Focus on Facility Guidelines Institute Ceilings  

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The Facility Guidelines Institute (FGI) Guidelines provide much-needed standards for the design of healthcare facilities and are an important tool for architects.

The Facility Guidelines Institute (FGI) is a non-profit organization that creates comprehensive guidelines and best practices for the design and construction of healthcare facilities. Its Guidelines ensure that healthcare environments, including hospitals, clinics, and specialized medical centers, are safe, and effective, and promote the well-being of patients and staff. Adherence to FGI Guidelines is critical in healthcare facility design, as they address a wide array of considerations, including environmental health, safety, acoustics, and infection control.

A key component in creating a healthy, safe, aesthetically pleasing, and sustainable healthcare facility is the design and specification of ceilings. FGI mandates ceilings in all spaces, except mechanical rooms, to ensure the physical environment supports the operations and cleanliness needed in healthcare settings. The type and style of ceiling specified by architects can contribute in many ways to improving the patient experience, as well as impact the outcome of medical procedures, recovery, and duration of care. A significant element that impacts both patients and staff in healthcare settings is acoustic design. Everything from privacy to rest and recovery can be impacted by the amount of noise in the space. Because privacy, rest, and recovery are integral in healthcare treatment, it is important to create designs for healthcare settings that comply with FGI standards including acoustic needs, all of which can be challenging and critical for the architect. Specifically, acoustical ceiling systems can promote noise abatement and provide privacy, both important attributes to enable the healing of patients and the well-being of staff and visitors.

This article will provide guidance and suggestions for both the architect and designer to help navigate the FGI ceiling requirements while also promoting best practices to enhance and ensure a positive and productive healthcare environment through acoustical ceiling design.

OVERVIEW OF THE FACILITY GUIDELINES INSTITUTE (FGI)

FGI is a nonprofit organization dedicated to promoting safety and quality in healthcare facility design. FGI publishes Guidelines that are widely recognized as the gold standard for the planning, construction, and design of hospitals, outpatient facilities, and other healthcare environments. These Guidelines are regularly updated to reflect new findings in healthcare delivery, patient safety, and building performance. The process required by the FGI helps establish that facilities are equipped to safeguard the best possible outcomes for patients and staff alike.

As the healthcare industry continues to evolve, with advances in medical technologies and a heightened emphasis on patient-centered care, these Guidelines have become increasingly vital. They provide a structured framework that informs the design, construction, and renovation of healthcare facilities, ensuring that buildings meet the industry-acceptable standards of safety, efficiency, and quality. For architects who design healthcare spaces, understanding and adhering to the FGI Guidelines is not just beneficial; it’s essential to doing good work.

Photo © 2022 Zvonkovic Photography; courtesy of Perkins&Will

Today, the FGI Guidelines are recognized as the authoritative resource for healthcare construction and are referenced by regulatory agencies, accrediting bodies, and healthcare organizations across the United States. In many cases, these Guidelines are incorporated into state and local building codes, making adherence to them a legal requirement for healthcare facility projects.

History of the FGI

The origins of the Facility Guidelines Institute can be traced back to the early 20th century, as healthcare facility design became increasingly specialized. The original Guidelines for healthcare facility construction were created in 1947 by the U.S. Public Health Service as General Standards and appeared in the Federal Register in 1947. Over the decades since then, these Guidelines evolved in response to advancements in medicine and technology, as well as shifts in healthcare delivery models.

The documents produced by FGI are updated and revised every four years by a dedicated group of healthcare experts serving on the Health Guidelines Revision Committee (HGRC). The process is a consensus-based approach during which a wide range of members of the healthcare community are encouraged to provide suggestions, comments, and feedback to help update and improve the Guidelines. Over the years, FGI has partnered with other industry organizations to ensure the content is complete, accurate, and relevant to modern building codes, standards, and expectations. For instance, in the 2010 update of the Guidelines, the HGRC voted to abandon previous Guidelines ventilation tables and data and instead partner with the American Society of Heating, Refrigeration, and Air-Conditioning Engineers (ASHRAE) by adopting ASHRAE 170 in its entirety.

A significant update to the 2018 edition included more information and a reference table to help designers and owners quickly determine which procedure should be performed in each room type; updated clearances required for operating rooms; requirements addressing sustainable design; and accommodations for telemedicine services. In addition, the existing acoustic criteria in the Guidelines were reviewed by the Acoustics Proposal Review Committee, leading to an update to acoustic requirements.

