Adopts Without Amendments:

FGI Outpatient, 2018

Part 1 General

Part 2 Outpatient Facility Types

ANSI/ASHRAE/ASHE Standard 170-2017 Ventilation of Health Care Facilities

Heads up: There are no amended sections in this chapter.
Appendix material, shown in shaded boxes at the bottom of the page, is advisory only.
The provisions of this chapter shall apply to all new construction and major renovation projects in outpatient facilities.
A1.1-1.1 Application. This document covers outpatient facilities common to communities in the United States. Facilities with unique services will require special consideration. However, sections herein may be applicable for parts of any facility and may be used where appropriate.
A1.1-1.2 Performance vs. prescriptive standards. The minimum standards in the Guidelines have been established to obtain a desired performance result. Prescriptive limitations (such as exact minimum dimensions or quantities), when given, describe a condition that is commonly recognized as a practical standard for normal operation. For example, reference to a room or area by the patient, equipment, or staff activity that identifies its use avoids the need for complex descriptions of procedures for appropriate functional programming.
Each chapter in this document contains information intended as minimum standards for design and construction of new outpatient facilities and major renovations of existing outpatient facilities.
Standards set forth in the Guidelines shall be considered minimum and do not prohibit designing facilities and systems that exceed these requirements where desired by the governing body of the health care facility.
A1.1-1.2.2 The Guidelines text is not intended to restrict innovation and improvement in design or construction techniques. Accordingly, authorities adopting these standards as code may approve plans and specifications that contain deviations if they determine the applicable intent or objective of the standards has been met. For more information, see sections 1.1-3.1.2 (Exceptions) and 1.1-6 (Equivalency Concepts). Final implementation of Guidelines requirements may be subject to decisions of the authority having jurisdiction.
Projects with any of the following scopes of work shall be considered new construction and shall comply with the requirements in the Guidelines for Design and Construction of Outpatient Facilities:
Site preparation for and construction of entirely new structures and systems
Structural additions to existing facilities that result in an increase of occupied floor area
Change in function in an existing space
Where renovation or replacement work is done in an existing facility, all new work or additions or both shall comply with applicable sections of the Guidelines and local, state, and federal codes.
Major renovation projects. Projects with either of the following scopes of work shall be considered a major renovation and shall comply with the requirements for new construction in the Guidelines for Design and Construction of Outpatient Facilities to the extent possible as determined by the authority having jurisdiction:
  1. A series of planned changes and updates to the physical plant of an existing facility
  2. A renovation project that includes modification of an entire building or an entire area in a building to accommodate a new use or occupancy
When a building is converted from one occupancy type to another, it shall comply with the new construction requirements.
  1. Only the altered, renovated, or modernized portion of an existing building system or individual component shall be required to meet the installation and equipment requirements in the Guidelines.
  2. When such construction impairs the performance of the balance of an affected building system, upgrades to that system shall be required beyond the limits of the project to the extent required to maintain existing operational performance.
A1.1-3.1.2 Nonconforming conditions. When renovating or expanding existing facilities, it is not always practical or financially feasible to renovate or upgrade an entire existing facility to totally conform with requirements in the Guidelines. Therefore, authorities having jurisdiction are permitted to grant approval to renovate portions of a structure, space, or system if facility operations and patient safety in renovated and existing areas are not jeopardized by existing features of areas retained without complete corrective measures.
This recommendation does not guarantee an AHJ will grant an exception, but attempts to minimize restrictions on those improvements where total compliance would create an unreasonable hardship and would not substantially improve safety.
Where major structural elements make total compliance impractical or impossible, exceptions shall be considered.
Minor renovation or replacement work shall be permitted to be exempted from the requirements in Section 1.1-3.1.1 (Compliance Requirements) provided they do not reduce the level of health and safety in an existing facility.
A1.1- Exceptions for minor renovations or replacement work. The project types described below are examples of minor renovations or replacement work that are not likely to reduce the level of health and safety in an existing facility.
  1. Routine repairs and maintenance to buildings, systems, or equipment. This project type does not require improvements to building features or systems.
  2. Replacement of building furnishings and movable or fixed equipment. These projects only require improvements to building systems that serve the equipment being replaced and only to the extent necessary to provide sufficient capacity for the replacement.
  3. Minor changes to the configuration of an existing space do not require upgrade of the entire space.
  4. Cosmetic changes or upgrades to an existing space do not require an upgrade of the entire space.
  5. Improvements to a building system or a space that cannot reasonably meet the requirements of this document should be permitted provided the improvement does not impair other systems or functions of the building.
