Application Guidance

NOTE: The 2026 Health Guidelines Revision Committee has assembled a Procedure Room Task Group to address the complexity of this topic. As a result, several proposals have been submitted to clarify these sections in the 2026 Guidelines for Design and Construction documents. These proposals, which will be supplemented by a white paper in progress, aim to clearly demonstrate the role of the functional program and safety risk assessment in determining room use. Further emphasis is placed on the importance of gathering input from clinicians and infection preventionists during the planning stage. Accepted proposals will be available for public review and comment when the 2026 draft Guidelines documents are released in July 2024.

 

**********

The application guidance below is part of a larger previously published application guidance (click on link at the bottom) titled “Applying the FGI Guidelines to Spaces Where Invasive vs. Noninvasive Patient Care is Delivered.”

 

The Facility Guidelines Institute (FGI) regularly receives inquiries from designers, infection preventionists, and clinical staff looking for guidance on where patient procedures can and cannot be performed in hospitals and outpatient facilities.

 

During each Guidelines revision cycle, the Health Guidelines Revision Committee (the body responsible for updating Guidelines for Design and Construction content) strives to strengthen the Guidelines standards for new construction and renovation of areas where patient care is provided. However, the question of where patient procedures can be performed is not one the Guidelines can precisely answer, nor is the Guidelines language written with this intent.

 

The Guidelines requires health care organizations to develop a functional program and perform a safety risk assessment during the planning and design phases of every project. One of the primary objectives of using these owner-driven tools is to actively engage clinicians, infection preventionists, and other care providers in the planning and design processes. Development of the functional program is the opportunity to identify the types of patient care to be provided as well as the spaces needed to support that care.

 

Performance of the safety risk assessment (SRA), particularly the infection control risk assessment (ICRA), will help the project team (including clinical and infection prevention staff as well as designers) determine how to allocate space for invasive and non-invasive procedures. In particular, the ICRA is essential to assure the new or renovated space will support the organization’s infection prevention practices.

 

 

FGI_determining_appropriate_room_type_2022-06-24

NOTE: The 2026 Health Guidelines Revision Committee has assembled a Procedure Room Task Group to address the complexity of this topic. As a result, several proposals have been submitted to clarify these sections in the 2026 Guidelines for Design and Construction documents. These proposals, which will be supplemented by a white paper in progress, aim to clearly demonstrate the role of the functional program and safety risk assessment in determining room use. Further emphasis is placed on the importance of gathering input from clinicians and infection preventionists during the planning stage. Accepted proposals will be available for public review and comment when the 2026 draft Guidelines documents are released in July 2024.

 

**********

 

The application guidance below is part of a larger previously published application guidance (click on link at the bottom) titled “Applying the FGI Guidelines to Spaces Where Invasive vs. Noninvasive Patient Care is Delivered.” 

 

To help decision-makers identify the physical environment features each treatment space will need to support planned clinical care, the 2018 and 2022 Hospital and Outpatient Guidelines documents include a table (2.2-1 in the Hospital document and 2.1-4 in Outpatient) with examples of basic procedures appropriately performed in exam/treatment, procedure, and operating rooms. (These tables do not present an exhaustive list of the requirements for these room types but are meant to help distinguish their uses to support project planning.) 

 

Table 2.2-1: Exam/Treatment, Procedure, and Operating Room Classification¹

 

Room	Use	Design Requirements2
		Room Type	Location	Surfaces
Exam or treatment room	Patient care that may require high-level disinfected or sterile instruments but does not require the environmental controls of a procedure room	Unrestricted area	Accessed from an unrestricted area	Flooring: cleanable and wear-resistant for the location; stable, firm, and slip-resistant Wall finishes: washable Ceiling: cleanable with routine housekeeping equipment; lay-in ceiling permitted
Procedure room	Patient care that requires high-level disinfected or sterile instruments, and some environmental controls but does not require the environmental controls of an operating room Endoscopic procedures	Semi-restricted area	Accessed from an unrestricted or a semi-restricted area	Flooring: cleanable and wear-resistant for the location; stable, firm, and slip-resistant Floor and wall base assemblies in cystoscopy, urology, and endoscopy procedure rooms and endoscope processing room: monolithic floor with integral coved wall base carried up the wall a minimum of 6 inches (15.24 centimeters) Wall finishes: washable Wall finishes in endoscopy procedure room and endoscope processing room: washable; free of fissures, open joints, or crevices Ceiling: smooth and without crevices, scrubbable, non-absorptive, non-perforated; capable of withstanding cleaning chemicals; lay-in ceiling permitted if gasketed or each ceiling tile weighs at least one pound per square foot and no perforated, tegular, serrated, or highly textured tiles
Operating room	Invasive procedures3 Any procedure during which the patient will require physiological monitoring and is anticipated to require active life support	Restricted area	Accessed from a semi-restricted area	Flooring: cleanable and wear-resistant for the location; stable, firm, and slip-resistant Floor and wall base assemblies: monolithic floor with integral coved wall base carried up the wall a minimum of 6 inches (15.24 centimeters) Wall finishes: washable; free of fissures, open joints, or crevices Ceiling: monolithic, scrubbable, capable of withstanding cleaning and/or disinfecting chemicals, gasketed access openings4

 

¹This table includes a brief description of what clinical services are performed in these room types and a summary of some applicable requirements that appear elsewhere in the 2022 Guidelines for Design and Construction of Hospitals. The table has been provided to help users determine when an exam/treatment, procedure, or operating room is required for a project. “Exam room,” “treatment room,” “procedure room,” and “operating room” are defined in the glossary.

