The 2018 FGI Guidelines - Proposed Revisions to Procedure, Operating, and Imaging Room Requirements

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The 2018 FGI Guidelines - Proposed Revisions to Procedure, Operating, and Imaging Room Requirements
The 2018 FGI Guidelines
 Proposed Revisions to Procedure, Operating,
           and Imaging Room Requirements

Bryan Langlands   AIA, ACHA, EDAC, LEED GA
The 2018 FGI Guidelines - Proposed Revisions to Procedure, Operating, and Imaging Room Requirements
The views and opinions expressed in this
presentation are the opinion of the speakers and not
the official position of FGI or the Health Guidelines
                 Revision Committee.
The 2018 FGI Guidelines - Proposed Revisions to Procedure, Operating, and Imaging Room Requirements
PROPOSED CHANGES TO SURGERY SECTIONS
Clarification of procedure room and operating room requirements intended to
support space for equipment and staff present for procedures provided

           Section 2.1-3.2.2 (H) and 3.8-3.1 (OP)       Procedure Room
           Section 2.1-3.2.3 (H) and 3.7-3.4 (OP)       Operating Room
           Section 2.2-3.3.4 (H)                        Hybrid Operating Room

New classification structure for imaging rooms based on procedures performed and
environmental controls needed to allow flexibility in imaging room requirements as
procedures and equipment change over time

           Section 2.2-3.4.1.2 (H) and 2.1-3.5.2 (OP)   Imaging Rooms
           Table 2.2-2 (H)
The 2018 FGI Guidelines - Proposed Revisions to Procedure, Operating, and Imaging Room Requirements
2018 FGI PROCEDURES
 An understanding of the following is required to inform the planning of diagnostic, surgical, and
 interventional spaces.

                                                 •    Level of invasiveness, likelihood of infection
                                                 •    Type of sedation used to conduct procedure
                     Level of                    •    Number of staff expected in the room during procedure
                   Invasiveness                  •    Equipment needed to support procedure

                   Infrastructure              Which, in turn, determine the design requirements:
                   Requirements
   Equip & Staff                     Type of         • Room classification
     required                       Sedation               Procedure room (formerly Class A)
                                                           Operating room (formerly Class B & C)
                                                           Type of Imaging room (new Class 1, 2, and 3)
                                                     • Room size
                                                     • Room finishes
                                                     • Room Infrastructure (MEP systems)
The 2018 FGI Guidelines - Proposed Revisions to Procedure, Operating, and Imaging Room Requirements
INVASIVE PROCEDURE
A procedure that is performed in an aseptic surgical field and penetrates the protective surfaces of
a patient’s body (e.g., subcutaneous tissue, mucous membranes, cornea).

An invasive procedure may fall into one or more of the following categories:

     § Requires entry into or opening a sterile body cavity
              (i.e., cranium, chest, abdomen, pelvis, joint spaces)
     § Involves insertion of an indwelling foreign body
     § Includes excision and grafting of burns that cover more than 20 percent of total body area
     § Does not begin as an open procedure but has a risk, as determined by the physician, of
       requiring conversion to an open procedure
The 2018 FGI Guidelines - Proposed Revisions to Procedure, Operating, and Imaging Room Requirements
2018 GUIDELINES OBJECTIVE
• To make it easier for designers to know when what type of room is acceptable
• To make it easier for designers to right-size procedure and operating rooms
  Task group concerns and discussions included increasing patient acuity and
  complexity of outpatient surgical procedures, growing number of 23-hour-stay
  post-procedure outpatient services, and need for consistency and standards for
  environments

                 Inpatient Operating Room            Outpatient Operating Room

                     Minimum 400 SF

                      Minimum 20’ width
The 2018 FGI Guidelines - Proposed Revisions to Procedure, Operating, and Imaging Room Requirements
THREE MAJOR TYPES OF ROOMS….

    Procedure    Imaging Room
                                                      Use
    Room Type    Type
                                  A room designated for the performance of

1
                                  patient care that may require high-level
     Exam/       Class 1
                                  disinfected or sterile instruments but is not
     Treatment   Imaging          required to be performed with the
     Room        Room             environmental controls of a procedure
                                  room.
                                  A room designated for the performance of
                                  patient care that requires high-level

2
                 Class 2          disinfection or sterile instruments and
     Procedure
                 Imaging          some environmental controls but is not
     Room                         required to be performed with the
                 Room
                                  environmental controls of an operating
                                  room.
                              A room that meets the requirements of a
                              restricted area, is designated and equipped

