![Page 1: Best Practices in Protecting HCW from Exposure to SARS CoV-2](https://reader036.vdocuments.site/reader036/viewer/2022081623/6157d429ce5a9d02d46f8bb2/html5/thumbnails/1.jpg)
Best Practices in Protecting HCWs from Exposure to SARS
CoV-2 (or what to do when 135 negative
pressure rooms is not enough)April 15, 2020
![Page 2: Best Practices in Protecting HCW from Exposure to SARS CoV-2](https://reader036.vdocuments.site/reader036/viewer/2022081623/6157d429ce5a9d02d46f8bb2/html5/thumbnails/2.jpg)
Disclaimer
The findings, observations and recommendations presented here are those of the author and do not necessarily represent the views of the University of Maryland Medical Center.
2
![Page 3: Best Practices in Protecting HCW from Exposure to SARS CoV-2](https://reader036.vdocuments.site/reader036/viewer/2022081623/6157d429ce5a9d02d46f8bb2/html5/thumbnails/3.jpg)
Who we are
The University of Maryland Medical Center is a 789-bed academic medical
center located in the heart of Baltimore, MD. UMMC is the flagship of the 13
hospital UMMS
• MAGNET Designated
• Approximately 8,900 staff and 1,200 faculty members
• 29,316 admissions, 56,184 emergency/OBS visits, 319,529 outpatient visits,
18,024 outpatient surgeries (2018)
• Full range of services including trauma, heart and vascular care, NCICC
(cancer care), NeuroCare, women’s and children’s health, organ
transplantation and psychiatry.
• Partner with UMB Schools of Medicine, Nursing, Pharmacy, Dentistry,
Social Work, Law and Allied Health
3
![Page 4: Best Practices in Protecting HCW from Exposure to SARS CoV-2](https://reader036.vdocuments.site/reader036/viewer/2022081623/6157d429ce5a9d02d46f8bb2/html5/thumbnails/4.jpg)
Objectives
• Define what a negative pressure room is
• Discuss why negative pressure rooms should be considered for SARS CoV2
• Discuss how negative pressure rooms and wards could be implemented • Operational and Safety considerations
4
![Page 5: Best Practices in Protecting HCW from Exposure to SARS CoV-2](https://reader036.vdocuments.site/reader036/viewer/2022081623/6157d429ce5a9d02d46f8bb2/html5/thumbnails/5.jpg)
Negative pressure rooms – aka AirborneInfection Isolation Rooms (AIIRs)
Negative pressure rooms are rooms designed to prevent
airborne microorganisms in the room from entering hallways and
corridors
Design specifications
• Direction of airflow is into the room
• -0.01” water gauge (-2.5 Pa)
• >12 ach (for renovations and new construction)
• Directly exhausted to the outside (avoiding reentrainment) or HEPA
filtered if recirculated
• No anteroom is required (FGI)
5
![Page 6: Best Practices in Protecting HCW from Exposure to SARS CoV-2](https://reader036.vdocuments.site/reader036/viewer/2022081623/6157d429ce5a9d02d46f8bb2/html5/thumbnails/6.jpg)
CDC recommendations (or why do I need an AIIR?)
CDC no longer requires a negative pressure room (AIIR) for SARS CoV2 to save these rooms for aerosol generating procedures
• Understand the rationale - CDC is acknowledging that AIIRs are a finite commodity and may not be available to all settings
• SARS CoV2 patients are constantly generating aerosols – coughing, sneezing, talking, being suctioned (airway maintenance).
• SARS CoV2 is an airborne, contact, droplet spreader. CDC guidance has changed to recommend an N95 (if available) for all patient contact
• SARS CoV2 patients get in trouble quickly often necessitating emergent life sustaining interventions (i.e., intubation and ventilation) – intubation/extubation are among the most hazardous procedures from the aerosol generation perspective
Recommendation - Use of negative pressure rooms for SARS CoV2+ patients should be considered whenever possible.
