Facility Guidelines Institute Are You Ready? · Facility Guidelines Institute Are You Ready? Guidelines Update Review 2018 May 3, 2019. Wheeling Hospital ... WV State Fire Marshall

Facility Guidelines Institute

Are You Ready?Guidelines Update Review 2018

May 3, 2019

http://www.wvshe.org/

Wheeling Hospital

Charleston Area Medical Center

West Virginia University Cancer Institute

Fairmont Regional Medical Center

Mon General

Weirton Medical Center

Princeton Community Hospital

Roane General Hospital

Glenville State College

NETL

US Customs

Highmark Headquarters

OFLAC

WV State Fire Marshall

SafetyMoment

• Safety vs. Risk• Focus on people rather than

objects• Be aware of the checklist• Learn the art of humble inquiry• Entertain doubt• Never use safety as a

punishment

AgendaIntroductionsTimothy Cowan

General OverviewChuck Parker

Emergency Services, Observation, & Behavioral HealthJennifer Storey

Surgical ServicesChuck Parker

Endoscopy, Radiation & ImagingAbhishek Bodkay

OncologyJennifer Storey

Mechanical EngineeringCarl Shilling

Electrical EngineeringBryon Schmidt

OutpatientCollin Beers

Sheikh Shakbout Medical Center VideoTimothy Cowan

Topic Groups are formed to focus review significant changes and focused modifications on specific topics felt to be weak, or emerging. For the 2022 Edition the following are the initial Topic Groups:

Palliative CareAcousticsGeriatricsBehavioral HealthResiliency & Business ContinuityLightingRural Health [Critical Access + MicroHospitals]

What’s Next

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Hospital Reps = 40 C-Suite/MD/RN/Facilities

Architects/ID = 29

Engineers = 16 MEP/IT/Acoustics

Contractors/Project Managers = 9

Authorities Having Jurisdiction [AHJs] State reviewers = 19

Research = 16 i.e. geriatrics

Voting + Alternates = approx. 132 Members

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Brief History of the Guidelines• Hill-Burton document [first published in 1947]• Minimum construction requirements [1947-84]• Turned over to the public sector in 1985 and has

been the Guidelines ever since• Published by AIA from 1987-2006• Published by ASHE from 2010 – 2014• Now FGI – HGRC• State Adoption

Suggested Edits Face Scrutiny

General OverviewUpdate Review by Chuck Parker

Please note that much of the text is taken from the Major Additions and Revisions section of the 2018 Guidelines

Implementation

PA DOH• Optional beginning May 1, 2018• Mandatory for any review beginning November 1,

2018, regardless of when the design was initiated.

West Virginia• OFLAC has already adopted it. As of May 1, any

projects not having already been reviewed or in progress will be under 2018 Guidelines.

Referenced StandardsWe have noticed a trend of FGI eliminating specific, detailed requirements in favor of referencing national standards• ASHRAE 170• AAMI standards for central sterile• USP Chapters

Guidelines – Outpatient FacilitiesThe Hospital and Outpatient Facilities volume has been separated into two volumes to eliminate the cross referencing back to inpatient language and to favor simpler solutions to follow outpatient facility development trends.

Functional Program

Revisions to the functional program were incorporated to clarify its intent and scope and the space program was removed to its own section as development of the space program is a separate process from functional programming.

AcousticsAcoustic design revisions update, clarify, and provide consistent design criteria; modify exterior noise classification; expand exterior shell ratings; and round out requirements for vibration control and isolation, including exterior sources of ground vibration (e.g., road and rail traffic).

Sustainable DesignKey sustainable design requirements have been modified. Guidance also has been introduced for creation of a measurement and verification plan to address long-term continuous use of utilities.

Patients of SizeThe term “bariatric” has been replaced with ‘Patients of Size’, except when in reference to patients undergoing bariatric surgery. Determining the need for accommodations for patients of size is now required during the planning phase, when the health care organization must project the number of spaces needed to accommodate patients of size and the number of expanded-capacity lifts that will be required to serve its patient population.

Emergency Preparedness and ManagementNew appendix information provides guidance for preparing an emergency preparedness assessment, planning for resiliency, and projecting space needs in the event of an emergency.

Airborne Infection Isolation Room

• AII room doors and doors to the anteroom are now permitted to have either a self-closing device or an audible alarm that can be activated when the AII room is in use as an isolation room. This revision also applies to the airborne infection isolation/protective environment room.

