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.
This chapter of the Guidelines shall apply to outpatient facilities where same-day surgery is performed.
The outpatient surgery facility shall meet the standards in this chapter and the standards in Part 1 of these Guidelines as amended in this section.
Requirements in Chapter 2.1, Common Elements for Outpatient Facilities, shall apply to outpatient surgery facilities as cross-referenced in this chapter.
If the outpatient surgery facility is part of an acute care hospital or other medical facility, services shall be permitted to be shared to minimize duplication as acceptable to authorities having jurisdiction.
Space(s) shall be reserved or designated for pickup of patients after recovery.
A2.7-1.3.2 This parking space(s) should be located on the shortest possible accessible route from the intended surgery discharge door. The route from the door to the patient pickup point should be sheltered from weather by overhangs or canopies.
See Section 2.1-2 (Accommodations for Care of Patients of Size) for requirements.
A2.7-3 Recovery care center. Outpatient medical care is performed without anticipation of overnight patient care, and most outpatient procedures do not require an overnight stay.
  1. An extended care possibility can be addressed in a recovery care center that provides facilities for sleeping, bathroom, and nutrition services for the patient.
  2. Recovery care centers should have waiting areas for family, including children and adolescents, and privacy (noise barriers and sight barriers) for meetings between physicians and other professionals with family. The areas should be large enough for translators or have available translation equipment.
  3. A key element to housing patients is the communication system and the ability to obtain additional assistance as necessary.
The semi-restricted and restricted areas of the surgery facility shall be arranged to prevent unrelated traffic through those spaces.
Patient care areas shall be designed to facilitate movement of patients and personnel into, through, and out of defined areas in the surgery facility.
Signs that clearly indicate where surgical attire is required shall be provided at all entrances to semi-restricted areas.
The outpatient surgery facility shall be divided into three designated areas-unrestricted, semi-restricted, and restricted-that are defined by the physical activities performed in each area.
A2.7-3.1.1.4 Areas in the outpatient surgery facility
  1. Unrestricted area: Any area of the surgery facility that is not defined as semi-restricted or restricted. These areas may include a central control point for designated personnel to monitor the entrance of patients, personnel, and materials into the semi-restricted areas; staff changing areas; a staff lounge; offices; waiting rooms or areas; pre- and postoperative patient care areas; and access to procedure rooms (e.g., endoscopy procedure rooms, laser treatment rooms). Street clothes are permitted in these areas. Public access to unrestricted areas may be limited based on the facility's policy and procedures.
  2. Semi-restricted area: Peripheral areas that support surgical services. These areas may include storage for equipment and clean and sterile supplies; work areas for processing instruments; sterile processing facilities; hand scrub stations; corridors leading from the unrestricted area to the restricted area; and entrances to staff changing areas, pre- and postoperative patient care areas, and sterile processing facilities. The semi-restricted area is entered directly from the unrestricted area past a nurse station or from other areas. Semi-restricted areas have specific HVAC design requirements associated with the intended use of the space (see Part 3: ANSI/ASHRAE/ASHE 170: Ventilation of Health Care Facilities). Personnel in the semi-restricted area should wear surgical attire and cover all head and facial hair. Access to the semi-restricted area should be limited to authorized personnel and patients accompanied by authorized personnel.
  3. Restricted area: A designated space contained within the semi-restricted area and accessible only through a semi-restricted area. The restricted area includes operating and other rooms in which operative or other invasive procedures are performed. Restricted areas have specific HVAC design requirements associated with the intended use of the space (see ANSI/ASHRAE/ASHE 170: Ventilation of Health Care Facilities). Personnel in the restricted area should wear surgical attire and cover head and facial hair. Masks should be worn when the wearer is in the presence of open sterile supplies or of persons who are completing or have completed a surgical hand scrub. Only authorized personnel and patients accompanied by authorized personnel should be admitted to this area.
Facilities for diagnostic services shall be provided on- or off-site for pre-admission tests required for the procedures performed in the facility.
