2017 Midwest Healthcare

Engineering Conference-
2018 FGI Guidelines Major Changes

Todd W. Hite, P.E.

Program Manager, Health Care Engineering
November 29, 2017
 Acknowledgements

The information provided is courtesy of the Facility Guidelines

Institute and the work of the Healthcare Guidelines Revision
Committee (HGRC)
 The views and opinions expressed in this
presentation are the opinion of the speaker
and may not be the official position of FGI or
the Health Guidelines Revision Committee.
An Update on Major
Changes in the
2018 Hospital
Guidelines
 AII Room Changes
Audible Alarm Arrangement

Sections impacted are:

2.1–2.4.2.3 (2)
2.1-2.4.2.4 (1)(b)(i)
2.1-2.4.2.5
2.2-2.2.4.5 (3)(b) — (Combo AII/PE Room)

“All doors to the anteroom shall have self-closing

devices and/or an audible alarm arrangement that
can be activated when the AII room is in use as an
isolation room.”
Airborne Infection Isolation Room Special Design Elements
 2.1-2.4.2.4 AII Room
Architectural details

• Edge seals provided along top and sides

of doorframe for any door into AII room
• Door sweep provided where AII room not
sealed well enough to maintain negative
pressure at -.01 inches of water column
 Critical Care Unit

New adult and pediatric critical

care patient rooms must be
single-patient rooms.
 Critical Care Unit Private Rooms

• Section 2.2-2.6.2.2(4) provides an exception for

renovations.
• NICUs are exempt because the cross-reference to the
CCU section applies only to Application.
 Patients of Size

Introduces the term “patients of

size” to include those who don’t fit
standard definition of “obese.”
Bariatric patient now refers
exclusively to those who require
bariatric surgery.
 Patients of Size

• Requirements moved from Nursing Units

(Section 2.2-2.16 in 2014) to Common
Elements (Section 2.1-2.3).
• Section 2.2-2.14 Bariatric Patient Care Unit
now states, “Where a bariatric patient care
unit is provided, it shall meet the
requirements in Section 2.2-2.2
(Medical/Surgical Patient Care Unit) and the
requirements in Section 2.1-2.3
(Accommodations for Care of Patients of
Size).”
 Patients of Size

• The owner still defines the program and

determines the threshold weight capacity
of patients they can accommodate.
• Every hospital needs to treat patients of
size in the ED, but they could have a
transfer policy and not treat them as an
inpatient.
• An AII room dedicated to POS is not a
requirement for every hospital.
 Patients of Size

• ED must treat patients of size in a single-

patient treatment room with expanded
clearances for patient movement equipment.
• The room may be subdivided for use by two
patients when not used for patients of size,
provided it meets the clearance requirements
for patient care stations in multi-patient exam
room, has direct access to a hand-washing
station, and meets electrical and med/gas
requirements for two patients.
 Patients of Size

• A lift system is required where patients of size will be

treated but the owner has the option of built-in ceiling- or
wall-mounted lifts or mobile lifts.
• Lifts are required for patient rooms designated for care of
patients weighing 600 pounds or more.
• Lifts in other areas determined by facility’s threshold
weight capacity.
 Clearances for POS patient rooms

Rooms with fixed lift: 10’-6” by 5’

18” 10’-6”

5’
Graphics compliments of Hill-Rom
 Clearances for Patients of Size

Rooms without fixed lift: 10’6” by 7’

18”

Graphics compliments of Hill-Rom

 Patients of Size Door Size

Inpatient rooms
entry door:
57” clear width

Toilet room door:

45.5” clear width

Graphics compliments of Hill-Rom

 Patients of Size Toilet Clearance

Patient toilet :
• 36” centerline to both
sides if expanded
capacity toilet
• 44” centerline to sides if
standard toilet
• 72” long x 46” wide
clearance in front
of toilet required Graphics compliments of Hill-Rom
 Patients of Size Bathing

• Minimum shower size (4’x6’) not changed

• Shower grab bars must support 800# minimum,
decreased from 1,000#
• Hand-held wand or nozzle required on sidewall not
changed.
 Patients of Size Waiting

• A minimum of 5% of seating must have 600# capacity.

