Health

Isolation Room Maintenance: Best Practices for Hygiene and Safety

December 11, 2023
SAHIL BATRA
Table of contents

Isolation rooms are among the frontline healthcare facilities in the event of an outbreak, whether the disease is well-known or new. Holding dozens of patients and the necessary equipment, these wards curb the spread of the illness to a localized area. They form the core of any disease control strategy, let alone a decisive health response.

Given their roles, these rooms should be one of, if not, the cleanest in a brick-and-mortar or field hospital. A patient who comes in sick and leaves healthy but carrying the pathogen that got them in there defeats the purpose of controlling the infection. Consider the following best practices to ensure isolation rooms keep working as intended:

Check air pressure levels

Air pressure is a core mechanic of isolation rooms and can be negative or positive. Differences in the pressure levels between the room and the outside environment keep pathogens from escaping containment every time the door opens.

A negative pressure isolation room (also called a Class N isolation room) has a lower air pressure than outside, preventing bacteria and viruses from leaking. Instead, they’re expelled through the ventilation system. High-efficiency particulate absorption (HEPA) filters capture particulates and pathogens in incoming air with a posted 99.97% efficiency.  

Meanwhile, a positive pressure isolation room (also called a Class P isolation room) is the polar opposite, with the room’s pressure being higher than outside. In this case, it stops the pathogens from entering the area, which is ideal for holding immunocompromised patients.

Pressure checks should be performed at least every month. The most basic method is the smoke or tissue test, where a smoke trail or tissue is squeezed into the gap below the door. The direction of the blow indicates that the room has adequate pressure. However, this test shouldn’t be relied upon for monitoring the levels, lest risk over-pressurizing the isolation room.

Certain hardware, like pressure sensors and monitoring suites, allows medical workers to observe levels in real-time. Quick reaction to imbalances is crucial, especially in emergencies, and in this case, it’s adjusting the rate of incoming and outgoing air. Other measures include checking doors and windows for leakage and inspecting air exchangers for problems.

Disinfect surfaces regularly

Despite being synonymous, quarantine and isolation have a world of difference between them—and the latter is the more serious scenario. Isolated patients have already tested positive for the disease in question and must be kept away from others for the time being to mitigate its spread.

This fact makes isolation rooms high-risk areas in a fixed or mobile hospital setting. Without a proper cleaning and disinfection plan, people entering and leaving the room can inadvertently allow a pathogen to escape into open country. Hence, medical staff must deal with bacteria or viruses within the confines by making their surroundings as adverse for proliferation as possible.

Even as HEPA filters and other state-of-the-art systems pull their weight, surface cleaning is still the most effective. Not only does it kill harmful microorganisms on the spot, but it also deprives those remaining of what they need to survive and thrive. Therefore, a spotless isolation room is the best way of curbing the spread of most diseases.

That said, an active isolation room can be home to various pathogens, many exhibiting resistances to disinfectants or drugs. As such, cleaning should be done with utmost emphasis on caution. The Centers for Disease Control and Prevention (CDC) advises adopting the following best practices:

  • Wear personal protective equipment (PPE) when disinfecting isolation rooms and dispose of it afterward. If possible, allocate a stock of PPE sets exclusively for such a task.
  • If bringing a cart for cleaning, only bring necessary cleaning equipment and supplies to the isolation room. Leave the cart outside to minimize exposure.
  • Save isolation rooms for last on the cleaning checklist to limit the spread of infection.
  • Set schedules for how often to clean each type of surface. Ideally, it should be once or twice daily (for high-touch surfaces) and after the patient’s discharge or transfer.

The CDC also published further guidelines for eradicating specific pathogens, namely those that can develop into outbreaks. Examples include Ebola, CRE-CRAB-CRPsA, and C. difficile.

Conduct thorough HVAC cleaning

Maintaining a functional heating, ventilation, and air conditioning (HVAC) system is equally important for several reasons, not the least of which involves infection control. As mentioned previously, negative pressure isolation rooms expel pathogens with stale indoor air through the ventilation.

However, harmful matter builds up along the entire system with each use. Studies have linked local outbreaks of drug-resistant bacteria in hospitals to inadequate HVAC maintenance. Similar situations have also occurred outside medical facilities, with the most notable example being the Legionnaire’s disease outbreak of 1976.

Isolation rooms pose a slightly lower risk of infection, as guidelines prohibit recirculating indoor air. Though not strictly required, some setups include HEPA filters along the exhaust path. That said, the more components an HVAC system has, the more important routine maintenance is.

Experts stress that complete HVAC maintenance should be performed at least once a year. This includes swapping out ineffective HEPA filters, cleaning the ventilation network, and repairing visible and recently uncovered damage.

Conclusion

The healthcare system must always be prepared to respond to health threats. As a facility on the frontline in an outbreak, isolation rooms must be working as intended when one occurs. These maintenance practices may cost a lot, but you can’t put a price on something that countless lives depend on.