions potentially harmful to others  shall
be admitted to the isolation nursery or private room with running water in
the obstetric or pediatric department, and shall never be  transferred  to
the well-baby nursery.
  (i) The state health director may designate a  hospital  to  maintain  a
neonatal intensive care unit or special newborn nursery unit  as  part  of
the department's regional perinatal intensive care program.
  (ii) The unit shall be under the direction of a physician who is a board
eligible or certified neonatologist, or whose experience,  qualifications,
and training are accepted in writing by the  state  health  director.  The
unit shall be under supervision of a nurse prepared at the master's  level
in maternal and infant care,  or  whose  experience,  qualifications,  and
training are accepted in writing by the state health director.
  (iii) The state health  director  may  authorize  the  neonatologist  or
physician director to transfer  convalescent  infants  to  the  hospital's
newborn nursery, or the newborn nursery of another hospital, pursuant to a
written plan approved by the  neonatologist  or  physician  director,  the
governing bodies of the involved hospitals, and the state health director.
  (e) A  patient  who  is  pregnant  may  be  admitted  to  the  maternity
department during any stage of pregnancy, including an ectopic  pregnancy,
or following abortion.
  (f) Any mother with infection, fever, or diarrhea shall be isolated in a
separate room which is equipped with a lavatory and a toilet.
  (g) Whenever it becomes necessary for the same nursing personnel to care
for both well and infected mothers or  infants  or  other  than  obstetric
patients, individual isolation techniques shall be employed.
  (h) A graduate nurse registered in Michigan  shall  supervise  the  care
given in the maternity department.
  (i)  All  personnel  entering  the  nursery,  including  physicians  and
cleaning people, shall be free from the symptoms of infection, fever,  and
diarrhea, and shall wear clean, fresh gowns.

  History:  1954 AC; 1979 AC.


R  325.1053   Required equipment and supplies.
  Rule 53. The hospital shall provide all of the following  equipment  and
supplies:
  (a) Equipment for individual breast care.
  (b) Equipment for individual perineal care.
  (c) All of the following items for the immediate  care  of  the  newborn
infant shall be assembled in the delivery room:
  (i) An incubator or heated bed.
  (ii) A warm sterile receiving blanket.
  (iii) Available oxygen.
  (iv) A suction device for the  gentle  aspiration  of  the  pharynx  and
trachea.
  (v) A newborn eye prophylaxis, as specified in R 325.60, which  is  kept
in the original and dated container.
  (vi) Equipment for the care of the cord.
  (vii) Identification equipment.
  (d) All nurseries shall be equipped for individual care of  the  infants
in their bassinets and shall contain all of the following:
  (i) A 24-hour supply of linen provided by the hospital.
  (ii) A lavatory with tempered running water.
  (iii) Soap and individual towels in a towel dispenser.
  (iv) Hampers for soiled linen other than diapers.
  (v)  Receptacles  for  soiled  diapers  with   impervious   liners   and
foot-controlled covers.
  (vi) A suction device for the  gentle  aspiration  of  the  pharynx  and
trachea.
  (vii) Available oxygen.

  History:  1954 AC; 1979 AC; 1979 ACS 8, Eff. Oct. 31, 1981.


R  325.1054   Postdelivery procedures.
  Rule 54. The following techniques shall be  observed  in  the  immediate
care of newborn infants:
  (a) The eyes of the newborn infant shall be treated within an hour after
birth with a  newborn  eye  prophylaxis  as  specified  in  R 325.60.  The
prophylaxis is to be kept in the original and  dated  container.  Outdated
approved eye medication shall not be used.
  (b) Every infant shall be  identified  by  1 or  more  of  the  reliable
methods in common use before the infant is removed from the delivery room.
This information shall be sufficient to identify the infant with  1 mother
only. If written tags are used, identification shall be in waterproof ink.
  (c) Provision shall be made for keeping the infant  warm  and  protected
from exposure to infection during transit from the delivery  room  to  the
nursery and at any other time the baby is removed from the nursery.

