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2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings

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Table 5. Components of a Protective Enviroment

(Adapted from MMWR 2003; 52 [RR-10])

  1. Patients: allogeneic hematopoeitic stem cell transplant (HSCT) only
    • Maintain in PE room except for required diagnostic or therapeutic procedures that cannot be performed in the room, e.g. radiology, operating room
    • Respiratory protection e.g., N95 respirator, for the patient when leaving PE during periods of construction
  2. Standard and Expanded Precautions
    • Hand hygiene observed before and after patient contact
    • Gown, gloves, mask NOT required for HCWs or visitors for routine entry into the room
    • Use of gown, gloves, mask by HCWs and visitors according to Standard Precautions and as indicated for suspected or proven infections for which Transmission-Based Precautions are recommended
  3. Engineering
    • Central or point-of-use HEPA (99.97% efficiency) filters capable of removing particles 0.3 μm in diameter for supply (incoming) air
    • Well-sealed rooms
      • Proper construction of windows, doors, and intake and exhaust ports
      • Ceilings: smooth, free of fissures, open joints, crevices
      • Walls sealed above and below the ceiling
      • If leakage detected, locate source and make necessary repairs
    • Ventilation to maintain >12 ACH
    • Directed air flow: air supply and exhaust grills located so that clean, filtered air enters from one side of the room, flows across the patient's bed, exits on opposite side of the room
      • Positive room air pressure in relation to the corridor
    • Pressure differential of >2.5 Pa [0.01" water gauge]
    • Monitor and document results of air flow patterns daily using visual methods (e.g., flutter strips, smoke tubes) or a hand held pressure gauge
    • Self-closing door on all room exits
    • Maintain back-up ventilation equipment (e.g., portable units for fans or filters) for emergency provision of ventilation requirements for PE areas and take immediate steps to restore the fixed ventilation system
    • For patients who require both a PE and Airborne Infection Isolation, use an anteroom to ensure proper air balance relationships and provide independent exhaust of contaminated air to the outside or place a HEPA filter in the exhaust duct. If an anteroom is not available, place patient in an AIIR and use portable ventilation units, industrial-grade HEPA filters to enhance filtration of spores.
  4. Surfaces
    • Daily wet-dusting of horizontal surfaces using cloths moistened with EPA-registered hospital disinfectant/detergent
    • Avoid dusting methods that disperse dust
    • No carpeting in patient rooms or hallways
    • No upholstered furniture and furnishings
  5. Other
    • No flowers (fresh or dried) or potted plants in PE rooms or areas
    • Use vacuum cleaner equipped with HEPA filters when vacuum cleaning is necessary 133

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