Sexual Assault Forensic Examination (SAFE) Room• Although a SAFE room is

not a requirement for hospitals, the Guidelines now detail design requirements should a health care organization choose to provide one.

Telemedicine• Minimal requirements and considerable appendix guidance on considerations for

designing clinical telemedicine spaces. The requirement is only for spaces where clinical telemedicine services are provided. Use of bays, cubicles, or rooms is permitted, and space requirements are dependent on the equipment and persons to be accommodated. Provisions for privacy, lighting, surfaces, acoustics, and facility identification are considered.

Pre- and Post-Procedure Patient Care

• The requirements for pre- and post-procedure patient care areas now allow either separate pre-procedure and recovery patient care areas or combining Phase I (PACU) and Phase II recovery areas into one space.

Sterile Processing

• The minimum requirement for these spaces is a two-room sterile processing facility, consisting of a decontamination room and a clean workroom. For spaces where small countertop sterilizers are used for a limited workflow, a one-room sterile processing facility is permitted as an exception. However, whether a project has a two-room or one-room sterile processing facility, the facility must be designed to support a one-way traffic flow from contaminated to clean. Requirements for storage of clean instruments are also provided. Both the Hospital Guidelines and the Outpatient Guidelines provide expanded guidance for designing sterile processing facilities that support and encourage clinical personnel to comply with professional practice guidelines for cleaning, decontaminating, and sterilizing surgical instruments.

Technology Distribution Room

• TDR space requirements have been revised to provide a minimum three-foot clearance on all sides of equipment racks rather than a blanket 12’ by 14’ room.

Critical Care Unit Patient Rooms

• In new construction, all patient rooms in critical care unit, except NICUs, will be single-patient rooms. An exception is provided for renovation of patient rooms or cubicles for single-patient use provided they have a minimum clear floor area of 150 square feet.

Imaging Rooms

• Imaging requirements were completely overhauled. Interventional imaging was removed from the text and nuclear medicine was incorporated into the imaging services requirements. A classification system for imaging rooms was created, which outlines basic imaging room requirements and provides additional details for specific modalities.

Mobile/Transportable Medical Units• To support the principle that physical design requirements for specific medical

services should be the same regardless of where those services are provided, the chapter on mobile/transportable medical unit design was completely revised based on the imaging classification system and clarified requirements for examination/treatment, procedure, and operating rooms.

Pharmacies

• Appendix information references USP Chapters 795, 797, and 800 for requirements

Stantec relocated a helipad on top of an existing building that was not originally designed to accommodate a helipad. The Helideck is supported twelve columns thru the existing roof and the deck was raised approximately 28’-0” above the roof to allow safe approaches and departures.

Did you know…

Emergency Department, Observation, and Behavioral Health

Update Review by Jennifer Storey

Did you know…

• Construction During Occupancy

• Phasing Starts / Stops

• DOH Inspections

• Infection Control

Sexual Assault Forensic Examination Room2.1-3.2.4

This is a newly added section Sexual assault forensic examination rooms are not required

If one is provided it shall have the following items• Pelvic examination bed/table • Lockable storage for forensic collection kits, laboratory supplies, and equipment • A private toilet and shower with storage space for clothing, shoes linens, and

bathing products that is directly accessible to the sexual assault forensic examination room

• Consultation Room (readily accessible)

Source ‘Guidelines for Design and Construction of Hospitals’ The Facilities Guidelines Institute , 2018 Edition, pg. 81

2.2-2.12 Psychiatric Patient Care Unit 2.2-2 Nursing Units

2.2-2.12

Psychiatric Patient Care Unit(Previously 2.2-2.14 Psychiatric Nursing Unit)

…adapt the unit based on the (1.2-4.6) behavioral and mental health elements of the safety risk assessment not the 2014 functional program requirement

2.2-3.1 Emergency Services 2.2-3 Diagnostic and Treatment Facilities

2.2-3.1.2 Basic Emergency Care Communications center

2014: …connections to the regional emergency medical service…

2018: …connections to local and other emergency medical service…

2.2-3.1.2.5

2.2-3.1.3 Emergency Department Public waiting area

2014• Access to drinking water• Telephone

2018• Provisions for drinking water• Provisions for telephone access

2.2-3.1.3.4

2018 simplifies the requirements of the communication center:

Communication connections to emergency medical services (EMS) shall be provided.