  History:  1954 AC; 1979 AC; 1979 ACS 8, Eff. Oct. 31, 1981.


R  325.1055   Nursery procedures.
  Rule 55. The following procedures shall be observed in nurseries:
  (a) If nursery lavatory faucets are not elbow, foot, or knee  controlled
the water shall be left running during  all  periods  of  infant  care  or
sterile paper lifters shall be used each time  the  hands  manipulate  the
faucet control.
  (b) Each bassinet shall be marked with the mother's name and the  baby's
birth date.
  (c) Each infant shall be given completely individual  care  in  his  own
bassinet.
  (d) The use of a common carrier for transporting babies  is  prohibited.
  (e) Receptacles for soiled diapers shall be kept covered.
  (f) An immediate report of inflammation  or  pus  in  the  eyes  of  the
newborn infants shall be made to  the  physician  in  charge  and  to  the
hospital administrator.

  History:  1954 AC; 1979 AC.


R  325.1056   Formulas and water solutions for infant feeding.
  Rule 56. (1)  Infant  formulas  and  water  solutions  prepared  in  the
hospital for use in infant  feeding  shall  be  made  and  used  with  the
following restrictions:
  (a) A separate room shall be provided  for  the  preparation  of  infant
formulas and water solutions and shall be reserved for this purpose  only.
  (b) The formula room shall contain a  handwash  lavatory  with  tempered
running water, soap, and  individual  towels  in  a  towel  dispenser  for
hand-washing.
  (c) The formula room shall have a double compartment sink with  hot  and
cold running water for use in the preparation of infant formulas and water
solutions.
  (d) The formula room shall contain  enclosed  cabinets  for  storage  of
supplies used in the preparation of infant formulas and  water  solutions.
  (e) Cleaning supplies used in the formula room  shall  be  stored  in  a
separate cabinet clearly identified for this purpose only.
  (f) A refrigerator shall be available exclusively  for  the  storage  of
infant formulas and water solutions requiring refrigeration.
  (g) After nippling and capping each individual unit of infant formula or
water solution prepared in the formula room, the unit shall  be  subjected
to a terminal sterilizing process at a minimum of 230  degrees  Fahrenheit
at 7 pounds pressure for 10 minutes.
  (h) Nipples shall not  be  changed  following  sterilization.  Provision
shall be made to protect the sterility of the units in transportation from
the formula room to the infant.
  (i) The sterility of infant formulas and water solutions prepared in the
formula room and the attached nipples shall be  checked  by  bacteriologic
methods at least once a month.
  (j) Records of the bacteriologic check  of  infant  formulas  and  water
solutions prepared in the formula room and the attached nipples  shall  be
maintained for 1 year from the date of bacteriologic check.
  (k) The hospital shall develop and have available written  policies  for
the preparation, storage, distribution, and use  of  infant  formulas  and
water solutions prepared in the formula room.
  (2) Commercially prepared and  prepackaged  infant  formulas  and  water
solutions used for  infant  feeding  shall  be  used  with  the  following
restrictions:
  (a) The director of public health shall approve each  type  of  packaged
unit of commercially prepared and prepackaged  infant  formula  and  water
solution before it can be used for infant feeding.
  (b) Disposable  components  of  commercially  prepared  and  prepackaged
infant formula and water solution units shall not be reused.
  (c) Enclosed cabinets shall be provided for the  short-term  storage  of
commercially prepared and prepackaged infant formulas and water  solutions
removed  from  their  original   shipping   carton   and   not   requiring
refrigeration.
  (d) Nipples shall not be  changed  following  assembly  of  commercially
prepared and prepackaged infant formula and water solution units.
  (e) A refrigerator shall be available exclusively  for  the  storage  of
infant formulas and water solutions requiring refrigeration.
  (f) Provision shall be made to protect the sterility of the commercially
prepared  and  prepackaged   formula   and   water   solution   units   in
transportation from the point of unit assembly to the infant.
  (g) The hospital shall develop and have available written  policies  for
the storage, assembly, distribution, and use of commercially prepared  and
prepackaged units of infant formula and water  solution  used  for  infant
feeding.