3
                 Class 3      for performing surgical or other invasive
     Operating   Imaging room procedures, and has the environmental
     Room
                 (Hybrid OR) controls for an OR as indicated in ASHRAE
                              170. An aseptic field is required for all
                              procedures performed in an OR.
The 2018 FGI Guidelines - Proposed Revisions to Procedure, Operating, and Imaging Room Requirements
2018 GUIDELINES MINIMUM ROOM SIZES                                                                                        48 SF

                                                                                              48 SF
                                                                                             (6’ x 8’)
       80 SF                      120 SF                         130 SF                                                  130 SF
                                                                                          Anesthesia
     OP Exam                  Hospital Exam               Procedure Room                  Work Area                Procedure Room
                                                   (WITHOUT Need for Anesthesia Equip)                        (WITH Need for Anesthesia Equip)

                                                       48 SF                                        48 SF

             255 SF                                   270 SF                                       400 SF                  600 SF
              15’                                                                                   20’
        Outpatient OR                            Outpatient OR                                 Hospital OR                 Hybrid
(WITHOUT Need for Anesthesia Equip)        (WITH Need for Anesthesia Equip)              (ALWAYS PLANNED for WITH Anesthesia Equip)
STUDY BY AMERICAN SOCIETY OF ANESTHESIOLOGISTS
Operating Room Architectural Flow Diagram
  Copyright © 2017 American Society of Anesthesiologists. All rights reserved.

                             What is the minimum
                              SF required for an                                               Nurses               Anesthesiologists
                            Anesthesia Work Area?
                                                                                               Surgeons              Perfusionists

                                                                                 Realizing Improved Patient Care through Human-centered
                                                                                     Operating Room Design:
                                                                                 A Human Factors Methodology for Observing Flow Disruptions in
                                                                                     the Cardiothoracic Operating Room
                                                                                                        Anesthesiology. 2013;119(5):1066-1077.
                                                                                                          doi:10.1097/ALN.0b013e31829f68cf
CLEARANCE ZONE DIAGRAM
Establishing the Anesthesia Work Area

                         Anesthesia     Patient area
                         Work Area
              8’         48 SF

                    6’
                               8’
                                        Anesthesia 6’ x 8’ work zone

             8’

              7’
           GURNEY                         3’ X 7’ Gurney for planning purposes
                                        6’ x 8’ Anesthesia Work Zone at Head
             3’
CLEARANCE ZONE DIAGRAM
Establishing the Anesthesia Work Area
                                                       Any room (Exam, Treatment, or Imaging rooms)
                                    Perimeter          where general anesthesia will be administered
                                    Circulation        using an anesthesia machine and supply carts
                  8’
                                                       shall have 48 square feet at the head of the
                        2’                             table, gurney, or chair for an anesthesia work
                                                       zone.
                             6’
                                           8’
                                                          Anesthesia 6’ x 8’ work zone

                                                          Gray and White area is 2’ area shared between
                                                          anesthesia and circulator.

  The anesthesia work zone is a 6’ x 8’
  space at the head of the table, but when
  the anesthesia care provider(s) are not                   6’ x 8’ Anesthesia Work Zone at Head
  actively setting up sedation of the             2’ x 8’ at Perimeter, may serve as Circulation
  patient 2’ at the top of that zone can be
  used as part of the circulator pathway.
ROOM CLASSIFICATION
                                                                                                  Environmental Controls
Room Type               Use
                                               Location                             Ventilation                                                        Surfaces

               Patient care that may                             4 total ACH for general exam room
Exam Room require high-level
                                                                 6 total ACH for exam rooms programmed for use    Ceilings: Cleanable with routine housekeeping equipment
          disinfected or sterile
or                                        Accessed from an       by patients with undiagnosed gastrointestinal
               instruments but does                              symptoms, respiratory symptoms, or skin symptoms Floor: No special requirement
                                          unrestricted area
Treatment      not require the
                                                                 No pressure requirement                                Walls: No special requirement
Room           environmental controls
               of a procedure room                               Standard diffuser and return array