2.2-3.1.3.5

2.2-3.1.3 Emergency Department Communications with EMS (formally Communications center)

2.2-3.1.3.6

2.2-3.1.3 Emergency Department Treatment room or area

single-patient trauma/ resuscitation room

multiple-patient trauma/ resuscitation room

(4) Trauma/ resuscitation room shall contain the following:

2.2-3.1.3.6

2.2-3.1.3 Emergency Department Treatment room or area

2014i. Cabinets ii. Emergency supply shelves iii. A picture archiving and communication

systems (PACS) and at lease one x-ray film illuminator

iv. Examination lights v. Documentation area vi. Patient physiologic monitor equipment.

Provisions shall be made for monitoring patients

vii. Storage for immediate access to personal protective equipment

2018i. Space for storage of supplies ii. PACS, film illuminators, or other systems to allow viewing

of images and films in the roomiii. A hand-washing station that meets the requirements in

Section 2.1-2.8.7iv. Space for a code cart v. Examination lightsvi. Accommodations for written or electronic

documentation for both the licensed independent practitioner and other staff

vii. Physiological monitoring equipment viii. Storage for personal protective equipment

Treatment Room or Area (Cont.)2.2-3.1.3.6

(6) Treatment rooms for patients of size(formally 2.2-3.1.3.6(5) bariatric)

Space requirements now refer to 2.1-2.3

(b) Clearance for lifts is 5’-6” (2014 = 5’-0”)

(7) Geriatric treatment room or areaNewly added section

All finishes, light fixtures, vents and diffusers, and sprinklers shall be impact-, tamper-,and ligature-resistant.

2.2-3.1.4.3

2.2-3.1.4 Special Patient Care AreasSecure holding room

2.2-3.1.8.2

2.2-3.1.8 Support Areas for the EDAdministrative center or nurse station

Removed…• The administrative or nurse station shall

include space for medication storage

Added…• Nurse master station and central

monitoring equipment shall be provided

2.2-3.2 Observation Unit 2.2-3 Diagnostic and Treatment Facilities

2.2-3.2.1.1

2.2-3.2 Observation UnitApplication

No longer designated patients under observation for 24 hours or less.

Surgical Services

Update Review by Chuck Parker

Surgical Services• Surgical Department divided

into 3 designated areas: Unrestricted, Semi-restricted, and Restricted

• New Table 2.2-1 Helps to determine room type for project: Exam or Treatment, Procedure room, and Operating room

• New Classification of Imaging Room types – Class 1, 2 and 3 (hybrid OR)

2.2-3.3

Procedure Room• Procedure Room – 130sf

clear area. Where anesthesia is used – 160sf and 6’ clearance at head.

• Hand wash must be in room, or scrub sink directly accessible to room.

2.2-3.3

Operating Rooms• Invasive Procedures-

Restricted Area• Clearances: Still 400 sf Clear

• 8’-6” on each side of table• 6’ at head for anesthesia work

zone, clear floor area of 6’x8’• 7’ at foot

2.2-3.3

Hybrid OR• Class 3 Imaging Room,

comply with 2.2-3.3.3 and 2.2-3.4 Imaging Services

• Control Room Size was 120 sf, now only to comply with manuf.

• No door is required from control to OR if it serves only 1 OR and is built, maintained and controlled same as OR

2.2-3.3

Pre- and Postoperative Patient Care• Now there is opportunity to

combine pre and post in one area – use most restrictive

• If separate:• Pre-procedure - 1 station per

Imaging, Procedure or OR• Phase I – 1 station per OR or

Class 3 Imaging Room (was 1.5 per OR)

• Phase II – 1 station per procedure, OR or Class 2 or 3 Imaging Room

• If combined into one area – 2 patient care stations per OR, Procedure, and Class 2 or 3 Imaging

2.2-3.3.52.1-3.4

Satellite Sterile Processing• If conducted in the semi-

restricted area, must meet section 2.1-5.1.2 (On-Site Sterile Processing)

• Two-room layout with separated decontamination and clean or One room layout only if using table-top sterilizers

• Always provide one way traffic flow

2.2-3.3.6.152.1-5.1.2

• Stantec designed the world’s first upper floor PET Scan located on the 9th

floor of a 12-story infill building.

