2018 Revision Cycle

Public Comment Period

The public comment period for the 2018 FGI Guidelines has closed. The 2018 Health Guidelines Revision Committee will review the comments and vote on them and further develop the content between January and April 2017. The full HGRC will vote on the final manuscript next summer, and publication of the new documents is planned for November 2017.

Background on the 2018 Revision Cycle

For the 2018 revision cycle, FGI has undertaken several efforts to dig deeper into the content of the Guidelines.

First, the Health Guidelines Revision Committee (HGRC) was asked to identify any non-baseline Guidelines text. To support this effort, FGI funded a research project to look for evidence supporting existing Guidelines content and to suggest requirements that may go beyond the fundamentals needed for design of a safe, effective, and efficient environment of care.

The concept is not to remove all appendix language as much of that is information needed to help users of the documents apply Guidelines requirements to specific projects. How to publish any requirements determined to be beyond fundamental is still under consideration.

Second, a Cost/Benefit Committee has again been formed to review the potential costs and benefits associated with all proposed changes to the FGI Guidelines text. For the 2018 revision cycle, those submitting proposals were required to fill out a cost/benefit matrix to communicate their take on the costs and benefits of each proposal; an optional cost/benefit comment box was also provided.

The Cost/Benefit Committee members are reviewing all the proposals and adding their determination of the costs and benefits associated with them for consideration by the HGRC.

Third, as part of the study mentioned above, FGI undertook an assessment of the evidence that supports the current requirements. The research team has identified four types of evidence:

Rational understanding/experience: The requirements supported by this kind of evidence are practical, common sense items everyone can agree on, such as a paved road leading to an emergency department entrance.

Clinical practice, policy, or guidelines: This category includes physical environment features needed to support clinical practice and a safe environment for the provision of care. An example is the CDC guidelines for hand hygiene.

Direct evidence: This type of evidence demonstrates a direct association between a requirement and a patient or staff outcome. For example, the requirement for an airborne infection isolation room to be a single-patient room is supported by documentation showing that airborne transmission of pathogens to other patients and to staff is reduced when patients with airborne infections are isolated.

Indirect evidence: Indirect evidence shows an association between a design requirement and an outcome that does not directly affected a patient or staff outcome but can be inferred to affect that outcome. An example is air change rates for exam rooms. The current requirement is for six air changes per hour, which reduces the number of airborne particulates in the room and has been shown to provide a safe environment. However, a direct correlation has not been shown between this number of air changes and reduced infection rates for staff or patients.

Proposers were asked to provide any evidence they might have to support their proposals. In addition, FGI is interested in receiving published papers, case studies, or letters detailing field evidence that validate Guidelines requirements at any time. We look forward to hearing from you!

As a physician, being involved with FGI and the Guidelines revision process allows me to make an impact on the design of health care facilities that will help patients and staff for the lifespan of their buildings, which may be 40 years or more.
Arthur St. André, MD, FCCM, MedStar Washington Hospital Center

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