May 20 2016

Bronchoscopy Procedure Rooms

Category: BlogBKeyes @ 12:00 am
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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 22 2016

Frequency of Ventilation Checks

Category: BlogBKeyes @ 12:00 am
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Q: Is there a code or standard that states how frequent the test intervals must be for air-exchange rates and air-pressure relationships in operating rooms, soiled utility rooms, and central sterile supply clean rooms must be conducted? We check air-pressure relationships periodically, but typically we only check air-exchange rates if we suspect or know of a problem.

A: Depending on the particular authority having jurisdiction (AHJ), they may have specific standards that addresses the frequency of air-pressure checks and air-exchange rates, but generally speaking, there is no specific code or standard that addresses this on a national level, that I am aware of. A quick check of the FGI Guidelines (2010 edition) did not identify anything specific on the frequencies of these checks. NFPA, CMS, Joint Commission, HFAP and DNV do not have specific standards that address the frequency of ventilation checks.

When the standards do not specifically state a specific action, then it is up to the AHJ to make an interpretation on this issue. Where the AHJ has not made an interpretation, then it is up to the institution to make an interpretation. But be aware, that most AHJs have their own interpretation and/or rules on the frequency of air-pressure checks and air-exchange rates, whether they publish those interpretations or not. Many of them usually want to see daily checks on basic requirements like air-pressure relationships to surrounding areas. This can be done with a tissue held at the bottom of the door to confirm air-flow in or out of the room; or you can invest into some air-pressure gauges that are mounted on the wall. The air-exchange rates are more difficult to confirm, so this may be done less frequent, such as semi-annual or annual. Check with your operating room nurse manager. I believe their professional organization, the Association of periOperative Registered Nurses (AORN), has published recommendations of daily checks for air-pressure relationship requirements for operating rooms. Make sure all checks are documented.

My best advice for you is to contact all of your AHJs and ask them directly how frequent they expect you to test these ventilation requirements.

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Jan 10 2013

Ventilation Requirements for Endoscopy Procedure Rooms

Category: BlogBKeyes @ 6:00 am
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I was asked recently if the ventilation requirements for Endoscopy procedure rooms have changed recently, and the answer is yes. But the changes only apply to new construction, meaning you are not required to go back and retroactively update the ventilation design of the Endoscopy rooms.

The following editions of the Guidelines for Design and Construction of Healthcare Facilities have the following air pressure relationship requirements:

 

 

  • (AIA) 1996-1997 edition                 Neutral                 6 ACH                    2 ACH (outdoor air)
  • (AIA) 2001 edition                           Negative               6 ACH                    2 ACH (outdoor air)
  • (FGI) 2006 edition                           Neutral                 6 ACH                    2 ACH (outdoor air)
  • (FGI) 2010 edition                           Positive               15 ACH                     2 ACH (outdoor air)

So, from 1996 to 2010, the air pressure relationship for the endoscopy procedure room, went from being neutral, to negative, back to neutral, then to positive, and the air changes per hour (ACH) went from 6 to 15.

These are guidelines, and are not standards, meaning these are meant to be followed at the time of new construction, unless there are other reasons not to follow them (such as state requirements). The good thing is, as long as you have documented what edition of the guidelines you designed your Endoscopy procedure room to, you are not required to go back and update the room to meet the newer edition of the guidelines.

Typically, most states have firm requirements on ventilation requirements in hospitals that frequently follow along with the guidelines, so in those situations the hospital would have to follow the state’s requirements. Joint Commission has currently adopted the 2010 FGI guidelines (see EC.02.05.01, EP 6) which applies to new construction, and is not enforceable to older designs (many surveyors are not fully aware of this). Again, the guidelines are just guidelines, not standards. In lieu of any other reason, TJC would expect compliance with the guidelines that apply at the time the Endoscopy room was constructed.

CMS has not adopted any specific edition of the Guidelines…. See §482.41(c)(4) [A-0726], which requires ‘proper ventilation’. The CMS interpretative guidelines for this standard just says acceptable standards from AIA should be incorporated. This is not a specific requirement to use the AIA (or FGI) Guidelines. [NOTE: AIA used to write the Guidelines for Design and Construction, but in 2006 they turned it over to FGI.]

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