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Design, Assessment, and Upgrade FRANCIS J. CURRY NATIONAL TUBERCULOSIS CENTERThe Francis J. Curry National Tuberculosis Center is a joint project of the San Francisco Department of Public Health and the University of California, San Francisco, funded by the Centers for Disease Control and Prevention. Institutional Consultation Services is also partially funded by the California Department of Health Services. All material in this document is in the public domain and may be used and reprinted without special permission; citation as to source, however, is appreciated.
Contents Page 1
1. Introduction2. What Does Engineering Have to Do with Infection Control? The Basics 4. Designing a New State-of-the-Art Isolation Room 5. Assessing an Existing Isolation Room
6. Upgrading or Converting an Existing Room
Appendices Resources, Acknowledgements and Abbreviations A Institutional Consultation ServicesInstitutional Consultation Services (ICS), a component of the Francis J. Curry National Tuberculosis Center, is funded by the Centers for Disease Control and Prevention (CDC) and the California Department of Health Services (CDHS). ICS staff have expertise and practical experience in infection control, occupational health, and mechanical engineering. Telephone and on-site consultations are provided to tuberculosis (TB) control staff of high-risk institutions, including healthcare facilities, correctional facilities, and shelters. B Background of the Isolation Room GuidelineDuring 1997 and 1998, ICS provided 24 on-site consultations to: 7 acute care hospital emergency departments, 14 public health clinics, and 3 community clinics. These consultations included evaluations of engineering control measures in rooms used to isolate or segregate known or suspected infectious TB patients. Consultations also included interviews with facility TB control personnel to determine their knowledge and skills regarding critical aspects of isolation room engineering controls. C Key Findings from On-Site ConsultationsDeficiencies in isolation room engineering controls identified by ICS were due primarily to a lack of available information and included the following observations:
D Identified Facility NeedsA consistent need was identified among facility TB control personnel for additional information about engineering control measures, in general, and their use in isolation rooms, in particular. The need for information and guidance pertaining to isolation room engineering controls in the following areas was compelling:
1 IntroductionA properly designed and operating isolation room can be an effective infection control measure. Infectious airborne particles are contained within the room, and the concentration of these particles inside the room is reduced. However, a badly designed and/or incorrectly operating isolation room can place health-care workers and other patients at risk for TB infection and disease. In this situation, infectious particles may not be contained in the room, and/or their concentration inside the room may not be effectively reduced. Staff who rely on such an isolation room may have a false sense of security. The mechanical elements that make an isolation room effective will deteriorate over time, which may make the controls ineffective. For example, fans can break and ducts can become clogged with dust and lint. People who have not been trained in engineering controls may inadvertently adjust or alter the controls. An isolation room that was successfully tested after construction may not be operating correctly a month later. Hence, periodic and ongoing assessment of negative pressure isolation rooms is important. This guideline provides basic information about assessing and improving the design and operation of a negative pressure isolation room. It also includes options to convert an existing patient room into a negative pressure isolation room and information on guidelines and regulations covering isolation room engineering controls. In this guideline, the term "engineering controls" refers to the use of engineering concepts to help prevent the spread of infection. TB control in high-risk settings is commonly organized in a hierarch y: administrative (or work practice) controls are the most important, followed by engineering controls and then respiratory protection. Although this guideline only addresses engineering controls, all three components should be in place for an effective TB control program.Whenever an isolation room is used, written policies and procedures should be developed and implemented to address the administrative aspects of the isolation room. They should include: criteria for initiating and discontinuing isolation; who has authority for initiating and discontinuing isolation; isolation practices; and how often and by whom the policy and procedure is evaluated. Development and implementation of a written respiratory protection program is also required.It is hoped that this document will prove useful to people responsible for engineering controls in health-care facilities. The target audience includes management, infection control, environmental health and safety, facilities management, and engineering staff in hospitals and clinics.
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