• 100,000 pound cyclotron• Center of a structural bay• Floor deflection – no

margin for error

Did you know…

Endoscopy, Radiation, Imaging and OncologyUpdate Review by Abhishek Bodkay

Room classificationFGI 2018

https://henricodoctors.com/util/images/services/imaging-services-banner.jpg

Room ClassificationThree types of Rooms

FGI Guidelines 2018: Proposed Revisions to Procedure, Operating, and Imaging Room Requirements Bryan Langlands AIA, ACHA, EDAC, LEED GA | NBBJ

CO

CO

Use• Patient care that may

require high-level disinfected or sterile instruments but does not require the environmental controls of a procedure room

https://www.princetonhcs.org/-/media/images/care-and-services/center-for-testing-and-treatment/nuclear_med-phs7-2-12-2498-1280w.jpg

Exam / TreatmentRooms

Location• Unrestricted area • Accessed from an

unrestricted area

Procedure Rooms


Location• Semi-restricted area • Accessed from an

unrestricted or a semi-restricted area

Use• Patient care that requires

high-level disinfection or sterile instruments and some environmental controls but does not require the environmental controls of an operating room

Operating Rooms


Location• Restricted area • Accessed from a semi-

restricted area

Use• Invasive procedures • Any procedure during which

the patient will require physiological monitoring and is anticipated to require active life support

Room Use Design Requirements2

Room Type Location SurfacesExam or treatment room

Patient care that may require high-level disinfected or sterile instruments but does not require the environmental controls of a procedure room

Unrestricted area

Accessed from an unrestricted area Flooring: cleanable and wear-resistant for the location; stable, firm, and slip-resistant

Wall finishes: washable

Ceiling: cleanable with routine housekeeping equipment; lay-in ceiling permitted

Procedure room

Patient care that requires high-level disinfection of the room, sterile instruments, and some environmental controls but does not require the environmental controls of an operating room

Endoscopic procedures

Semi-restricted area

Accessed from an unrestricted or a semi-restricted area Flooring: cleanable and wear-resistant for the location; stable, firm, and slip-resistant

Floor and wall base assemblies in cystoscopy, urology, and endoscopy procedure rooms and endoscope processing room: monolithic floor with integral coved wall base carried up the wall a minimum of 6 inches


Wall finishes in endoscopy procedure room and endoscope processing room: washable; free of fissures, open joints, or crevices

Ceiling: smooth and without crevices, scrubbable, non-absorptive, non-perforated; capable of withstanding cleaning chemicals; 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

Operating room

Invasive procedures3

Any procedure during which the patient will require physiological monitoring and is anticipated to require active life support

Restricted area

Accessed from a semi-restricted area Flooring: cleanable and wear-resistant for the location; stable, firm, and slip-resistant

Floor and wall base assemblies: monolithic floor with integral coved wall base carried up the wall a minimum of 6 inches

Wall finishes: washable; free of fissures, open joints, or crevices Ceiling: monolithic, scrubbable, capable of withstanding cleaning and/or disinfecting chemicals, gasketed access openings

Examination/Treatment, Procedure, and Operating Room Classification

Imaging ServicesFGI 2018

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Imaging (Major Changes)

• 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).

• Integrated into Imaging: Nuclear Imaging• Interventional Imaging removed from text

2017 Midwest Healthcare Engineering Conference- 2018 FGI Guidelines Major Changes. By Todd W. Hite, P.E.

Room UseDesign Requirements2

Room Type Location Surfaces

Class 1 imaging room

Diagnostic radiography, fluoroscopy, mammography, computed tomography (CT), ultrasound, magnetic resonance imaging (MRI), and other imaging modalities

Services that use natural orifice entry and do not pierce or penetrate natural protective membranes

Unrestricted area

Accessed from an unrestricted area Flooring: cleanable and wear-resistant for the location; stable, firm, and slip-resistant


Ceiling: cleanable with routine housekeeping equipment; lay-in ceiling permitted


Diagnostic and therapeutic procedures such as coronary, neurological, or peripheral angiography

Electrophysiology procedures

Semi-restricted area

Accessed from an unrestricted or a semi-restricted area Flooring: cleanable and wear-resistant for the location; stable, firm, and slip-resistant


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; 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


Invasive procedures3

Any Class 2 procedure during which the patient will require physiological monitoring and is anticipated to require active life support

Restricted area

Accessed from a semi-restricted area Flooring: cleanable and wear-resistant for the location; stable, firm, and slip-resistant


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

Ceiling: monolithic, scrubbable, capable of withstanding cleaning and/or disinfecting chemicals, gasketed access openingsClassification of Room Types for Imaging Services

ImagingShielded 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.

