DR.SHARAD H. GAJURYAL

JUNIOR RESIDENT,MD(HA)

BPKIHS,NEPAL

ISOLATION FACILITY

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

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.

• 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.

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

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.

• 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.

• 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

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.

Documents issued for Guidance of Isolation

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.

• 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

• 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

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.

Basic concept of Pressure

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

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

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

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.

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.

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

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.

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.

Hierarchy of Infection Prevention and Control Measures

PPE

Engineering Controls

Protects only the wearer

Elimination of Potential Exposures

Administrative Controls

Protects most

people

Elimination of Potential Exposures

• Example: patients with mild influenza like illness stay home

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

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

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

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

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

THANK YOU FOR YOUR STERILE ATTENTION !