6
![Page 7: Best Practices in Protecting HCW from Exposure to SARS CoV-2](https://reader036.vdocuments.site/reader036/viewer/2022081623/6157d429ce5a9d02d46f8bb2/html5/thumbnails/7.jpg)
How to implement negative pressure rooms and wards
Talk to your plant engineer to take advantage of existing building design features
Option 1 - utilize existing AIIRs
• Pros – Already operational
• Cons – Often occupied and/or in geographically disparate locations creating staffing & PPE burn rate issues; may not have anterooms
Option 1a – create AIIRs (and anteroom)
• Pros – can locate where needed (e.g., clustered)
• Cons – it’s not as easy as it looks
Option 2 – create negative pressure wards
• Pros – may be the most efficient use of resources
• Cons – staff are in the hot zone for prolonged periods of time
Option 3 – use non-negative pressure options
7
![Page 8: Best Practices in Protecting HCW from Exposure to SARS CoV-2](https://reader036.vdocuments.site/reader036/viewer/2022081623/6157d429ce5a9d02d46f8bb2/html5/thumbnails/8.jpg)
Option 1a - DIY AIIR Left photo – use of a hospital grade HEPA Machine. Right photo – use of an industrial air scrubber unit
Considerations – noise, patient safety
8
![Page 9: Best Practices in Protecting HCW from Exposure to SARS CoV-2](https://reader036.vdocuments.site/reader036/viewer/2022081623/6157d429ce5a9d02d46f8bb2/html5/thumbnails/9.jpg)
Considerations
• Barriers can be rigid or flexible. If you use poly, use FR poly • Windows are desirable for observation
• Doors – make sure they’re wide enough for beds. Hard doors are more durable than zipper doors
• Need a cleaning plan for zipper doors • Reinforce zippers = consider mechanical fasteners
• Consider pressure monitoring (flexible barriers are obvious, rigid walls are not)
• Exhausting through a window? Make sure it is safe
• Fans should be tamper proof
• Fire and patient safety plan - ILSM
9
![Page 10: Best Practices in Protecting HCW from Exposure to SARS CoV-2](https://reader036.vdocuments.site/reader036/viewer/2022081623/6157d429ce5a9d02d46f8bb2/html5/thumbnails/10.jpg)
.,e...... · f L 0 EST. 1e1'
COVID-19 RESPONSE
Types of containment
10
![Page 11: Best Practices in Protecting HCW from Exposure to SARS CoV-2](https://reader036.vdocuments.site/reader036/viewer/2022081623/6157d429ce5a9d02d46f8bb2/html5/thumbnails/11.jpg)
Example of a Negative Pressure Ward
N13W is a 15-bed, acute care medicine unit. In the pandemic plan, N13W converts to a 27-bed negative pressure capable, acute care unit
• 2 existing AIIRs
• North Building was designed with once–through air (air is not recirculated). Exhausted air is discharged vertically via two high velocity stacks away from air intakes
• Created a negative pressure capable zone with a poly barrier on back corridor and an anteroom using existing smoke door and new hard all door.
• Negative pressure is created by adjusting exhaust off of floor >> supply. Pressure is monitored by magnahelic gauge and BAS
11
![Page 12: Best Practices in Protecting HCW from Exposure to SARS CoV-2](https://reader036.vdocuments.site/reader036/viewer/2022081623/6157d429ce5a9d02d46f8bb2/html5/thumbnails/12.jpg)
~ Ill
ZONE N13-01 EXISTING HEAL TH CARE
COMPLETE SPRINKLER PROTECTION 12386 SQFT
COVID-19
~ CJ-'<~--··,--: . ..,,
: ··-··~ : STAIR N2
~ 0
r ;~~.
- F·
ZONE N13-02 EXISTING HEALTH CARE
COMPLETE SPRINKLER PROTECTION 1174250 FT
RESPONSE 12
![Page 13: Best Practices in Protecting HCW from Exposure to SARS CoV-2](https://reader036.vdocuments.site/reader036/viewer/2022081623/6157d429ce5a9d02d46f8bb2/html5/thumbnails/13.jpg)
COVID-19 RESPONSE
IV pumps located out of room
13
![Page 14: Best Practices in Protecting HCW from Exposure to SARS CoV-2](https://reader036.vdocuments.site/reader036/viewer/2022081623/6157d429ce5a9d02d46f8bb2/html5/thumbnails/14.jpg)
COVID-19 RESPONSE
Vent monitoring
14
![Page 15: Best Practices in Protecting HCW from Exposure to SARS CoV-2](https://reader036.vdocuments.site/reader036/viewer/2022081623/6157d429ce5a9d02d46f8bb2/html5/thumbnails/15.jpg)
~· ....• -c-- .·::: _ ::r-,.. .. .. ~.~.--.~~. . ---a.~ - .:;:.i 'TU,; - .. ·--="- =-•• ••• =p_._~:::-_~.~ • &: ..,,. ..... ~
1- ~ •·;:· :-;-. :-=r
COVID-19 RESPONSE
Remote monitoring
15
![Page 16: Best Practices in Protecting HCW from Exposure to SARS CoV-2](https://reader036.vdocuments.site/reader036/viewer/2022081623/6157d429ce5a9d02d46f8bb2/html5/thumbnails/16.jpg)
Your Questions
Questions?
16
![Page 17: Best Practices in Protecting HCW from Exposure to SARS CoV-2](https://reader036.vdocuments.site/reader036/viewer/2022081623/6157d429ce5a9d02d46f8bb2/html5/thumbnails/17.jpg)
COVID-19 RESPONSE
Remember - Social distancing and hand hygiene
17