 

²Other design requirements that apply to these room types include, but are not limited to, ventilation, lighting, medical gas and vacuum systems, and sound transmission requirements. See Part 3 (ANSI/ASHRAE/ASHE Standard 170: Ventilation of Health Care Facilities) for ventilation requirements for these rooms. See Section 2.1-8.3.4.2 (Lighting for specific locations in the hospital) and facility chapters for lighting requirements, Table 2.1-3 (Oxygen, Vacuum, Medical Air, WAGD, and Instrument Air Systems) for medical gas and vacuum systems requirements, and Section 1.2-6.1 (Acoustic Design) for noise transmission requirements.

 

³“Invasive procedure” is defined in the glossary.

 

⁴See Section 2.1-7.2.3.3 (3)(b) (Ceilings: Restricted areas—Use of a modular or prefabricated laminar (or controlled) flow ceiling system…) for exceptions to monolithic ceilings in operating rooms.

 

 

 

FGI_determining_appropriate_room_type_2022-06-24

NOTE: The 2026 Health Guidelines Revision Committee has assembled a Procedure Room Task Group to address the complexity of this topic. As a result, several proposals have been submitted to clarify these sections in the 2026 Guidelines for Design and Construction documents. These proposals, which will be supplemented by a white paper in progress, aim to clearly demonstrate the role of the functional program and safety risk assessment in determining room use. Further emphasis is placed on the importance of gathering input from clinicians and infection preventionists during the planning stage. Accepted proposals will be available for public review and comment when the 2026 draft Guidelines documents are released in July 2024.

 

********

 

The application guidance below is part of a larger previously published application guidance (click on link at the bottom) titled “Applying the FGI Guidelines to Spaces Where Invasive vs. Noninvasive Patient Care is Delivered.” 

 

The 2018 and 2022 Hospital and Outpatient Guidelines documents include a limited glossary definition of “invasive procedure”: 

 

2018 and 2022 FGI Guidelines Glossary Definition of Invasive Procedure

Invasive procedure

A procedure that is performed in an aseptic surgical field and penetrates the protective surfaces of a patient’s body (e.g., subcutaneous tissue, mucous membranes, cornea). An invasive procedure may fall into one or more of the following categories: Requires entry into or opening of a sterile body cavity (i.e., cranium, chest, abdomen, pelvis, joint spaces) Involves insertion of an indwelling foreign body Includes excision and grafting of burns that cover more than 20 percent of total body area Does not begin as an open procedure but has a recognized measurable risk of requiring conversion to an open procedure Note: Invasive procedures are performed in locations suitable to the technical requirements of the procedure with consideration of infection control and anesthetic risks and goals. Accepted standards of patient care are used to determine where an invasive procedure is performed. “Invasive procedure” is a broad term commonly used to describe procedures ranging from a simple injection to a major surgical procedure. For the purposes of this document, the term is limited to the above description. The intent is to differentiate those procedures that carry a high risk of infection, either by exposure of a usually sterile body cavity to the external environment or by implantation of a foreign object(s) into a normally sterile site. Procedures performed through orifices normally colonized with bacteria and percutaneous procedures that do not involve an incision deeper than skin would not be included in this definition.

 

 

 

 

FGI_determining_appropriate_room_type_2022-06-24

NOTE: The 2026 Health Guidelines Revision Committee has assembled a Procedure Room Task Group to address the complexity of this topic. As a result, several proposals have been submitted to clarify these sections in the 2026 Guidelines for Design and Construction documents. These proposals, which will be supplemented by a white paper in progress, aim to clearly demonstrate the role of the functional program and safety risk assessment in determining room use. Further emphasis is placed on the importance of gathering input from clinicians and infection preventionists during the planning stage. Accepted proposals will be available for public review and comment when the 2026 draft Guidelines documents are released in July 2024.

 

*****

 

The application guidance below is part of a larger previously published application guidance (click on link at the bottom) titled “Applying the FGI Guidelines to Spaces Where Invasive vs. Noninvasive Patient Care is Delivered.” 

 

As noted in Table 2.2-1: Exam/Treatment, Procedure, and Operation Room Classification (see excerpt below), an OR is the appropriate location for any procedure during which the patient will require physiological monitoring and is anticipated to require active life support. The HGRC intended “active life support” to mean a patient’s basic respiratory or circulatory functions depend on a machine or will be made dependent on a machine during a procedure (i.e., the patient is unable to either breathe and/or circulate blood on their own or unable to do so sufficiently to preclude physiological damage).

 

Excerpt from Table 2.2-1: Exam/Treatment, Procedure, and Operating Room Classification

 

Room	Use	Design Requirements2
		Room Type	Location	Surfaces

 

Operating room

Invasive procedures3 Any procedure during which the patient will require physiological monitoring and is anticipated to require active life support

Restricted area

Accessed from a semi-restricted area

Flooring: cleanable and wear-resistant for the location; stable, firm, and slip-resistant Floor and wall base assemblies: monolithic floor with integral coved wall base carried up the wall a minimum of 6 inches (15.24 centimeters) Wall finishes: washable; free of fissures, open joints, or crevices Ceiling: monolithic, scrubbable, capable of withstanding cleaning and/or disinfecting chemicals, gasketed access openings4

 

 

FGI_determining_appropriate_room_type_2022-06-24

NOTE: The 2026 Health Guidelines Revision Committee has assembled a Procedure Room Task Group to address the complexity of this topic. As a result, several proposals have been submitted to clarify these sections in the 2026 Guidelines for Design and Construction documents. These proposals, which will be supplemented by a white paper in progress, aim to clearly demonstrate the role of the functional program and safety risk assessment in determining room use. Further emphasis is placed on the importance of gathering input from clinicians and infection preventionists during the planning stage. Accepted proposals will be available for public review and comment when the 2026 draft Guidelines documents are released in July 2024.