An examination room is not required, but where one is provided it shall be located in the unrestricted area and shall comply with the following requirements in Section 2.1-3.2.1.2 (Single-patient examination/observation room):
Section 2.1-3.2.1.2 (2) (Space requirements)
Section 2.1-3.2.1.2 (3) (Room features)
Use of a procedure room as an examination room shall be permitted.
A procedure room is not required in an outpatient surgery facility, but where one is provided it shall meet the requirements in Section 2.1-3.2.2 (Procedure Room).
See Section 2.1-3.2.3 (Operating Rooms) for requirements.
A2.7-3.4 Provisions for patients with airborne infectious diseases. When invasive procedures need to be performed on persons who are known or suspected of having airborne infectious disease and the procedure must be performed in an operating room, the recommendations outlined in the CDC "Guidelines for Environmental Infection Control in Health-Care Facilities" or the CDC "Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings" should be followed.
Pre- and postoperative patient care area(s) shall meet the requirements in Section 2.1-3.7 (Pre- and Post-Procedure Patient Care).
The support areas in this section shall be provided in or directly accessible to pre- and postoperative patient care areas as noted in this section.
See Section 2.1-3.8.2 (Nurse Station) for requirements.
Provision of the clinical sink shall be permitted in one of the following locations:
  1. In a soiled workroom in the postoperative patient care area as described in Section 2.7-3.5.8.12 (Provisions for soiled linen and waste holding)
  2. In the soiled workroom in Section 2.7-3.7.12 (Support Areas Directly Accessible to the Semi-Restricted Area-Soiled Workroom or Soiled Holding Room) if the workroom is directly accessible to the postoperative patient care area
  3. In the soiled workroom required in Section 2.7-3.8.12 (Other Support Areas in the Outpatient Surgery Facility-Soiled Workroom or Soiled Holding Room) if the workroom is directly accessible to the postoperative patient care area
See Section 2.1-3.8.8 (Medication Safety Zones) for requirements.
  1. The nourishment area shall be directly accessible to the postoperative patient care area.
  2. See Section 2.1-3.8.9 (Nourishment Area or Room) for other requirements.
  1. Ice-making equipment shall be provided in accordance with Section 2.1-3.8.10 (Ice-Making Equipment).
  2. Ice-making equipment shall not be located in the semi-restricted area.
Location of these provisions in the soiled workroom required in Section 2.7-3.7.12 (Soiled Workroom or Soiled Holding Room) shall be permitted if the soiled workroom is directly accessible to pre- and postoperative patient care areas.
  1. Reserved
  2. Location of storage for equipment and supplies in the clean equipment and supply storage room required in Section 2.7-3.7.13 (Clean Equipment and Supply Storage) shall be permitted if that storage room is directly accessible to pre- and postoperative patient care areas.
  3. Reserved
  4. Emergency equipment storage shall be provided in accordance with Section 2.1-3.8.13.4 (Emergency equipment storage).
  1. A staff toilet room shall be immediately accessible to pre- and postoperative patient care areas.
  2. The toilets in the staff changing area shall be permitted to meet this requirement.
(1)  Location
(a) A patient toilet room shall be directly accessible to each pre- and postoperative patient care area.
(b) Where separate pre- and postoperative patient care areas are provided, the patient toilet room(s) shall be permitted to be shared if directly accessible to preoperative and Phase II recovery areas.
(c) Where pre- and postoperative patient care stations that are single-patient rooms are used for airborne infection isolation patients, the toilet room shall be directly accessible from the patient care station.
(2)  Number
(a) Additional toilets shall be provided at the ratio of one patient toilet for each eight patient care stations or fewer and for each major fraction thereof.
(b) Pre- and postoperative patient care stations that are single-patient rooms with directly accessible toilet rooms that serve only that private room shall not contribute to the patient care station count when determining the number of patient toilets to be provided.
Where visitor seating is allowed in the recovery area, space for at least one seat for a visitor shall be provided within the boundaries of each patient care station.
The support areas in this section shall be provided in the semi-restricted area.
The nurse or control station shall be permitted to be in the unrestricted area if it is directly accessible to the semi-restricted area.
The nurse or control station shall permit direct visual observation of traffic into the semi-restricted area.