  6. Existing systems that are not in strict compliance with the provisions of this document should be permitted to continue in use, unless the AHJ has determined that such use constitutes a distinct hazard to life.
  7. Replacement of mechanical, electrical, plumbing, and fire protection equipment and infrastructure for maintenance purposes due to the failure or degraded performance of the components being replaced should be permitted provided the health and safety in the facility is maintained at existing levels.
These standards shall not be construed as prohibiting a single phase of improvement.
A1.1-3.1.3 Phased projects. As an example, a facility may plan to replace a flammable ceiling with noncombustible material but lack funds to do other corrective work. However, the Guidelines standards are not intended as encouragement to ignore deficiencies when resources are available to correct life-threatening problems. See Section 1.1-6 (Equivalency Concepts).
In renovation projects and additions to existing facilities, only that portion of the total facility affected by the project shall be required to comply with applicable sections of the Guidelines.
When parts of an existing facility essential to continued overall facility operation cannot comply with particular standards during a renovation project, a temporary waiver of those standards shall be permitted as determined by the authority having jurisdiction if patient care and safety will not be jeopardized as a result.
In renovation projects and additions to existing facilities, only that portion of the total facility affected by the project shall be required to comply with applicable sections of the Guidelines.
Existing portions of the facility and associated building systems that are not included in a renovation project but are essential to the functionality or code compliance of the renovated spaces shall, at minimum, comply with the applicable occupancy chapter of NFPA 101: Life Safety Code®.
A1.1-3.2.2 When construction is complete, the facility should satisfy functional requirements for its classification (e.g., outpatient surgery facility, dialysis center, etc.) in an environment that will provide acceptable care and safety to all occupants.
Renovations, including new additions, shall not diminish the safety level that existed prior to the start of the work. However, a safety level that exceeds that required for new facilities is not required.
Nothing in the Guidelines shall be construed as placing restrictions on a facility that chooses to do work or alterations as part of a phased long-range safety improvement plan.
All hazards to life and safety and all areas of noncompliance with applicable codes and regulations shall be corrected as soon as possible in accordance with a plan of correction.
A1.1-4.1 Design standards for accessibility.
Users of outpatient health care facilities often have very different accessibility needs than the typical adult with disabilities addressed by federal model standards and guidelines that focus on design for the disabled. Patients in an outpatient facility, especially elderly patients, due to their stature, reach, and strength characteristics, may require the assistance of caregivers during transfer maneuvers. Designs that follow some prescriptive requirements in model accessibility standards place both older persons and caregivers at greater risk of injury than facility designs that would be considered noncompliant. Thus, flexibility in applying federal model guidelines should be permitted to support the use of assistive configurations that address the need for transfer assistance.
  1. Federal accessibility standards. The Americans with Disabilities Act (ADA), which became law in 1990, extends comprehensive civil rights protection to individuals with disabilities. Under Titles II and III of the ADA, health care facilities are required to comply with the Americans with Disabilities Act Standards for Accessible Design for alterations and new construction. The Uniform Federal Accessibility Standards (UFAS) also provides criteria for accessible design.
    Individual federal agencies provide direction on applicable criteria to be used for the design of federal facilities.
  2. State and local accessibility standards. Many state and local jurisdictions have adopted ICC A117.1: Accessible and Usable Buildings and Facilities, which is also available for use in providing quality design for the disabled. However, some state and local standards for accessibility and usability are more stringent than ADA, UFAS, or ICC/ANSI A117.1. Designers and owners, therefore, are responsible for verification of all applicable requirements.
A1.1-4.2 Seismic standards. The seismic provisions in ASCE/SEI 7: Minimum Design Loads and Associated Criteria for Buildings and Other Structures are based on the National Earthquake Hazards Reduction Program (NEHRP) provisions developed by the National Institute of Building Science's Building Seismic Safety Council for the Federal Emergency Management Agency. The following seismic standards are essentially equivalent to the ASCE/SEI 7 provisions:
  1. NEHRP Recommended Seismic Provisions for New Buildings and Other Structures
  2. International Building Code
A1.1-4.3 Executive Order 11988: Flood Protection, dated May 24, 1977, was issued to minimize financial loss from flood damage to facilities constructed with federal assistance.
A1.1-4.4 HIPAA. The Health Insurance Portability and Accountability Act (HIPAA) became law in 1996. HIPAA consists of three major parts: the Privacy Rule, Transaction and Code Sets, and the Security Rule. The U.S. Department of Health and Human Services (HHS) issued the Privacy Rule to implement the requirement of HIPAA. Within HHS, the Office of Civil Rights (OCR) has responsibility for enforcement of the HIPAA regulations. HHS may provide direction and clarification on the Privacy Rule and Security Rule.