 

*****

 

The application guidance below is part of a larger previously published application guidance (click on link at the bottom) titled “Applying the FGI Guidelines to Spaces Where Invasive vs. Noninvasive Patient Care is Delivered.” 

 

To help decision-makers identify the physical environment features each treatment space will need to support planned clinical care, the 2018 and 2022 Hospital and Outpatient Guidelines documents include a table (2.2-1 in the Hospital document and 2.1-4 in Outpatient) with examples of basic procedures appropriately performed in exam/treatment, procedure, and operating rooms. (These tables do not present an exhaustive list of the requirements for these room types but are meant to help distinguish their uses to support project planning.)

 

Table 2.2-1: Exam/Treatment, Procedure, and Operating Room Classification¹

 

Room	Use	Design Requirements2
		Room Type	Location	Surfaces
Exam or treatment room	Patient care that may require high-level disinfected or sterile instruments but does not require the environmental controls of a procedure room	Unrestricted area	Accessed from an unrestricted area	Flooring: cleanable and wear-resistant for the location; stable, firm, and slip-resistant Wall finishes: washable Ceiling: cleanable with routine housekeeping equipment; lay-in ceiling permitted
Procedure room	Patient care that requires high-level disinfected or sterile instruments, and some environmental controls but does not require the environmental controls of an operating room Endoscopic procedures	Semi-restricted area	Accessed from an unrestricted or a semi-restricted area	Flooring: cleanable and wear-resistant for the location; stable, firm, and slip-resistant Floor and wall base assemblies in cystoscopy, urology, and endoscopy procedure rooms and endoscope processing room: monolithic floor with integral coved wall base carried up the wall a minimum of 6 inches (15.24 centimeters) Wall finishes: washable Wall finishes in endoscopy procedure room and endoscope processing room: washable; free of fissures, open joints, or crevices Ceiling: smooth and without crevices, scrubbable, non-absorptive, non-perforated; capable of withstanding cleaning chemicals; lay-in ceiling permitted if gasketed or each ceiling tile weighs at least one pound per square foot and no perforated, tegular, serrated, or highly textured tiles
Operating room	Invasive procedures3 Any procedure during which the patient will require physiological monitoring and is anticipated to require active life support	Restricted area	Accessed from a semi-restricted area	Flooring: cleanable and wear-resistant for the location; stable, firm, and slip-resistant Floor and wall base assemblies: monolithic floor with integral coved wall base carried up the wall a minimum of 6 inches (15.24 centimeters) Wall finishes: washable; free of fissures, open joints, or crevices Ceiling: monolithic, scrubbable, capable of withstanding cleaning and/or disinfecting chemicals, gasketed access openings4

 

¹This table includes a brief description of what clinical services are performed in these room types and a summary of some applicable requirements that appear elsewhere in the 2022 Guidelines for Design and Construction of Hospitals. The table has been provided to help users determine when an exam/treatment, procedure, or operating room is required for a project. “Exam room,” “treatment room,” “procedure room,” and “operating room” are defined in the glossary.

 

²Other design requirements that apply to these room types include, but are not limited to, ventilation, lighting, medical gas and vacuum systems, and sound transmission requirements. See Part 3 (ANSI/ASHRAE/ASHE Standard 170: Ventilation of Health Care Facilities) for ventilation requirements for these rooms. See Section 2.1-8.3.4.2 (Lighting for specific locations in the hospital) and facility chapters for lighting requirements, Table 2.1-3 (Oxygen, Vacuum, Medical Air, WAGD, and Instrument Air Systems) for medical gas and vacuum systems requirements, and Section 1.2-6.1 (Acoustic Design) for noise transmission requirements.

 

³“Invasive procedure” is defined in the glossary.

 

⁴See Section 2.1-7.2.3.3 (3)(b) (Ceilings: Restricted areas—Use of a modular or prefabricated laminar (or controlled) flow ceiling system…) for exceptions to monolithic ceilings in operating rooms.

 

 

 

FGI_determining_appropriate_room_type_2022-06-24

NOTE: The 2026 Health Guidelines Revision Committee has assembled a Procedure Room Task Group to address the complexity of this topic. As a result, several proposals have been submitted to clarify these sections in the 2026 Guidelines for Design and Construction documents. These proposals, which will be supplemented by a white paper in progress, aim to clearly demonstrate the role of the functional program and safety risk assessment in determining room use. Further emphasis is placed on the importance of gathering input from clinicians and infection preventionists during the planning stage. Accepted proposals will be available for public review and comment when the 2026 draft Guidelines documents are released in July 2024.

 

*****

 

The application guidance below is part of a larger previously published application guidance (click on link at the bottom) titled “Applying the FGI Guidelines to Spaces Where Invasive vs. Noninvasive Patient Care is Delivered.” 