  History:  1954 AC; 1979 AC; 1979 ACS 6, Eff. Apr. 10, 1981.


R  325.1057   Care of mothers.
  Rule 57. The care of mothers shall include:
  (a) Individual perineal care.
  (b) Individual breast care.

  History:  1954 AC; 1979 AC.


R  325.1058   Mothers' records.
  Rule 58. (1) Mothers' records shall contain:
  (a) Past history, including:
  (i) Number, complications, and outcome of all previous pregnancies.
  (ii) Number of now living children.
  (iii) Type of previous deliveries.
  (iv) Birth weights of infants.
  (v) Date of delivery of last viable fetus.
  (vi) Significant past medical and family history.
  (vii) Weight before present pregnancy.
  (viii) Weight gain during this pregnancy.
  (b) The following information about the present pregnancy and labor:
  (i) Prenatal complications.
  (ii) History of recent exposure to communicable disease or  diarrhea  or
other communicable disease in the mother or family.
  (iii) Time of onset of labor.
  (iv) Frequency and intensity of contractions.
  (v) Condition of the membranes.
  (vi) Any symptoms of toxemia.
  (vii) Amount and character of any bleeding.
  (viii) Time and amount of last meal.
  (2) Except in emergencies, the  patient's  admission  examination  shall
record the following information:
  (a) Temperature, pulse, respiration and blood pressure.
  (b) Weight.
  (c) Skin lesions, degree of edema, condition of the throat,  lungs,  and
heart.
  (d) Presentation and position of the fetus.
  (e) The rate and character of the fetal heart.
  (f) A urine analysis.
  (g) An estimation of the degree of engagement of the presenting part and
the amount of cervical effacement dilation.
  (h) A determination of the pelvic measurements, if not already done.
  (3) A delivery room record book shall be maintained  with  chronological
entries of all deliveries including items pertinent to the history of each
delivery.
  (4) Each maternity record shall contain a physician's signed  report  of
the physical condition of the mother immediately before she is  discharged
from the hospital.

  History:  1954 AC; 1979 AC.


R  325.1059   Infants' records.
  Rule 59. (1) Records of infants shall include information sufficient  to
duplicate a birth certificate. This information shall be recorded  in  ink
within 48 hours after the birth of each infant.
  (2) The record of each newborn  infant  shall  contain  the  physician's
signed report on the physical condition of the infant  immediately  before
the infant is discharged from the hospital.
  (3) Infants' records shall be separate from mothers' records.

  History:  1954 AC; 1979 AC.


