Airborne Infectious Disease Management Methods for Temporary Negative Pressure Isolation Minnesota Department of Health Office of Emergency Preparedness Healthcare Systems Preparedness Program Airborne Infectious Disease Management Methods for Temporary Negative Pressure Isolation This guide has been produced by: Office of Emergency Preparedness Healthcare Systems Preparedness Program Acknowledgements This user guide has been written by The authors gratefully acknowledge the the Minnesota Department of Health Minnesota Emergency Readiness in conjunction with the University of Education and Training (MERET) at the Minnesota to assist hospital personnel University of Minnesota Centers for in the management of airborne Public Health Education and Outreach infection isolation. and the following individuals for their participation, assistance, and support AUTHORS: of this project: Airborne Infectious Jeanne Anderson Keith Carlson Infection Control Practitioner Director of Facilities Management Disease Management Office of Emergency Preparedness Mercy Hospital and Health Care Center Methods for Temporary Minnesota Department of Health Moose Lake, MN Negative Pressure Isolation Andrew Geeslin Gary Davis Engineering/Infection Control Intern Plant Engineer University of Minnesota LakeWood Health Center Baudette, MN Andrew Streifel Pete Swanson Hospital Environmental Health Specialist Facility Services Manager Environmental Health and Safety Pipestone County Medical Center University of Minnesota Pipestone, MN For further Information, please contact: Office of Emergency Preparedness Minnesota Department of Health The following individuals are gratefully 625 Robert Street North Minnesota Department of Health acknowledged for their invaluable P.O. Box 64975 does not endorse particular brands among suggestions: St. Paul, MN 55164-0975 competing products. Examples shown Judene Bartley in these materials are for illustration only. Vice President Phone: (651) 201-5701 Epidemiology Consulting Services Inc. Fax: (651) 201-5720 All material in this document is in the public Beverly Hills, MI domain and may be used and reprinted Rick Hermans without special permission. This user guide is available on the Senior Project Manager Minnesota Department of Health Web site: Center for Energy and Environment http://www.health.state.mn.us/oep/training/ Minneapolis, MN bhpp/isolation.html Curtain TNPI photographs courtesy of Ken Meade, Research Mechanical Engineer, NIOSH/CDC, USPHS MERET photos provided by Paul Bernhardt AIRBORNE INFECTIOUS DISEASE MANAGEMENT • PREPARED BY THE MINNESOTA DEPARTMENT OF HEALTH References Appendix Surge Portable TNPI Environmental Principles of airborne Introduction 1 capacity anteroom Temporary Negative controls infectious disease Pressure Isolation management 37 20 16 13 5 3 2 Hospital preparedness for to other patients and health care bioterrorism and other public health workers.4 Heating, ventilation, emergencies such as emerging airborne and air conditioning (HVAC) Introduction infectious diseases requires strategic expertise is essential for proper planning to ensure that all components environmental management when of respiratory protection programs, planning control of airborne infectious including environmental controls, disease outbreaks (natural or are in place for airborne infection intentional). Design manuals and isolation rooms (AIIRs). Hospitals guidelines provide direction for have insufficient facilities to provide infectious disease management.5-11 airborne infection isolation for large Refer to Appendix A, “2006 AIA numbers of patients with airborne Criteria” on page 21. infectious diseases presenting in This guide will assist health care facility 1, 2 a short time period. However, AIIRs plant maintenance and engineering have been increased recently, due to staff, in coordination with infection requirements of National Bioterrorism control professionals, to prepare for 3 Hospital Preparedness Program. a natural or terroristic event, involving an infectious agent transmitted by Without adequate environmental airborne droplet nuclei. Examples controls, patients with airborne of such agents include measles, infectious diseases will pose a risk varicella, and tuberculosis.5 Audience for this Guide Purpose of this Guide Goal of this Guide The intended audience for this I Provide guidance on environmental A timely response is crucial for guideline includes health care: controls for airborne infectious identification and containment I facility engineering and maintenance disease management of potentially infectious patients. The goal is for facilities to develop I infection control I Provide a general guide for a 12-hour response to implement I environmental health and safety temporary