May 20 2016

Bronchoscopy Procedure Rooms

Category: BlogBKeyes @ 12:00 am

Q: Are Bronchoscopy procedures to be performed in negative pressure rooms under all circumstances, or can they be performed in OR suites? Does the negative pressure rule only apply to new construction, or does it apply universally to all facilities old and new?

A: According to the 2010 FGI Guidelines for Design and Construction of Health Care Facilities, ventilation requirements for a Bronchoscopy procedure room requires negative air pressure relationship to the surrounding area, and a minimum of 2 outdoor air exchanges per hour and a total of 12 air exchanges per hour. This ventilation requirement must be met regardless where the Bronchoscopy procedure is conducted, which includes the operating rooms. So, to answer your first question: Yes, this requirement applies to all circumstances.

The ventilation requirements found in the 2010 FGI guidelines applies to new construction or renovated areas. It is not a standard, and it does not apply to existing conditions. However, the ventilation requirements for Bronchoscopy procedures have been consistent since the 1996-1997 edition of the guidelines, and perhaps even before that (I only have records back to the 1996-1997 edition). So, if you have constructed or renovated the Bronchoscopy procedure room since 1996-1997, then these ventilation requirements must be complied with.

Some authorities will allow deviance from the FGI guidelines as they are guidelines and not standards. So, if you have extenuating circumstances that requires you to deviate from the FGI guidelines, then contact your AHJ to determine what their expectations are.

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Apr 29 2016

Which Edition of FGI Guidelines Do We Use?

Category: BlogBKeyes @ 12:00 am

Q: We were using the 2006 edition of the FGI Guidelines for Design and Construction of Health Care Facilities but we have both the 2006 and the 2010 version of this document. The guidelines are different related to air pressures in Endoscopy and Bronchoscopy procedure rooms. We are trying to determine if air flow should be positive or negative. Can you tell us which edition of this book we are to be using as the current guideline?

A: The ventilation requirements for Bronchoscopy procedure rooms have stayed consistent through the many recent editions of the Facility Guidelines Institute (FGI) Guidelines for Design and Construction of Health Care Facilities. There have been no changes in the requirement for negative air pressure in relationship to the surrounding areas, and a minimum of 2 outdoor air changes per hour with an overall total of 12 air changes per hour.

However, the same cannot be said for Endoscopy procedure rooms. From the 1996-1997 edition to the 2014 edition, the ventilation requirements seemed to change every edition:

Edition Air-Pressure Requirement Outdoor Air Changes

per Hour

Total Air Changes

per hour

1996-1997 No Requirement 2 6
2001 Negative 2 6
2006 No Requirement 2 6
2010 Positive 2 15
2014 No Requirement 2 6
[It is noted that the 1996 – 1997 edition was written and published by the American Institute of Architects (AIA), and the 2001 and 2006 editions were written by the FGI and AIA together. All subsequent editions are written by FGI and published by the American Society for Healthcare Engineers (ASHE).]

So, depending on when the Endoscopy room was designed, the ventilation requirements fluctuated. You authorities having jurisdiction usually state which edition of the FGI guidelines they are using as a guide. The interpretive guidelines for the Centers for Medicare & Medicaid Services (CMS) standard 482.41(c)(4) says acceptable standards such as the FGI guidelines should be incorporated into the hospital’s policy, but the standard does not say which edition. Likewise, the HFAP standard 11.07.03 says virtually the same thing, but The Joint Commission standard EC.02.06.05, EP 1 does reference the 2010 edition of the FGI guidelines.

For CMS and HFAP purposes, the assumption is clear that they would require the most recent edition, which would be the 2014 edition. For Joint Commission purposes, George Mills, Engineering Director for the accreditor recently stated during a regional ASHE meeting they would allow a health care organization to use the more recent 2014 edition.

The current edition of the FGI guidelines is the 2014 edition, which has no requirement for air pressure relationship to surrounding areas, and requires 2 outdoor air changes per hour and 6 total air changes per hour. But please check with you state and local authorities to determine what their requirements are.


Sep 25 2014

The FGI Guidelines

Category: BlogBKeyes @ 6:00 am

fgi[1]Recently, the issue of whether or not the FGI guidelines were enforceable in certain situations came up for discussion. To be sure, the FGI guidelines are guidelines: They are not standards or code requirements. CMS and the accreditation organizations expect hospitals to design their new construction and renovation projects in accordance with the current edition of the FGI guidelines or applicable state and local standards if more restrictive. If there is a physical reason why the hospital cannot meet the FGI guidelines, then that must be discussed with their state and local authorities having jurisdiction over hospital construction, and any variances from the FGI guidelines must be approved by them.

Existing conditions in hospitals do not have to meet the requirements of the most current edition of the FGI guidelines, including the ventilation and air-pressure requirements. Existing conditions in hospitals must comply with the requirements of the FGI guidelines edition (or the AIA guidelines if older) at the time the facility was designed. So, as an example if an operating room was designed 20 years ago, it would only have to meet the 15 air changes per hour requirement of the guidelines enforced at that time; not the 20 air changes per hour required in the 2014 FGI guidelines for new construction.

I was contacted recently by a hospital that was doing some renovation in their operating rooms, and wanted to know if they had to update their HVAC system to meet the current FGI guidelines on air changes per hour. Apparently, they would have to install a whole-new HVAC system in order to meet the 2010 or 2014 FGI requirements. They said they were updating their medical gases, room lights, installing new floors, and installing some special equipment, but it wasn’t a gut-and-replace job. The FGI guidelines has a section at the beginning of the book that describes when an entire upgrade needs to be done, but this isn’t something that I should be answering for this hospital. They needed to contact their state and local authorities to determine what they would require.

Accreditation organizations like The Joint Commission, HFAP, and DNV do not approve construction or renovation projects. Their job is to assess the hospital for compliance with all applicable codes and standards. The accreditation organization standards do reference the FGI guidelines, but only as a reference; not as a standard. If a hospital has a letter on file from their state and local authorities allowing the deviation from the FGI guidelines, then surveyors should not cite the deviation from the FGI guidelines.

It is critically important for the hospital to retain all documentation from their state or local authorities at the hospital location, and be able to retrieve them during a survey.