Diagnostic and Treatment
Areas

Section 2.1-3.2 (Examination

Room or ED Treatment Room)
Major Changes
 Sexual Assault Forensic Examination Room

2.1-3.2.4 Where provided, must meet requirements

in Section 2.1-3.2.2 (Single-Patient Examination
Room) and contain:
(1) Pelvic examination bed/table
(2) Lockable storage areas for forensic collection
kits, laboratory supplies, and equipment
(3) Private toilet and shower with storage directly
accessible to the sexual assault forensic
examination room
 Sexual Assault Forensic Examination Room

2.1-3.2.4.2 A room for consultation, family, support services,

and law enforcement shall be readily accessible to the
sexual assault forensic examination room.
 2018 FGI:
Integrated Into Imaging

Nuclear Medicine

Removed from text: Interventional

Imaging
Diagnostic and Treatment Facilities
Imaging Services

Section 2.2-3.4 (Imaging Services)

Major Changes
 Imaging General

• The requirements in this section shall not apply to

imaging services provided in mobile/transportable
medical units.

• Imaging room designations are determined by the

types of procedures performed and the levels of
support needed for patient safety as described in
Table 2.2-2 (Classification of Room Types for
Imaging Services).
 Shielded Control Alcove or Room
• The control alcove or room shall be, at minimum,
sized and configured in compliance with the
manufacturer’s recommendations for installation,
service, and maintenance.

• Can serve more than one imaging room.

 Control Alcove or Room
• Shall include a shielded view window with a full
view of exam/procedure table. If a direct line of
sight cannot be accommodated, use of closed-
circuit video monitoring is permitted.

• The control room shall be physically separated

from the Class 2 or Class 3 imaging room with
walls and a door.
 Environmental Controls1
Room Type Use
Location Ventilation Surfaces
Class 1 Diagnostic radiography, Accessed from an 6 total ACH Flooring: cleanable and wear-resistant for the location;
imaging
room
Table 2.2-2: Classification of Room Types
fluoroscopy, mammography,
computed tomography (CT),
unrestricted area No pressure requirement
Standard diffuser and return array
stable, firm, and slip-resistant
Wall finishes: washable

for Imaging •Services

ultrasound, magnetic resonance
imaging (MRI), and other imaging Diagnostic imaging Ceiling: cleanable with routine housekeeping equipment;
lay-in ceiling permitted
modalities
Services that use natural orifice
entry and do not pierce or penetrate
natural protective membranes
*“Invasive procedure” is defined in the glossary.
Class 2 Diagnostic and therapeutic Accessed from an 15 total ACH Flooring: cleanable and wear-resistant for the location;
imaging procedures such as coronary, unrestricted or a semi- Positive pressure for catheterization stable, firm, and slip-resistant
room neurological, or peripheral restricted area No pressure requirements for other Floor and wall base assemblies: monolithic floor with
angiography
Electrophysiology procedures
rooms
• Diagnostic and therapeutic
Standard diffuser and return array
integral coved wall base carried up the wall a minimum of
6 inches
Wall finishes: washable; free of fissures, open joints, or
• Coronary, neurological, or
crevices
Ceiling: smooth and without crevices, scrubbable, non-
peripheral angiography
absorptive, non-perforated; capable of withstanding
cleaning chemicals; without crevices; lay-in ceiling
permitted if gasketed or each ceiling tile weighs at least
• Electrophysiology procedures
one pound per square foot and no perforated, tegular,
serrated, or highly textured tiles

Class 3 Invasive procedures* Accessed from a semi- Airflow downward and unidirectional Flooring: cleanable and wear-resistant for the location;
imaging Any Class 2 procedure during which restricted area with an average diffuser velocity of 25 stable, firm, and slip-resistant
room the patient will require physiological to 35 cfm/ft2 (127 to 178 L/s/m2) and Floor and wall base assemblies: monolithic floor with
(hybrid monitoring and is anticipated to diffusers positioned to provide an integral coved wall base carried up the wall a minimum of
operating require active life support airflow pattern over the patient and 6 inches
room) surgical team Wall finishes: washable; free of fissures, open joints, or
Primary supply diffuser arrays extend a crevices
• Invasive procedures
minimum of 12 in. (305 mm) beyond the
footprint of the surgical table on each
Ceiling: monolithic, scrubbable, capable of withstanding
cleaning and/or disinfecting chemicals, gasketed access
side openings
At least two low sidewall return or
exhaust grilles spaced at opposite
corners or as far apart as possible
 Design Requirements
Room Type Use
Table 2.2-2: LocationClassification of Room Surfaces Types
Class 1 Diagnostic radiography, fluoroscopy, Accessed from an Flooring: cleanable and wear-resistant for the location; stable, firm, and slip-resistant
imaging mammography, computed tomography for Imaging
unrestricted area Services
Wall finishes: washable
room (CT), ultrasound, magnetic resonance
imaging (MRI), and other imaging
modalities Ceiling: cleanable with routine housekeeping equipment; lay-in ceiling permitted
Services that use natural orifice entry and *“Invasive procedure” is defined in the glossary.
do not pierce or penetrate natural
protective membranes
Class 2 Diagnostic and therapeutic procedures Accessed from an Flooring: cleanable and wear-resistant for the location; stable, firm, and slip-resistant
imaging such as coronary, neurological, or unrestricted or a semi-
room peripheral angiography restricted area Floor and wall base assemblies: monolithic floor with integral coved wall base carried up the wall a minimum of 6
Electrophysiology procedures inches