• A control alcove or room shall be permitted to serve more than one imaging room.

• The control room shall be physically separated from the Class 2 or Class 3 imaging room with walls and a door.

2017 Midwest Healthcare Engineering Conference- 2018 FGI Guidelines Major Changes. By Todd W. Hite, P.E. and FGI Guidelines 2018 https://pdcbiz.com/wp-content/uploads/2016/08/door-frame-waveguide.jpg

• Space requirements will vary depending on the specific requirements of each nuclear imaging device.

• Nuclear imaging rooms shall meet the requirements in Section 2.2-3.4.2

• Exercise area or room to be provided.

FGI Guidelines 2018 https://www.princetonhcs.org/-/media/images/care-and-services/center-for-testing-and-treatment/nuclear_med-phs7-2-12-2498-1280w.jpg

ImagingNuclear Imaging Services

• Where cleaning and high-level disinfection of ultrasound probes is performed in a dedicated room or area

• The processing room shall allow for the flow of ultrasound probes from the decontamination area to a clean area and then to storage.

• Storage for clean ultrasound probes shall be provided.

FGI Guidelines 2018 https://pdcbiz.com/wp-content/uploads/2016/08/door-frame-waveguide.jpg

ImagingProcessing Ultrasound Probes

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Radiation TherapyExternal Beam Radiation Therapy

• An examination room shall be provided for each external beam radiation therapy room. See section 2.2-3.5.8.15 (Support Areas for Radiation Therapy – Examination room) for requirements.

Proton Therapy Suite

• Examination rooms. Two examination rooms shall be provided for each proton therapy room. See section 2.2-3.5.8.15 (Support Areas for Radiation Therapy – Examination room) for requirements.

FGI Guidelines 2018 https://pdcbiz.com/wp-content/uploads/2016/08/door-frame-waveguide.jpg

Baptist Health South Florida Proton Therapy Center Provision Center for Proton Therapy

Hampton University Proton Therapy Institute Johns Hopkins Sibley Hospital Proton Center

One of the world’s leading particle therapy design firms

One of only four U.S. architecture firms with fully commissioned particle therapy centers in the last 20 years

Stantec is responsible for over 1/3 of US proton centers

A 3- room proton center uses enough concrete to fill 4 ½ Olympic-sized swimming pools. That’s 1,600 concrete trucks. Those trucks parked end-to-end total eight miles.

A large proton center requires about 360 miles of reinforcing steel, 36 miles of electrical conduit, and 5 miles of mechanical piping.

Did you know…

• The radiation oncology floor line is about 12 feet below the water line of lake Erie

• 377,000 gsf and $15M under budget and we didn’t use value engineering to get there

• The ribbon display placed by all of the tradesmen and team members is a permanent part of the art work in the building

• Team disputes were settled in the trailers at the ping pong table

Did you know…

OncologyFGI 2018

2.6 Infusion Center Care stations - bays, cubicles or rooms

CubiclesBays Rooms

Stantec created a fully functional Radiation Oncology Practice, 24,000 square feet with two linear accelerators, below an existing slab on grade medical office building, while it remained occupied?

Did you know…

Did You Know…..AIA Award Winner 2015 People’s Choice Award

Charleston Area Medical Center Outpatient Cancer Center

Concept was inspired by nature and the history of Charleston as the foundation for the patient’s journey through the healing process

Inspired by limestone quarries, local flowers and trees -rain through the trees

Artwork used as a focal point and distraction Connection to Hope

Accessibility Changes – ICC A117.1-2017New sizes will not apply to existing buildings or facilities but will apply to new construction and additions

Clear Floor Space

Currently: 30”x48”

New: 30”x52”

Affects floor space and maneuvering clearances

Accessible Routes - Interior

Clear width increased from 48” to 52”

Turning Space – Circular

60” diameter turn radius with a 25” maximum overlap of the knee/toe clearances

67” diameter turn radius with a 10” maximum overlap of those same clearances


Turning Space – 90 Degree Turn

New requirement in 2017

Four options available to comply


Turning Space – 90 Degree Turn


Sales and Service Counters and Windows

Parallel Approach - a portion of the public use side of the counter surface 36” minimum in length and 26” minimum to 36” maximum in height above the floor must be provided

(Exception: where counter is less than 36” in length, the entire surface must be 26” minimum to 36” maximum in height above the floor)

Parallel Approach and Forward Approach - the space between the accessible counter surface and any projecting objects above the accessible counter must be 12” minimum

Counter Depth - where counters are provided, the accessible portion of the countertop shall extend the same depth as the public portion of the sales and service countertop provided for standing customers


Finish Refresh ProjectsSimple finish upgrade projects can domino into major renovations.