R  325.1060   Additional requirements for tuberculosis hospitals and other
  communicable disease units.
  Rule 60. (1) General requirements:
  (a) The superintendent or medical director of any tuberculosis  hospital
shall be a physician, licensed to practice in Michigan,  or  eligible  for
licensure, whose training and experience in  the  care  and  treatment  of
tuberculosis is approved  by  the  state  health  commissioner  and  whose
vocation is restricted to the interests of the institution, the control of
tuberculosis, or the practice of public health. He  shall  be  responsible
for the proper and adequate care of the tuberculosis patients admitted  to
the facility.
  (b) The administrator of a nontuberculosis hospital shall be responsible
for the effective carrying out of all  applicable  rules  in  communicable
disease units of such hospital.
  (2) Housekeeping requirements:
  (a) Dry dusting and sweeping shall not be permitted.
  (b) The  medical  director  or  administrator  in  the  tuberculosis  or
nontuberculosis communicable disease care units  shall  make  arrangements
for the instruction  of  employees  in  the  proper  handling  of  linens,
instruments, and utensils, and in protective techniques.
  (c) Employees handling contaminated linens shall wear washable  clothing
and isolation gowns and masks when handling this material.
  (3) Dietary requirements:
  (a) The equipment in the food service department shall be  adequate  for
efficient and safe food service.
  (b) Employees' dishes  shall  be  readily  identifiable  from  patients'
dishes.
  (c) Dishwashing shall be handled in such a manner  as  to  preclude  the
transmission of disease on dishes and utensils.
  (4) Facilities:
  (a) Fluoroscopy shall be available in tuberculosis hospitals.
  (b) Facilities shall be available for all recognized therapy.
  (c) There shall be a laboratory within the institution  registered  with
the Michigan department of health under the provisions of  Act  No. 45  of
the Public Acts of 1931.
  (d) There shall be adequate provision for  the  performance  of  routine
dental services for patients.
  (e) A locker and dressing room shall be provided  for  the  changing  of
uniforms and for leaving outside wraps:
  (i) This dressing room shall be separate from the nursing unit.
  (ii) There shall be adequate handwashing facilities.
  (f)  There  shall  be  separate  toilet  facilities  for  patients   and
personnel:
  (i) All toilet rooms shall have handwashing facilities.
  (ii) Patient toilet facilities shall not be used by visitors.
  (iii)  The  use  of  spring-loaded  valves  or  faucets  in  handwashing
facilities is prohibited.
  (g) Each lavatory in patient care, laboratory, and x-ray areas shall  be
equipped with a gooseneck water supply  pipe  and  foot,  knee,  or  elbow
controlled valves.
  (h) Each nursing unit shall have a room for gowns. This room shall  have
a complete handwashing facility.
  (5) Patient care:
  (a) Patients in whom the diagnosis is not clearly established, and those
known to be free of communicable diseases,  shall  be  hospitalized  apart
from those with known communicable diseases.
  (b) Materials for sputum disposal shall be  available  at  the  bedside.
These shall include: (1) a supply of impervious tissues,  (2)  a  bag  for
tissue disposal, and (3) a sputum cup when necessary.
  (i) Used materials shall be collected and incinerated at least daily.
  (ii) The attendant carrying out these procedures shall  wear  protective
clothing and mask and practice good handwashing procedures.
  (c) Techniques shall be such as to protect  personnel  from  sensitizing
drugs used in the treatment of patients.
  (6) Records:
  (a) Progress notes shall be written at sufficiently  frequent  intervals
to record significant events and changes in the clinical course and at the
time of such physical or x-ray examinations as may be performed.
  (b) There shall be complete records of employee health programs.
  (c) Each hospital treating tuberculosis patients shall  send  a  monthly
report (K-80 form supplied by the Michigan department of  health)  to  the
Michigan department of health covering all information requested.
  (7) Employee and patient protection:
  (a) There shall be written policies  and  techniques  designed  for  the
protection of all personnel.
  (b) There shall be routine instruction for patients and orientation  for
employees whereby they are informed  as  to  the  nature  and  hazards  of
tuberculosis or other communicable disease  cared  for  so  as  to  better
protect all involved from the transmission of communicable  disease.  This
program  shall  be  on  a  continuing  basis  and  shall  include,   where
applicable, instruction as to hospital  rules,  procedures,  policies  and
practices.
  (c) There shall be protective routines for visitors.
  (d) Isolation gowns and masks shall be worn when giving care to patients
or when working with contaminated equipment or material or in contaminated
areas. Masks, when worn, shall cover the  mouth  and  nose  and  shall  be
changed as soon as they become moist, but in no case shall be worn  longer
than 1 hour.
  (e) Receptacles for clean and contaminated masks shall be  provided  and
masks once removed shall not be re-worn until they have been laundered and
sterilized.
  (f)  At  necropsy,  the  examiners  and  observers  shall  wear   proper
protective clothing.
  (g) All employees shall have, at the  time  of  employment,  an  initial
examination that includes a tuberculin test, unless there is a record of a
previous reaction to tuberculin; a chest x-ray examination; a  serological
test for syphilis; and any other indicated examinations.
  (h) All employees who are in contact with patients, patients' rooms, and
laboratories, or  fomites,  shall  have  a  chest  x-ray  at  least  every
6 months, except that such employees who  are  tuberculin  negative  shall
receive the tuberculin test in lieu of the x-ray until such time  as  they
are observed to react.

