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Isolation facility in Hospital


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Isolation facility- Introduction/ History/background and planning and designing

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Isolation facility in Hospital

  2. 2. 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
  3. 3. 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.
  4. 4. • 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.
  5. 5. 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
  6. 6. 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.
  7. 7. • 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.
  8. 8. • 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
  9. 9. 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.
  10. 10. Documents issued for Guidance of Isolation
  11. 11. 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.
  12. 12. • 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
  13. 13. • 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
  14. 14. 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.
  15. 15. Basic concept of Pressure
  16. 16. 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
  17. 17. Source Isolation Room requirements : 1.Negetive pressure maintained with or without ante room/ or bathroom. 2. More than 12 Air change per hour 3.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
  18. 18. - + - - - -
  19. 19. The exhaust air should be drawn from low level exhaust duct approximately 150mm above the floor
  21. 21. 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.
  22. 22. 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.
  23. 23. 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
  24. 24. 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.
  25. 25. 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.
  26. 26. Hierarchy of Infection Prevention and Control Measures PPE Engineering Controls Protects only the wearer Elimination of Potential Exposures Administrative Controls Protects most people
  27. 27. Elimination of Potential Exposures • Example: patients with mild influenza like illness stay home
  28. 28. Engineering Controls Physically separates the employee from the hazard Does not require employee compliance to be effective Examples: Physical barriers at Triage Airborne infection isolation room for patients with known or suspect airborne infectious diseases
  29. 29. 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 public Standard procedures/ behaviors in caring for patients e.g. hand hygiene, HCW vaccination
  30. 30. Administrative aspect in management of epidemics and communicable disease PPE should be readily available Avaibility of appropriate medications and disposables and life saving equipments has to be ensured Proper BMW disposal should be carried out In 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
  31. 31. 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
  32. 32. 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