Wall finishes: washable; free of fissures, open joints, or crevices

Ceiling: smooth and without crevices, scrubbable, non-absorptive, non-perforated; capable of withstanding
cleaning chemicals; without crevices; lay-in ceiling permitted if gasketed or each ceiling tile weighs at least one
pound per square foot and no perforated, tegular, serrated, or highly textured tiles

Class 3 Invasive procedures* Accessed from a Flooring: cleanable and wear-resistant for the location; stable, firm, and slip-resistant
imaging Any Class 2 procedure during which the semi-restricted area
room (hybrid patient will require physiological Floor and wall base assemblies: monolithic floor with integral coved wall base carried up the wall a minimum of 6
operating monitoring and is anticipated to require inches
room) active life support
Wall finishes: washable; free of fissures, open joints, or crevices

Ceiling: monolithic, scrubbable, capable of withstanding cleaning and/or disinfecting chemicals, gasketed access
openings
 Table 2.1-4
Station Outlets for Oxygen, Vacuum (Suction), Medical Air, and Instrument Air Systems in
Hospitals1

DIAGNOSTIC AND TREATMENT LOCATIONS

2.1-3.2 Examination room or emergency department 1/room 1/room — — —
treatment room
2.1-3.4.4 Phase I post-anesthesia (PACU) patient care 2/station 3/station 1/station — —
station
2.1-3.4.5 Phase II recovery patient care station 1/station 1/station6 — — —
2.2-3.1.2.6 Treatment room for basic emergency services 1/gurney 1/gurney — — —
2.2-3.1.3.3 Triage area (emergency department) 1/station 1/station — — —
2.2-3.1.3.6 Emergency department treatment room or area 1/gurney 1/gurney 1/gurney — —
2.2-3.1.3.6 (4) Trauma/resuscitation room 2/gurney 3/gurney 1/gurney — —
Plaster and cast room 1/room 1/room — — —
2.2-3.2.2 Observation unit patient care station 1/station 1/station — — —
Table 2.2-2 Class 1 imaging room 1/room 1/room — — —
2.2-3.3.2 Procedure room 2/room 2/room 1/room — —
Table 2.2-2 Class 2 imaging room
2.2-3.3.3 Operating room 2/room 5/room 1/room 1/room 1/room
Table 2.2-2 Class 3 imaging room
 New table
Examination/treatment room
Room Design Requirements
Use
Type Location Surfaces
Exam or Patient care Unrestricted Flooring: cleanable and wear-resistant for the location; stable, firm,
treatment that may area and slip-resistant
room require high- Wall finishes: washable
level
disinfected or Accessed from Ceiling: cleanable with routine housekeeping equipment; lay-in
sterile an unrestricted ceiling permitted
instruments area
but does not
require the
environmental
controls of a
procedure
room

©FGI 2017
 Procedure room
Design Requirements
Use
Location Surfaces
Patient care that Semi- Flooring: cleanable and wear-resistant for the location; stable, firm, and slip-
requires high- restricted resistant
level disinfection area
Floor and wall base assemblies in cystoscopy, urology, and endoscopy
or sterile
procedure rooms and endoscope processing room: monolithic floor with
instruments and
integral coved wall base carried up the wall a minimum of 6 inches
some Accessed
environmental from an Wall finishes: washable
controls but unrestricted
does not require or a semi- Wall finishes in endoscopy procedure room and endoscope processing
the restricted room: washable; free of fissures, open joints, or crevices
environmental area Ceiling: smooth and without crevices, scrubbable, non-absorptive, non-
controls of an perforated; capable of withstanding cleaning chemicals; without crevices;
operating room lay-in ceiling permitted if gasketed or each ceiling tile weighs at least one
Endoscopic pound per square foot and no perforated, tegular, serrated, or highly
procedures textured tiles