One Thing Leads to Another Project begins with a simple wallcovering removal

and painting… Then handrails/corner guards are removed – then

added to scope to update… Then flooring and base added to complete the

refresh… Then the existing doors and hardware are maybe

not looking so well……

DOH Implications Now….we have a project that DOH would need to

review and inspect

Mechanical EngineeringUpdate Review by Carl Shilling

Did You Know…..Hurricane Sandy Disaster Response and Recovery NYC’s Hospital and Healthcare (HHC) Facilities

On October 29th, 2012, massive flooding in the basements of the network’s three largest hospitals.

The power at these facilities was also knocked out, along with critical mechanical, electrical and medical systems.

Stantec hit the ground running in the days that followed the catastrophic event by providing a broad array of specialty planning, architectural and engineering disaster response and recovery services

We partnered with HHC’s Disaster Management Consultant (BASE Tactical), and provided support to maximize FEMA reimbursements while implementing both effective temporary and long-term flood resilient solutions.

Large Operating Room Air Handler Replacement.

• 22 operating room suite• 24/7 availability• Replaced Air Handling Unit

and terminal units over a 6 month period incrementally.

• No loss of use over life of project.

Did you know…

Sustainable Design• Diversion of building materials from land fills• Mercury free and mercury reduced products• Potable water use reduction

• 1.2-6.2.1.3 Potable water quality and conservation• (3) Plumbing fixtures and fittings for

water reductions shall comply with ANSI/ASHRAE/ASHE 189.3: Design, Construction, and Operation of Sustainable High Performance Health Care Facilities.

• (4) Vacuum pumps and air compressors. Potable water shall not be used for vacuum pumps and air compressors.

1.2-6.5 Emergency Preparedness and Management

• During project planning and design, the following shall be considered: 1.2-6.5.1 The likelihood that a facility will experience events that go beyond a facility’s normal operations.• Space needs in the event of an

emergency for operations to:•Protect facility occupants during the event

•Continue providing services• 1.3-3.5.2 Access to emergency

services shall be located to incur minimal damage from floods and other natural disasters…..

1.2-8.2.3.2 Commissioning Specifications

• Expanded requirements on the documentation for heated potable water distribution systems

• Added security systems to the list of systems to be commissioned

ASHRAE 170

• This 2017 edition to the standard includes a number of significant improvements to the 2013 edition. As a continuous maintenance document, Standard 170 is updated on a four-year cycle in concert with documents published by FGI.

Table 2.1-3 Station Outlets• Cesarean Delivery Rooms - WAGD

requirement removed• ED Exam Rooms – MA requirement removed• Phase II Recovery – 1 MV in lieu of 3 MV

unless combined with PACU• Operating Room ERRATA – Instrument Air

requirement is in error• Separate requirements for Procedure (old

Class A) and Operating Rooms (old Class B and C)

• New designations for Imaging Class 1, 2 and 3 in lieu of MRI, and Interventional Imaging

• Instrument Air is now noted for Endoscope and Decontamination areas if needed

2.1-8.4.2.6 Drainage Systems• Expanded requirements for leakage

protection for:• Procedure Rooms• Trama Rooms• Sterile Processing• Class 2 and 3 Imaging• Main Switchgear and Electrical Rooms• Data Processing Areas

• The addition of adiabatic humidifiers as an acceptable type of humidifier

• RO or UV sterilization of water and Submicron Filtration

• Continuous circulation of water

• Testing ports required

• Moisture eliminators in ductwork

• A new type of exam room with lower requirements for less acute applications

• General examination room (4 AC, 2 OA)

• Special examination room (6 AC, 2 OA) – Undiagnosed gastrointestinal, respiratory, or skin symptoms.

• Clarification that controls to change pressure relationships between spaces are prohibited for all

spaces, not only airborne infection isolation and protective environment rooms

The 2017 Edition Includes Several Significant Improvements

• Reduction in requirements for electroconvulsive therapy procedure rooms

• Now 4 AC total, 2 AC OA

• Reduction in requirements for laboratories when allowed by certain calculations

• Airflows determined program requirements and a Hazard Assessment.

• Demand control ventilation permitted with active sensing of contaminants.