Today, the FGI Guidelines are recognized as the authoritative resource for healthcare construction and are referenced by regulatory agencies, accrediting bodies, and healthcare organizations across the United States. In many cases, these Guidelines are incorporated into state and local building codes, making adherence to them a legal requirement for healthcare facility projects.

The Importance of Adherence to the FGI Guidelines

For architects involved in healthcare design, adherence to the FGI Guidelines is not just a matter of compliance; it’s a fundamental responsibility. The Guidelines are designed to ensure that healthcare facilities are safe, efficient, and capable of supporting the delivery of high-quality care. By following these standards, architects can help mitigate risks, enhance patient outcomes, and ensure that facilities meet the expectations of both regulatory agencies and healthcare providers and recipients.

One of the key benefits of adhering to the FGI Guidelines is that they help architects anticipate and address potential challenges early in the design process. For example, the Guidelines provide detailed specifications for critical elements such as room sizes, clearances, and infrastructure systems, ensuring that spaces are functional and meet the operational needs of healthcare providers. This can help prevent costly modifications or delays during construction, as well as reduce the likelihood of issues arising after the facility is in use.

Additionally, the FGI Guidelines are designed to be flexible and adaptable, allowing architects to tailor their designs to the specific needs of the healthcare facility while still adhering to best practices. This is particularly important in the current healthcare landscape, where the needs of patients and providers can vary widely depending on the type of facility, the services they offer, and the community that is served.

The Scope of the FGI Guidelines

The scope of the FGI Guidelines is comprehensive, covering a wide range of healthcare facility types, from hospitals and outpatient clinics to nursing homes and behavioral health centers. The Guidelines are divided into three primary documents:

• Guidelines for Design and Construction of Hospitals: This document provides detailed requirements for the design of hospitals and inpatient care facilities, including recommendations for patient rooms, surgical suites, emergency departments, and support areas.
• Guidelines for Design and Construction of Outpatient Facilities: This document focuses on the design of facilities that provide outpatient services, such as medical offices, ambulatory surgical centers, and diagnostic imaging centers.
• Guidelines for Design and Construction of Residential Health, Care, and Support Facilities: This document addresses the design of long-term care facilities, assisted living centers, and behavioral health environments, with a focus on creating safe and supportive living spaces for residents.

Each of these documents is regularly updated to reflect new developments in healthcare delivery and facility design, ensuring that the Guidelines remain relevant and applicable to the latest trends and technologies.

Today the FGI Guidelines are more relevant than ever. All states, except four, Illinois, Texas, South Dakota, and Hawaii, have officially adopted and codified FGI’s Guidelines in full or in part, or they allow the FGI Guidelines as an alternate compliance path even though not officially adopted.

For architects working in the healthcare sector, the FGI Guidelines are an indispensable resource. They provide a solid foundation for designing healthcare environments that are safe, functional, and aligned with the latest industry standards. As the healthcare landscape continues to evolve, FGI will remain a critical tool, helping architects create spaces that support high-quality care, improve patient outcomes, and respond to the ever-changing needs of the medical community. By adhering to these Guidelines, architects can ensure that their designs not only meet regulatory requirements but also contribute to the ongoing advancement of healthcare facility design.

Photo: © 2022 Zvonkovic Photography; courtesy of Perkins&Will

The FGI Guidelines identify specific requirements when it comes to the design, specification, and installation requirements for ceilings in healthcare environments.

FGI AND A FOCUS ON CEILINGS

Key concerns regarding ceiling specifications include:

• Cleanability: Ceilings in healthcare settings, particularly in sensitive areas such as operating rooms, must be easily cleanable to maintain hygiene standards. This often means avoiding materials that trap dust or are difficult to sanitize.
• Acoustics: Healthcare environments require sound control to minimize noise, which can disturb patients or interfere with accurate communication. Acoustic ceiling tiles are commonly specified to meet these standards.
• Infection Control: Ceilings in specific spaces such as surgical rooms or areas with immunocompromised patients must support infection control efforts. This can include non-porous, mold-resistant materials and specialized construction techniques.
• Fire Safety: Ceilings in healthcare facilities must meet fire resistance ratings in accordance with life safety codes. This includes fire-resistant materials and proper installation to prevent smoke or fire spread.
• Integration with mechanical and other systems/devices: Ceilings must also accommodate HVAC systems, sprinklers, lighting, and other mechanical systems. The Guidelines specify clearances and integration methods to ensure functionality without compromising safety.

