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WARD ISOLATION SUITEBASIC CONCEPTS and
RESEARCH PROGRAMME
Malcolm ThomasConsulting Engineer
01132 582788March 2006
DHDH EstatesEstates & & FacilitiesFacilities 2
Isolation – Fact and FictionIsolation is required!When admitted, patients condition unknownLevels of protection:-1. A closed door2. Universal nursing precautions3. Medication4. VentilationComplicated systems are unreliableStaff change; knowledge is lost
DHDH EstatesEstates & & FacilitiesFacilities 3
Single room
Corridor
Doorway
Extract fan
(Optional)
WC
(Optional)
E
Bed
View panel
Window
DHDH EstatesEstates & & FacilitiesFacilities 4
Negative pressure isolation room with lobby
CorridorBed door
WC
Lobby
E
Staff door
E
E
S
Bed
View panel
DHDH EstatesEstates & & FacilitiesFacilities 5
Negative pressure isolation room with lobby
CorridorBed door
WC
Lobby
E
Staff door
E
E
S
Bed
View panel
DHDH EstatesEstates & & FacilitiesFacilities 6
Switchable airflow isolation room with lobby
CorridorBed door
WC
Lobby
S
E
Staff door
S
E
E
Bed
View panelNot Recommended!
DHDH EstatesEstates & & FacilitiesFacilities 7
Summary of current UK situation
Many different types of room installed
“On site” staff knowledge poorNursingEstates and Facilities
Many rooms modifiedDo not work as intendedChange of use
DHDH EstatesEstates & & FacilitiesFacilities 8
Types of Isolation RoomsPositive pressure room• Transplant units / ChemotherapyNegative pressure room• Infectious diseases unitsSwitchable room (Positive / Negative)• Wards / ITU / HDU
Neutral pressure room with Ventilated lobby• New concept• Universal application?
DHDH EstatesEstates & & FacilitiesFacilities 9
Isolation room, en suite and ventilated lobby
CorridorAccess door
En suite
Lobby
E
S
Transfergrille
Pressurestabiliser
Bed
View panel
Locked / Sealed window
DHDH EstatesEstates & & FacilitiesFacilities 10
Isolation room, en suite and ventilated lobby (Schematic of alternative layout)
Bed door
En suite
Lobby
E
Staff door
S
Transfergrille
Pressurestabiliser
Bed
View panel
Locked / Sealed window and Solid ceiling
DHDH EstatesEstates & & FacilitiesFacilities 11
CorridorBed door
En suite
Lobby
E
Staff door
S
Transfergrille
Pressurestabiliser
Bed
View panel
Locked / Sealed window
Neutral10 ac/h
-ve; Min 10ac/h
+ve 10Pa
and Solid ceiling
Isolation room – Pressure and flow regime
DHDH EstatesEstates & & FacilitiesFacilities 12
Corridor
En suite
Lobby
E
Staff door
S
Transfergrille
Pressurestabiliser
View panel
Isolation room, en suite and ventilated lobby
+ve
-ve
Neutral
DHDH EstatesEstates & & FacilitiesFacilities 13
Nominal Ventilation Parameters
Lobby:- Pressure to corridor 10 PascalsSupply air flow 208 - 238L/sAir change rate 63 - 69 per hour
Isolation room:- Pressure to corridor Nominally ZeroRoom air flow 158L/sAir change rate 10 per hour
En suite:- Pressure to room NegativeExtract air flow 45 - 158L/sAir change rate min 10 per hour
DHDH EstatesEstates & & FacilitiesFacilities 14
How robust is the concept?
What is the consequence of failure?Is the patient safe?Are the staff safe?
1. Extract fails; Supply maintained2. Supply fails; Extract maintained3. Both supply and extract fail
DHDH EstatesEstates & & FacilitiesFacilities 15
Corridor
En suite
Lobby
E
Staff door
S
Transfergrille
Pressurestabiliser
View panel
Isolation room, en suite and ventilated lobby
+ve
-ve
Neutral E
S
EE
DHDH EstatesEstates & & FacilitiesFacilities 16
HBN 4; Supplement 1Isolation facilities in acute settings
DHDH EstatesEstates & & FacilitiesFacilities 17
Isolation Suite Design
Historical perspective
Conclusions following outbreaks / incidentsLaboratory experimentsSmall scale modelsLidwells particle distribution work (KI discus)
The need for a more scientific approach!
DHDH EstatesEstates & & FacilitiesFacilities 18
NHS Estates / Department of HealthIsolation Suite Research Project
Research contract awarded to the Building Services Research & Information Association (BSRIA) Bracknell
Full size isolation suite constructed• Side room with Lobby and En suite
Test programme partners recruited• Frimley Park Hospital - Doors, Lights, Furniture• APRECO – Pressure stabilisers• GRADA – Air terminals and Transfer grilles
DHDH EstatesEstates & & FacilitiesFacilities 19
New build ward isolation roomSuggested design – HBN 4; Supp 1.
DHDH EstatesEstates & & FacilitiesFacilities 20
DH Isolation room research projectTest Programme
Air velocity and flow measurement• Velocity, Temperature, Noise
Flow visualisation using smoke• Gross air direction• Point air direction
Dilution control using tracer gas• Nitrous oxide and “sniffer” array around doors
Computed Fluid Dynamic Modelling (CFD)• Model to be calibrated to match the “real” data!
DHDH EstatesEstates & & FacilitiesFacilities 21
CFD Prediction of supply air jet
DHDH EstatesEstates & & FacilitiesFacilities 22
Physical measurement of supply air jet
DHDH EstatesEstates & & FacilitiesFacilities 23
DH Isolation room Research ProjectProgramme
Check the practicality of constructionTest the commissioning protocolProve the neutral pressure room conceptDefine the ventilation performanceOpen days for feedback and outside opinionDetermine the level of protection offeredExperiment to find the design limitsQuestion:- Is this a truly universal solution?
Thank You
Malcolm Thomas01132 582788