Tom Kennedy

The latest government data counts 26,000 COVID-19 deaths in long-term care facilities. That’s a staggering 25% of the total COVID-19 deaths in the U.S. Facility managers are working hard to stop the spread of this infectious disease through various strategies. As administrators explore their options to mitigate the risk of the virus spreading to their high-risk residents, creating isolation rooms is essential.

As we now know, COVID-19 is an aerosol respiratory disease that spreads through airborne particles. This dramatically increases the need for isolation rooms, not only to keep residents safe, but also to give family members and workers peace of mind that the facility is doing everything it possibly can to stop the spread of infection. This article will explore key considerations that long-term care administrators should be aware of when creating, or retrofitting, isolation rooms and working to protect residents and staff from COVID-19.

Design considerations for isolation rooms

Heating, ventilation and air conditioning (HVAC) can help control COVID-19 spread. When an infected resident coughs, sneezes, exhales or even talks, virus particles are released and can spread from person to person through the building. This could result in a loss of control over the virus and increased risk of spreading the infection. An isolation room is designed to get contaminated air out of the building instead of recirculating it.

To be effective, there must be a negative pressure differential inside an isolation room to ensure that the pressure in the room is lower than the surrounding areas. This prevents viruses or bacteria in the room from migrating through open doors or other openings. In many cases, isolation rooms are permanent rooms that were planned for when the facility was originally designed to accommodate these public health scenarios, but there are steps that long-term care facilities can take to quickly and effectively convert existing rooms into working isolation rooms.

Converting critical spaces

The gold standard for isolation rooms is the Airborne Infectious Isolation (AII) Room, which has direct exhaust, no air recirculation, negative pressure differential, and maintains a temperature of 70-75°F among other attributes. If a facility is being built from scratch, AII rooms are essential, but what can a long-term care facility do in the interim to retrofit an exisiting space to function closer to an AII room? First, you will need a fan powered high-efficiency particulate air (HEPA) unit and ducting, a room balancing monitor as well as tools that measure air pressure, temperature and humidity. Second, it is important to understand the isolation room conversion options that work best based on the facility and room layout.

In every instance, the key steps to create an effective isolation room are 1) disconnect or seal off the return air, 2) add a HEPA air filtration unit to exhaust the air and capture particles to ensure contaminated air particles do not re-enter the building and 3) monitor the air pressure both before a resident can use the room and continuously after a resident has moved in. Standards, such as those set by ASHRAE 170 and the Facility Guidelines Institute, say isolation rooms need to have a permanent visual/audible alarm to demonstrate compliance with The Joint Commision (TJC) and CMS inspections, among other governing bodies.

To ensure that the room is properly pressurized and keeping bad contaminants in — or out — a room pressure monitor, like a PresSura, can be installed to verify proper airflow and pressure both inside the room and outside, ensuring safety for residents and staff alike. Below are three common options and considerations for isolation room conversions:

  • Easiest solution — HEPA to outside: This solution requires the room to have a door and a window. Seal off the return air grill, add a HEPA filtered negative air pressure unit to the window in the resident room (similar to installing an in-window air conditioner), duct to outside and keep the door closed to maintain negative pressure inside the room.
  • No windows – HEPA to corridor: If you do not have a window, build a sealed anteroom/foyer outside of the room. The anteroom should be a minimum of 3’ x 6’ and be built around the entrance. In this instance, the HEPA unit should be placed inside of the anteroom, the door to the anteroom should remain closed and the door to the resident remains room open.
  • Multiple residents per room: Place a negative pressure HEPA unit in between every resident, add plastic curtains/sheeting, sealed from floor to ceiling and underneath the bed, to divide the room and essentially create separate rooms for each resident to force air movement above the beds. Keep the door to the resident room closed.

By creating proper isolation rooms long-term care facilities can show current residents, staff and prospects that they are taking science-based prevention measures to maintain a healthy facility and mitigate the spread of airborne infections like COVID-19. It is an essential component to include in every infection control strategy.

Thomas Kennedy is president of TSI Inc. He earned his Ph.D. in electrical engineering from the University of Illinois. Prior to leading TSI, Tom worked with medical companies such as GE Medical Systems and Camtronics, as well as GE Corporate Research. TSI is a leading provider of respirator fit testing instruments, room pressure monitors and controls, flow meters critical to the production and proper maintenance of ventilators, as well as filter testing equipment to ensure personal protect equipment is within the target range to filter out harmful particles. TSI has been in business more than 50 years and has offices around the globe.