Section 2.1-7.2.3.3 in the 2022 version states “ceilings shall be provided in all areas” except for mechanical, electrical, and communications rooms. In these rooms, ceilings are optional. For all other areas, the Guidelines are very specific about the need for ceilings and general expectations when it comes to their design and construction. Without ceilings, all the structural members, pipes, conduits, ducts, and wires of the building’s systems would be exposed to the occupied areas below. It would be impractical and ineffective to try to clean or disinfect all these elements if ceilings were not separating them from the rooms below.

For architects, one of the most common challenges is understanding which requirements are needed for a project based on the space and intended use of the healthcare facility. Ceiling requirements differ in certain areas because ceiling systems play an important role in a facility’s ability to maintain asepsis. Asepsis (i.e., cleanliness) refers to practices that reduce the risk of proliferation of harmful microorganisms. In healthcare facilities, maintaining asepsis is crucial to prevent hospital-acquired infections. Risks include contamination through surgical instruments, improper hand hygiene, and inadequate sterilization, potentially leading to infections in patients, increased morbidity, and prolonged hospital stays. As asepsis becomes more important to the function of a given area, ceiling requirements differ.

The language stated in the Guidelines notes that ceilings “shall be cleanable with routine housekeeping equipment” and that to this end “shall not create ledges or crevices,” for these could hold dust or debris and not be easily cleaned. Lastly, “all normally occupied hospital and outpatient spaces shall incorporate floor, wall, or ceiling acoustic surfaces”. Because floor and wall surfaces need to be cleaned and disinfected regularly and be able to hold up to considerable wear and impact, the ceilings are the acoustical surfaces typically used to achieve the minimum sound absorption required by the Guidelines.

FGI Ceiling Systems

There are three ceiling systems described in the Guidelines that architects can choose from when designing healthcare facilities. These include lay-in ceilings with acoustic ceiling panels (ACPs) and no minimum panel weight requirement and a non-gasketed grid. In addition, there are lay-in ceilings with ACPs that weigh a minimum of 4.88 kg/m² (1 lb/ft²), and/or a gasketed grid (at least one lay-in or gasketed grid is required). Finally, monolithic ceilings are described.

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Lay-in ceilings refer to ACPs that are laid into a standard, metal, tee-bar grid for support, and are acceptable in most healthcare facility areas. For areas that require increased asepsis, where the passage of air between the space above the ceiling and the clinical area should be minimized, ACPs need to weigh a minimum of 4.88 kg/m² (1 lb/ft²) and/or a gasketed grid needs to be used.

The Guidelines do not require ceiling panel hold-down clips for any ceiling systems, and ceiling panel clips are not a substitute for the weight minimum or for the gasketed grid. For areas where maximum asepsis is required, monolithic ceilings, such as painted gypsum board, must be implemented and are defined as free of fissures, cracks, and crevices.

Photo courtesy of Rockfon

Specialty gasketed grids have continuous, closed-cell, PVC adhered to the topsides of the grid flanges to decrease airflow between the plenum above the ceiling and occupied rooms below.

LOCATION, LOCATION, LOCATION

Broadly speaking, the ceiling specification required by the Guidelines is determined by the types of procedures for which the space is designed. In short, the ceiling must satisfy all the basic requirements of the Guidelines based on the specific risks to the type of patient or procedure expected to be in that space.

In the majority of areas in healthcare facilities, invasive procedures are not performed on patients. For these areas, ACPs have no minimum weight requirement and a non-gasketed grid is permitted. ACPs with no other requirements are allowed in many communal areas, including public areas such as waiting areas, corridors, lobbies, reception, dining, shops, and toilet rooms. Administrative areas for staff must be cleanable and provide adequate sound absorption, and include offices, lounges, conference rooms, and sleeping quarters. Other areas that require ceilings but can utilize ACPs include rooms for medical purposes including examination rooms, laboratories, and most emergency department spaces. In addition, these requirements apply to all non-surgically invasive patient areas, like patient rooms and patient toilet rooms, laboratories, Class 1 imaging rooms, dialysis areas, nuclear medicine areas, and labor, delivery, recovery, and postpartum rooms.

