Which Edition of FGI Guidelines Do We Use?

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.