HIPAA does not preempt or override laws that grant individuals even greater privacy protection. Additionally, covered entities are free to retain or adopt more protective policies or practices.
Ultimately, designers and owners are responsible for developing policies and procedures for verification of all applicable requirements that appropriately limit access to personal health information without sacrificing the quality of health care.
A1.1-4.5.1 The principal federal environmental statutes likely to be applied to outpatient health care facilities include the following:
  1. Clean Air Act (CAA)
  2. National Environmental Policy Act (NEPA)
  3. Occupational Safety and Health Act (OSHA)
  4. Resource Conservation and Recovery Act (RCRA)
  5. Safe Drinking Water Act (SDWA)
  6. Superfund Amendments and Reauthorization Act (SARA)
  7. Toxic Substance Control Act (TSCA)
A1.1-4.5.2 State and local environmental regulations. The U.S. Department of Health and Human Services, U.S. Environmental Protection Agency (EPA) regional offices, and other federal, state, or local authorities having jurisdiction can provide information on state and local regulations pertaining to environmental pollution that may affect the design, construction, or operation of health care facilities, including management of industrial chemicals, pharmaceuticals, radionuclides, and waste as well as trash, noise, and traffic (including air traffic).
Every outpatient facility shall provide and maintain a safe environment for patients, staff, and the public.
A1.1-5.2 References made in the Guidelines to appropriate model codes and standards do not, generally, duplicate wording of the referenced codes. National Fire Protection Association (NFPA) standards are the basic standards of reference, but other codes and/or standards may be included as part of the Guidelines. See Section 1.1-8 (Codes, Standards, and Other Documents Referenced in the Guidelines).
In the absence of state or local requirements, the project shall comply with approved nationally recognized building codes except as modified in the latest edition of NFPA 101: Life Safety Code and/or herein.
Code material referred to in the Guidelines is contained in the edition of the referenced code current when this edition of the Guidelines was published.
A1.1-5.2.2 The latest revision of code material is usually a clarification of intent and/or general improvement in safety concepts and may be used as an explanatory document for earlier code editions.
Questions of applicability should be addressed as the need occurs. The version of a code adopted by a jurisdiction may be different. Confirm the version adopted in a specific location with the authority having jurisdiction.
Although the Guidelines is adopted as a regulatory standard by many jurisdictions, it is the intent of the document to permit and promote equivalency concepts.
A1.1-6.1 Equivalency concepts. When contemplating equivalency allowances, the authority having jurisdiction may use a variety of expert sources to make equivalency findings and may document the reasons for approval or denial of equivalency to the requester.
Operational methods and procedures, design criteria, and/or clinical functional variations other than those that appear in the Guidelines may be approved by the authority having jurisdiction when the health care organization can effectively demonstrate that the intent of the Guidelines is met and the variation does not reduce the safety or operational effectiveness of the facility below that required by the exact language of the Guidelines.
In all cases where specific limits are described, equivalent solutions will be acceptable if the authority having jurisdiction approves them as meeting the intent of the Guidelines.
Nothing in this document shall be construed as restricting innovations that provide an equivalent level of performance with these standards, provided that no other safety element or system is compromised to establish equivalency.
Where measurements are a part of this document, the English units given shall constitute the basic requirement. Approximately equivalent metric units are provided in parentheses after the English units.
Either method shall be consistently used throughout design and construction of a project.
Listed in this section are codes and standards that have been referenced in whole or in part in the various sections of this document as well as documents from which Guidelines concepts have been adopted.
Users of the Guidelines are encouraged to consult these publications for further information as may be necessary to achieve the final product. The editions cited are those available at the time of publication. Later editions will normally be acceptable where requirements for function and safety are not reduced; however, editions of different dates may have portions renumbered or retitled. Care must be taken to ensure that appropriate sections are used.
U.S. Access Board ( Also see Americans with Disabilities Act.
