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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.