Reducing the Risk of Airborne Infection Transmission: An Algorithm for Isolation Patient Placement in Times of Crisis

Introduction: Airborne Precautions aid in decreasing the risk of nosocomial spread of diseases spread by droplet nuclei. However, there is a lack of available and/or properly functioning negative pressure rooms in U.S. hospitals. Creating new rooms or retrofitting existing facilities is time-consuming and expensive. If a bioterrorism attack or naturally occurring outbreak of an infectious disease that is spread via airborne droplet nuclei occurred, many U.S. hospitals would quickly exceed their capacity to safely house infectious patients, increasing the risk of secondary exposure.

Methods: Alternative methods of achieving negative pressure were determined by a literature review. English language research articles in peer-reviewed journals, national organization publications, and book chapters that discuss methods of and provide empirical evidence related to airborne isolation and/or establishing negative air pressure for rooms/areas were utilized. From 86 titles and abstracts screened, 13 met the criteria; 8 additional references were identified using the snowball technique. Relevant data were analyzed and synthesized to generate a response algorithm that visually depicts the correct order of the steps that should be initiated to achieve maximum reduction of the secondary spread risk.

Results: A response algorithm was generated that depicts both ideal patient placement and the appropriate steps for creating temporary negative pressure or other protective environments for emergency situations in which the ideal cannot be met. Options and order of steps for providing partial protection against airborne contaminants, such as the use of in-duct or portable high-efficiency particulate air (HEPA) filtration units, are also delineated. All findings were summarized in a treatment algorithm that can be utilized by hospitals or other healthcare facilities to decrease the risk of secondary exposure until ideal patient placement can be arranged.

Discussion: The threat of bioterrorism and emerging infections increases the healthcare system's need for protective environments to prevent the transmission of nosocomial infections. This algorithm outlines appropriate response steps to decrease the risk of nosocomial transmission until an ideal protective environment can be obtained. Use of this algorithm should help prepare infection control professionals to better respond to a bioterrorism attack or outbreak of an infectious disease that is spread via the airborne droplet nuclei route by providing guidelines for proper patient placement.