Copyright FGI 2014

 Operating room
Design Requirements
Use
Location Surfaces
Invasive Restricted Floor and wall base assemblies: monolithic floor with integral
procedures area coved wall base carried up the wall a minimum of 6 inches

Any Floor and wall base assemblies: monolithic floor with integral
procedure coved wall base carried up the wall a minimum of 6 inches
Accessed
during which from a Wall finishes: washable; free of fissures, open joints, or crevices
the patient semi-
will require Ceiling: monolithic, scrubbable, capable of withstanding cleaning
restricted
physiological and/or disinfecting chemicals, gasketed access openings
area
monitoring
and is
anticipated to
require
active life
support
To summarize:
Invasive procedure –
Operating room

Patient care that requires high-level

disinfection or sterile instruments but does
not require OR environmental controls –
Procedure room

Non-invasive procedure –
Exam room
Treatment room
 Inpatient and OP space requirement updates
• Procedure room
– Clear floor area reduced to:
130 square feet
– Clearances reduced to:
• 3 ft. 6 in. on sides table/gurney/chair
• 3 ft. at head and foot
– EXCEPTION where anesthesia
machine and cart are used:
• Clear floor area: 160 square feet
• Clearances: 6 ft. at head
 Space requirement updates
• Outpatient operating room
– Minimum clear floor area: 255 sq. ft.
– Clearances:
• 6 ft. on sides of table/chair
• 5 ft. at head and foot
– EXCEPTION with anesthesia
machine and cart :
• Clear floor area: 270 sq. ft.
• Clearances: 6 ft. x 8 ft. at head
6 ft. on sides, 5 ft. at foot
 Inpatient and OP pre- and post-procedure patient
care
• Allows combination of all patient care stations
(pre-procedure, Phase I, Phase II) in one area
– Must meet the most restrictive requirements
– Where combined into one area, at least two
patient care stations per procedure, operating,
or Class 2 or Class 3 imaging room
Outpatient surgery facility
 Outpatient surgery facility
Support areas organized into categories for clarity:
• Support areas in the semi-restricted area
• Support areas directly accessible to the semi-
restricted area
• Other support areas in the outpatient surgery
facility
 General Support Facilities
Sterile Processing

Section 2.1-5.1 (Sterile Processing)

Major Changes
 Facilities for On-Site Sterile Processing
2.1-5.1.2.1 General/Application

(a) Where provided on-site, facilities that meet the

requirements in Section 2.1-5.1.2.2 (Two-room
sterile processing facility) shall be provided with
the following exception:
(b) Where sterilization equipment is limited to a
table-top or similar-sized sterilizer(s), a one-
room sterile processing facility that complies
with Section 2.1-5.1.2.3 (One-room sterile
processing facility) is permitted.
 Two-room Sterile Processing Facility

2.1-5.1.2.2 (1)(b) A sterilizer access room shall be provided if

required by the manufacturer.

2.1-5.1.2.2 (2) Decontamination room: sized to meet the minimum

equipment space and clearances needed for the equipment used.
 Two-room Sterile Processing Facility
New text at 2.1-5.1.2.2(2)(b)(vii) and 2.1-5.1.2.3
(2)(a)(v). Instrument air outlet or portable compressed
air for drying instruments. See Table 2.1-4 (Station
Outlets for Oxygen, Vacuum, Medical Air, and
Instrument Air Systems in Hospitals).

Table 2.1-4 (Footnote 11) NFPA 99 permits the use of

portable compressed air for single applications. Where
cylinders are used for non-respiratory purposes, such
as air for blowing down scopes and/or running
decontamination equipment, NFPA 99 should be
consulted for cylinder air quality, placement, and
handling.
 Sterile Processing – Equipment and Supply Storage

A2.1-5.1.2.4 offers guidance on providing space for instrument vendor (loaner

set) receiving/pickup.

2.1-5.1.2.4 (1) Storage for clean and sterile instruments and supplies:
• Can be separate room or portion of clean workroom
• Provides space for case cart storage, if used
• Maintain manufacturer’s specified humidity and temperature levels
 Support Areas for Off-Site Sterilization
2.1-5.1.3 Where provided off-site, the following on-site
support spaces shall be provided:

• A room for breakdown (receiving/unpacking) of

clean/sterile supplies.

• A room for storage of clean and sterile supplies.

• A room with a flush-type device for gross

decontamination and holding of instruments (could be
soiled workroom in Section 2.1-2.8.12).
 Questions?

Contact Info:
Todd W. Hite, P.E.
Program Manager, Health Care Engineering
[email protected]
317-233-7166