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Room Pressurization

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Establishing
Airborne infection isolation rooms (AIIR)
&
Protective Environments

(commonly referred to as negative pressure
& positive pressure isolation rooms)

Airborne infection isolation room (AIIR). Formerly, negative pressure isolation room, an AIIR is a single-occupancy patient-care room used to isolate persons with a suspected or confirmed airborne infectious disease. Environmental factors are controlled in AIIRs to minimize the transmission of infectious agents that are usually transmitted from person to person by droplet nuclei associated with coughing or aerosolization of contaminated fluids. AIIRs should provide negative pressure in the room (so that air flows under the door gap into the room); and an air flow rate of 6-12 ACH ( 6 ACH for existing structures, 12 ACH for new construction or renovation); and direct exhaust of air from the room to the outside of the building or recirculation of air through a HEPA filter before returning to circulation (MMWR 2005; 54 [RR-17]).

Protective Environment (PE). A specialized patient-care area, usually in a hospital, that has a positive air flow relative to the corridor (i.e., air flows from the room to the outside adjacent space). The combination of high-efficiency particulate air (HEPA) filtration, high numbers (>12) of air changes per hour (ACH), and minimal leakage of air into the room creates an environment that can safely accommodate patients with a severely compromised immune system (e.g., those who have received allogeneic hemopoietic stem-cell transplant [HSCT]) and decrease the risk of exposure to spores

produced by environmental fungi. Other components include use of scrubbable surfaces instead of materials such as upholstery or carpeting, cleaning to prevent dust accumulation, and prohibition of fresh flowers or potted plants.


Engineered specifications for positive and negative pressure rooms*
  Positive pressure areas (e.g., protective environments [PE]) Negative pressure areas (e.g., airborne infection isolation [AII])
Pressure differentials > +2.5 Pa§ (0.01water gauge) > -2.5 Pa (0.01 water gauge)
Air changes per hour (ACH) >12 >12 (for renovation or new construction)
Filtration efficiency

Supply: 99.97% @ 0.3 μm DOP¶
Return: none required**

Supply: 90% (dust spot test)
Return: 99.97% @ 0.3 μm DOP¶
^

Room airflow direction Out to the adjacent area In to the room
Clean-to-dirty airflow in room

Away from the patient (high-risk patient, immunosuppressed patient)

Towards the patient (airborne disease patient)

Ideal pressure differential > + 8 Pa > - 2.5 Pa

* From Table 6, full-text version, "Guidelines for Environmental Infection Control in Health-Care Facilities", U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, Published: 2003.   See original document at above link, for references.

§ Pa is the abbreviation for Pascal, a metric unit of measurement for pressure based on air velocity; 250 Pa equals 1.0 inch water gauge.

¶ DOP is the abbreviation for dioctylphthalate particles of 0.3 μm diameter.

** If the patient requires both PE and AII, return air should be HEPA-filtered or otherwise exhausted to the outside.

^ HEPA filtration of exhaust air from AII rooms should not be required, providing that the exhaust is properly located to prevent re-entry into the building.

Ventilation requirements for areas affecting patient care in hospitals and outpatient facilities

Further information:

  1. Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, CDC, June 2007
  2. Guidelines for Environmental Infection Control in Health-Care Facilities, 2003
  3. Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Facilities, 1994
  4. OSHA Safety and Health Topics, Healthcare Facilities
  5. Guidelines & Recommendations for Ventilation, Construction, and Renovation of Hospitals
  6. Isolation Rooms & Pressurization Control pictorials, Penn State University Architectural Engineering Indoor Environment Center

 

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