 

As noted in Table 2.2-1: Exam/Treatment, Procedure, and Operation Room Classification (see excerpt below), an OR is the appropriate location for any procedure during which the patient will require physiological monitoring and is anticipated to require active life support. The HGRC intended “active life support” to mean a patient’s basic respiratory or circulatory functions depend on a machine or will be made dependent on a machine during a procedure (i.e., the patient is unable to either breathe and/or circulate blood on their own or unable to do so sufficiently to preclude physiological damage).

 

Excerpt from Table 2.2-1: Exam/Treatment, Procedure, and Operating Room Classification

 

Room	Use	Design Requirements2
		Room Type	Location	Surfaces

 

Operating room

Invasive procedures3 Any procedure during which the patient will require physiological monitoring and is anticipated to require active life support

Restricted area

Accessed from a semi-restricted area

Flooring: cleanable and wear-resistant for the location; stable, firm, and slip-resistant Floor and wall base assemblies: monolithic floor with integral coved wall base carried up the wall a minimum of 6 inches (15.24 centimeters) Wall finishes: washable; free of fissures, open joints, or crevices Ceiling: monolithic, scrubbable, capable of withstanding cleaning and/or disinfecting chemicals, gasketed access openings4

 

 

 

 

FGI_determining_appropriate_room_type_2022-06-24

NOTE: The 2026 Health Guidelines Revision Committee has assembled a Procedure Room Task Group to address the complexity of this topic. As a result, several proposals have been submitted to clarify these sections in the 2026 Guidelines for Design and Construction documents. These proposals, which will be supplemented by a white paper in progress, aim to clearly demonstrate the role of the functional program and safety risk assessment in determining room use. Further emphasis is placed on the importance of gathering input from clinicians and infection preventionists during the planning stage. Accepted proposals will be available for public review and comment when the 2026 draft Guidelines documents are released in July 2024.

 

*****

 

The application guidance below is part of a larger previously published application guidance (click on link at the bottom) titled “Applying the FGI Guidelines to Spaces Where Invasive vs. Noninvasive Patient Care is Delivered.” 

 

The Facility Guidelines Institute (FGI) regularly receives inquiries from designers, infection preventionists, and clinical staff looking for guidance on where patient procedures can and cannot be performed in hospitals and outpatient facilities.

 

During each Guidelines revision cycle, the Health Guidelines Revision Committee (the body responsible for updating Guidelines for Design and Construction content) strives to strengthen the Guidelines standards for new construction and renovation of areas where patient care is provided. However, the question of where patient procedures can be performed is not one the Guidelines can precisely answer, nor is the Guidelines language written with this intent.

 

The Guidelines requires health care organizations to develop a functional program and perform a safety risk assessment during the planning and design phases of every project. One of the primary objectives of using these owner-driven tools is to actively engage clinicians, infection preventionists, and other care providers in the planning and design processes. Development of the functional program is the opportunity to identify the types of patient care to be provided as well as the spaces needed to support that care.

 

Performance of the safety risk assessment (SRA), particularly the infection control risk assessment (ICRA), will help the project team (including clinical and infection prevention staff as well as designers) determine how to allocate space for invasive and non-invasive procedures. In particular, the ICRA is essential to assure the new or renovated space will support the organization’s infection prevention practices.

 

FGI_determining_appropriate_room_type_2022-06-24

NOTE: The 2026 Health Guidelines Revision Committee has assembled a Procedure Room Task Group to address the complexity of this topic. As a result, several proposals have been submitted to clarify these sections in the 2026 Guidelines for Design and Construction documents. These proposals, which will be supplemented by a white paper in progress, aim to clearly demonstrate the role of the functional program and safety risk assessment in determining room use. Further emphasis is placed on the importance of gathering input from clinicians and infection preventionists during the planning stage. Accepted proposals will be available for public review and comment when the 2026 draft Guidelines documents are released in July 2024.

 

*****

 

The application guidance below is part of a larger previously published application titled “Applying the FGI Guidelines to Spaces Where Invasive vs. Noninvasive Patient Care is Delivered.” 

 

The Facility Guidelines Institute (FGI) regularly receives inquiries from designers, infection preventionists, and clinical staff looking for guidance on where patient procedures can and cannot be performed in hospitals and outpatient facilities.

 

During each Guidelines revision cycle, the Health Guidelines Revision Committee (the body responsible for updating Guidelines for Design and Construction content) strives to strengthen the Guidelines standards for new construction and renovation of areas where patient care is provided. However, the question of where patient procedures can be performed is not one the Guidelines can precisely answer, nor is the Guidelines language written with this intent.

 

The Guidelines requires health care organizations to develop a functional program and perform a safety risk assessment during the planning and design phases of every project. One of the primary objectives of using these owner-driven tools is to actively engage clinicians, infection preventionists, and other care providers in the planning and design processes. Development of the functional program is the opportunity to identify the types of patient care to be provided as well as the spaces needed to support that care.

 

Performance of the safety risk assessment (SRA), particularly the infection control risk assessment (ICRA), will help the project team (including clinical and infection prevention staff as well as designers) determine how to allocate space for invasive and non-invasive procedures. In particular, the ICRA is essential to assure the new or renovated space will support the organization’s infection prevention practices.