• Higher requirements for higher hazard exhaust airstreams

• Sputum collection

• Pentamidine administration

• Pharmacy hazardous drug exhausted enclosure


• Coordination of space temperature requirements in the Sterile

Processing Department with AAMI (Association for the Advancement of

Medical Instrumentation).

• Decontamination 60-65 deg. F and 30%-60% RH

• Clarification of the definition of the primary diffuser array in operating

rooms

• …Additional supply diffusers shall be permitted within the room, outside the

primary supply diffuser array, to provide additional ventilation to the operating

room to achieve the environmental requirements of Table 7.1………


• The 2017 edition was also editorially reformatted into three sections: hospital spaces, outpatient

spaces, and nursing home spaces. This change allows for easier coordination between the

standard and FGI documents, which, as of the 2018 edition, will consist of three separate books:

• Guidelines for the Design and Construction of Hospitals

• Guidelines for the Design and Construction of Residential Health, Care, and Support

Facilities

• Guidelines for the Design and Construction of Outpatient Facilities

Standard 170 will be included in the Hospitals and Outpatient Facilities books.

• Due to timing constraints, these three sections in the standard are identical. Changes to help differentiate

outpatient and residential health, care, and support requirements from hospital requirements are currently

undergoing final publication approval and will be published as Addendum n. The reformat was included in

this edition to simplify the incorporation of these upcoming changes. As always, the standard does not

dictate which types of spaces are required in which types of facilities. The requirements for spaces that do

not exist in any given facility type may be ignored.


Electrical EngineeringUpdate Review by Bryon Schmidt

Did You Know…..Sleep Lab

Keeps patients awake for long periods of time Improve Alertness Patients include: NASA Astronauts Military Pilots Truck Drivers

Installed fixtures capable of producing a full spectrum of precisely controllable light, including million of saturated colors, pastels, and uniform white light.

Sophisticated controls allowed researchers to evaluate exact wavelengths of light and how they effect sleep patterns.

Hospitals• Ground fault protection

o Where GFCI devices are used in a critical care area, each receptacle shall be individually protected by a GFCI device.

• Generator System NoiseoGenerator system design shall assure

the maximum noise levels for interior spaces as listed in Chapter 1 table are not exceeded.

Considerations:• Sound attenuation on generator • Location in Facility• Sound proofing of room• Acoustics engineer analysis

Hospitals• Lighting• Uplight fixtures in patient care areas shall be

coveredo Translucent lens prevent dust and for ease

of cleaning

• Electrical Receptacles• Operating rooms increased from 24 to 36• Added requirements for three classifications

of imaging rooms− Class 1, 8 receptacles− Class 2, 12 receptacles− Class 3, 36 receptacles

• Receptacles to be minimum height of 30” AFF at patient beds and exam tables

Hospitals• Nurse Call

o Staff Lounge – Duty Stations are now optionalo Code call stations are now referred to simply as

Emergency call station, revisions made to requirements for emergency call station

o Bath Stations are required to be at 3’-4” AFF in lieu of 5’-6”

o Recommend a needs assessment to be with users to determine how the nurse call system needs to function for a specific department.

• Telecommunicationso Technology distribution room (TDR)o Shall provide minimum three-foot clearance on all

sides of equipment racks.o Inside dimension of 12 by 16 feet is recommended.

Outpatient• Panelboards

o Panelboards shall be accessible to the healthcare tenant they serve.

o Critical panelboards shall be located on the floor they serve

o Life safety panelboards permitted to serve floor immediately above and immediately below only.

o Panelboards shall not be located in exit enclosure or passageway.

• Ground fault protectiono Where GFCI devices are used in a critical care

area, each receptacle shall be individually protected by a GFCI device.

• Lightingo Uplight fixtures in patient care areas shall be

covered− Translucent lens prevent dust and for ease

of cleaning

Outpatient• Fire alarm system

o All Healthcare Facilities shall be provided with a fire alarm system

• Receptacleso Operating and Class 3 imaging rooms

require 36 receptacleso Emergency facilities added with treatment

rooms requiring 12, Trauma/resuscitation requiring 16 and Triage requiring 6

• Nurse Callo Code call stations are now referred to simply

as Emergency call station, revisions made to requirements for emergency call station

o Dialysis and electroconvulsive therapy now require nurse call devices.

o Recommend a needs assessment to be with users to determine how the nurse call system needs to function for a specific department.