  History:  1954 AC; 1979 AC.


R  325.1071   Definition of hospital.
  Rule 71. A hospital is:
  (1) An establishment which meets the definitions of a maternity hospital
as given in Act No. 263 of the Public Acts  of  1913,  being  S331.401  et
seq. of the Michigan Compiled Laws.
  (2)  An  establishment  offering  in-patient   services   and   physical
facilities to  4  or  more  nonrelated  individuals  requiring  diagnosis,
treatment, or care for a period of more than 24 hours. Such  establishment
shall make readily available therein  at  least  clinical  laboratory  and
diagnostic x-ray services, as well as facilities  for  definitive  medical
and surgical treatment.
  (3)  An  establishment  offering  in-patient   services   and   physical
facilities in one of the recognized  medical  specialties  to  4  or  more
nonrelated individuals  requiring  diagnosis,  treatment,  and  continuing
daily  care  of  physicians  licensed  to  practice  in  Michigan,   which
establishment shall make readily available  therein  facilities  necessary
for definitive treatment in the recognized speciality; provided  that  the
Michigan department of health's written evaluation  of  the  establishment
shall be reviewed by  the  commissioner's  hospital  committee,  favorably
recommended to the commissioner, and subsequently approved by  him  before
certification.

  History:  1954 AC; 1979 AC.


R  325.1081   Additional requirements for hospitals.
  Rule 81. (1) The medical care available for  children  in  the  hospital
shall be found to be satisfactory in the judgment  of  the  chief  of  the
bureau of maternal and child health of the department.
  (2) Patients 12 years of age and under shall be cared for in a pediatric
unit which meets the following requirements:
  (a) It shall be segregated from the adult unit and consist of at least 2
rooms.
  (b) Each room shall have a hand wash lavatory with gooseneck outlet  and
wrist, knee or foot controls.
  (c) At least 1 room shall be available for use as an isolation room  and
shall have a toilet in addition to the lavatory for handwashing.
  (d) A multipatient room shall provide a minimum  of  80 square  feet  of
floor space per bed or crib, and a single room shall  provide  100  square
feet of floor space per bed or crib.
  (e) A multipatient room shall provide a minimum work clearance of 3 feet
around beds, cribs, and bassinets.
  (f) A room used for bassinets shall provide a minimum area of  40 square
feet per bassinet.
  (3) A pediatric unit of  16  beds  or  more  shall  meet  the  following
additional requirements:
  (a) A graduate professional nurse currently  registered  in  this  state
shall be assigned to the unit at all times and be responsible for  nursing
care in the unit.
  (b) The unit shall have a separate nursing station.
  (c) The unit shall have utility rooms.
  (d) The unit shall have a room for examinations and treatments.
  (e) The unit shall have a playroom.
  (f) The unit shall have bathroom facilities.
  (g) The unit shall have provisions for storage and distribution of  food
and nourishment.
  (h) The unit shall provide space for  storage  and  a  janitor's  closet
shall be located in the unit or close by.
  (4) A hospital providing care for premature infants shall have at  least
2 incubators and other equipment, facilities, and personnel  necessary  to
adequately care for these infants.

  History:  1954 AC; 1979 AC.


R  325.1100   Licensing of hospitals.
  Rule 100. (1) Until such  times  as  rules  are  promulgated  under  the
authority of section 5 of Act No. 17 of the Public Acts of 1968, licensing
of all hospitals shall be based upon compliance with the minimum standards
for hospitals set forth  in  R 325.1001  to  R 325.1081  of  the  Michigan
Administrative Code.
  (2) An application for a license shall be made on forms  authorized  and
provided by the director of public health and shall be completed in  full.

  History:  1954 AC; 1979 AC.