Isolation Unit Design Strategies for Complying with CDC PPE Guidelines

February 3, 2015  |  Kathy Clarke

Once an Ebola patient presents at the ED, they must proceed from triage or the EMS entry directly to an isolation room. We developed a range of solutions for converting or creating isolation space to comply with the October 20, 2014 CDC guidelines for PPE donning, doffing, and staff observation. Approaches vary from interim configurations with minimal facility impacts to long term solutions with dedicated space and additional square footage.

GUIDELINES SUMMARY
– Isolate patients: private room, toilet
– 1 way flow from clean to contaminated
– Donning must occur outside patient room
– Doffing: chair(s) + infectious waste containers
– Trained observer must watch all phases
– Shower after doffing PPE recommended

FIVE SOLUTIONS
When determining an appropriate level of facility intervention, hospitals in major metropolitan areas with an international airport may consider solutions 3, 4, or 5. Solutions 1 or 2 may suffice for rural and community-based hospitals or hospitals with a relatively low infection risk. Regardless of the approach, flexible dual use spaces can serve infectious patients now, and function differently as program needs evolve.

SOLUTION 1: Donn in Corridor, Doff in Ante Room
310 square feet
Estimated Construction Cost: $69,000 phased retrofit in occupied space, $55,000 new space
1Appropriate for emergency departments that have a very low risk for an Ebola occurrence, such as in community hospitals. This configuration requires an existing available ante room.

Pros:
– Doffing room can be used as an ante room in normal isolation use
– Minimal renovation

Cons:
– Sliding door complicates negative pressure when an ante room is not the primary entrance.
– Ebola incident flow is different from normal isolation flow.
– Must dedicate corridor space for PPE/cart, donning seating, and observer.

SOLUTION 2: Donn in Adjacent Room, Doff in Ante Room
475 square feet
Estimated Construction Cost: $78,000 phased retrofit in occupied space, $63,000 new space
2
Appropriate for emergency departments with a lower risk for an Ebola occurrence. This configuration requires staff to commandeer an additional treatment room for donning in the event of Ebola isolation.

Pros:
– Doffing room could be used as standard ante room when protocol is not activated

Cons:
– Lose a treatment room every time the protocol is activated
– Adjacent room door requires additional security measures during normal use
– Ebola incident flow is different from normal isolation flow.

SOLUTION 3: Donn in Dedicated Space, Doff in Staff Toilet
445 square feet
Estimated Construction Cost: $106,000 phased retrofit in occupied space, $87,000 new space
3

Appropriate when hospital infection control risk assessment (ICRA) indicates a higher Ebola risk and need for dedicated doffing space.

Pros:
– Maintains same flow regardless of doffing
– Toilet room provides doffing air buffer
– Available shower on doffing path in staff toilet
– Staff always enter ante room first, so flow and protocols remain consistent

Cons:
– Staff toilet becomes observation space and unavailable during Ebola isolation
– Dedicated doffing space is less flexible

SOLUTION 4: Donn in Ante Room, Doff in Decon Shower
555 square feet
Estimated Construction Cost: $142,000 phased retrofit in occupied space, $118,000 new space
4

Appropriate when the isolation space can be newly constructed as part of a 3-zone decontamination strategy.

Pros:
– Maintains same flow regardless of doffing
– Toilet room provides doffing air buffer
– Available shower on doffing path
– Patients can enter directly from outside rather than pass through waiting room

Cons:
– Most expensive option
– Not suited for renovation

SOLUTION 5: Donn in Ante Room, Doff in Staff Toilet
440 square feet
Estimated Construction Cost: $95,000 phased retrofit in occupied space, $78,000 new space
5

Appropriate when hospital infection control risk assessment (ICRA) indicates a higher Ebola risk but dual-natured spaces and flexibility are important during day-to-day use.

Download the complete guide to ED Isolation strategies here.

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