setup, installation, containment measures. Temporary I management personnel negative pressure isolation methods and operation of portable HEPA are a safe alternative for hospitals machines when used to create that lack engineered AIIRs. negative pressure in a hospital These can be utilized in facilities to room/area meet increased surge capacity for patient isolation. TNPI should also I Provide instruction on the use of: be used during hospital construction Pressure gauges projects to reduce risks associated Particle counters with airborne infectious diseases. I Outline of preventative These temporary measures should maintenance schedule for be incorporated into the facility’s HVAC equipment related to AIIR infection control and emergency response plans. L AIRBORNE INFECTIOUS DISEASE MANAGEMENT • PREPARED BY THE MINNESOTA DEPARTMENT OF HEALTH References Appendix Surge Portable TNPI Environmental Principles Introduction 2 capacity anteroom Temporary Negative controls of airborne Pressure Isolation infectious disease 37 20 16 13 5 3 management 1 Airborne infection isolation is based on the following hierarchy of control measures. Principles of Administrative (work practice) controls airborne infectious Environmental controls disease management Personal protective equipment (PPE) These measures are intended to reduce the risk for exposure to airborne infectious disease agents by uninfected persons. AIIRs and hospital systems in general must be monitored to provide continual protective measures. Refer to Appendixes B and C, AIIR and HVAC System Maintenance Schedules, on pages 22 and 23. Administrative Environmental Personal (work practice) controls controls protective equipment (PPE) I Managerial measures that reduce I Physical or mechanical measures I Equipment worn by health care the risk for exposure to persons (as opposed to administrative workers and others to reduce who might have an airborne control measures) used to reduce exposure to communicable infectious disease. the risk for transmission of airborne diseases. I Work practice controls include infectious diseases. using infection control precautions while performing aerosol-generating procedures, closing doors to AIIRs, hand hygiene, and signage. EXAMPLES EXAMPLES EXAMPLES written policies and ventilation gowns protocols to ensure filtration gloves the rapid identification, ultraviolet germicidal masks isolation, diagnostic irradiation evaluation, and respirators treatment of persons AIIRs eye protection likely to have an local exhaust airborne infectious ventilation devices disease AIRBORNE INFECTIOUS DISEASE MANAGEMENT • PREPARED BY THE MINNESOTA DEPARTMENT OF HEALTH References Appendix Surge Portable TNPI Environmental Principles of airborne Introduction 3 capacity anteroom Temporary Negative controls infectious disease Pressure Isolation management 37 20 16 13 5 2 1 ••• A difference in pressure causes movement of air from areas at higher pressure to those at lower This user guide will focus on the pressure. The greater the pressure environmental controls necessary difference, the greater the resulting Environmental for airborne infection isolation. air velocity. The movement of air is controls The ventilation parameters essential used to help provide containment of for airborne infection isolation infectious particles by providing clean rooms/areas include: to dirty airflow. Refer to Appendix D, “Using a Pressure Gauge to I Pressure management for Measure Relative Pressurization appropriate airflow direction; Between Two Spaces” on page 24 for instructions on using a pressure I Room air changes for gauge to determine differential dilution ventilation; and pressure. • Filtration to remove •• The differential pressure or infectious particles. pressure offset is established by mechanically adjusting the supply and exhaust air. For a negative pressure room, the sum of the mechanically exhausted air must Pressure management exceed the sum of the mechanically supplied air. This offset forces air to enter the room under the door and For the purposes of this guide, through other leakages and prevents L pressure refers to the differential infectious particles from escaping.9 NEGATIVELY pressure between two spaces PRESSURIZED (FIGURE 1). ••• In order to maintain consistent offset airflow, the difference between In health care settings, the two spaces exhaust and supply should create are typically the isolation room and the a pressure differential of about corridor. For AIIR, the room should 0.01 inch water gauge (in. w.g.) be negatively pressurized in relation or 2.5 Pascals (Pa).9 Pressure in to the corridor. This helps to prevent this application is used to induce H infectious particles from escaping the POSITIVELY airflow from adjacent spaces into PRESSURIZED room envelope.