                                                                                                                        Ceilings: Smooth and without crevices, scrubbable, non-absorptive,
                                                                                                                        non-perforated; capable of withstanding cleaning chemicals; without
               Patient care that requires                                                                               crevices; lay-in ceiling permitted if gasketed or each ceiling tile weighs
               high-level disinfection or                                                                               at least one pound per square foot and no perforated, tegular, serrated, or
               sterile instruments and                           15 ACH / Positive pressure                             highly textured tiles. Lay-in ceiling permitted if gasketed or each ceiling
                                          Accessed from an
Procedure      some environmental                                                                                       tile weighs at least 1lb/SF
                                          unrestricted or a      Standard diffuser and return array
Room           controls but does not                                                                                    Floor and wall base assemblies for cystoscopy, urology, and
                                          semi-restricted area
               require the                                                                                              endoscopy procedure rooms: Monolithic with an integral coved wall
               environmental controls                                                                                   base that is carried up the wall a minimum of 6’
               of an operating room
                                                                                                                        Wall finishes for endoscopy: Free of fissures, open joints, or crevices
                                                                                                                        that may retain or permit passage of dirt particles

               Invasive procedures*
                                                                 20 total ACH / Positive pressure                       Ceilings: Monolithic, scrubbable, capable of withstanding cleaning
               Any procedure during                              Primary supply diffuser array extend a minimum of
                                                                                                                        and/or disinfecting chemicals, gasketed access openings
               which the patient will     Accessed from a
Operating                                                        12’ beyond the footprint of the surgical table on      Floor and wall base assemblies: Monolithic with an integral coved wall
               require physiological      semi-restricted        each side                                              base that is carried up the wall a minimum of 6’
Room                                      area
               monitoring and is
                                                                 At least two low sidewall return or exhaust grilles    Wall finishes: Free of fissures, open joints, or crevices that may retain
               anticipated to require                            spaced at opposite corners or as far apart as possible or permit passage of dirt particles
               active life support
EXAMINATION ROOM

A room with a bed, stretcher, or examination table and
capability for periodic monitoring (e.g., measurement of
blood pressure or pulse oximetry) in which procedures that
do not require a specialized suite can be performed (e.g.,
pelvic examination).

TREATMENT ROOM
A standard patient room in an emergency department (ED)
or urgent care center that may be used for a variety of
functions, including patient examination and various
treatments or procedures, including wound packing, suture
placement, or casting. This room may contain specialized
equipment as identified in the functional program.
EXAM ROOM CLASSIFICATION
                                                                                             Environmental Controls
Room Type               Use
                                            Location                           Ventilation                                                 Surfaces

               Patient care that may                         4 total ACH for general exam room
Exam Room require high-level
                                                             6 total ACH for exam rooms programmed for use    Ceilings: Cleanable with routine housekeeping equipment
          disinfected or sterile
or                                      Accessed from an     by patients with undiagnosed gastrointestinal
               instruments but does                          symptoms, respiratory symptoms, or skin symptoms Floor: No special requirement
                                        unrestricted area
Treatment      not require the
                                                             No pressure requirement                           Walls: No special requirement
Room           environmental controls
               of a procedure room                           Standard diffuser and return array

                                                             80 SF                            120 SF

                                                            OP Exam                     Hospital Exam
PROCEDURE ROOM
A room designated for the performance of
patient care that requires high-level
disinfection or sterile instruments and some
environmental controls but is not required to
be performed with the environmental controls
of an operating room.
ROOM CLASSIFICATION
                                                                                                 Environmental Controls
Room Type               Use
                                               Location                            Ventilation                                                    Surfaces

               Patient care that may                             4 total ACH for general exam room
Exam Room require high-level
                                                                 6 total ACH for exam rooms programmed for use    Ceilings: Cleanable with routine housekeeping equipment
          disinfected or sterile
or                                        Accessed from an       by patients with undiagnosed gastrointestinal
               instruments but does                              symptoms, respiratory symptoms, or skin symptoms Floor: No special requirement
                                          unrestricted area
Treatment      not require the
                                                                 No pressure requirement                           Walls: No special requirement
Room           environmental controls
               of a procedure room                               Standard diffuser and return array

                                                                                                                   Ceilings: Smooth and without crevices, scrubbable, non-absorptive,
                                                                                                                   non-perforated; capable of withstanding cleaning chemicals; without
               Patient care that requires                                                                          crevices; lay-in ceiling permitted if gasketed or each ceiling tile weighs
               high-level disinfection or                                                                          at least one pound per square foot and no perforated, tegular, serrated, or
               sterile instruments and                           15 ACH / Positive pressure                        highly textured tiles. Lay-in ceiling permitted if gasketed or each ceiling
                                          Accessed from an
Procedure      some environmental                                                                                  tile weighs at least 1lb/SF
                                          unrestricted or a      Standard diffuser and return array
Room           controls but does not                                                                               Floor and wall base assemblies for cystoscopy, urology, and
                                          semi-restricted area
               require the                                                                                         endoscopy procedure rooms: Monolithic with an integral coved wall
               environmental controls                                                                              base that is carried up the wall a minimum of 6’
               of an operating room
                                                                                                                   Wall finishes for endoscopy: Free of fissures, open joints, or crevices
                                                                                                                   that may retain or permit passage of dirt particles
CLEARANCE ZONE DIAGRAM
PROCEDURE ROOM – INPATIENT & OUTPATIENT
(WITHOUT Need for Anesthesia Equipment)   PROCEDURE ROOM ZONES W/O NEED FOR ANESTHESIA EQUIP

