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Evaluation of Rooms with Negative Pressure Ventilation Used for Respiratory Isolation in Seven Midwestern Hospitals

Published online by Cambridge University Press:  21 June 2016

Victoria J. Fraser*
Affiliation:
Division of Infectious Disease, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
Krista Johnson
Affiliation:
Division of Infectious Disease, Department of Medicine, Washington University School of Medicine, St Louis, Missouri Barnes Hospital, St. Louis, Missouri
Jonathan Primack
Affiliation:
Division of Infectious Disease, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
Marilyn Jones
Affiliation:
Division of Infectious Disease, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
Gerald Medoff
Affiliation:
Division of Infectious Disease, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
W.C. Dunagan
Affiliation:
Division of Infectious Disease, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
*
Box 8051, Infectious Disease Division, Washington University School of Medicine, 660 S. Euclid, St. Louis, MO 63110

Abstract

Objective:

To determine the number and efficacy of respiratory isolation facilities in St. Louis hospitals and to assess the mechanisms in place for evaluating function of hospital ventilation systems.

Design:

A prospective multi-hospital surveillance study using direct observation and a standardized questionnaire.

Setting:

Seven hospitals (including university-affiliated large teaching, private community, private teaching, and private nonteaching adult hospitals, and one pediatric teaching hospital) in St. Louis, Missouri.

Measurements:

Actual direction of airflow in rooms designated for respiratory isolation was measured using smokesticks. Hospital demographic information, respiratory isolation policies, and frequency of ventilation tests were provided by infection control personnel.

Results:

One hundred twenty-one (3.4%) of 3,574 hospital rooms were designed to have negative pressure ventilation suitable for respiratory isolation. The percentage of isolation rooms in each institution ranged from 0.4% (92 of 486) to 93% (39 of 42). Only three (43%) of seven hospitals had intensive care respiratory isolation rooms, and none had isolation rooms in the emergency department. No hospital had tested routinely the efficacy of the negative pressure ventilation, and two (28%) of seven had tested airflow for the first time in the past year.

We tested 115 (95%) of 121 isolation rooms. With the doors closed, 52 (45%) of 115 designated negative pressure rooms actually had positive airflow to the corridor. The number of negative pressure rooms and the presence or absence of anterooms did not predict correct direction of airflow. There was a significant difference among hospitals in the percentage of designated isolation rooms that had truly negative pressure (P<0.0001). Hospital age, size, and type corre-latedwith correct direction of airflow (R<.0001).

Conclusion:

In the hospitals studied, only a small number of rooms were designated for respiratory isolation, and the performance of these was not tested routinely. High-risk areas including intensive care units and emergency rooms were not equipped to provide respiratory isolation. The direction of airflow in respiratory isolation rooms was not always correct and should be evaluated frequently. (Infect Control Hosp Epidemiol 1993;14:623-628.)

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1993 

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