 

NOTE: The 2026 Health Guidelines Revision Committee has assembled a Procedure Room Task Group to address the complexity of this topic. As a result, several proposals have been submitted to clarify these sections in the 2026 Guidelines for Design and Construction documents. These proposals, which will be supplemented by a white paper in progress, aim to clearly demonstrate the role of the functional program and safety risk assessment in determining room use. Further emphasis is placed on the importance of gathering input from clinicians and infection preventionists during the planning stage. Accepted proposals will be available for public review and comment when the 2026 draft Guidelines documents are released in July 2024.

 

*****

 

The application guidance below is part of a larger previously published application guidance (click on link at the bottom) titled “Applying the FGI Guidelines to Spaces Where Invasive vs. Noninvasive Patient Care is Delivered.” 

 

The Facility Guidelines Institute (FGI) regularly receives inquiries from designers, infection preventionists, and clinical staff looking for guidance on where patient procedures can and cannot be performed in hospitals and outpatient facilities.

 

During each Guidelines revision cycle, the Health Guidelines Revision Committee (the body responsible for updating Guidelines for Design and Construction content) strives to strengthen the Guidelines standards for new construction and renovation of areas where patient care is provided. However, the question of where patient procedures can be performed is not one the Guidelines can precisely answer, nor is the Guidelines language written with this intent.

 

The Guidelines requires health care organizations to develop a functional program and perform a safety risk assessment during the planning and design phases of every project. One of the primary objectives of using these owner-driven tools is to actively engage clinicians, infection preventionists, and other care providers in the planning and design processes. Development of the functional program is the opportunity to identify the types of patient care to be provided as well as the spaces needed to support that care.

 

Performance of the safety risk assessment (SRA), particularly the infection control risk assessment (ICRA), will help the project team (including clinical and infection prevention staff as well as designers) determine how to allocate space for invasive and non-invasive procedures. In particular, the ICRA is essential to assure the new or renovated space will support the organization’s infection prevention practices.

 

NOTE: The 2026 Health Guidelines Revision Committee has assembled a Procedure Room Task Group to address the complexity of this topic. As a result, several proposals have been submitted to clarify these sections in the 2026 Guidelines for Design and Construction documents. These proposals, which will be supplemented by a white paper in progress, aim to clearly demonstrate the role of the functional program and safety risk assessment in determining room use. Further emphasis is placed on the importance of gathering input from clinicians and infection preventionists during the planning stage. Accepted proposals will be available for public review and comment when the 2026 draft Guidelines documents are released in July 2024.

 

*****

 

The application guidance below is part of a larger previously published application guidance (click on link at the bottom) titled “Applying the FGI Guidelines to Spaces Where Invasive vs. Noninvasive Patient Care is Delivered.” 

 

The types of procedures to be performed will dictate which floor/wall/ceiling surfaces, air exchange rates, and clearances are required for each room type as well as the locations for handwashing or hand scrub stations and the required number of medical gas outlets and vacuum inlets. 

 

NOTE: The 2026 Health Guidelines Revision Committee has assembled a Procedure Room Task Group to address the complexity of this topic. As a result, several proposals have been submitted to clarify these sections in the 2026 Guidelines for Design and Construction documents. These proposals, which will be supplemented by a white paper in progress, aim to clearly demonstrate the role of the functional program and safety risk assessment in determining room use. Further emphasis is placed on the importance of gathering input from clinicians and infection preventionists during the planning stage. Accepted proposals will be available for public review and comment when the 2026 draft Guidelines documents are released in July 2024.

 

*****

 

The application guidance below is part of a larger previously published application guidance (click on link at the bottom) titled “Applying the FGI Guidelines to Spaces Where Invasive vs. Noninvasive Patient Care is Delivered.” 

 

On one end of the spectrum is the operating room (OR) environment, which is classified as a “restricted area” and needs the maximum environmental control requirements. At the other end is the exam room or emergency department treatment room, where diagnostic procedures and simple treatments are provided. Between these two room types is the procedure room, which is the space type most likely to present a conundrum to design teams and health care organization leaders looking to classify and design these rooms. The tricky part is identifying when an OR may be required for procedures that otherwise could be safely performed in a procedure room. The table shows that an OR is the appropriate location for any procedure during which the patient will require physiological monitoring and is anticipated to require active life support. The HGRC intended “active life support” to mean a patient’s basic respiratory or circulatory functions depend on a machine or will be made dependent on a machine during a procedure (i.e., the patient is unable to either breathe and/or circulate blood on their own or unable to do so sufficiently to preclude physiological damage).

 

 

FGI_determining_appropriate_room_type_2022-06-24

In the 2018 Guidelines for Design and Construction of Hospitals and Guidelines for Design and Construction of Outpatient Facilities, an imaging room classification system was introduced to help designers and clinicians determine the room types needed when planning and designing imaging facilities. This framework is continued in the 2022 edition. The imaging classes correspond with the exam/treatment, procedure, and operating rooms:

 

Class 1 imaging room	for diagnostic procedures
Class 2 imaging room	for diagnostic and therapeutic procedures
Class 3 imaging rooms (ORs with mobile or built-in imaging equipment—the latter may be termed a “hybrid OR”)	for invasive procedures (i.e., surgery)

 

 

FGI_determining_appropriate_room_type_2022-06-24

NOTE: The 2026 Health Guidelines Revision Committee has assembled a Procedure Room Task Group to address the complexity of this topic. As a result, several proposals have been submitted to clarify these sections in the 2026 Guidelines for Design and Construction documents. These proposals, which will be supplemented by a white paper in progress, aim to clearly demonstrate the role of the functional program and safety risk assessment in determining room use. Further emphasis is placed on the importance of gathering input from clinicians and infection preventionists during the planning stage. Accepted proposals will be available for public review and comment when the 2026 draft Guidelines documents are released in July 2024.

