333-077-0220 Physical Environment (1) As used in this rule: (a) "Area" means a particular space or surface serving a defined function. An 'area' exists as a small portion of an overall 'room' or space. (b) "Authorities having jurisdiction" means an organization, office, or individual responsible for enforcing the requirements of a code or standard, or for approving equipment, materials, an installation, or a procedure. (c) "Room" means a space enclosed by hard walls and having a door. (2) At the time of initial licensure, a birthing center must meet the physical environment requirements in these rules including any applicable local, state, or federal building and specialty codes in effect at the time of initial licensure. (3) Subsequent modifications to a facility after initial licensure must comply with these rules and any applicable building or specialty codes in effect at the time of the modification. (4) A licensed birthing center must continue to meet all applicable building and physical environment standards, including but not limited to structural, mechanical, electrical, plumbing, fire and life safety codes that were in effect at the time of licensure, or the standards that applied at the time of a major alteration or new construction as required by this rule. Each instance of non-compliance with a building or physical environment standard or code is a separate violation. (5) For an existing licensed birthing center, only the portion of the building that is being altered or renovated, and any impacted ancillary areas required to ensure full functionality of the birthing center, must meet the requirements in this rule. (6) On or after November 3, 2025, any person proposing to construct a new birthing center, or proposing to make certain alterations or additions to an existing birthing center, must before commencing new construction, alterations, or additions, comply with OAR chapter 333, division 675 and these rules. (7) An applicant or a licensed birthing center must comply with the following requirements: (a) The birthing center shall be classified as an outpatient clinic business occupancy pursuant to 2025, Oregon Structural Specialty Code (OSSC). A client must be capable of promptly evacuating the birthing center in an emergency, such as fire, to a safe place based upon the services offered. (b) Security and safety: (A) All exterior and interior surfaces, furnishings, fixtures, and equipment shall be kept clean and in good repair. (B) Hallways, doors, and stairs shall be sized and arranged to accommodate emergency transport. (i) Hallways and stairs shall be a minimum of 36 inches clear excluding minor encroachments such as stair handrails. (ii) Doors shall be sized to provide a minimum clear opening of 32 inches. (iii) Stairs shall be provided with handrails and emergency egress lighting. (C) Smoke alarms are required within each birthing room, outside of each birthing room but in immediate vicinity, and on each occupiable floor. Additional locations may be required by other authorities having jurisdiction. (D) Fire extinguishers shall be placed within 20 feet of each birthing room, kitchen, and laundry equipment (measured along path of travel) in a readily accessible location. Fire extinguishers shall be installed, inspected, and serviced as required by the authorities having jurisdiction. Additional locations and provisions may be required by other authorities having jurisdiction. (E) Emergency egress lighting shall be provided. (F) Exit routes shall be free of obstructions. Areas outside of exit routes shall not place any obstructions (chairs, birthing balls, or similar) that may impede emergency medical services (EMS) access to clients or newborns. (G) Combustibles, flammables, and refuse shall not be stored within three feet of heating sources such as furnaces, fireplaces, stoves, hot water heaters, and open flames. (H) All electrical outlets accessible to the public shall be of the tamper resistant type. (I) Ground fault circuit interrupter (GFCI) protection shall be provided at all electrical receptacles that serve kitchens, toilet rooms, bathrooms, and where outlets are within six feet of any other water source. (J) The use of extension cords is prohibited except: (i) In response to emergencies such as power failure for the duration of the emergency as long as risk of injury is minimized wherever possible. (ii) Relocatable power strips such as those used at computer work areas to power multiple items are allowed as long as they are UL listed, cords are not a tripping hazard, and the relocatable power strips are selected and installed per local and state fire prevention requirements. (K) Placing extension cords or placing equipment plug wiring under rugs is prohibited. (L) After regular business hours, exterior doors shall be locked to preclude unscheduled access into the facility. Door locking functions