FGI Bulletin #1

Welcome from the Facility Guidelines Institute

Welcome to the FGI Guidelines Bulletin, a new quarterly newsletter from the Facility Guidelines Institute (FGI). The Bulletin is intended to be brief yet informative and to keep you up-to-date with the latest activities of FGI and the Health Guidelines Revision Committee. It will cover new releases of errata and formal interpretations; proposal and comment period announcements; and publication of new Guidelines editions, white papers, and other content-rich material added to the FGI website. We also will seek your opinion and comments on various sections of the Guidelines as we move through our revision cycles. We hope you find this new service useful.

Douglas S. Erickson, FASHE, CHFM, HFDP, CHC
CEO, Facility Guidelines Institute
Chair, 2018 Health Guidelines Revision Committee

The 2018 FGI Guidelines: Public Input Encouraged

The Facility Guidelines Institute invites you to review and comment on its draft 2018 documents:

• Guidelines for Design and Construction of Hospitals;
• Guidelines for Design and Construction of Outpatient Facilities; and
• Guidelines for Design and Construction of Residential Health, Care, and Support Facilities.

The Guidelines publications provide fundamental standards for the design and construction of hospitals, outpatient health care facilities, and residential facilities that provide health care or other support for vulnerable populations. If you design, build, own, manage, or work in any of these facility types, FGI values your input on planning and design of the physical environment.

Revision of the 2014 Guidelines for Design and Construction of Hospitals and Outpatient Facilities and Guidelines for Design and Construction of Residential Health, Care, and Support Facilities has been underway for well over a year. At this point in the revision cycle, comments may be made only on changes (whether deletions, revisions, or new material) that were proposed in 2015 and accepted by the Health Guidelines Revision Committee (HGRC), the multidisciplinary body responsible for updating the content of the Guidelines.

The public comment period will remain open through December 12, 2016. To access the three Guidelines drafts, visit www.fgiguidelines.org/revision-process/2018-revision-cycle/public-comment-period/. From the same Web page, you can link to the comment systems when you are ready to submit your comments. To access the drafts, registration is required on the website of FGI’s partner MADCAD, and an abbreviated registration is required to access each comment system.

Guidance Requested on OR Ceilings and Procedure Definitions

FGI is interested in your opinion on two issues the 2018 HGRC has discussed at some length during this revision cycle. To share your opinions on either or both of these issues, please write to us here. We would appreciate receiving any research references or specific experiences from the field that you can provide to support your opinions.

Operating room (OR) ceilings

A lot of equipment is installed in OR ceilings today, making it difficult to provide a true “monolithic” ceiling, which has been a Guidelines requirement for more than a decade. In light of this fact, the HGRC has debated whether it made sense to allow use of lay-in ceilings in ORs in the future. The lay-in ceilings would have to be of cleanroom quality and gasketed with smooth tiles installed in a manner to prevent particles from above from penetrating the ceiling assembly and contaminating the surgical site. The decision for the draft 2018 Guidelines was to leave the monolithic requirement in sections 2.1-7.2.3.3 (4)(a) and 3.1-7.2.3.3 (4)(a), but FGI is interested in hearing from the industry about this requirement and whether it should be changed.

Definitions for invasive and percutaneous procedures

For the 2018 Hospital and Outpatient Guidelines drafts, the HGRC is working to clarify which requirements apply to which room types by using procedure type and patient acuity as determining factors. See the new “Classification of Room Types for Imaging, Invasive, and Percutaneous Procedure” in both drafts (Table 2.2-1 and Table 3.1-4) for a quick summary of this approach. [See the first story in this newsletter for how to access the drafts.]

The following glossary definitions are being recommended to support this proposed new language; please let us know what you think.

Invasive procedure: A procedure that is performed in an aseptic surgical field and penetrates the protective surfaces of a patient’s body (e.g., skin, mucous membranes, cornea), excluding percutaneous procedures as defined in the glossary. An invasive procedure may fall into one or more of the following categories:

• • Requires entry into or opening a sterile body cavity (e.g., cranium, chest, abdomen, pelvis, joint spaces);
  • Involves insertion of an indwelling foreign body (temporary or permanent);
  • Includes excision and grafting of burns that cover more than 20 percent of total body area; or
  • Does not begin as an open procedure but has a measurable risk of requiring emergency conversion to an open procedure.

Note: Invasive procedures are performed in locations suitable to the technical requirements of the procedure with consideration of infection control, anesthetic risks and goals, and patient risk factors. Accepted standards of patient care are used to determine where an invasive procedure is performed. “Invasive procedure” is a broad term commonly used to describe procedures ranging from a simple injection to a major surgical procedure. For the purposes of this document, the term is limited to the above description. The intent is to differentiate those procedures that carry a high risk of infection, either by exposure of a usually sterile body cavity to the external environment or by implantation of a foreign object(s) into a normally sterile site. Procedures performed through orifices normally colonized with bacteria and percutaneous procedures that do not involve an incision deeper than skin and subcutaneous space would not be included in this definition.

Percutaneous procedure: A procedure during which the skin is penetrated by a needle puncture or an incision that goes no deeper than the skin or subcutaneous space and may involve introduction of wires and catheters and/or insertion of an indwelling foreign body (temporary or permanent).

Note: An example is a procedure in which a needle is used to puncture the structure and a guide wire is threaded through the needle; when the needle is withdrawn, a catheter is threaded over the wire. The wire is then withdrawn, leaving the catheter in place.

Please note: To help users of the Guidelines determine how to apply its design requirements to their building projects, FGI has long included a glossary in its documents. The definitions provided are intended solely to support the Guidelines requirements and, in some cases, may be narrower than industry or public use of the terms.