 

*****

 

The application guidance below is part of a larger previously published application guidance (click on link at the bottom) titled “Applying the FGI Guidelines to Spaces Where Invasive vs. Noninvasive Patient Care is Delivered.” 

 

The distinction between when a Class 2 and a Class 3 imaging room is needed is the most difficult to determine. The Hospital and Outpatient documents in the 2018 and 2022 editions include this table (“Classification of Room Types for Imaging Services”) to help users understand the differences between these imaging room types.

 

The Guidelines provides some guidance on uses for newly constructed procedure rooms and Class 2 imaging rooms; however, it is preferable to base final determinations on what type and how many of these rooms will be included in a project on:

(1) a clinical assessment of procedures to be performed in the rooms and

(2) the environmental needs of the most stringent procedure to be performed in a given space

 

These decisions are also supported by information developed during the functional program and SRA/ICRA processes.

 

 

 

FGI_determining_appropriate_room_type_2022-06-24

NOTE: The 2026 Health Guidelines Revision Committee has assembled a Procedure Room Task Group to address the complexity of this topic. As a result, several proposals have been submitted to clarify these sections in the 2026 Guidelines for Design and Construction documents. These proposals, which will be supplemented by a white paper in progress, aim to clearly demonstrate the role of the functional program and safety risk assessment in determining room use. Further emphasis is placed on the importance of gathering input from clinicians and infection preventionists during the planning stage. Accepted proposals will be available for public review and comment when the 2026 draft Guidelines documents are released in July 2024.

 

*****

 

The application guidance below is part of a larger previously published application guidance (click on link at the bottom) titled “Applying the FGI Guidelines to Spaces Where Invasive vs. Noninvasive Patient Care is Delivered.” 

 

How a space is used after occupancy is something the Guidelines cannot control. For example, a Class 2 imaging room may be built for cardiac catheterizations, in which a catheter is inserted into an artery or a vein in the groin, neck, or arm and threaded through blood vessels to the heart. Clinicians have indicated these procedures are safe to perform in a Class 2 imaging room; however, when a cardiac catheterization may result in surgery to close a hole in the heart or repair or replace a heart valve, balloon valvuloplasty, or another invasive procedure, clinicians recommend performing the surgical procedure in a Class 3 imaging room.

 

As the invasiveness of a procedure increases, so do the infection prevention requirements of the Guidelines. A room designed for one level of procedure but used for a more invasive procedure is not considered a safe environment for patients or staff. Thus, in the example above, a health care organization should assess how often their cardiac cath procedures turn into open heart surgery to determine how many Class 2 and Class 3 imaging rooms are needed.

 

 

 

FGI_determining_appropriate_room_type_2022-06-24

The application guidance below is part of a larger previously published application guidance (click on link at the bottom) titled “Applying the FGI Guidelines to Spaces Where Invasive vs. Noninvasive Patient Care is Delivered.” 

 

Continuous advancements in non-invasive medical procedures, coupled with the lengthy duration of most capital projects, can cause a health care organization to revise its clinical plans for a new facility before the facility is occupied. To mitigate any need for changes to the physical environment that may result from such operational changes, the recommended goal is to design rooms that can flex to accommodate procedure types a health care organization may want to perform in the future.

 

For example, an organization may plan to use newly designed rooms to address facility needs during a pandemic or other emergency condition that requires more stringent room controls. Building the cost of such rooms into a construction project is more cost-effective than retrofitting rooms for this purpose later.

 

 

FGI_determining_appropriate_room_type_2022-06-24

Clarifying application of requirements for hybrid operating rooms:

 

The 2022 edition of the Guidelines for Design and Construction of Hospitals states hybrid operating rooms are to meet the following:

 

• Manufacturer’s recommended clearances for installation, service, and maintenance
• Clearance of at least 5 feet (1.52 meters) on at least one designated patient transfer side of the patient table/bed/couch.
• Omission of these clearances are permitted in locations where small mobile ultrasound equipment or similar imaging devices will be used.
• Sized to accommodate the personnel and equipment planned to be in the room during procedures.
• Have a minimum clear floor area of 600 square feet (55.74 square meters) with a minimum clear dimension of 20 feet (6.10 meters).

 

(Where renovation work is undertaken and it is not possible to meet the above minimum standards, these rooms shall have a minimum clear floor area of 500 square feet (46.50 square meters) with a minimum clear dimension of 20 feet (6.10 meters).

 

• Fixed encroachments permitted to be included when determining the minimum clear floor area for an operating room as long as:
  • The encroachments do not extend more than 12 inches (30.5 centimeters) into the minimum clear floor area outside the sterile field.
  • The encroachment width along each wall does not exceed 10 percent of the length of that wall.

 

Questions about application of requirements for hybrid operating rooms may arise due to the clarity of the text below in the 2022 edition of the Guidelines for Design and Construction of Hospitals:

 

2.2-3.4.4.1 Application. Hybrid operating rooms, which are functionally equivalent to a Class 3 operating room, shall be designed to comply with the the requirements in Section 2.2-3.4.3 (Operating Rooms), except for Section 2.2-3.4.3.2 (1) (Space requirements—Operating room), and the requirements in Section 2.2-3.5 (Imaging Services) that apply to the imaging modality used in the hybrid operating room.

