Guidelines for Design and Construction of Health Care Facilities

The Guidelines for Design and Construction of Health Care Facilities is referenced by architects, engineers, and health care professionals throughout the United States and in other countries who are planning new or renovated health care facility construction. Authorities in 42 states, the Joint Commission for the Accreditation of Healthcare Organizations, and several federal agencies use the Guidelines as a reference, code, or standard when reviewing construction designs and plans and completed health care facilities.

The Guidelines are updated on a four-year cycle by the multidisciplinary Health Guidelines Revision Committee (HGRC). Individuals knowledgeable about health care practices and health care facility design (doctors, nurses, facility managers, architects, and engineers) and those who apply the document in the field (state and federal authorities having jurisdiction, or AHJs) serve on the committee. (AHJs reviewing and approving plans and construction for health facilities are often architects or engineers.)

The Guidelines revision process involves two opportunities for public comment. During a proposal period, anyone can submit a proposal to change language in the Guidelines. The HGRC considers these proposals and develops a draft manuscript. This draft is then posted for public comment, and anyone can comment on the proposed changes. From its review of these comments, the HGRC develops the manuscript for the next edition of the Guidelines.

The 2006 edition
The 2006 edition has been completely reorganized and renumbered to make it easier to find material in the document. A relocation matrix for users of earlier editions can be found in the back of the book.

New content and major revisions that appear in the 2006 edition are summarized below:

     Part 1—General (applicable to all health care facilities)

• Expansion of the environment of care chapter, including detailed functional program requirements and an appendix on green design
• New material on infection control risk assessments (ICRAs) and infection control risk mitigation recommendations
• A chapter on common requirements for all health care facility types

     Part 2—Hospitals

• Single-bed rooms as the minimum standard for medical/surgical and postpartum nursing units in general hospitals
• Revised bed clearances and new bedside documentation areas in critical care units
• New sections on intermediate care units in general hospitals, observation units in emergency departments, freestanding emergency facilities, and in-hospital skilled nursing units
• Revised text for decontamination areas and appendix language on surge capacity in emergency departments
• Revised section on in-hospital psychiatric nursing units
• New chapter on small inpatient primary care hospitals

     Part 3—Ambulatory Care Facilities

• A chapter of common elements for outpatient facilities
• Revised chapters on freestanding surgical facilities, birthing centers, and primary care outpatient facilities
• New chapters on urgent care facilities, office surgical facilities, gastrointestinal endoscopy facilities, renal dialysis centers, and psychiatric outpatient centers

     Part 4—Other Health Care Facilities

• Revised chapter on nursing facilities
• Completely new chapters on assisted living, hospice, and adult day health care facilities

Questions may be addressed to healthcareguidelines@aia.org. The Facility Guidelines Institute has a Web page at www.fgi-guidelines.org.

How to reference the 2006 edition
The reorganization of the Guidelines is accompanied by a new numbering system, which places the chapter number at the top of the page and paragraph numbers in the text. Thus, each paragraph reference must include both the chapter number (followed by a hyphen) and the paragraph number. For instance, the reference to typical patient rooms in a hospital medical/surgical unit in Chapter 2.1, General Hospitals, is 2.1-3.1.1.

To make the document easy to read, it was decided not to include full-length paragraph references in the text itself. Therefore, full references appear only in cross-references and in the index. The one exception is a matrix at the back of the book that was developed for Guidelines users accustomed to the previous numbering system. This matrix lists paragraph numbers in the 2001 edition and their corresponding complete paragraph references in the 2006 edition.

Bottom line: The paragraph numbers in the text of the 2006 edition often appear in multiple chapters. Therefore, users must provide complete paragraph references (chapter number [hyphen] paragraph number, such as 2.1-3.1.1) to adequately reference the new edition.

Errata sheet for 2006 edition
Errors found in the 2006 edition are corrected in the next printing. To determine which printing you have, please refer to the copyright page in the 2006 edition (facing the dedication page). The last line on the copyright page of the first printing begins “Printed in the United States . . . .”  After the first printing, there are lines listing the different printings and their dates.

Periodic updates are made to the errata sheet. Please refer to the date on the sheet to determine if you have the most current copy (June 5, 2007).

Errata sheet for the first printing (June 2006)

Errata sheet for the second printing (November 2006)

SINGLE-BED ROOM RESEARCH
To review research on "The Use of Single Patient Rooms versus Multiple Occupancy Rooms in Acute Care Environments" carried out by Simon Fraser University, Vancouver, BC, Canada, and sponsored by the Facility Guidelines Institute, please use the PDFs posted below. 

• Cover Letter from Researchers 
• Executive Summary 
• Review and Analysis of the Literature 
• Pilot Study on Comparative Assessment of Patient Care Issues in Single and Multiple Occupancy Patient Rooms 
• Comparative First Cost Assessment of Single and Multiple Occupancy Patient Rooms 
•  Appendix A—Literature Review (charts) 
•  Appendix B—Literature Review (annotations) 
•  Appendix C—Bibliography 
•  Appendix D—Nursing Unit Floor Plans 
•  Appendix E—Preliminary Comparative Cost Study

INTERPRETATIONS
Users of the Guidelines occasionally have questions about a portion of the document. The Facility Guidelines Institute, with funding from the American Society for Healthcare Engineering (ASHE), offers a formal interpretation process to address substantive questions about the content of the Guidelines. Nonetheless, it is important to remember that the ultimate interpretation of information contained in the Guidelines is the responsibility of the state or federal authority having jurisdiction.

Click on the following links for more information.

• Rules for requesting a formal interpretation (PDF)
• Form for requesting an interpretation (PDF)
• Formal interpretations (PDF)

WHERE TO FIND EARLIER EDITIONS OF THE GUIDELINES
Since 1987, the Guidelines have been published by the American Institute of Architects with assistance from the U.S. Department of Health and Human Services. Copies of the 1987, 1992–93, and 1996–97 editions are available in non-searchable PDF form. Click the titles below to access these PDFs. PLEASE NOTE: You cannot open these very large PDFs from the AIA Web site; you must right-click the link and save the PDF to your computer.

Guidelines for Construction and Equipment of Hospital and Medical Facilities, 1987 edition

Guidelines for Construction and Equipment of Hospital and Medical Facilities, 1992–93 edition

Guidelines for Design and Construction of Hospital and Health Care Facilities, 1996–97 edition

The 2001 edition of the Guidelines for Design and Construction of Hospital and Health Care Facilities is still available for purchase from the AIA bookstore.  

Prior to 1987, the Guidelines were published by the Department of Health and Human Services (formerly the Department of Health, Education, and Welfare). An earlier title was Minimum Requirements of Construction and Equipment for Medical Facilities.

Government publications are available through your local Federal Depository Library, usually located in a public or university library. The document numbers for the last four federal versions of the Guidelines/Minimum Requirements are:

Guidelines for Construction and Equipment of Hospital and Medical Facilities, 1983/1984 Edition
DHHS Publication No. (HRS-M-HF) 84-1

Minimum Requirements of Construction and Equipment for Hospital and Medical Facilities
DHEW Publication No. (HRA) 81-14500

Minimum Requirements of Construction and Equipment for Hospital and Medical Facilities
DHEW Publication No. (HRA) 79-14500

Minimum Requirements of Construction and Equipment for Hospital and Medical Facilities
DHEW Publication No. (HRA) 76-4000