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GUIDING PRINCIPLES Maintain a high degree of suspicion for those patients who present with compatible symptoms of an airborne infection, prompt implementation of airborne precautions and rapid diagnosis. 3.2. For the purpose of this guideline, the term Airborne Isolation Room will be used to refer to a “negative pressure room”. An Airborne Isolation Room must have: · Ventilation creating inward directional airflow from adjacent spaces to the room (‘negative pressure’) that is regularly monitored. · Direct exhaust of air from the room to the outside of the building or recirculation of air through a HEPA filter before returning to circulation. · Twelve (12) air changes per hour. · The door into the room kept closed to maintain negative pressure, even if the patient is not in the room. · Windows closed at all times; opening the window may cause reversal of air flow, an effect that can vary according to wind direction and indoor/outdoor temperature differentials. All healthcare providers in high risk areas must be fit tested for an N95 respirator. REFER TO AV 1900 RESPIRATORY PROTECTION PROGRAM POLICY (NOT AVAILABLE TO NON IH FACILITIES. Only immune healthcare providers should enter a room where airborne precautions are in place for measles or varicella; an N95 respirator is not required. An N95 respirator must be worn if non-immune health care providers are required to enter the room of a patient with measles or varicella when there are no qualified immune health care providers available and patient safety would be compromised if they did not provide care. A point of care risk assessment for every patient interaction needs to be done to determine additional precautions, room placement and PPE: DEFINITIONS Airborne Precautions – measures used for diseases that are spread by airborne transmission. This primarily occurs through dissemination of microorganisms by aerosolization. Organisms are contained in droplet nuclei which are small airborne particles, less than 5 microns in size that result from evaporation of large droplets. Organisms can also be contained in debris in dust particles that remain suspended in the air for long periods of time. These microorganisms are then widely dispersed by air currents and can be inhaled by susceptible hosts who may be some distance away from the source patient. Control of airborne transmission is the most difficult, as it requires control of air flow through special ventilation systems and use of respirators. Conditions/clinical presentations and specific etiologies requiring airborne precautions: Conditions/clinical presentation Specific etiologies * Cough, fever, pulmonary infiltrate in person at risk for TB (pleuropulmonary or laryngeal TB) Rash, maculopapular with fever and one of coryza, conjunctivitis or cough Rash, vesicular with fever * * * * * Measles (rubeola) Monkeypox Tuberculosis (pleuropulmonary or laryngeal) ■ nonpulmonary lesions, during procedures that may aerosolize tuberculi bacilli Smallpox Varicella zoster virus ■ varicella (chicken pox) ■ zoster, disseminated ■ zoster in immunocompromised patient