In places where minimally invasive surgical, diagnostic, and therapeutic procedures are performed, as well as areas serving operating rooms, the Guidelines permit lay-in ceilings with ACPs that weigh a minimum of 4.88 kg/m² (1 lb/ft²) and/or a gasketed grid. Some examples are Class 2 imaging rooms, endoscopy rooms, bronchoscopy rooms, neonatal intensive care, as well as clean/sterile corridors, operating room equipment storage rooms, and sterile processing rooms. In addition, most laundry areas have these requirements. ACPs with a minimum weight of 4.88 kg/m² (1 lb/ft²) and/or a gasketed grid are also required in semi-restricted areas for some invasive procedures such as cardiac catheterization, trauma rooms, airborne infection isolation (A.I.I), and their associated anterooms, some procedure rooms, and Class 2 images rooms.

To reduce the chance of infection, rooms for surgically invasive procedures that require an aseptic surgical field, such as operating rooms and Class 1 imaging rooms, monolithic ceilings are typically required. Some versions of FGI allow for alternatives to monolithic ceilings and exceptions will be discussed in the next section. Standard lay-in ceilings are not permitted. These are areas requiring maximum asepsis for immunocompromised patients like burn patients and oncology patients, as well as those with certain airborne infections, and the toilet rooms that serve those patients, together with pharmacy clean rooms, and Class 3 imaging rooms. Most areas for behavioral health patients also require monolithic ceilings to meet ligature-resistant requirements.

To help ensure the health and safety of patients, staff, and visitors to healthcare facilities, these requirements make sense. Much of the rationale for ceiling requirements in healthcare facilities is outlined by FGI in a 2022 publication called Applying the FGI Guidelines to Spaces Where Invasive vs. Noninvasive Patient Care is Delivered, available on the FGI website. There are also tables within the FGI Guidelines specifically created to help architects and designers understand ceiling requirements in some rooms where more specific care and caution are required.

Photo: © 2022 Zvonkovic Photography; courtesy of Perkins&Will.

Waiting rooms are considered unrestricted areas and have no minimum weight requirement and a non-gasketed grid is permitted.

Exceptions to General Ceiling Requirements

There are quite a few exceptions to the general requirements for ceilings outlined in the Guidelines, and most of these apply to unrestricted areas in healthcare facilities. For example, mechanical spaces do not require ceilings (though they are permitted); public corridors require ceilings, but ACPs have no weight or gasketed grid requirement. Additionally, behavioral health areas require monolithic ceilings.

Another exception could be A.I.I. rooms, including their associated anterooms if they occur in the project. As a refresher, A.I.I. (airborne infection isolation) rooms are specialized rooms in healthcare facilities designed to prevent the spread of airborne pathogens like tuberculosis, measles, and varicella (chickenpox). A.I.I. rooms require ceilings with a weight minimum of 4.88 kg/m² (1 lb/ft²) and/or a gasketed grid. These rooms use negative pressure, meaning the room must maintain a lower pressure than surrounding areas to ensure airflow into the room but not out of it to keep contaminated air from flowing out into adjacent areas. A.I.I rooms also require High-Efficiency Particulate Air (HEPA) filtration, proper handwashing or sanitizing before entering and after leaving the room, the use of Personal Protective Equipment (PPE) by healthcare staff, and they have restricted access.

Notable exceptions also impact areas like laundry areas, food preparation areas and food supply rooms, and storage rooms in hospitals. In these cases, if lay-in ceilings are implemented, the ACPs must weigh a minimum of 4.88 kg/m² (1 lb/ft²) and a gasketed grid alone does not meet this requirement. Note that this does not apply to those same areas in outpatient facilities or residential facilities, where lay-in ceilings with ACPs with no weight minimum and a non-gasketed grid can be implemented in all laundry, food preparation, supply, and storage areas.

Additionally, section 2.1-7.2.3.3 of the 2022 Guidelines allows for alternative, prefabricated, ceiling systems in operating rooms, Caesarian delivery rooms, and Class 3 imaging rooms that are not monolithic.

Eldercare Residential Facilities

The FGI Guidelines have expanded over time to include a wide range of healthcare facilities that do not fall into traditional hospital environments. These include nursing homes and hospices, residential care, and support facilities. Other facilities that can fall under the Guidelines are assisted living, independent living and long-term residential substance use disorder treatment facilities, and nonresidential support facilities such as adult day care, wellness centers, and outpatient rehabilitation therapy facilities. It is not typical for invasive medical procedures to be performed in most rooms in these facilities. Therefore, neither ceiling panels with a minimum weight of 4.88 kg/m² (1 lb/ft²) nor specialty gasketed grids are required.