Access through all entries to the semi-restricted area shall be controlled.
Hand scrub facilities shall be provided in accordance with Section 2.1-3.8.6 (Hand Scrub Facilities).
Emergency equipment storage shall be provided in accordance with Section 2.1-3.8.13.4 (Emergency equipment storage).
An environmental services room shall be provided in accordance with Section 2.1-5.3.1 (Environmental Services Room).
The environmental services room shall not be shared with other areas.
The environmental services room shall be accessed from a semi-restricted corridor or area.
Where sterilization processes are conducted in the semi-restricted area, a sterile processing facility that meets requirements in Section 2.1-4.3.2 (Facilities for On-Site Sterile Processing) shall be provided.
The support areas in this section shall be directly accessible to the semi-restricted area of the surgery facility.
  1. The room described in Section 2.1-4.3.2.2 (2) (Decontamination room) or in Section 2.1-4.3.3.3 (A room...for gross decontamination and holding of instruments) shall be permitted to meet this requirement.
  2. Sharing of the soiled workroom or soiled holding room with the unrestricted area or another semi-restricted area shall be permitted if direct access is provided from the semi-restricted area and a separate entrance is provided from the unrestricted area.
  3. The soiled workroom or soiled holding room shall not have direct connection with operating rooms or other sterile activity rooms.
Where a soiled workroom is provided, it shall meet the requirements in Section 2.1-3.8.12.2 (Soiled workroom).
  1. Where a soiled holding room is provided, it shall meet the requirements in Section 2.1-3.8.12.3 (Soiled holding room).
  2. Where a soiled holding room is provided instead of a soiled workroom, other provisions for disposal of liquid waste shall be provided.
Storage shall be provided for clean equipment and supplies used in the semi-restricted and restricted areas.
The clean equipment and supply storage room shall be separate from and have no direct connection with the soiled workroom or soiled holding room.
The combined floor area of the clean equipment and supply storage room(s) shall be a minimum of 50 square feet (4.65 square meters) for each operating room up to two plus an additional 25 square feet (2.33 square meters) per additional operating room(s) beyond two.
A soiled workroom or soiled holding room shall be provided in the surgery facility. This shall be permitted to be the same room required in Section 2.7-3.7.12 (Soiled Workroom or Soiled Holding Room) as indicated in Section 2.7-3.7.12.1 (2).
  1. Storage for clean linen shall be provided.
  2. Location of clean linen storage in the clean supply and equipment room in Section 2.7-3.7.13 (Clean Equipment and Supply Storage) shall be permitted.
Space for supply and storage of medical gas(es) used in the facility, including space for reserve cylinders, shall be provided and protected in accordance with NFPA 99: Health Care Facilities Code.
Where equipment-intensive procedures are performed or large mobile equipment is used for surgery, storage space in addition to that in Section 2.7-3.7.13 (Clean Equipment and Supply Storage) shall be provided.
A2.7-3.8.13.6 Storage. Equipment requiring storage may include robotic equipment, mobile radiology equipment, lasers, and specialty tables.
Where storage of blood, tissue, and pathological specimens is required, the requirements in this section shall be met.
A2.7-3.8.16.1 The American Association of Tissue Banks (formerly the American Association of Blood Banks) and the College of American Pathologists have standards that dictate the provisions necessary for storage of tissue. These standards include when refrigeration is required, what type of refrigeration to use, and other requirements (e.g., alarms).
Provisions for storage of blood, tissue, and pathological specimens, including equipment, temperature controls, alarms, and monitoring, shall meet the requirements of the Clinical Laboratory Improvements Amendments (CLIA) and other applicable regulatory requirements.
(1)  A refrigerator shall be provided.
*(2)  Where the refrigerator is used to store blood for transfusions, it shall be equipped with temperature-monitoring and alarm signals.
A2.7-3.8.16.3 (2) Any refrigerator used to store patient specimens or reagents is monitored; this includes specimens waiting for a courier to pick them up for further testing.
A staff lounge shall be provided in facilities with three or more operating rooms.
