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The Isolation Room

A negative pressure isolation room is intended for a patient that has active Tb, SARS, H1N1 (or any another disease transmitted by airborne means) and must be situated in a room that has a negative pressure atmosphere in relation to the area outside the room where the patient is residing.  With this in mind, we will discuss what an isolation room should be.  The data presented here is based on various CDC recommendations, current OSHA regulations (CPL 2.106) and JCAHO "Environment of Care" standards (EC 3.2.x).

MAS can act as a consultant for new construction or help design the renovation of an existing patient room into a infectious isolation room.  We can also perform a "turnkey" renovation.  Contact MAS for details.

Other areas of the healthcare institution may have negative pressure isolation rooms such as: Bronchoscopy, Autopsy, ICU, NICU, Maternity, the ER, etc.  These rooms must meet the same requirements as those utilized for negative pressure isolation.

NOTE: Text displayed in this color are excerpts from OSHA, CDC or JCAHO documents. 

(JCAHO documents will be rendered as to the intent of the standard being referenced.  Their written standards are copyrighted and may not be copied or reprinted here.)

By law, these institutions must institute a program to reduce the risk of infecting their workers with Tb:

This document will deal primarily with hospitals.  While all aspects of of the program will be discussed here, the emphasis will be on engineering controls.

The hierarchy of a program outlined in OSHA CPL 2.106 states that it shall consist of three parts that should be implemented in order.  Each part of the program is essential and must be addressed. 

Administrative Controls - The first level of the hierarchy, and that which affects the largest number of persons, is using administrative measures intended primarily to reduce the risk for exposing uninfected persons to persons who have infectious Tb.  These measures include a) developing and implementing effective written policies and protocols to ensure the rapid identification, isolation, diagnostic evaluation, and treatment of persons likely to have Tb; b) implementing effective work practices among HCWs in the health-care facility (e.g., correctly wearing respiratory protection and keeping doors to isolation rooms closed); c) educating, training, and counseling HCWs about Tb; and d) screening HCWs for Tb infection and disease.

Engineering Controls - These controls include a) direct source control using local exhaust ventilation, b) controlling direction of airflow to prevent contamination of air in areas adjacent to the infectious source, c) diluting and removing contaminated air via general ventilation, and d) air cleaning via air filtration or ultraviolet germicidal irradiation (UVGI).

Respiratory Protection - For areas in the health-care facility where exposure to infectious Tb may occur, and they reduce, but do not eliminate, the risk in those few areas where exposure to M. tuberculosis can still occur (e.g., rooms in which patients with known or suspected infectious Tb are being isolated and treatment rooms in which cough-inducing or aerosol-generating procedures are performed on such patients). Because persons entering such rooms may be exposed to M. tuberculosis, this third level of the hierarchy is the use of personal respiratory protective equipment in these and certain other situations in which the risk for infection with M. tuberculosis may be relatively higher.

The Administrative Controls (procedures, protocols and training) is the first item to address simply because it can be accomplished quickly with relatively little expense.  The CDC, OSHA, NIOSH and APIC all have documents that can assist in developing procedures and protocols and in instituting a training regimen.

The same applies to a Respiratory Protection program.  The training, testing and equipment can be in place quickly and is relatively inexpensive.

Providing Engineering Controls will usually involve capital expenditures and necessitate discussion between various medical and engineering personnel.  Much of this document will discuss the design of an isolation room for either new construction or renovation of an existing room.  This includes upgrading a standard patient room into a fully functional isolation room.

Administrative Controls

The basic Procedures and Protocols outlined here by the CDC (and incorporated into the OSHA standard) are sometimes site specific.  This is the general outline of an effective Tb administrative control program.

I. Assignment of responsibility

II. Risk assessment, Tb infection-control plan, and periodic reassessment

III. Identification, evaluation, and treatment of patients who have Tb

IV. Managing outpatients who have possible infectious Tb

V. Managing inpatients who have possible infectious Tb

Respiratory Protection

This is the third part of the program.  Most hospitals already have a program like this in place. 

Personal respiratory protection should be used by a) persons entering rooms in which patients with known or suspected infectious Tb are being isolated, b) persons present during cough-inducing or aerosol-generating procedures performed on such patients, and c) persons in other settings where administrative and engineering controls are not likely to protect them from inhaling infectious airborne droplet nuclei (Suppl. 4). These other settings include transporting patients who may have infectious Tb in emergency transport vehicles and providing urgent surgical or dental care to patients who may have infectious Tb before a determination has been made that the patient is noninfectious.

The complete document that describes a respirator program is 29 CFR Part 1910.134.

Engineering Controls

Engineering controls are the most costly of the three parts of the program.  It is also the most effective since it relies only on mechanical devices.  These devices, provided they are correctly maintained, are in operation and are not tampered with, do not 'forget', are not 'rushed' into situations where precautions are forgotten or ignored, and, they do not require 'training'. 

CPL 2.106 also defines other areas, other than infectious isolation rooms, where air quality is of particular concern in a hospital.  OSHA specifically mentions the following areas:

As of 1/1/03, JCAHO started enforcing these new EC standards adopted from the May, 2001, AIA (American Institute of Architects) update of hospital construction and renovation document.  All rooms designated as "critical" must be brought up to the new standard after major renovation of existing rooms and for all rooms in new construction.  This will be discussed on the next page, but, here is a list of rooms that are affected.

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