Isolation facility in Hospital
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DR.SHARAD H. GAJURYAL
JUNIOR RESIDENT,MD(HA)
BPKIHS,NEPAL
ISOLATION FACILITY
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Background/History
• Contagious disease has challenged society throughout human history.
• In the 18th and 19th centuries, smallpox led to smallpox hospitals in some large urban communities. At the same time, citizens lived with the fear of outbreaks of typhus, typhoid fever, diphtheria, scarlet fever and influenza.
• The effectiveness of isolation was often limited due to the lack of knowledge of the cause and transmission of these infectious diseases
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The germ theory of infectious disease was formulated during the second half of the 19th century.
In the absence of specific treatment, isolation became the principle strategy to prevent the transmission of contagious disease.
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• The Ontario Public Health Act in 1884 provided for the expropriation of land for isolation hospitals and required separate facilities for smallpox.
• The Nickle Wing of the Kingston General Hospital, one of the earliest isolation facilities in Canada, served the community from 1892 until 1922.
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The introduction of public health defenses included improved sanitation and safe water to prevent cholera and typhoid fever;
Vaccines that lowered the incidence of smallpox, diphtheria, pertussis, tetanus, rubella, measles, mumps and polio;
And the discovery of antibiotics to treat specific infectious disease
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Extrapolating from these dramatic advances, many concluded that infectious disease could be prevented or easily managed. During the 20th century, the practice of isolation in hospital and the home declined.
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• In recent years, even developed countries have discovered that they remain painfully vulnerable to infectious disease.
• The re-emergence of antibiotic resistant organisms such as staph aureus, c. difficile, and tuberculosis particularly in the immune deficient contribute to nosocomial infections in hospitals, nursing homes and the community, while epidemics of cholera occur due to failure of sanitary conditions.
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• The emergence of mutations of the influenza virus leading to pandemics such as the SARS outbreak for which there is little or no specific treatment are annual concerns.
• These infections again require isolation in hospital and the community. The lessons learned in the 19th century are particularly relevant to these present day challenges
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In 1969, The Joint Commission on Accreditation of Health Care Organisation (JCHAO) recommended for the need of isolation facility and infection control committee in Hospitals.
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Documents issued for Guidance of Isolation
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Definition :- Isolation is the separation of a person or a group of person infected or believed to be infected with contagious disease to prevent spread of infection in hospital setting.
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• Types of Isolation :
• Source Isolation :AIIR ( Airborne Infection Isolation Room) or negative pressure room.
• Protective Isolation : Positive Pressure Room
*It is considered inadvisable to mix accomodation for patients requiring src isolation and protective isolation
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• Source Isolation ( Most frequent Type ;Negetive Pressure Room) – This type of isolation facility is used to prevent spread of infection from the patient to other patient and hospital Staffs .
• Patients with communicable disease who can pass infections to others via airborne droplets are isolated in this type of room. eg.:TB.SARS,H1N1
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Protective Isolation : (positive Pressure Room)- These type of isolation facility are meant to isolate profoundly immune -compromised patients, such as patient undergoing organ transplant, or oncology patient receiving chemotherapy, HIV, etc.
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Basic concept of Pressure
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Planning & Designing
1.Requirement of Isolation Facility
Influenced by the pattern of clinical work and type of specialist units
• 2.5% of total beds , • 10-20% of Total ICU beds in ICU (1 per 5 bed)• 1 per 30 beds/100 bedded Hospital
• 2. Area of Isolation Room – 22 Sq. m
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Source Isolation Room requirements :1.Negetive pressure maintained with or without ante room/
or bathroom.2. More than 12 Air change per hour3.Minimum leakage maximum 1 inch under the room door.4.Air should be exhausted to outside (No recirculation) or
must pass through HEPA filter in case of recirculation.5.Pressure sensor with alarm is recommended.6.Pressure difference equal or more than 2 pascal.With airlock ,degree of protection is about 10000 times that found
in an open situation
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The exhaust air should be drawn from low level exhaust duct approximately 150mm above the floor
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1- SMOKE TUBE TEST
2- TISSUE TEST A THIN STRIP OF TISSUE SHOULD BE HELD PARALLEL TO THE GAP BETWEEN THE FLOOR AND BOTTOM OF THE DOOR. THE DIRECTION OF THE TISSUE‘S MOVEMENT
WILL INDICATE THE DIRECTION OF AIR MOVEMENT.