In healthcare facilities such as nursing homes and hospices, A.I.I. rooms require either a gasketed grid or ceiling panel with a minimum weight of 4.88 kg/m² (1 lb/ft²). In behavioral health departments or facilities, all patient areas are required to have a monolithic ceiling. ACP ceilings are not permitted.

NAVIGATING THE GUIDELINES FOR UNRESTRICTED, SEMI-RESTRICTED, AND RESTRICTED AREAS

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Most areas of healthcare facilities are classified as unrestricted and therefore can have acoustical ceiling panels with no minimum weight and suspension grid without gaskets.

 

Photo: © 2022 Zvonkovic Photography; courtesy of Perkins&Will

Clean corridors, occurring between restricted and unrestricted spaces, are classified as semi-restricted and require either the grid to be gasketed or the ceiling panels to weigh at least 4.88 kg/m² (1 lb/ft²).

To better navigate the FGI Guidelines requirements for ceiling installation in healthcare facilities, it is necessary to have a working knowledge of three definitions often used to describe the type of space and ceiling expectation. Generally speaking, the designation of a space as unrestricted, semi-restricted, or restricted can be a good starting point in determining which types of ceiling systems are permitted in an area of a facility.

Unrestricted Areas: Unrestricted areas include most areas of healthcare facilities outside of operating rooms (and other rooms in which surgical or other invasive procedures are performed) and their peripheral support spaces. Where ceilings are required, ACPs are mostly permitted without the panel weight or gasket requirements.

Semi-Restricted: Semi-restricted areas are intended to separate unrestricted and restricted areas and include peripheral support areas for restricted areas, such as endoscope processing rooms, decontamination rooms, clean corridors, and central sterile supply. Where ACPs are implemented in semi-restricted areas, ACPs must weigh a minimum of 4.88 kg/m² (1 lb/ ft2) and/or have a gasketed grid. Ceilings of this type are required in other areas, as well.

Restricted Areas: Restricted areas are those that can only be accessed through semi-restricted areas; access is restricted to maintain asepsis rather than for security purposes, and usually, they have garbing requirements. These include operating rooms, Class 3 imaging rooms, and protected environment rooms. Ceilings in restricted areas must be of monolithic construction, meaning ACPs are not allowed in these areas.

CEILING ACOUSTIC CONSIDERATIONS IN HEALTHCARE FACILITIES

Hospitals and other healthcare facilities can be noisy places. Imaging and medical monitoring equipment, foot traffic, and conversations, often with several happening all at once, can all contribute to noise. Yet creating a comfortable acoustic environment in a healthcare environment can play an important role in supporting the safety, health, healing, and well-being of patients, staff, and visitors alike. An optimized acoustic environment reduces stress not only for the patient but also for doctors, nurses, and support staff.

Acoustics in healthcare settings also need to support speech privacy. Patients and their healthcare providers must be able to talk candidly about the patient’s condition. Architects must design spaces that minimize the risk of unintended disclosures of patient information. This includes creating private areas for consultations and treatments, using soundproofing materials to limit overheard conversations, and designing patient intake or reception areas that prevent sensitive information from being exposed. A patient who feels their conversation may be overheard may withhold certain vital information or be reluctant to voice all their concerns. Maintaining speech privacy in healthcare settings encourages honest communication among patients, providers, and family members. It also helps reduce medical errors. Speech privacy is mandated by the Health Insurance Portability and Accountability Act (HIPAA), which protects patients’ health information through its Privacy Rule.

There are even financial incentives for good acoustics in healthcare facilities. Hospitals that earn good scores on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, which includes a question about the acoustic environment, qualify for incentive payments through the Hospital Value-Based Purchasing Program.

The attention placed on acoustics in healthcare is based on extensive research. According to the World Health Organization, noise can seriously impact human health. Excess noise can cause both short- and long-term health problems. Noise can disrupt sleep and interfere with concentration; it can also induce a stress response, which comes with several potentially harmful physiological responses such as increased blood pressure. And, as most of us have experienced, noise can be irritating, negatively affecting our mood and overall well-being. In healthcare settings, noise can be more than just a nuisance, it can greatly impact patient comfort, privacy, medical accuracy, and recovery times.