Uniform Federal Accessibility Standards (UFAS)
Acoustical Society of America
ANSI/ASA S2.71: Guide to the Evaluation of Human Exposure to Vibration in Buildings (2012)
ANSI/ASA S3.5: Methods for Calculation of the Speech Intelligibility Index (2017)
ANSI/ASA S12.9: Quantities and Procedures for Description and Measurement of Environmental Sound, Part 2: "Measurement of Long-Term, Wide-Area Sound" (2013)
Acoustics Research Council, Acoustics Working Group (
"Sound & Vibration: Design Guidelines for Health Care Facilities" (2010) (
American Association of Birth Centers
Standards for Birth Centers (2016)
American College of Emergency Physicians
"Geriatric Emergency Department Guidelines"
American College of Obstetricians and Gynecologists ( and American Academy of Pediatrics (
Guidelines for Perinatal Care, 8th ed. (2017)
American College of Radiology (
Kanal, Emanuel, et al. "ACR Guidance Document on MR Safe Practices: 2013." Journal of Magnetic Resonance Imaging 37:501-30 (2013). (
American Institute of Steel Construction
Design Guide 11: Vibrations of Steel-Framed Structural Systems Due to Human Activity, 2nd ed. (2016)
American National Standards Institute
ANSI S1.1: Acoustical Terminology (2013)
American Society of Civil Engineers/Structural Engineering Institute (
ASCE/SEI 7: Minimum Design Loads and Associated Criteria for Buildings and Other Structures (2016)
American Society for Healthcare Engineering (ASHE) (
Health Facility Commissioning Guidelines (2010)
American Society of Heating, Refrigerating and Air-Conditioning Engineers (
ASHRAE Guideline 12: Minimizing the Risk of Legionellosis Associated with Building Water Systems (2000)
ASHRAE Handbook-HVAC Applications (2017)
ANSI/ASHRAE/IES Standard 90.1: Energy Standard for Buildings Except Low-Rise Residential Buildings (2016)
ANSI/ASHRAE/ASHE Standard 170: Ventilation of Health Care Facilities (2017)
ANSI/ASHRAE Standard 188: Legionellosis: Risk Management for Building Water Systems (2015)
ANSI/ASHRAE/USGBC/IES 189.1: Standard for the Design of High-Performance Green Buildings, Except Low-Rise Residential Buildings (2014)
ANSI/ASHRAE/ASHE Standard 189.3: Design, Construction, and Operation of Sustainable High-Performance Health Care Facilities (2017)
American Society of Mechanical Engineers (
ANSI/ASME A17.1/CSA B44: Safety Code for Elevators and Escalators (2016)
ANSI/ASME A17.3: Safety Code for Existing Elevators and Escalators (2015)
American Society for Testing and Materials
D1193-06: Standard Specification for Reagent Water (2011)
E1130-16: Standard Test Method for Objective Measurement of Speech Privacy in Open Plan Spaces Using Articulation Index (2016)
E2638-10: Standard Test Method for Objective Measurement of the Speech Privacy Provided by a Closed Room (2010)
American Water Works Association (
AWWA M14: Backflow Prevention and Cross-Connection Control: Recommended Practices, 4th ed. (2015)
Americans with Disabilities Act, U.S. Department of Justice, Civil Rights Division ( Also see U.S. Access Board.
ADA Standards for Accessible Design (2010)
Association for the Advancement of Medical Instrumentation (
ANSI/AAMI/ISO 13959: Water for Hemodialysis and Related Therapies (2014)
ANSI/AAMI/ISO 26722: Water Treatment Equipment for Hemodialysis and Related Therapies (2014)
Business and Institutional Furniture Manufacturers Association (
Furniture standards (
The Center for Health Design (
Calkins, M. P., et al. "Contribution of the Designed Environment to Fall Risk in Hospitals" (2012). (
Joseph, A., et al. "Designing for Patient Safety: Developing Methods to Integrate Patient Safety Concerns in the Design Process" (2012). (
Safety Risk Assessment Toolkit (
Centers for Disease Control and Prevention
Biosafety in Microbiological and Biomedical Laboratories (BMBL), 5th ed. (December 2009) (
"Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005." Morbidity and Mortality Weekly Report (MMWR) 2005:54 (No. RR-17). (
"Guidelines for Environmental Infection Control in Health-Care Facilities" (2003) (
"Primary Containment for Biohazards: Selection, Installation and Use of Biological Safety Cabinets," Appendix A to Biosafety in Microbiological and Biomedical Laboratories (
Centers for Medicare & Medicaid Services
Clinical Laboratory Improvement Amendments (CLIA) (
Concrete Reinforcing Steel Institute (CRSI)
Design Guide for Vibrations of Reinforced Concrete Floor Systems (2014)
U.S. Department of Health and Human Services ( and U.S. Department of Justice (
"Americans with Disabilities Act: Access to Medical Care for Individuals with Mobility Disabilities" (
U.S. Department of Housing and Urban Development (
The Noise Guidebook (2009)