3-MANOMETER
Verifying Negative Pressure
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Protective Isolation Room
1. Positive pressure room in relation to corridor with inside bathroom with
2. Pressure difference minimum 8 Pascal .3. > 12 ACH is required .4. Well sealed room.5. Supply air must pass through HEPA filter.6. Directed room airflow with air supply on
one side of the room that moves air across the patient bed and out through an exhaust on the opposite side of the room.
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Protective Isolation Room requirements
1. Positive pressure room in relation to corridor with inside bathroom with
2. Pressure difference minimum 8 Pascal .3. > 12 ACH is required .4. Well sealed room.5. Supply air must pass through HEPA filter.6. Directed room airflow with air supply on
one side of the room that moves air across the patient bed and out through an exhaust on the opposite side of the room.
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3. Other requirement : • Access to oxygen and compressed air ,• Ante room, • Wash room, • Disposable crockery and cultery items ,• Paper plastic Cups,• speaking panel/ glass partitions to avoid direct
contact with visitors
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Isolation cart
When a room used for isolation lacks the ante room or lock chamber,an isolation cart is used which is not taken inside the isolation room.
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Physiological Stress of isolation
• Many patients with complete isolation from any audible or visual indications of life outside impose great psychological stress.
• Occasionally elderly patient subjected to prolonged isolation have appeared to suffer from it .
• Children in isolation ward think they are being punished, they have been rejected or unworthy.
• It is desirable for nurses to spend extra time in room.• Mothers may also help to look after babies if
isolation procedures are shown to them.
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Hierarchy of Infection Prevention and Control Measures
PPE
Engineering Controls
Protects only the wearer
Elimination of Potential Exposures
Administrative Controls
Protects most
people
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Elimination of Potential Exposures
• Example: patients with mild influenza like illness stay home
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Engineering Controls
Physically separates the employee from the hazard
Does not require employee compliance to be effective
Examples:
Physical barriers at TriageAirborne infection isolation room for
patients with known or suspect airborne infectious diseases
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Administrative Controls/ Workplace Practices
Policies, procedures, and programs that minimize intensity or duration of exposure Examples:
signs on door of an airborne isolation room
triage, mask symptomatic patient provide tissues/ masks/hand sanitizer
to publicStandard procedures/ behaviors in caring
for patients e.g. hand hygiene, HCW vaccination
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Administrative aspect in management of epidemics and communicable disease
PPE should be readily availableAvaibility of appropriate medications and disposables and
life saving equipments has to be ensuredProper BMW disposal should be carried outIn case of exposure to staff,prophylaxis has to be provided
by institue.Information to the state authority to be provided about the
case.Media has to be provided relevent disease information and
update without creating panic
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Personal Protective Equipment
Lowest level of hierarchy - requires employee compliance for efficacy
Means higher elements of hierarchy fail to adequately protect employee
May involve use of gowns, gloves, eye/splash protection or respirators
Last line of defense
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Face Masks vs. N95 Respirators
Loose fitting, not designed to filter out small aerosols
Place on coughing patient (source control)
HCW should wear mask to protect patient during
certain procedures (e.g., surgery)
protect HCW droplet precautions Mask + goggles for
anticipated spray/splash
Tight fitting respirator, designed to filter the air
Protects the wearer
HCW should wear when concerned about transmission by airborne route
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THANK YOU FOR YOUR STERILE ATTENTION !