                                             Patient area
                                             Circulation pathway where the circulator
                                             walks to perform duties. Cannot walk into
                                             sterile field.
                                             Movable equipment zone where the required
                                             movable equipment is stored and provides
                                             for door swing and opening of fixed drawers
                                             or opening of door and drawers on carts
                  3’

                                             CFA Clear Floor Area - 130 SF
                   7’
                GURNEY                                  3’-0” Clearance at Head & Foot
                                                               3’-6” Clearance at Sides
        3’-6”     3’     3’-6”                                              130 SF CFA
                   3’
CLEARANCE ZONE DIAGRAM
PROCEDURE ROOM – INPATIENT & OUTPATIENT
(WITH Need for Anesthesia Equipment)                         PROCEDURE ROOM ZONES WITH NEED FOR ANESTHESIA EQUIP

                                                                Patient area
                                                                Circulation pathway where the circulator
                                                                walks to perform duties. Cannot walk into
                                                                sterile field.

                              2’                                Movable equipment zone where the required
                                      3’                        movable equipment is stored and provides
                         6’                                     for door swing and opening of fixed drawers
                48 SF                                           or opening of door and drawers on carts
                   3’                                           Anesthesia 6’ x 8’ work zone
                8’
                                                                Gray and White area is 2’ area shared between
                                                                anesthesia and circulator.
                                                                CFA Clear Floor Area - 130 SF
                   7’
                GURNEY                                            3’ X 7’ Gurney for planning purposes
                                                                 6’ x 8’ Anesthesia Work Zone at Head
        3’-6”     3’          3’-6”                     2’ x 8’ at Perimeter, may serve as Circulation
                                           3’-0” Clearance at Head & Foot, 3’-6” Clearance at Sides
                   3’
                                                                            130 SF CFA + 24 SF (3’ x 8’)
2018 GUIDELINES MINIMUM ROOM SIZES
Exam, Treatment & Procedure Rooms

                                                                   48 SF

   80 SF      120 SF           130 SF             48 SF            130 SF

 OP Exam   Hospital Exam   Procedure Room       Anesthesia    Procedure Room
                                                Work Area
                           (WITHOUT Need for      (6’ x 8’)     (WITH Need for
                            Anesthesia Equip)                  Anesthesia Equip)
2018 GUIDELINES MINIMUM ROOM SIZES
Operating Rooms

                                                   48 SF                             48 SF

              255 SF                              270 SF                            400 SF           600 SF
               15’                                                                   20’
         Outpatient OR                       Outpatient OR                   Hospital OR              Hybrid
 (WITHOUT Need for Anesthesia Equip)   (WITH Need for Anesthesia Equip)   (ALWAYS PLANNED for      or Specialty
                                                                          WITH Anesthesia Equip)
OPERATING ROOM
A room that meets the requirements
of a restricted area, is designated
and equipped for performing surgical
or other invasive procedures, and
has the environmental controls for
an OR as indicated in ASHRAE 170.
An aseptic field is required for all
procedures performed in an OR.
ROOM CLASSIFICATION
                                                                                                  Environmental Controls
Room Type               Use
                                               Location                             Ventilation                                                        Surfaces

               Patient care that may                             4 total ACH for general exam room
Exam Room require high-level
                                                                 6 total ACH for exam rooms programmed for use    Ceilings: Cleanable with routine housekeeping equipment
          disinfected or sterile
or                                        Accessed from an       by patients with undiagnosed gastrointestinal
               instruments but does                              symptoms, respiratory symptoms, or skin symptoms Floor: No special requirement
                                          unrestricted area
Treatment      not require the
                                                                 No pressure requirement                                Walls: No special requirement
Room           environmental controls
               of a procedure room                               Standard diffuser and return array

