The public comment period for the latest draft of the Facility Guidelines Institute’s (FGI) Guidelines for Design and Construction is open now through Dec. 12, and the body behind the 2018 revision is urging industry members to weigh in.
The Guidelines are the healthcare design standard used most often by medical planners, designers, and owners. Currently, authorities having jurisdiction (AHJ) in 35 states enforce some edition of the documents, but even those states that haven’t officially adopted them often refer to the Guidelines to help determine their own minimum standards.
The 100-member Health Guidelines Revision Committee (HGRC) revises and updates the text every four years with the help of the healthcare industry through public proposal and comment periods like these.
In the 2018 Guidelines, one major change of note will be the separation of hospital and outpatient standards, resulting in the publication of three Guidelines documents—one for hospitals; one for outpatient facilities; and one for residential health, care, and support facilities. In addition to these fundamental design requirements, companion publications in a “Beyond Fundamentals” series are planned. Any material that currently resides in the Guidelines appendix section that’s not directly relevant to the application of that requirement will be moved to Beyond Fundamentals—for example, anything that may be considered additional information or best practice.
Proposed deletions and revisions to existing text, along with proposed new material, can be found throughout the documents; however, much of the focus during this revision cycle was on clarifying and consistently applying the requirements, including the following:
Room design for different types of procedures
An effort has been made throughout the hospital and outpatient documents to align the definition and application of requirements for the various types of rooms where procedures take place, based on the level of invasiveness of the procedure and the perceived level of risk to the patient.
The term “percutaneous procedure” has been proposed to help define what in the past some have referred to as “minimally invasive” procedures. The definition of a percutaneous procedure is “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).”
Another topic for which the HGRC attempted to clarify requirements and bring them into line with practices in the field is design requirements for imaging facilities. Because imaging practices are changing so rapidly and are sometimes used in conjunction with each other, the goal was to make it easier for designers to determine what’s needed. Rather than providing detailed requirements for each imaging modality, a classification system has been developed that gives basic imaging room requirements, with additional details for certain modalities specified separately. In this approach, imaging rooms are organized into three categories:
  • Class 1 for diagnostic or noninvasive treatments
  • Class 2 for percutaneous or therapeutic procedures that require the same design approach as a procedure room
  • Class 3 for invasive procedures, which need to be done in a space that meets the same requirements as an operating room.
Sterile processing space exception
The drafts for hospitals and outpatient facilities also attempt to clarify the design requirements for sterile processing spaces. In earlier editions of the Guidelines, the sterile processing requirements consisted of a central sterile processing department presented under the title “Central Services” and a satellite sterile processing room in the surgery department. In the 2018 drafts, two rooms are required in both locations—a decontamination room and a clean workroom—except in locations where “sterilization equipment is limited to a table-top or similar sized sterilizer.” In the latter, limited situation, a single sterile processing room with a decontamination area and a clean work area is permitted.
In either case, the sterile processing area is set up to support a work flow from dirty to clean. The instruments flow from the decontamination room or area, where they are cleaned, into the clean workroom or work area, where they are packaged, sterilized, and may be stored. For all but the smallest sterilization activities (as described above), two distinct rooms are required to allow for proper ventilation and separation of clean and dirty. In the hospital and in a large ambulatory setting, this is where the majority of dirty surgical instruments are readied for reuse. If sterilization will occur outside a central sterile processing area, such as in the surgery department, a satellite sterile processing area is required. This area is a miniature sterile processing area, still consisting of two rooms.
Speak up
These are only a few of the changes proposed for the 2018 edition. The open public comment period allows users of the Guidelines to participate in the process and to express their support or objection to any or all of the recommendations.
Additional detail on proposed changes can be found in the FGI Guidelines Bulletin 
To access the draft documents and the FGI comment system for each document, please visit the FGI website at
Bryan Langlands, AIA, ACHA, EDAC, LEED GA, is principal at NBBJ (New York). He can be reached at Byron Burlingame, MS, RN, CNOR, is a perioperative nursing specialist at the Association of periOperative Registered Nurses (Denver). He can be reached at