U.S. Department of Veterans Affairs, National Center for Patient Safety (
"Falls Prevention Toolkit" (
Environmental Protection Agency (
"Safe Storage and Handling of Swimming Pool Chemicals" (2001) (
Facility Guidelines Institute (
Hunt, J. M., and D. M. Sine. "Behavioral Health Design Guide" (2017)
"Patient Handling and Movement Assessments: A White Paper" (2010)
Federal Aviation Administration (
Advisory Circular 150/5390-2C: Heliport Design (2012) (
Federal Emergency Management Agency
Executive Order 11988: Floodplain Management
FEMA P-750: NEHRP [National Earthquake Hazards Reduction Program] Recommended Seismic Provisions for New Buildings and Other Structures (2009) (
Green Guide for Health Care™ (
Green Building Initiative
ANSI/GBI 01: Green Building Assessment Protocol for Commercial Buildings (2010)
Illuminating Engineering Society (
ANSI/IES RP-28: Lighting and the Visual Environment for Seniors and the Low Vision Population (2016)
ANSI/IES RP-29: Lighting for Hospitals and Healthcare Facilities (2016)
International Association for Healthcare Security & Safety (
Security Design Guidelines for Healthcare Facilities (2016)
International Code Council (
ICC A117.1: Accessible and Usable Buildings and Facilities (2017)
International Building Code (2018)
International Green Construction Code (2012)
International Electrotechnical Commission (
IEC Standard 60601-2-33: Medical electrical equipment — Part 2-33: Particular requirements for the basic safety and essential performance of magnetic resonance equipment for medical diagnosis (2010)
International Safety Equipment Association (
ANSI/ISEA Z358.1: American National Standard for Emergency Eyewash and Shower Equipment (2014)
The Joint Commission (
"Improving Patient and Worker Safety: Opportunities for Synergy, Collaboration, and Innovation" (2012)
National Council on Radiation Protection & Measurements (
Report No. 102: Medical X-Ray, Electron Beam and Gamma-Ray Protection for Energies Up to 50 MeV (Equipment Design, Performance and Use) (1989)
Report No. 116: Limitation of Exposure to Ionizing Radiation (1993)
Report No. 144: Radiation Protection for Particle Accelerator Facilities (2003)
Report No. 147: Structural Shielding Design for Medical X-Ray Imaging Facilities (2004)
Report No. 151: Structural Shielding Design and Evaluation for Megavoltage X- and Gamma-Ray Radiotherapy Facilities (2005)
National Fire Protection Association (
NFPA 10: Standard for Portable Fire Extinguishers (2018)
NFPA 13: Standard for the Installation of Sprinkler Systems (2016)
NFPA 30: Flammable and Combustible Liquids Code (2015)
NFPA 70: National Electrical Code® (2017)
NFPA 72: National Fire Alarm and Signaling Code (2016)
NFPA 82: Standard on Incinerators and Waste and Linen Handling Systems and Equipment (2014)
NFPA 90A: Standard for the Installation of Air-Conditioning and Ventilating Systems (2018)
NFPA 99: Health Care Facilities Code (2015)
NFPA 101: Life Safety Code® (2015)
NFPA 110: Standard for Emergency and Standby Power Systems (2016)
NFPA 111: Standard on Stored Electrical Energy Emergency and Standby Power Systems (2016)
NFPA 400: Hazardous Materials Code (2016)
National Institute of Occupational Safety and Health (
DHHS (NIOSH) Publication 97-111: "Selecting, Evaluating, and Using Sharps Disposal Containers" (January 1998) (
New York State Office of Mental Health
"Patient Safety Standards, Materials and Systems Guidelines," 18th ed. (2017) (
Nuclear Regulatory Commission (
Code of Federal Regulations, Title 10-Energy, Chapter 1-Nuclear Regulatory Commission
  • Part 20 (10 CFR 20), Standards for Protection Against Radiation
  • Part 35 (10 CFR 35), Medical Use of Byproduct Material
Occupational Safety and Health Administration, U.S. Department of Labor (
Code of Federal Regulations, Title 29-OSHA Regulations, Part 1910 (29 CFR 1910): Occupational Safety and Health Standards (
U.S. Pharmacopeial Convention (
U.S. Pharmacopeia-National Formulary (USP-NF) general chapters:
<795>: Pharmaceutical Compounding-Nonsterile Preparations
<797>: Pharmaceutical Compounding-Sterile Preparations
<800>: Hazardous Drugs-Handling in Healthcare Settings
<1066>: Physical Environments that Promote Safe Medication Use
The Robert Wood Johnson Foundation
Joynt, J., and B. Kimball, "Innovative Care Delivery Models: Identifying New Models that Effectively Leverage Nurses" (Health Workforce Solutions, 2008). For a summary, see "New Website Profiles 24 Innovative Nursing-Driven Models of Health Care Delivery" (
Society for Experiential Graphic Design (
"Universal Symbols in Health Care: Developing a Symbols-Based Wayfinding System: Implementation Guidebook" (
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