Facilities Guidelines Institute 2014 Guidelines for the Design ... - AWS

Facilities Guidelines Institute 2014 Guidelines for the Design and Construction of Health Care Facilities APIC Palmetto 2014 Fall Conference Linda Dickey, RN, MPH, CIC

Objectives

• Gain an understanding of how the FGI Guidelines are organized and how they provide value to Infection Preventionists • Learn the significant design updates in the 2014 Guidelines for inpatient and ambulatory health care facilities • Identify 3 key changes in the 2014 Guidelines related to design of Perioperative Services areas

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Epidemiology & Infection Prevention

FGI Guidelines: Value to Infection Preventionists

• Referenced by regulators (e.g. The Joint Commission) • Used as reference for state building code (S.C.) • Provides guidance for you during design discussions • Resource for IP consultants in various health care settings

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Background • Previously “AIA Guidelines”, now FGI Guidelines ‒ Consensus based: 150 Designers, Engineers, Clinicians, AHJs, FMs • Focus is design-not an operational • Example: 2.1-2.2.5 HW station must be at or adjacent to pt. room entry • Provides minimum guidelines • Appendix: Rationale, some best practices • 4 year update cycle-Continuous maintenance a challenge due to state adoption

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2014 Guidelines: HOP and Residential

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Organization-Hospital & Outpatient Facilities (HOP)

Four parts • Part 1: General-Applies to all inpatient & outpatient facility types • Part 2: Applies to hospitals ‒ Common elements to all hospitals ‒ Specific elements for certain hospital types, e.g.: • • • •

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General Psychiatric Critical Access Children


Organization-Hospital & Outpatient Facilities

• Part 3: Applies to outpatient facilities ‒ Common elements to all outpatient facilities ‒ Specific elements to certain outpatient facility types, e.g.: • • • •

Primary Care Diagnostic & Treatment Freestanding Urgent Care Outpatient Surgery Center

• Part 4: ANSI/ASHRAE/ASHE Standard 170-2013 Ventilation of Health Care Facilities

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Organization-Residential Six parts • Part 1: General-Applies to all health care facility types • Part 2: Common elements for residential health, care & support facilities • Part 3: Applies to Residential Health facilities ‒ Common elements ‒ Specific elements for certain residential health facility types, e.g.: • •

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Nursing Homes Hospice


Organization-Residential • Part 4: Applies to Residential Care & Support facilities ‒ Common elements ‒ Specific elements for certain residential care & support facility types, e.g.: • •

Assisted Living Facilities Independent Living Settings

• Part 5: Applies to Non-Residential Support Facilities ‒ Common elements ‒ Specific elements for certain Non-Residential Support facilities, e.g.: • • •

Adult Day Care Facilities Wellness Centers Outpatient Rehabilitation Therapy Facilities

• Part 6: ANSI/ASHRAE/ASHE Standard 170-2013 Ventilation of Health Care Facilities 9



Regulatory Adoption • States adopt various versions of the Guidelines ‒ 13 states and D.C. have adopted 2010 as code •

FL, GA, IA, LA, MA, NJ, NY, PA, VA, TN, WA, WV, WI

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CA, CT, MI, MO, NM

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AZ, IN, MD, MS, OR, UT

‒ 5 states reference 2010 in state code ‒ Planning adoption

• Joint Commission references the Guidelines • CMS looks to the Guidelines during surveys ‒ Local AHJ will take precedence

11 Epidemiology & Infection Prevention

2014 HOP Guidelines •

1.2-3 Safety Risk Assessment (SRA) – Modeled after the ICRA – Requires multidisciplinary team to consider a variety of risks that can affect design •

Ergonomics, visibility, mobilization, noise

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ICRA part of SRA

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Requires documentation of recommended design features, part of project documents


2014 HOP Guidelines • Clarifications: – 2.1-2.2.5.1 HW station in pt room shall be located “at or adjacent to the entrance to the patient room with unobstructed access”


2014 HOP Guidelines • Clarifications: – 2.1-2.6.5.3 HW stations serving multiple pt. care stations shall be provided “for every four pt. care stations or fewer”. “Shall be evenly distributed”


2014 HOP Guidelines • Clarifications: – 2.1-3.3.1 At least 1 hand scrub position shall be located next to the entrance of each c section, trauma, OR and IR procedure room


2014 HOP Guidelines • Decorative water features – 2.1-7.2.2.14 Indoor, unsealed (open) water features shall not be permitted. Covered fish tanks shall be permitted in public areas.