STONE WOOL CEILING TILES HELP TRANSFORM BIG BOX RETAIL INTO STATE-OF-THE-ART HEALTHCARE

Photo: ThinkDero, Inc., Dero Sanford; courtesy of Rockfon

Evidence-based design helped transform a former big box retail space into the new Premier Medical Plaza by incorporating stone wool ceiling systems that do not absorb water, moisture, or humidity.

Evidence-based design and modern highperformance acoustic materials were key ingredients for Premier Gastroenterology Associates (PGA) when they sought to repurpose a long-vacant big box retail space into the new Premier Medical Plaza. Serving the greater Little Rock, Arkansas area, PGA established project goals early on that included the creation of an environment that enables excellent patient care while meeting or exceeding acoustic, safety, maintenance, and sustainability goals.

To accomplish the design task, PGA collaborated with WER Architects, a local firm. With over 40 years of projects to their credit, WER was well versed in large projects, specifically scientific institutions and performing arts venues. Their professional experience blended perfectly with the needs of PGA, especially in terms of acoustic design.

Converting the 100,000 square feet of retail space into a healthcare facility presented multiple challenges for the team. All materials introduced into the design space had to support the overall project goals of health and safety, noise control, and the ability to be cleaned.

To satisfy the requirements where infection control is the priority, specially treated medical and hygienic ceiling panel surface finishes were specified that allow cleaning with water and some diluted disinfectants. Meeting Premier Medical Plaza’s most critical cleaning requirements, ceiling panels classified as Bacteriological Classes B5 and B10 were used. These ceiling panels have low particle emissions, resulting in Clean Room Classification ISO Class 5.

Primarily stone wool ceiling systems were selected due to the material’s natural ability to not absorb water, moisture, or humidity. In addition, stone wool systems do not contain organic materials. The inherent qualities of these ceiling panels also resist mold, mildew, and other potentially harmful microorganisms.

To help protect privacy, increase comprehension and improve concentration for PGA’s team, WER designed Premier Medical Plaza with acoustic comfort in mind. A ceiling system was designed to optimize acoustic absorption. Where needed, full-height walls or plenum barriers and floor slabs were included to effectively optimize sound insulation or blocking between rooms.

The stone wool panels installed throughout PGA’s facility have also earned UL Environmental GREENGUARD® Gold certification for low chemical emissions into indoor air during product usage. The certification process ensures that a product is suitable for environments such as healthcare facilities and takes into consideration safety factors that may affect those with vulnerable immune systems, children, and seniors.

Based on EBD research, this approach offered the best sound experience, lower maintenance costs for cleaning, and met long-term performance goals to reduce turnover and improve patient outcomes.

Evidence-Based Design (EBD) to Improve Healthcare

Increasingly healthcare providers are tasked with providing comprehensive care for patients while also maintaining the bottom line. The business of healthcare is challenged on many fronts today, from managing workforce shortages to increased consumer expectations, and the unpredictable nature of insurance reimbursement. In response to this, hospitals and care facilities need to balance investment in the design of a building with the potential outcome for patients. In short, tight operating margins require a more scientific and deliberate approach to the design of healthcare facilities.

Evidence-based design (EBD) has emerged as a reliable, practical, and cost-effective approach for healthcare architecture and design, both in existing buildings and new construction. EBD uses empirical research to create design options for healthcare facilities based on historical examples. For healthcare providers, there is a strong business case for using EBD because often the suggestions help address many of the challenges they face. For instance, one leading cause of staff burnout and turnover is the impact noise has on the work environment. Everything from potential errors due to poor intelligibility to the overall negative emotional impact of excessive noise are reasons staff leave positions.

EBD recommendations for controlling sound and reducing unwanted noise in healthcare facilities are extensive and go beyond simply creating a quieter environment. For existing healthcare facilities, EBD research encourages building owners and operators to conduct a noise audit to determine if the amount and type of noise within the space is potentially harmful to patients and staff.

Next, EBD research has noted that installing high-performance sound-absorbing ceiling tiles and panels results in reduced noise levels, improves intelligibility, and relieves stress and work pressure from staff. Even when overall sound levels remained the same, the attributes of sound-absorbing ceiling tiles improved working conditions and patient recovery. It is important to recall that noise is simply defined as unwanted sound. In busy hospital environments, equipment, conversation, and basic care activities will generate noise, and this is unavoidable. The key is to design and specify materials that will control the noise and reduce potential harm.