 

To reflect the intent of these requirements by the HGRC (Health Guidelines Revision Committee), the following clarification is offered:

 

2.2-3.4.4.1 Application. Hybrid operating rooms, which are functionally equivalent to a Class 3 operating room, shall be designed to comply with the following: a. Section 2.2-3.4.3 (Operating Rooms), except for Section 2.2-3.4.3.2 (1) (Space requirements—[Standard] operating room) b. The requirements in Section 2.2-3.5 (Imaging Services) that apply to the imaging modality used in the hybrid operating room

 

The word “Standard” has been added to 2.2-3.4.3.2 (1) as a point of clarification both in the cross-reference above and in the section head in 2.2-3.4.3.2 (1).

 

Clarifying the space requirements for hybrid operating rooms:

 

2.2-3.4.4.2 Space requirements. See Section 2.2-3.5.2.2 (Imaging Rooms—Space requirements) for requirements.

 

Because this section includes a cross-reference, which, in turn, has an additional cross-reference, the following application guidance has been provided to avoid the arduous process of tracking down requirements. Included in boxes below are each cross-referenced section.

 

*2.2-3.4.4.2 Space requirements. Hybrid operating rooms shall meet the requirements in the following sections.

 

(1) Section 2.2-3.5.2.2 (1)(a) (Clearances—All imaging rooms…)

 

(1) Clearances. Imaging rooms shall be sized and configured to provide the minimum clearances described here: (a) All imaging rooms (i) The manufacturer’s recommended clearances for installation, service, and maintenance shall be provided. (ii) A clearance of at least 5 feet (1.52 meters) shall be provided on at least one designated patient transfer side of the patient table/bed/couch. (iii) Omission of these clearances shall be permitted in locations where small mobile ultrasound equipment or similar imaging devices will be used.

 

(2) Section 2.2-3.4.3.2 (2) (Operating room for image-guided surgery…) 

 

*(2) Operating room for image-guided surgery using portable imaging equipment or surgical procedures that require additional personnel and/or large equipment A2.2-3.4.3.2 (2) Operating rooms for image-guided surgery or procedures requiring more space for personnel or equipment. Image-guided surgery occurs in rooms equipped with advanced audiovisual technology. Surgical procedures that may require additional personnel and/or large equipment include some cardiovascular, orthopedic, and neurological procedures. (a) An operating room of this type shall: (i) Be sized to accommodate the personnel and equipment planned to be in the room during procedures. (ii) Have a minimum clear floor area of 600 square feet (55.74 square meters) with a minimum clear dimension of 20 feet (6.10 meters). (b) Where renovation work is undertaken and it is not possible to meet the above minimum standards, these rooms shall have a minimum clear floor area of 500 square feet (46.50 square meters) with a minimum clear dimension of 20 feet (6.10 meters).

 

(3) Section 2.2-3.4.3.2 (3) (Fixed encroachments into the minimum clear floor area)

 

(3) Fixed encroachments into the minimum clear floor area. Fixed encroachments shall be permitted to be included when determining the minimum clear floor area for an operating room as long as: (a) The encroachments do not extend more than 12 inches (30.5 centimeters) into the minimum clear floor area outside the sterile field. (b) The encroachment width along each wall does not exceed 10 percent of the length of that wall.

In the 2022 edition of the Guidelines for Design and Construction of Hospitals, class 3 imaging rooms are to meet the following:

 

• Manufacturer’s recommended clearances for installation, service, and maintenance
• Clearance of at least 5 feet (1.52 meters) on at least one designated patient transfer side of the patient table/bed/couch.
• Omission of these clearances are permitted in locations where small mobile ultrasound equipment or similar imaging devices will be used.
• Sized to accommodate the personnel and equipment planned to be in the room during procedures.
• Have a minimum clear floor area of 600 square feet (55.74 square meters) with a minimum clear dimension of 20 feet (6.10 meters).

 

(Where renovation work is undertaken and it is not possible to meet the above minimum standards, these rooms shall have a minimum clear floor area of 500 square feet (46.50 square meters) with a minimum clear dimension of 20 feet (6.10 meters).

 

• Fixed encroachments permitted to be included when determining the minimum clear floor area for an operating room as long as:
  • The encroachments do not extend more than 12 inches (30.5 centimeters) into the minimum clear floor area outside the sterile field.
  • The encroachment width along each wall does not exceed 10 percent of the length of that wall.

 

The space requirements for Class 3 imaging rooms originate in the 2022 Hospital document here, in Section 2.2-3.5.2.1 (3):

 

The above, put simply, requires Class 3 imaging rooms to follow the requirements of either:

 

(a) Section 2.2-3.4.4 (Hybrid Operating Room), as Class 3 imaging rooms are functionally equivalent to a hybrid OR
or
(b) The applicable imaging modality and Section 2.2-3.4.3 (Operating Rooms), except for Section 2.2-3.4.3.2 (1) (Space requirements—[Standard] operating room).

 

To clarify the intent of the HGRC and avoid the arduous process of following several cross-references, the following application guidance is given for both of the above.