                                                                                                                        Ceilings: Smooth and without crevices, scrubbable, non-absorptive,
                                                                                                                        non-perforated; capable of withstanding cleaning chemicals; without
               Patient care that requires                                                                               crevices; lay-in ceiling permitted if gasketed or each ceiling tile weighs
               high-level disinfection or                                                                               at least one pound per square foot and no perforated, tegular, serrated, or
               sterile instruments and                           15 ACH / Positive pressure                             highly textured tiles. Lay-in ceiling permitted if gasketed or each ceiling
                                          Accessed from an
Procedure      some environmental                                                                                       tile weighs at least 1lb/SF
                                          unrestricted or a      Standard diffuser and return array
Room           controls but does not                                                                                    Floor and wall base assemblies for cystoscopy, urology, and
                                          semi-restricted area
               require the                                                                                              endoscopy procedure rooms: Monolithic with an integral coved wall
               environmental controls                                                                                   base that is carried up the wall a minimum of 6’
               of an operating room
                                                                                                                        Wall finishes for endoscopy: Free of fissures, open joints, or crevices
                                                                                                                        that may retain or permit passage of dirt particles

               Invasive procedures*
                                                                 20 total ACH / Positive pressure                       Ceilings: Monolithic, scrubbable, capable of withstanding cleaning
               Any procedure during                              Primary supply diffuser array extend a minimum of
                                                                                                                        and/or disinfecting chemicals, gasketed access openings
               which the patient will     Accessed from a
Operating                                                        12’ beyond the footprint of the surgical table on      Floor and wall base assemblies: Monolithic with an integral coved wall
               require physiological      semi-restricted        each side                                              base that is carried up the wall a minimum of 6’
Room                                      area
               monitoring and is
                                                                 At least two low sidewall return or exhaust grilles    Wall finishes: Free of fissures, open joints, or crevices that may retain
               anticipated to require                            spaced at opposite corners or as far apart as possible or permit passage of dirt particles
               active life support
CLEARANCE ZONE DIAGRAM
OPERATING ROOM – INPATIENT
                                                     INPATIENT OPERATING ROOM
                        20’
                                                        Patient area
                                                        Sterile field where scrub and physician work
                                                        Circulation pathway where the circulator
                                                        walks to perform duties. Cannot walk into
                      48 SF
                                                        sterile field.
                                                        Movable equipment zone where the required
                                                        movable equipment is stored and provides for
                                                        door swing and opening of fixed drawers or
                                                        opening of door and drawers on carts
                         7’                             Anesthesia 6’ x 8’ work zone
                     OR TABLE
                                                        Gray and White area is 2’ area shared between
                                                        anesthesia and circulator.
   2’-6”   3’   3’      3’      3’   3’   2’-6”         CFA Clear Floor Area - 400 SF

                         3’                             3’ X 7’ Gurney for planning purposes
                                                              3’ at Sides & Foot – Sterile Field
                         2’                                3’ at Sides, 2’ at Foot – Circulation
                                                       2’-6” at Sides, 2’ at Foot – Equipment
                         2’
                                                  20’ Minimum Width, 400 SF Minimum CFA
CFA & CLEARANCE ALLOWANCE
Revised text in 2018 FGI in order to
acknowledge inevitable encroachments
and other intrusions to space.

Fixed encroachments shall be permitted
to be included when determining          Column
minimum CFA requirements for an OR       encroachment
provided:
1) There are no encroachments into the
   sterile field
2) The encroachments do not extend
   more than 12 inches into minimum
   CFA outside the sterile field
3) The encroachment width along each
   wall does not exceed 10 percent of
   the length of that wall
OPERATING ROOM - OUTPATIENT
WITHOUT Need for Anesthesia Equipment
Procedures (100s of) that may be           Procedures that are typically performed in
performed in an OR environment but may     an OR environment but may only require
only require Local Anesthesia (numbing     Local w/ Sedation (MAC – Monitored
medication), and do not necessarily have   Anesthesia Care) and do not necessarily
need for extensive anesthesia equipment:   have need for anesthesia extensive
                                           equipment:

    •   Small excision                         •   Carpal tunnel
    •   Cosmetic procedures                    •   Cataract removal
    •   Eyebrow lift                           •   Cystoscopy
    •   Blepharoplasty                         •   Hysteroscopy
    •   Podiatry                               •   Bunionectomy
    •   Hammertoe correction                   •   Hand procedures
                                               •   Excisions of small mass
CLEARANCE ZONE DIAGRAM
OPERATING ROOM – OUTPATIENT
(WITHOUT Need for Anesthesia Equipment)      OUTPATIENT OR ZONES W/O NEED FOR ANESTHIA EQUIPMENT

                                                Patient area
                     15’                        Sterile field where scrub and physician work

                                                Circulation pathway and
                                                movable equipment zone