2014 HOP Guidelines • Hot H2O for HH – 2.1-8.4.2.5 For HW stations, H2O shall be permitted to be supplied at a constant temp between 70°-80°F


2014 HOP Guidelines • Outpatient airborne infection isolation room – 3.1-3.4.2.2 Provision for PPE storage at entrance – 3.1-3.4.2.3 Shall have self closer or audible alarm that can be activated when in use for AII – No separate bathroom required


2014 HOP Guidelines • Removed protective environment room language from outpatient chapter


New: Residential Guideline • Design for nursing homes, assisted living or LTC facilities • Recognizes differences in needs and purposes of these environments


Residential Safety Risk Assessment (RSRA) • Same model as SRA for Hospitals & Outpatient Facilities – Required in up-front planning process – Includes multiple considerations, including • Infection risk • Mobility, transfer, fall risks • Dementia & mental health risks • Security risks • Disaster & emergency preparedness



AORN & FGI


Definitions •

Unrestricted

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Semi-restricted

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Restricted

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Not security related


Definitions Semi-restricted •Peripheral support areas •Include ‒ ‒ ‒ ‒

Storage supply Sterile processing Scrub stations Corridor to restricted area


Restricted •Access through semi-restricted corridor •Access limited •Required attire: scrubs, hats, •Masks if open sterile supplies

Definitions Operating Room

Procedure Room

•Restricted area •Unrestricted area •For invasive procedures that •For procedures that do not require an aseptic surgical require an aseptic field but may environment require use of sterile •Any form of anesthesia may be instruments or supplies •No general anesthesia administered


Invasive procedure •

Penetrates the protective surfaces

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Performed in an aseptic surgical field

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Requires entry into a body cavity

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May include insertion of a foreign body


Location terms • In • Directly accessible • Adjacent • Immediately accessible • Readily accessible • In the same building


Changing rooms 2010

2014

•Designed to provide a one-way •A locker area …shall be traffic pattern so that provided personnel entering from •Unisex locker area with one or outside the surgical suite can more private changing rooms is change and move directly into permitted the surgical suite


Question All surgical suites should include a sub-sterile room between every 2 ORs. True or false ?


Time for change! If we don’t do it this way, why still build it this way?


Substerile rooms: Sacred Cow? •Perpetuates outdated practice •Facilitates poor practices •Costly & unnecessary expense ‒ Equipment: $40K - $100K ‒ Mechanical and Electrical: $60K ‒ Floor space (50 square feet) - $1200/sq. ft. x 50 = $60K ‒ Total: $160K per room minimum •Plus long term: ‒ Maintenance ‒ Process monitoring supplies & ‒ Personnel time 32 Epidemiology & Infection Prevention

New: Sterile Processing The building design should provide functionally equivalent space for decontamination and sterilization of surgical instruments in all locations where sterilization processes are performed


Sterile processing room • 2 areas: decontamination & clean • One way traffic : dirty

clean

• Sink separated from clean work area by: – 4 ft from edge of sink or – a separating wall or screen

• Entrance to decontamination area from the semi-restricted area • Exit from clean side to the semi-restricted area or OR


Endoscopy processing • Minimum clearance of 3 feet (91.44 cm) between the decontamination area and the clean work area. • Backsplashes at least 12 inches high • Clean storage – Cabinet with doors – 3 ft from any sink – Accessed without crossing through decontamination area


Outpatient • No A, B, C’s • Procedure Room (formerly Class A Operating Room) – Access from semi-restricted or unrestricted corridor – Clear floor area of 150 sq ft – Minimum clearance of 4 ft on each side and at the head and foot of table


Outpatient Operating Rooms (Formerly Class B and C) • Minimum clear floor area of 250 sq ft – Inpt ORs 400 sq ft minimum

• Minimum clear dimension of 15 ft between fixed cabinets and built-in shelves • Otherwise same as inpatient (chapter 2.2)


2014 Guidelines Dedication Judene Bartley


For More Information: • FGI website: http://fgiguidelines.org/ – – – –

Purchase Guidelines (hard copy or electronic) Interpretations White papers Research

• Linda Dickey: [email protected] • Ramona Conner: [email protected]


Facilities Guidelines Institute 2014 Guidelines for the Design ... - AWS

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