Temporarily converting positive pressure rooms to negative pressure rooms, when the need arises, poses practical difficulties and has been explored too. It is recommended to turn off the positive pressure system in the operating theatre, if possible, with concern lying primarily in the potential for contamination of any adjacent areas including intermediary anterooms, setup rooms and pre-anaesthetic areas. These AGP are routinely encountered peri-operatively. AGP can result in higher airborne viral loads than under usual conditions. The benefits of reduced surgical infection to the patient, when operating in a positive pressure theatre complex, need to be balanced against the counter requirements of negative pressure rooms when considering staff safety against airborne pathogen exposure. However, operating theatres are conventionally equipped with positive pressure rooms. This is similar to the recommendations by health governance across Australia.Īs the requirement for respiratory isolation is considered ongoing and perennial, acute care areas such as the intensive care unit and the emergency department are conventionally equipped with a minimum of one Class N room. The Australian Health Facility Guidelines of 2016 state that patients with airborne transmitted infections should not be accommodated in Class P isolation. The Class A (alternating pressure isolation) rooms are no longer recommended due to the high risk of safety breaches. The European Society of Intensive Care Medicine recommends that all AGP on COVID-19 patients are to be performed in negative pressure rooms. If these are not available, Class S rooms (standard room air pressure) would be the next best option. The positive pressure air handling system within the room operates at a higher pressure (+30 Pa), with respect to adjacent rooms or spaces, and the air supply is filtered using high-efficiency particulate air (HEPA) filters.ĪNZICS recommends treating COVID-19 patients ideally in a class N room. The intent is to reduce the risk of airborne transmission of infection to a susceptible patient. Positive pressure (Class P) rooms are used in operating theatres. The risk of utilising these rooms for patients other than those with infectious conditions is that when the negative air pressure is turned off, it may compromise the integrity of the mandatory mechanics required for infection prevention and control. The requirement of a negative pressure room is an air handling system that operates at a lower pressure with respect to adjacent areas, with air exhausted appropriately to prevent air recirculation. Negative pressure isolation rooms (Class N) are used to care for patients who require airborne droplet nuclei isolation. It determines the kind of isolation precautions possible in each room. Typically, patient care areas can be classified into four basic types based on the pressure differential across the room. It is imperative to keep regular standardised checks and maintenance as needed to ensure that the isolation room serves the purpose of construction. Engineering controls allow the control of the quality and quantity of supply and exhaust air, control of the pressure differentials across adjoining areas, and control of the dilution of infectious particles by increasing the air changes per hour and designing patterns of airflow for particular clinical purposes. The aim of environmental control in an isolation room is to control the airflow, thereby reducing the number of airborne infectious particles that may infect others within the environment. Administrative controls and PPE measures are adjuncts to the above central measure. Engineering controls, by isolating people from the hazard at the source, scores the highest in the list of priorities to sustain staff protection. Neither elimination nor substitution would work with the current hazard in question. Although PPE is the least effective and elimination is the most effective method of protection, substitution, engineering controls, and administrative controls provide an intermediate level of hazard control. The hierarchy includes five strategies starting from PPE and moving through administrative control, engineering control, substitution, and elimination. The Australian and New Zealand Intensive Care Society (ANZICS) outlines a hierarchy of hazard controls in terms of the efficacy of exposure prevention, which is the fundamental method of protecting health care workers. NEGATIVE PRESSURE ROOM AND RESPIRATORY ISOLATION
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