Components of a Protective Environment

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

Appendix A: Table 5.

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


I. 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

 Top of Page

II. 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

 Top of Page

III. 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.

 Top of Page

IV. 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

 Top of Page

V. 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

 Top of Page