A staff changing area with one or more private changing rooms or separate areas shall be provided for male and female staff working in the semi-restricted and restricted areas of the surgery facility.
Provision of a unisex locker area with one or more private changing rooms shall be permitted to meet this requirement.
Staff changing area(s) shall meet the requirements in Section 2.1-3.9.4 (Staff Changing Area).
At least one staff shower shall be provided that is readily accessible to the semi-restricted area and recovery areas.
Location of the staff shower in the staff changing area shall be permitted.
See Section 2.7-3.5.10.2 (Patient toilet room) for requirements.
Space shall be provided for patients to change from street clothing into patient gowns and to prepare for surgery.
  1. This changing area shall be permitted to consist of private holding room(s) or cubicle(s) and/or a separate changing area.
  2. Patient care station(s) in the pre- and postoperative patient care area shall be permitted to serve this function.
Where a separate changing area is provided, it shall include the following:
  1. Provisions for secure storage of patients' belongings
  2. Access to toilet(s) without passing through a public space
  3. Space for changing or gowning
Where a separate changing area is not provided, provisions shall be made for secure storage of patients' belongings.
Where sterilization processes are conducted in the outpatient surgery facility outside the semi-restricted area, the requirements in Section 2.1-4.3.2.2 (Two-room sterile processing facility) shall be met.
For facilities where sterile processing services are provided off-site, see Section 2.1-4.3.3 (Support Areas for Outpatient Facilities Using Off-Site Sterile Processing) for requirements.
Designated separate spaces shall be provided for clean linen storage and soiled linen holding.
Location of clean linen storage in the unrestricted area, including in the clean equipment and supply room in Section 2.7-3.7.13 (Clean Equipment and Supply Storage), shall be permitted.
Soiled linen storage shall be permitted to be a portion of the soiled workroom in Section 2.7-3.7.12 (Soiled Workroom or Soiled Holding Room).
See Section 2.1-5.2 (Waste Management) for requirements.
An environmental services room(s) shall be provided in accordance with Section 2.1-5.3.1 (Environmental Services Room).
These are unrestricted areas and shall be permitted to be accessed from unrestricted or semi-restricted corridors.
Public areas shall be provided in accordance with Section 2.1-6.2 (Public Areas).
Administrative areas shall be provided in accordance with Section 2.1-6.3 (Administrative Areas) as amended in this section.
At least one private multipurpose or consultation room shall be provided as part of the unrestricted area.
Shared use of an office or interview room for this purpose shall be permitted.
See Section 2.1-6.4.2 (Storage for Staff) for requirements.
In addition to the requirements in Section 2.1-7.2 (Architectural Details, Surfaces, and Furnishings), the requirements in this section shall be met.
The requirements in Section 2.1-7.2.2.1 (Corridor width) shall be met as amended in this section:
  1. Where corridors are used for stretcher and gurney transport, at least one corridor that connects the surgical suite and the PACU to an exit shall have a minimum width of 6 feet (183 centimeters).
  2. The corridor connecting the semi-restricted area and the pre- and postoperative patient care area(s) shall have a minimum width of 8 feet (244 centimeters) to accommodate transport of patients between preoperative, procedure, and post-anesthesia recovery areas.
  3. Staff-only corridors shall be permitted to be a minimum of 3 feet 8 inches (112 centimeters) wide unless a greater width is required by occupant load calculations per local and state building codes.
Surfaces in the outpatient surgery center shall meet the requirements in Section 2.1-7.2.3 (Surfaces).
See Section 2.1-8.3 (Electrical Systems) for requirements.
See Section 2.1-8.4 (Plumbing Systems) for requirements in addition to those in this section.
Flammable anesthetics shall not be used in outpatient surgical facilities.
See Section 2.1-8.5 (Communications Systems) for requirements in addition to those in this section.
All operating rooms and Phase I post-anesthesia recovery room(s) shall be equipped with an emergency communication system that incorporates push activation of an emergency call switch.
A fire alarm system shall be provided in accordance with Section 2.1-8.6 (Fire Alarm System).
See Section 2.1-8.7 (Elevator Systems) for requirements.
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