By designing healthcare spaces with a scientific understanding of acoustics and human health, EBD not only optimizes the physical environment but also elevates the overall experience of care. For providers, the optimal solution can be found that meets both financial parameters as well as staff and patient expectations.

UNDERSTANDING SOUND

Before exploring the specific acoustic requirements of ceilings in healthcare facilities as outlined in the FGI Guidelines, it is important to have a strong working knowledge of the fundamentals of designing for sound.

In general, there are three components of acoustical performance that should be examined. They are comprised of absorption, interior isolation, and background sound control. Having a perspective on the measurement and metrics associated with these three components is necessary to understand how interior spaces, specifically ceilings, impact the science of speech intelligibility, sound absorption, and the general relationship between material/assembly and acoustical experience for an occupant of the space.

Acoustic design requires an approach where absorption, isolation, and background sound performance work together with aesthetic design to provide a positive environment for working and healing.

Sound absorption occurs when a material has the ability to absorb the sound. Softer materials, such as carpets, fabric panels, or acoustical ceiling panels, are most often used for this purpose. Acoustic absorption occurs when an architectural surface converts energy in sound waves into insignificant heat energy by means of friction inside the pores of the material. The more that sound energy is absorbed by the surface, the less it is reflected back into the room as noise, reverberation, echo, or flutter.

In a medical facility where conversations need to be both private and intelligible, sound absorption is key. Sound absorption is quantified using the Noise Reduction Coefficient, or NRC, which indicates the amount of sound absorbed by ceiling panels or other materials.

A higher NRC number indicates more absorption. NRC generally varies between 0 (no absorption) and 1 (very high absorption), and it is the average of the sound absorption coefficients at four frequency ranges, 250, 500, 1,000, and 2,000 Hertz (Hz) octave bands. The Best NRC value is 0.90 or above. A value of 0.70 is marginal.

The amount of acoustic absorption required in building standards, guidelines, and rating systems is defined in one of two ways, either by the minimum NRC of the suspended acoustic ceiling system or by the maximum reverberation time inside the room.

Reverberation time (RT) is the time it takes for sound inside a room to decrease 60 decibels, or for a loud sound to fade away to inaudibility. NRC is a property of sound-absorbing products, while RT is a property of the whole room. As higher NRC materials are used in enclosed rooms, the reverberation and echoes in the room decrease, and the speech intelligibility is greater. In open spaces such as cafeterias and nurse’s stations, noise propagates less, privacy is enhanced, and distractions are minimized.

Speech intelligibility is one of the measures of good acoustics in spaces where groups of people gather to talk and listen. It is defined simply as how well speech can be heard and understood in a room. Many factors influence speech intelligibility. These include the strength of the speech signal, the direction of the sound source, the background sound level, and the reverberation time (RT) of the room. Using acoustic absorption decreases reverberation in enclosed rooms, such as patient recovery areas, consultation areas, and conference rooms, improving speech intelligibility for small-group communication.

Background sound is noise that you are not intentionally meant to listen to or gain information from. It is low to moderate, constant, and consistent. It is broadband, containing a range of many pitches, but has no complex elements or strong rhythms. It is not consciously noticed. It’s important that the background sound in each enclosed room and open space is designed so that it is not too loud or too quiet. Loud background sound is stressful and makes it hard to understand speech. When the background sound is too low, you can hear everything that you don’t want to hear.  Generally louder background sound can help provide privacy when walls and floors offer less isolation. And, if lower background sounds are required, such as in a teleconference room, the walls and slabs need to be designed to provide more isolation.

Factors like the type of ceiling installed, the materials that are used, and how well the system is connected to walls, floors, and partitions are also important variables in acoustic design. Interior partitions or walls that are built full height to the structural slab or roof above, and without holes or gaps, function together to block sound from adjacent rooms or spaces from coming through as noise. When rooms are above or below one another, the floor slab plays the main role in sound insulation. For acoustic design, ceilings must be integrated with all other components in the space, meaning design approaches must consider the entire assembly of walls, floor slabs, interior doors, and windows for acoustic performance. 