Some Significant Proposed Changes in the 2018 FGI Guidelines Drafts

Listed below are some of the most significant changes proposed for the draft 2018 Guidelines for Design and Construction of hospitals, outpatient facilities, and residential facilities. To help you find this material, each listing includes the corresponding section number and title in the 2018 FGI Guidelines drafts.

Please review these and other proposed changes carefully and submit your comments by December 12, 2016, using the FGI comment system for each document. The comment systems can be accessed through links on the following page: www.fgiguidelines.org/revision-process/2018-revision-cycle/public-comment-period.

Changes affecting both hospitals and outpatient facilities

Section 1.2-5.2, Sustainable Design
Expanded sustainability requirements that include waste minimization, potable water conservation, and energy efficiency

Section 1.2-5.5, Emergency Preparedness and Management
Revised guidance for emergency preparedness and management (formerly Provisions for Disasters)

Sections 2.1-2.3 and 3.1-2, Accommodations for Care of Patients of Size
Updated design requirements for accommodations for care of patients of size to address patients of size who do not fit the definition of bariatric (i.e., those who are very tall or large but not considered overweight and those who are defined as obese but not undergoing bariatric surgery)

Sections 2.1-3.2.4 and 3.1-3.2.4, Accommodations for Telemedicine Services
New guidance for the design of telemedicine spaces

Sections 2.1-3.4 and 3.1-3.5, Pre- and Post-Procedure Patient Care
New flexibility in pre- and post-procedure patient care area design requirements to support how care is provided in these spaces

Sections 2.1-5.1 and 3.1-5.1, Sterile Processing
Two options for sterile processing area design: two required rooms (decontamination and clean) with an exception for a single room for small table-top sterilizers

Section 2.2-2.6.2.2, Critical Care Patient Care Areas—Space requirements
New requirement for single-bed critical care rooms

Section 2.2-3.1.3.6 (11), Sexual Assault Forensic Examination Room
New design requirements for a sexual assault forensic examination room

Sections 2.2-3.3.2 and 3.8-3.1, Procedure Room; Sections 2.2-3.3.3 and 3.7-3.4, Operating Room; and Section 2.2-3.3.4, Hybrid Operating Room
Clarification of procedure room and operating room requirements intended to support space for equipment and staff present for procedures provided

Section 2.2-3.4.1.2, Imaging Room Classification
New classification structure for imaging rooms based on procedures performed and patient acuity to allow flexibility in imaging room requirements as procedures and equipment change over time

Chapters 2.8 and 3.13, Mobile/Transportable Medical Units
Full chapter now devoted to mobile/transportable medical units; pre-fab structures are no longer considered mobile/transportable medical units

Additional changes affecting outpatient facilities

Cross-references at the beginning of each outpatient facility chapter clarified to indicate when common elements apply

Section 3.1-6.2.3, Waiting Areas or Rooms
New, consolidated waiting area common element requirements

Changes affecting residential facilities

Section 2.4-2.2.9, Grab Bars
Updated requirements for grab bar configurations

Section 2.5-8, Acoustic Design Systems
Updated acoustic requirements

Chapter 4.4
New chapter on settings for individuals with intellectual and/or developmental disabilities

Chapter 4.5
New chapter on long-term residential substance abuse treatment facilities

Remember to Check for Guidelines Errata and Interpretations

After publication of the Guidelines documents, errors are sometimes discovered. These range from incorrect cross-references to actual errors in translating the committee’s design intent into requirements. For example, in response to current practices in the industry, the requirement for a surgical staff changing area in the 2014 Hospital/Outpatient document was changed from the 2010 requirement to locate the changing area in or adjacent to the surgery suite to a simple requirement to have such a changing area. However, the HGRC neglected to extend this change to the obstetrical and interventional imaging suites, which had similar requirements to that for surgical staff in the 2010 edition; these omissions were corrected on the errata sheet. Errata sheets showing such corrections are kept for all FGI documents; these can be found on the FGI website page for each document.

As well, users of the Guidelines sometimes request interpretations of content they find unclear. A recent example was a query about inconsistent language in the 2014 FGI Residential Guidelines regarding showers in assisted living facilities. Although a shower is required in each resident bathroom for assisted living, a requirement for one shower for each eight residents “not otherwise served by showers in resident rooms” also appeared in the text. It was determined this contradiction, which resulted when language from the nursing home chapter was used without alteration in development of the assisted living chapter, was not intended. Interpretations such as this are posted on the FGI website on this page.

Please be sure to check the website periodically to make sure you have the most current errata sheet and interpretations as you use the FGI documents.

Have any questions or suggestions about the content of this newsletter? Please write to us here.

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About the Facility Guidelines Institute
Founded in 1998, the Facility Guidelines Institute is a not-for-profit corporation founded to provide leadership and continuity to the Guidelines revision process. FGI functions as the coordinating entity for development of the Guidelines series of documents using a multidisciplinary, consensus-based process and for provision of ancillary services that encourage and improve their application and use. FGI invests revenue derived from sales of the Guidelines to fund research and the activities of the next revision cycle.

About the FGI Guidelines for Design and Construction Documents
The FGI Guidelines for Design and Construction documents are updated every four years to keep pace with new concepts, capabilities, and technologies in the delivery of health care. The Guidelines documents are used by states to regulate health care facility design and construction, through adoption of the Guidelines as code, as a basis for state-written codes, as an adjunct to state codes, or for reference.

About the Health Guidelines Revision Committee
The Health Guidelines Revision Committee (HGRC) is a select multidisciplinary consensus body of about 100 clinicians, administrators, architects, engineers, and representatives from authorities having jurisdiction that is convened to revise and update the FGI Guidelines documents. As a group, HGRC members are experts on the many issues addressed in the Guidelines.