                        3’                      CFA Clear Floor Area - 250 SF

                        7’
                  OR TABLE

       3’    3’      3’      3’   3’              3’ X 7’ Gurney for planning purposes
                                           3’ at Sides & 3’ Foot & Head – Sterile Field
                        3’
                                                   3’ at Sides & 2’ Foot – Circ. & Equip
                                          15’ Minimum Width, 255 SF Minimum CFA
                   2’
OPERATING ROOM - OUTPATIENT
WITH Need for Anesthesia Equipment
Procedures that are typically performed in     Procedures that are typically performed in
an OR environment but could use general        an OR environment requiring “intubation”
medication propofol or mask, but have a        or using gas anesthesia (sevoflurane)
greater risk of requiring emergency care       requiring anesthesia machine with vent
where access to full anesthesia care and       capability:
equipment is advised:

    •   Breast augmentation                        •   Extended abdominoplasty
    •   Mini tummy tuck                            •   Shoulder arthroscopy
    •   Knee arthroscopy                           •   Partial knee replacement
    •   Laparoscopy                                •   Spinal fusion
    •   Cysto with holmium laser lithotripsy       •   Pediatric tonsillectomy
CLEARANCE ZONE DIAGRAM
OPERATING ROOM – OUTPATIENT
(WITH Need for Anesthesia Equipment)     OUTPATIENT OR ZONES WITH NEED FOR ANESTHIA EQUIPMENT
                     15’
                                             Patient area

                                             Sterile field where scrub and physician work

                                             Circulation pathway and
                   1’-6”                     movable equipment zone
                   48 SF                     CFA Clear Floor Area - 270 SF
                     3’

                      7’
                  OR TABLE

        3’   3’      3’      3’   3’           3’ X 7’ Gurney for planning purposes
                                        3’ at Sides & 3’ Foot & Head – Sterile Field
                      3’                    6’ x 8’ Anesthesia Work Zone at Head
                                            3’ at Sides & 2’ at Foot – Circ. & Equip
                     2’                15’ Minimum Width, 270 SF Minimum CFA
IMAGING ROOM CLASSIFICATION
                                                                                                                Environmental Controls
Room Type                       Use
                                                               Location                    Ventilation                                                 Surfaces
            •   Diagnostic radiography, fluoroscopy,
                mammography, computed tomography                                                                      Ceilings: Cleanable with routine housekeeping equipment; lay-in ceiling
                (CT), ultrasound, magnetic resonance
Class 1         imaging (MRI), and other imaging
                                                              Accessed from 6 total ACH                               permitted
                                                              an
Imaging         modalities                                    unrestricted
                                                                            No pressure requirement                   Floor: Cleanable and wear-resistant for the location; stable, firm, and slip-
                                                                                                                      resistant
Room        •   Services that utilize natural orifice entry   area          Standard diffuser and return array
                and do not pierce or penetrate natural                                                                Walls: Washable
                protective membranes
                                                                                                                      Ceiling: Smooth and without crevices, scrubbable, non-absorptive, non-
                                                                                                                      perforated; capable of withstanding cleaning chemicals; without crevices;
                                                                                                                      lay-in ceiling permitted if gasketed or each ceiling tile weighs at least one
                                                                              15 total ACH
                                                              Accessed from                                           pound per square foot and no perforated, tegular, serrated, or highly textured
            •   Diagnostic and therapeutic procedures
Class 2         such as coronary, neurological, or            an              Positive pressure for catheterization   tiles
Imaging         peripheral angiography                        unrestricted No pressure requirements for other         Flooring: Cleanable and wear-resistant for the location; stable, firm, and
                                                              or a semi-
Room        •   Electrophysiology procedures                  restricted area
                                                                              rooms                                   slip-resistant
                                                                              Standard diffuser and return array      Floor and wall base assemblies: Monolithic floor with integral coved wall
                                                                                                                      base carried up the wall a minimum of 6 inches
                                                                                                                      Wall finishes: Washable; free of fissures, open joints, or crevices

Class 3                                                                       20 total ACH, Positive pressure         Ceiling: Monolithic, scrubbable, capable of withstanding cleaning and/or
                                                                                                                      disinfecting chemicals, gasketed access openings
Imaging     •   Invasive procedures*                                          Primary supply diffuser array extend a
                                                              Accessed
room        •   Any Class 2 procedure during which the                        minimum of 12’ beyond the footprint of Flooring: Cleanable and wear-resistant for the location; stable, firm, and
                                                              from a semi-                                           slip-resistant
                patient will require physiological                            the surgical table on each side
                                                              restricted
(Hybrid         monitoring and is anticipated to require      area            At least two low sidewall return or    Floor and wall base assemblies: Monolithic floor with integral coved wall
Operating       active life support                                           exhaust grilles spaced at opposite     base carried up the wall a minimum of 6 inches
Room)                                                                         corners or as far apart as possible    Wall finishes: Washable; free of fissures, open joints, or crevices
IMAGING ROOM CLASSIFICATION
An imaging room is a room in which
imaging services are provided.

