Guidelines for the classification and design of isolation rooms in health care facilities

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Summary

In many health care facilities, patients with known or suspected infectious diseases are physically isolated from other patients. These guidelines aim to provide standards for new and renovated isolation rooms in health care facilities across Victoria, and are designed as a reference document for engineers, architects and infection control personnel.

The Clinical Epidemiology & Health Service Evaluation Unit at The Royal Melbourne Hospital undertook a review and analysis of national and international standards for isolation facilities for hospitals and provided recommendations to the Department of Human Services. These guidelines have been revised to include the recommendations from this review.

Section 2 introduces a classification system, based on function, for isolation rooms:

• Class S (standard pressure): Class S rooms are for isolating patients capable of transmitting infection by contact or droplet routes.
• Class N (negative pressure): Class N rooms are for isolating patients capable of transmitting infection by airborne droplet nuclei.
• Class P (positive pressure): Class P rooms may be used to isolate immuno-compromised patients.
• Class A (alternating pressures): Class A rooms are not recommended and will not be considered in this document.

Section 5 provides guidelines for the design, construction, and maintenance of new and renovated hospital isolation facilities. The key recommendations are:

• twelve air changes per hour or 145 litres per second per patient, whichever provides the greater air flow rate;
• an anteroom associated with Class N rooms;
• differential pressure gauges outside the room and a local alarm system to monitor fan status;
• low-level exhausts;
• provision of clinical handbasins;
• good sealing of the room;
• independent supply air on negative pressure rooms;
• independent exhaust on negative pressure rooms;
• exhausts under negative pressure within the building; and,
• minimum maintenance requirements.

These guidelines form part of the Department of Human Services Victorian Guidelines for Hospitals and Day Procedure Centres (Part D – Infection Control, 830 Isolation Rooms), and can be found at: www.healthdesign.com.au/vic.dghdp/guidelines.htm. These guidelines can also be used to review, classify and benchmark existing isolation facilities.

Contents

Executive Summary

• Introduction
• • 2 Classification of isolation rooms
  • 2.1 Class S—Standard pressure room
  • 2.2 Class N—Negative pressure room
  • 2.3 Class P—Positive pressure room
  • 2.4 Class A—Alternating pressure (negative/positive pressure)
• 3 Isolation room checklist
• 4 Number of isolation rooms required
  • 4.1 General principles
  • 4.2 Class S rooms
  • 4.3 Class N rooms
  • 4.4 Class P rooms
• 5 Design recommendations and general principles of isolation space control
  • 5.1 Performance-based approach
  • 5.2 Pressure gradients
  • 5.3 Air filter efficiencies
  • 5.4 Supply air and exhaust duct design
  • 5.5 Ventilation design
  • 5.6 Air change rates
  • 5.7 Building exhaust discharge location
  • 5.8 Monitoring of room pressure
  • 5.9 Methods of varying room pressure
  • 5.10 Minimum outdoor air requirements
  • 5.11 Minimising room air leaks
  • 5.12 Isolation room interiors
  • 5.13 Signs and labels
  • 5.14 Doors
  • 5.15 Communication system
  • 5.16 Patient comfort and safety
  • 5.17 Energy conservation
  • 5.18 Plant back-up systems
  • 5.19 Renovating or converting a room
  • 5.20 Commissioning
  • 5.21 Patient transport
  • 5.22 Routine performance monitoring and maintenance
  • 5.23 Renovation, construction, remediation, repair and demolition: Infection control risk assessment
• 6 An introduction to general principles of microbial transmission
• • 6.1 Contact transmission
  • 6.2 Droplet transmission
  • 6.3 Airborne transmission
  • 6.4 Common vehicle transmission
  • 6.5 Vector-borne transmission
  • 6.6 Functional classification of isolation room
• References
• Glossary

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 Guidelines for the classification and design of isolation rooms in health care facilities - Victorian Advisory Committee on Infection Control 2007 (207kb, pdf)

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