shall not obstruct ability to freely exit the building. (c) Site and exterior: (A) Parking lots and exterior access walkways to building shall be provided with adequate lighting. (B) At least one entrance shall be accessible to persons with disabilities and shall be usable by persons in wheelchairs. (C) The entrance shall be clearly marked. (d) Birthing suite: (A) Birthing areas shall have distinct separation from unrelated facility traffic, including separation from exam rooms or other business functions. (B) Access to the birthing area shall be regulated for infant security. (C) The maximum number of beds per birthing room shall be one unless approved by the Oregon Health Authority (Authority). (D) Each birthing room shall provide adequate space for laboring clients, labor support persons, and staff and provide: (i) Sufficient space and access for staff to function safely; and (ii) Not less than seven feet in any plan dimension with a minimum of 100 square feet. (E) Within each birthing room, the newborn care area shall be located to provide the client and support person(s) direct visual observation of the newborn. The newborn care area shall provide adequate space for newborn resuscitation, stabilization, and examination. (F) Secure storage of emergency supplies for both the newborn and the client shall be provided within each birthing room. Any additional emergency equipment may be located outside the birthing rooms but must be secured and readily located for immediate access. (G) Emergency phone numbers shall be posted in each birthing room. (H) Each birthing room shall provide a private bathroom that contains a toilet, handwash station with soap and single use paper or cloth towels that are stored in a contactless enclosed dispenser to prevent contamination, and a shower or tub. Bathtubs intended for laboring or delivery may be located outside the private bathroom but within the birthing suite. (i) At least one birthing room bathroom shall be fully accessible in accordance with Oregon's adopted accessibility code, 2009 or 2017 edition of ICC ANSI A117.1 as determined by other authorities having jurisdiction. Additional requirements and quantities of fully accessible birthing suites may be required by other authorities having jurisdiction. (ii) Non-accessible birthing room bathroom tubs and showers shall include safety rails or grips to allow safe entrance, maneuvering, and exit. (iii) Thermometers shall be made available for monitoring bathtub water temperature. (I) Sharps disposal containers shall be provided in each birthing room. If mounted to the wall, the top of sharps disposal container shall be placed no higher than five feet, zero inches vertical dimension above floor. (J) For new construction or where seeking licensure of a previously unlicensed space, a handwash station is required in the birthing room. The handwash station must include soap and single use paper or cloth towels that are stored in a contactless enclosed dispenser to prevent contamination. (K) For renovation work within existing licensed space, a hand sanitation dispenser may be provided in the birthing room in lieu of a handwash station. (L) If window(s) are provided within a birthing suite, the window(s) must include locks for infant security and shall have window coverings that provide privacy and control exterior light. (M) Supplemental portable lighting shall be available for laceration or episiotomy repair, newborn exam, and other similar purposes. Emergency ambient lighting shall be provided for the birthing room. Both must remain functional during a power loss. Supplemental and emergency lighting need not be built-in; battery-powered lighting is allowed. (e) Support areas for birthing center: (A) An examination room is not required. If provided, the examination room shall provide adequate space to accommodate clients, support persons, and staff. (i) For new construction or where seeking licensure of previously unlicensed space, a handwash station is required in the examination room. Handwash station shall include soap and single use paper or cloth towels that are stored in a contactless enclosed dispenser to prevent contamination. (ii) For renovation work within existing licensed space, a hand sanitation dispenser may be provided in the examination room in lieu of a handwash station. (iii) Sharps disposal containers shall be provided in each examination room. If mounted to the wall, the top of sharps disposal container shall be placed no higher than five feet, zero inches vertical dimension above floor. (B) Laundry service may be provided onsite or contracted. All laundry contaminated with bodily fluids shall be placed in bags in impervious receptacles. (i) If laundry service is onsite, an area shall be provided that is large enough to accommodate the following: (I) Washer/extractor(s). Washers/extractors shall provide a temperature of