Depending on what takes place
within the imaging room, the room
maybe used for diagnostic,
therapeutic, or invasive procedures,
and as such should be designed to
the same standards as required for
those same procedures to take place
in non-imaging settings.

Proposed new classification system
for Imaging rooms.

                         T30 April 4 + 5, 2017 | 2018 FGI Guidelines: A New Class Act
COMPARISON
 Exam/Treatment Room & Class 1 Imaging Room
                                                                                           Environmental Controls
Room Type                        Use
                                                                Location                Ventilation                                   Surfaces

            Diagnostic radiography, fluoroscopy,
                                                                                                                    Ceilings: Cleanable with routine
            mammography, computed tomography (CT),                                                                  housekeeping equipment; lay-in ceiling
Class 1     ultrasound, magnetic resonance imaging                             6 total ACH
                                                                                                                    permitted
Imaging     (MRI), and other imaging modalities                                No pressure requirement
                                                                                                                    Floor: Cleanable and wear-resistant for the
Room        Services that utilize natural orifice entry and                    Standard diffuser and return array   location; stable, firm, and slip-resistant
            do not pierce or penetrate natural protective                                                           Walls: Washable
            membranes

                                                              Accessed from
                                                              an unrestricted 4 total ACH for general exam
                                                              area            room

Exam Room                                                                      6 total ACH for exam rooms
                                                                                                                 Ceilings: Cleanable with routine housekeeping
            Patient care that may require high-level                           programmed for use by patients
or          disinfected or sterile instruments but does not                    with undiagnosed gastrointestinal equipment
            require the environmental controls of a                            symptoms, respiratory             Floor: No special requirement
Treatment   procedure room
                                                                               symptoms, or skin symptoms
                                                                                                                 Walls: No special requirement
Room                                                                           No pressure requirement
                                                                               Standard diffuser and return
                                                                               array
COMPARISON
       Procedure Room & Class 2 Imaging Room
                                                                                              Environmental Controls
Room Type                    Use
                                                      Location                   Ventilation                                                Surfaces
                                                                                                              Ceiling: Smooth and without crevices, scrubbable, non-absorptive,
                                                                                                              non-perforated; capable of withstanding cleaning chemicals; without
                                                                                                              crevices; lay-in ceiling permitted if gasketed or each ceiling tile weighs
               Diagnostic and therapeutic                             15 total ACH
                                                                                                              at least one pound per square foot and no perforated, tegular, serrated,
               procedures such as coronary,                           Positive pressure for catheterization   or highly textured tiles
Class 2        neurological, or peripheral                            No pressure requirements for other      Flooring: Cleanable and wear-resistant for the location; stable, firm,
Imaging Room   angiography                                            rooms                                   and slip-resistant
               Electrophysiology procedures                           Standard diffuser and return array      Floor and wall base assemblies: Monolithic floor with integral coved
                                                                                                              wall base carried up the wall a minimum of 6 inches
                                                                                                              Wall finishes: Washable; free of fissures, open joints, or crevices
                                                  Accessed from an
                                                  unrestricted or a
                                                  semi-restricted                                             Ceilings: Smooth and without crevices, scrubbable, non-absorptive,
                                                                                                              non-perforated; capable of withstanding cleaning chemicals; without
                                                  area
                                                                                                              crevices; lay-in ceiling permitted if gasketed or each ceiling tile weighs
               Patient care that requires high-                                                               at least one pound per square foot and no perforated, tegular, serrated,
                                                                      15 ACH
               level disinfection or sterile                                                                  or highly textured tiles. Lay-in ceiling permitted if gasketed or each
Procedure      instruments and some                                   Positive pressure                       ceiling tile weighs at least 1lb/SF
Room           environmental controls but does                        Standard diffuser and return array      Floor and wall base assemblies for cystoscopy, urology, and
               not require the environmental                                                                  endoscopy procedure rooms: Monolithic with an integral coved wall
               controls of an operating room                                                                  base that is carried up the wall a minimum of 6’
                                                                                                              Wall finishes for endoscopy: Free of fissures, open joints, or crevices
                                                                                                              that may retain or permit passage of dirt particles
HYBRID OPERATING ROOM
A room that meets the definition of an
operating room and is also equipped
to enable diagnostic imaging before,
during, and after surgical procedures.

