Air Change Requirements in Ambulatory Surgical Facility Operating Rooms

Where air quality standards are applied to surgery facilities, they are based on requirements of the applicable State Health Department — almost always in relation to licensed healthcare facilities. CMS itself does not reference any air quality standard for facilities that are only Medicare certified as ASCs. As a consequence, ASCs developed in States that do not mandate licensure prior to Medicare certification are not specifically subject to minimum air quality standards.

A majority of states that license ASCs use for their physical environment standard a document titled "GUIDELINES FOR DESIGN AND CONSTRUCTION OF HEALTH CARE FACILITIES," written and maintained by the Facilities Guidelines Institute with assistance from the U.S. Department of Health and Human Services. And when you look at requirements for states that license ASCs without reference to the GUIDELINES, you find very similar if not identical standards to those contained in it.

The past many versions of the GUIDELINES (a new one has been released every three to five years), culminating with the 2006 edition, contained a minimum air change requirement in all ASC operating rooms of 15 room air changes per hour. The 2010 edition of the GUIDELINES increases that minimum value to 20 room air changes in Class B and Class C operating rooms (operating rooms where sedation/anesthesia greater than local or topical is administered). Procedure rooms (Class A operating rooms limited to local or topical anesthesia) continue to require 15 room air changes per hour. The updated standards apply to new facilities, additions to existing facilities, and modifications to existing ventilation systems.

The 2010 GUIDELINES ventilation standards are also known as "ANSI/ASHRAE/ASHE Standard 170-2008, Ventilation of Health Care Facilities."

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