at least 160 degrees Fahrenheit for a minimum of 25 minutes or include use of a chemical disinfectant; (II) Dryer; (III) Storage shall be provided for laundry supplies. If laundry area is accessible to the public, all chemicals shall be secured within locked rooms or cabinetry; and (IV) Separate and distinct areas shall be provided for processing soiled and clean laundry. A handwash station with soap and single use paper or cloth towels that are stored in a contactless enclosed dispenser to prevent contamination shall be provided within 20 feet of soiled linen area (measured along path of travel). (ii) If laundry service is contracted, adequate storage of soiled laundry under staff control and protected from public access shall be provided. (C) A kitchen shall be provided for staff, client, and support person use that includes: (i) A sink with soap and single use paper or cloth towels that are stored in a contactless enclosed dispenser to prevent contamination. The handwash sink must remain accessible at all times and be free of dishes or food when used for handwashing. (ii) A worksurface. (iii) Means to hold food below 41 degrees Fahrenheit. Refrigerators for food cannot contain birth center medications, placentas, or laboratory specimens. The refrigerator shall have a sign or label identifying the refrigerator is for food storage only. (iv) Means to heat food. Means for heating food shall be located or monitored to preclude tampering by children. (v) Commercial-grade cooking equipment and appliances may be required by other authorities having jurisdiction. (vi) Storage of dangerous or sharp utensils and equipment shall be secured to preclude access by children. (vii) Toilet rooms cannot directly open to rooms where food is being prepared. (viii) If ice is provided in the birthing center for therapeutic purposes or for consumption, it shall be self-dispensing to preclude possible contamination. Self-dispensing ice can be provided via refrigerator in-door dispenser or countertop ice dispenser as long as scoops are not used and hands cannot contact the ice. (D) Medications and ancillary supplies: (i) Medications, needles, and prescription pads shall be secure and lockable to preclude unauthorized use. (ii) Sharps disposal containers shall be provided near the medical supplies. If mounted to the wall, the top of sharps disposal container shall be placed no higher than five feet, zero inches vertical dimension above floor. (iii) If medication refrigerator(s) are included, they shall not store any food, placentas, or laboratory specimens. The refrigerator shall have a sign or label identifying the refrigerator is for medication only. (iv) Medication refrigerators shall include a temperature gauge. (v) A handwash station with soap and single use paper or cloth towels that are stored in a contactless enclosed dispenser to prevent contamination shall be provided within 20 feet of where medications are opened for handling or dispensing (measured along path of travel). (E) Storage shall be provided to meet the needs of the birthing center. A minimum area of 10 square feet per birthing room shall be provided in the birthing center to store all necessary items for immediate use and for satisfactory function of the overall facility. Designated separate and distinct storage room or areas shall include clean supplies, office supplies, and soiled materials holding. The 10 square feet is a cumulative total for both clean supplies and soiled materials holding and need not be provided in one assigned location nor within the birthing room. Use of closets, furniture like armoires, built-in casework, and storage rooms on different floors is acceptable as long as those locations meet or exceed the minimum required cumulative total. Utility and storage areas shall be designated for use as "clean" or "dirty" as these items must remain separate. (i) Designated space(s) shall be provided and sized for holding of soiled materials that is under staff control and protected from public access. These soiled holding spaces are included in the calculated minimum required cumulative total for storage. (I) Biohazard waste must be placed in clearly marked bags or containers and in accordance with OAR 333-077-0190(4). (II) A handwash station with soap and single use paper or cloth towels that are stored in a contactless enclosed dispenser to prevent contamination shall be provided within 20 feet of soiled material holding space(s) (measured along path of travel). (ii) Flammable liquids storage (such as hand sanitizer) exceeding five gallons shall be placed in a hazardous materials storage cabinet. (iii) All storage items need to be located below 24 inches of the ceiling or structure if the building is non-sprinklered or 18 inches below the sprinkler head deflector if the building is sprinklered. (F) Equipment. (i) A means for sterilizing equipment shall be