OutpatientUpdate Review by Chuck Parker

Common Elements2.1 - Two approaches to application:

Approach 1 – Used for projects where the scope of services is comprehensively described in one of the specific Outpatient Facility chapters:• General and Specialty Medical Services• Outpatient Imaging• Birth Center• Urgent Care Center• Infusion Center• Outpatient Surgery• Freestanding Emergency• Endoscopy• Renal Dialysis Centers• Outpatient Psychiatric• Outpatient Rehabilitation Therapy• Dental

Common Elements2.1 - Two approaches to application:

Approach 2 – Used for projects where the scope of services includes elements of one or more of the specific Outpatient Facility chapters.

This approach identifies minimum requirement found in the common elements chapter and in any facility chapters that are relevant to the project.

A design team using Approach 2 should identify the services to be included [both clinical and support services] and apply requirements from both General and Specific chapters to support

Significant ChangesCombined prep + phase 1 + phase 2 recovery.Meet most restrictive design requirements throughout.

Updated sterile processing focus for small facilities

Waiting area size not “prescribed” but determined during programming. Ratios are only in appendix language.

Freestanding Diagnostic & Treatment Facilities Chapter, revamped to Outpatient Imaging Center with “treatment elements” as options in snap on references to specific elements, for radiation therapy or nuclear imaging specialties, etc.

Endoscopy room reduced from 200sf to 180sf

Ultrasound without Toilet adjacent now allowed.

Multidisciplinary Project Team

1.2-1.2

a. The multidisciplinary project team should be assembled as earlyas possible in the design process.

b. multidisciplinary team may include…cast of thousands

c. For small outpatient facility projects, the project team is likely to include fewer participants. An individual participant may provide expertise in multiple categories.

The goal is to include the key stakeholders responsible for care delivery and determine if additional outside expertise is necessary.

Functional Program Purpose

1.2-2.1.1a. The primary purpose of the functional program shall be to

communicate the owner’s intent for the project to the designers of record as a basis of design at the initiation of the project.

*Appendix Language

All projects, large and small, require a functional program to guide the design. The length and complexity of the functional program will vary greatly depending on project scope. The functional program for a small, simple project might consist of a simple sketch or a description of a few sentences.

The functional program can be used as a supplement to the construction documents; it is not intended to be approved by the authority having jurisdiction.

Governing body can delegate to the architect or another consultant.

Size Matters• Equipment types 1.4-2 recognition

that Furniture and equipment size. (e.g., beds, exam tables, exam chairs, gurneys) impact clearance requirements.

• As furnishings and equipment vary based on clinical needs, patient size, manufacturer, and model, it is important that furnishings and equipment be selected for planning purposes by the operator of the facility.

Facilitate Users2.1-3.2.1.2Recognition that work flow and not simple adherence to “clearance requirements” is possible.

Exam Room ClearancesExam tables against walls on one side or on an angle can be allowed – if supporting clinical work preferences.

Specific Requirements2.2 – General and Specialty Medical Services Facilities [Formerly Primary Care]

At least ONE Exam Room which can serve multiple functions [consultation, blood-draw, and exams, etc.]

Clean Workroom or HOLDING [following the Hospital Guidelines to simplify plumbing requirements]

Limited office/administrative

Toilet room can be shared with waiting

Cancer2.6 – Infusion CenterRecognition that infusion is the “common ground” with references back to Specialty Chapters for Imaging, Nuclear Imaging and Radiation Therapy in Common Elements sections as “additive” approach.

Facility Guidelines Institute

What Next?

Guidelines Forecast for 2022

HGRC Mission• To create documents, using a multidisciplinary consensus process advised by

research, that can be used to create an advanced, cost-effective, high-quality built environment for the health care community.

2018 – 2019Put New Edition to the Test. State Adoption and AHJ use2019 – 2020HGRC internal ambitions for modification are prioritized2020 – 2021Public Input + Part Groups and Focus Topic Teams2021 – 2022Final edition for public comment, Final Edits, Publication

Did you know…

https://www.youtube.com/watch?v=lZOMMxdFfI0&feature=youtu.be&app=desktop

https://www.youtube.com/watch?v=lZOMMxdFfI0&feature=youtu.be&app=desktop

Documents

Facility Guidelines Institute Are You Ready? · Facility Guidelines Institute Are You Ready? Guidelines Update Review 2018 May 3, 2019. Wheeling Hospital ... WV State Fire Marshall