 

(a) Section 2.2-3.4.4 (Hybrid Operating Room), again noting Class 3 imaging rooms are functionally equivalent to a hybrid OR:

 

Section 2.2-3.4.4 (Hybrid Operating Room) … *2.2-3.4.4.2 Space requirements. See Section 2.2-3.5.2.2 (Imaging Rooms—Space requirements) for requirements. Hybrid operating rooms shall meet the requirements in the following sections:

 

(1) Section 2.2-3.5.2.2 (1)(a) (Clearances—All imaging rooms…)

 

(1) Clearances. Imaging rooms shall be sized and configured to provide the minimum clearances described here: (a) All imaging rooms (i) The manufacturer’s recommended clearances for installation, service, and maintenance shall be provided. (ii) A clearance of at least 5 feet (1.52 meters) shall be provided on at least one designated patient transfer side of the patient table/bed/couch. (iii) Omission of these clearances shall be permitted in locations where small mobile ultrasound equipment or similar imaging devices will be used.

 

(2) Section 2.2-3.4.3.2 (2) (Operating room for image-guided surgery…) 

 

*(2) Operating room for image-guided surgery using portable imaging equipment or surgical procedures that require additional personnel and/or large equipment A2.2-3.4.3.2 (2) Operating rooms for image-guided surgery or procedures requiring more space for personnel or equipment. Image-guided surgery occurs in rooms equipped with advanced audiovisual technology. Surgical procedures that may require additional personnel and/or large equipment include some cardiovascular, orthopedic, and neurological procedures. (a) An operating room of this type shall: (i) Be sized to accommodate the personnel and equipment planned to be in the room during procedures. (ii) Have a minimum clear floor area of 600 square feet (55.74 square meters) with a minimum clear dimension of 20 feet (6.10 meters). (b) Where renovation work is undertaken and it is not possible to meet the above minimum standards, these rooms shall have a minimum clear floor area of 500 square feet (46.50 square meters) with a minimum clear dimension of 20 feet (6.10 meters).

 

(3) Section 2.2-3.4.3.2 (3) (Fixed encroachments into the minimum clear floor area)

 

(3) Fixed encroachments into the minimum clear floor area. Fixed encroachments shall be permitted to be included when determining the minimum clear floor area for an operating room as long as: (a) The encroachments do not extend more than 12 inches (30.5 centimeters) into the minimum clear floor area outside the sterile field. (b) The encroachment width along each wall does not exceed 10 percent of the length of that wall.

 

or

 

(b) The applicable imaging modality and Section 2.2-3.4.3 (Operating Rooms), except for Section 2.2-3.4.3.2 (1) (Space requirements—[Standard] operating room)

 

Note: The word “Standard” has been added as a point of clarification; without it, the requirement reads as though Class 3 imaging rooms are exempt from space requirements: “…except for Section 2.2-3.4.3.2 (1) (Space requirements—operating room).”

 

2.2-3.4.3 Operating Rooms … *2.2-3.4.3.2 Space requirements … (1) [Standard] operating room [Does not apply to Class 3 imaging rooms] (a) Area. Each operating room shall have a minimum clear floor area of 400 square feet (37.20 square meters). (b) Clearances. The following minimum clearances shall be provided around the operating table, gurney, or procedural chair: (i) 8 feet 6 inches (2.59 meters) on each side (ii) 6 feet (1.83 meters) at the head. This dimension shall result in an anesthesia work zone with a clear floor area of 6 feet x 8 feet (1.83 meters x 2.4 meters). (iii) 7 feet (2.13 meters) at the foot (c) An operating room used for cesarean and other delivery procedures shall meet the requirements in Section 2.2-2.10.11.1 (Cesarean delivery room). [The following do apply to Class 3 imaging rooms]: *(2) Operating room for image-guided surgery using portable imaging equipment or surgical procedures that require additional personnel and/or large equipment A2.2-3.4.3.2 (2) Operating rooms for image-guided surgery or procedures requiring more space for personnel or equipment. Image-guided surgery occurs in rooms equipped with advanced audiovisual technology. Surgical procedures that may require additional personnel and/or large equipment include some cardiovascular, orthopedic, and neurological procedures. (a) An operating room of this type shall: (i) Be sized to accommodate the personnel and equipment planned to be in the room during procedures. (ii) Have a minimum clear floor area of 600 square feet (55.74 square meters) with a minimum clear dimension of 20 feet (6.10 meters). (b) Where renovation work is undertaken and it is not possible to meet the above minimum standards, these rooms shall have a minimum clear floor area of 500 square feet (46.50 square meters) with a minimum clear dimension of 20 feet (6.10 meters). (3) Fixed encroachments into the minimum clear floor area. Fixed encroachments shall be permitted to be included when determining the minimum clear floor area for an operating room as long as: (a) The encroachments do not extend more than 12 inches (30.5 centimeters) into the minimum clear floor area outside the sterile field. (b) The encroachment width along each wall does not exceed 10 percent of the length of that wall.

 

 

 

Yes, the clearance requirement cited in Section 2.14-3.2.2 of the 2022 Outpatient Guidelines is intended to be all the way around the dental chair, including at the foot. The 2022 edition removed the minimum 80 square feet required and now relies solely on the clearance requirement that also appeared in the 2018 edition.

 

The clearance is on “all sides” of the chair…this includes the foot of the chair.  This is measured from the reclined chair position.  This was a recommendation from the America Dental Association when we wrote this chapter and is there to be able to address patient rescue from any side in case of an emergency situation.