provided in accordance with OAR 333-077-0190 (6). (ii) A means for oxygen supplementation and vacuum or suction of airways shall be provided. (iii) If portable medical gas (includes oxygen and nitrous oxide) tanks are utilized: (I) Storage of cylinders not in use shall be 20 feet distance or greater separation from other flammables, combustibles, open electrical equipment, motor-driven equipment, kitchens, furnaces, fireplaces, candles, or any other open flame. (II) Cylinders not in use must be held within stands or chained to non-movable partitions to preclude tipping or falling. (III) If the volume of cylinders not in use is less than 300 cubic feet (12 or fewer E-size cylinders), no special room construction and fire protection is required for licensure purposes. Additional requirements may be required by other authorities having jurisdiction. (IV) Cylinders shall be identified as empty or full. Empty and full cylinder storage shall be in separate locations. (V) The door(s) to any rooms containing cylinders shall include signage that states “CAUTION: OXIDIZING GAS(ES) STORED WITHIN. NO SMOKING” (f) Support areas for visitors: (A) Toilet facilities shall be made available for staff and support persons that are not located within the birthing room. Each toilet room shall contain a toilet, a handwash station with soap, and single use paper or cloth towels that are stored in a contactless enclosed dispenser to prevent contamination. (i) At least one staff and support person use toilet room shall be fully accessible in accordance with Oregon's adopted accessibility code, 2009 or 2017 edition of ICC ANSI A117.1 as determined by other authorities having jurisdiction. (ii) Additional requirements and quantities of fully accessible toilet rooms may be required by other authorities having jurisdiction. (B) A reception and waiting area shall be provided. (C) A telephone shall be made available to the client and support persons to access emergency assistance. Hard-wired "land" line, VoIP, cellular phone, or similar are all acceptable options as long as service is reliable. Signage shall be posted notifying that a phone is available for use with emergency numbers listed. (g) Support areas for staff. (A) Staff work stations may be provided within the birthing room but an additional staff work area shall be located outside of birthing room(s). (B) An area or room shall be provided for staff to discuss clients' protected health information and this need not be on the same floor as the birthing room(s). (C) Storage of medical records whether paper copy or digital shall be secure and lockable from public access. (h) Materials and finishes: (A) Materials and finishes shall be appropriate for a birthing center. (B) Materials and finishes shall be wear-resistant and selected to withstand the type and frequency of cleaning or disinfection methods that occurs within each space. (i) Flooring finishes shall accommodate suitable cleaning methods for the spaces they serve. (ii) The use of carpeting shall be limited to rooms and spaces where risk of soiling with bodily fluids is minimal. Throw rugs or similar are allowed as long as their size allows regular washing. Throw rugs that do not lie flat are prohibited. (iii) Floor finishes in wet locations such as toilet rooms, bathrooms, kitchen, laundry, and any areas immediately within handwash station locations shall be slip-resistant. (iv) Bathrooms and areas surrounding bathtubs shall have floors and walls that have a smooth, hard, nonabsorbent finish. (8) Oregon Health Authority, Facility, Planning and Safety (FPS) issuance of final project approval is a prerequisite for licensure. FPS final project approval shall not be issued until the certificate of occupancy or permit sign-off issued by the local jurisdiction is submitted to the Authority documenting approval of work. (9) A request to waive physical environment standards in this rule will only be considered for portions of a structure, space, or system if the birthing center's operations and patient safety are not jeopardized. Waivers for physical environment standards may be granted to minimize restrictions on improvements where total compliance would create an unreasonable hardship and would not substantially improve safety. NOTE: The codes referenced in this rule are available upon request by contacting the Health Care Regulation and Quality Improvement, Facility Planning and Safety program at mailbox.fps@odhsoha.oregon.gov. Statutory/Other Authority: ORS 441.020 & ORS 442.015 Statutes/Other Implemented: ORS 441.020 & ORS 442.015 History: PH 23-2025, amend filed 11/03/2025, effective 11/03/2025 PH 121-2024, renumbered from 333-076-0710, filed 12/24/2024, effective 12/24/2024 PH 13-2008, f. & cert. ef. 8-15-08 PH 15-2006, f. & cert. ef. 6-27-06 HD 2-1990, f. 1-8-90, cert. ef. 1-15-90, Renumbered from 333-076-0430 HD 26-1985, f. & ef. 10-28-85