Imaging equipment is permanently
installed in the room and may include
MRI, fixed single-plane and bi-plane
tomographic imaging systems, and
computed tomography equipment.

Note:
Use of portable imaging technology
does not make an OR a hybrid
operating room.
COMPARISON
 Operating Room & Class 3 Imaging Room
                                                                                          Environmental Controls
Room Type                       Use
                                                              Location                 Ventilation                                 Surfaces

                                                                                                                 Ceiling: Monolithic, scrubbable, capable of
                                                                                                                 withstanding cleaning and/or disinfecting
Class 3                                                                                                          chemicals, gasketed access openings
Imaging     Invasive procedures*
                                                                                                                 Flooring: Cleanable and wear-resistant for the
room        Any Class 2 procedure during which the                                                               location; stable, firm, and slip-resistant
            patient will require physiological monitoring                                                        Floor and wall base assemblies: Monolithic
(Hybrid     and is anticipated to require active life                                                            floor with integral coved wall base carried up
Operating   support                                                                                              the wall a minimum of 6 inches
                                                                              20 total ACH, Positive pressure
Room)                                                                                                            Wall finishes: Washable; free of fissures,
                                                                          Primary supply diffuser array
                                                                                                                 open joints, or crevices
                                                            Accessed from extend a minimum of 12’ beyond
                                                                          the footprint of the surgical table
                                                            a semi-       on each side
                                                            restricted area
                                                                              At least two low sidewall return or
                                                                                                                  Ceilings: Monolithic, scrubbable, capable of
                                                                              exhaust grilles spaced at opposite
                                                                                                                  withstanding cleaning and/or disinfecting
                                                                              corners or as far apart as possible
                                                                                                                  chemicals, gasketed access openings
            Invasive procedures*
Operating                                                                                                        Floor and wall base assemblies: Monolithic
            Any procedure during which the patient will                                                          with an integral coved wall base that is carried
Room        require physiological monitoring and is                                                              up the wall a minimum of 6’
            anticipated to require active life support
                                                                                                                 Wall finishes: Free of fissures, open joints, or
                                                                                                                 crevices that may retain or permit passage of
                                                                                                                 dirt particles
THREE MAJOR TYPES OF ROOMS….

    Procedure    Imaging Room
                                                      Use
    Room Type    Type
                                  A room designated for the performance of

1
                                  patient care that may require high-level
     Exam/       Class 1
                                  disinfected or sterile instruments but is not
     Treatment   Imaging          required to be performed with the
     Room        Room             environmental controls of a procedure
                                  room.
                                  A room designated for the performance of
                                  patient care that requires high-level

2
                 Class 2          disinfection or sterile instruments and
     Procedure
                 Imaging          some environmental controls but is not
     Room                         required to be performed with the
                 Room
                                  environmental controls of an operating
                                  room.
                              A room that meets the requirements of a
                              restricted area, is designated and equipped

3
                 Class 3      for performing surgical or other invasive
     Operating   Imaging room procedures, and has the environmental
     Room
                 (Hybrid OR) controls for an OR as indicated in ASHRAE
                              170. An aseptic field is required for all
                              procedures performed in an OR.
2018 FGI PROCEDURES – SUMMARY
Type of Room

                                                    Level of      Risk of     Sterility of   Infrastructure
                                                  Invasiveness   Infection   Environment     Room Finishes

                    Level of
                  Invasiveness                1      Non
                                                   Invasive
                                                                   Low          Low,
                                                                              4-6 ACH
                                                                                                 Low

                  Infrastructure
                  Requirements
  Equip & Staff
    required
                                    Type of
                                   Sedation   2    Limited                     15 ACH

                                              3    Invasive,
                                                     Any
                                                                  High        High, 20
                                                                                ACH
                                                                                                 High
2018 FGI PROCEDURES – SUMMARY
Size of Room

                                                  Number of       Type of     Amount of   Minimum
                                                  Staff Req’d    Sedation     Equipment   Room Size

                    Level of
                  Invasiveness                1      Low          None         Limited    80-120 SF

                  Infrastructure
                  Requirements
  Equip & Staff
    required
                                    Type of
                                   Sedation   2                 Varies, may
                                                                be General
                                                                               15 ACH      130 SF

                                              3     High
                                                                 General
                                                                Anesthesia
                                                                                High      255 SF OP
                                                                                          400 SF IP
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