FGI Guidelines and Ceiling Specifications for Acoustics

The FGI Guidelines require sound absorption inside normally occupied rooms, but designers have the freedom to achieve that absorption using floor, wall, or ceiling finishes. However, due to infection prevention protocols and cleaning and durability requirements, it is typically only practical to achieve the required absorption with the ceilings. Similar to other requirements, the acoustic performance of ceiling materials is specific to the needs of the space. Some spaces in a healthcare setting may require more acoustic treatment than others regardless of the asepsis concerns.

Beyond the previously mentioned overarching requirement that all normally occupied spaces shall incorporate floor, wall, or ceiling acoustic surfaces, tables 1.2-3 in the Outpatient and Residential Guidelines and table 1.2-4 in the Hospitals Guideline further define the Minimum Design Room-Average Sound Absorption Coefficients for different types of rooms.

This acoustical metric, unique to FGI’s Guidelines, is an area-weighted average of the Noise Reduction Coefficient (NRC) ratings of the floor, walls, and ceiling. Values range from 0.10 to 0.25. In patient rooms, exam and treatment rooms, procedure rooms, and most support areas the minimum design room-average sound absorption coefficient is .15. Absorption requirements drop to 0.10 in large common spaces such as atriums, dining spaces, and natatoriums. The requirement increases to 0.25 in telemedicine rooms and waiting rooms close to patient care areas.

As noted previously, a higher NRC rating indicates more absorption, which may suggest that achieving an NRC rating of .10 or even .25 should be easy given the absorptive qualities of ceiling systems. However, requirements for cleanliness and hygiene put a disproportionate amount of emphasis on ceiling ratings.

To clarify this, consider an example. A patient room in a hospital is required to have an absorption coefficient no lower than 0.15. It would comply if the floor had an NRC of 0.15, the walls all had an NRC of 0.15, and the ceiling had an NRC of 0.15. But this scenario is unlikely. The floor is probably a hard, nonporous, and sound-reflective material, such as sheet vinyl, so it is easier to clean and remains durable. This means that other room surfaces need to be more sound-absorptive. For example, the walls and ceiling might now need to have NRC ratings of 0.55 to compensate for the 0 rating of the floor. Like the floors though, the walls are most likely going to be a hard, nonporous, and sound-reflective material as well, such as painted gypsum board. This means the ceiling NRC rating needs to be even higher, perhaps as high as 0.80 or 0.90 to provide a room-average coefficient of 0.15.

The exact NRC rating of the ceiling can vary greatly and depends on the room size and proportions; however, EBD research studies support a minimum ceiling NRC of .90. In industry terms, a ceiling tile with this rating would usually be classified as “high-performance.”

This is why specifying acoustic ceiling systems plays such a critical role in complying with FGI Guidelines. Noise must be controlled within healthcare facilities to promote healing, ensure privacy, and also support intelligibility, but in the design of the space, there are few variables to work with to achieve this level of sound control.

CONCLUSION

The FGI Guidelines are an essential tool for architects and designers involved in the development of healthcare facilities. Navigating the FGI documents is not difficult but requires a general understanding of both the intent and desired outcome of the design. Each space within a healthcare facility is carefully evaluated for how it can promote health, safety, wellness, and recovery for patients while also supporting a professional work environment for staff in the facility.

Achieving the requirements stated in the FGI Guidelines relies on designing within the established parameters. The ceiling system allowed is based on the expected invasiveness of the procedure to be carried out in that room. For some areas such as mechanical rooms, this may mean no ceiling is required, however, for surgical areas, monolithic ceilings need to be specified.

For each type of ceiling, acoustic performance also must be a consideration. Reducing noise in healthcare facilities is crucial to support patient health and recovery, as well as to establish the condition of privacy for patients. Understanding the metrics employed to evaluate acoustic ceiling solutions and also incorporating these into a design per FGI Guideline requirements will allow for both a successful design, and also an improved patient outcome potential.

RESOURCES

Facility Guidelines Institute (FGI) requirements for Acoustic Ceiling Panels/Tiles, June 20, 2024. www.rockfon.com/syssiteassets/rockfon-na/downloads/fgi-acoustic-ceiling-panels-requirements-for-health-care-facilities.pdf.

Andrew A. Hunt is Vice President of Confluence Communications and specializes in writing, design, and production of articles and presentations related to sustainable design in the built environment. In addition to instructional design, writing, and project management, Andrew is an accomplished musician and voice-over actor, providing score and narration for both the entertainment and education arena. www.confluencec.com, www.linkedin.com/in/ andrew-a-hunt-91b747