Appendix A: Table 5. Components of a Protective Environment

(Adapted from MMWR 2003; 52 [RR-10])

 

I. Patients: allogeneic hematopoeitic stem cell transplant (HSCT) only

• Maintain in PE room except for required diagnostic or therapeutic procedures that cannot be performed in the room, e.g., radiology, operating room
• Respiratory protection e.g., N95 respirator, for the patient when leaving PE during periods of construction

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II. Standard and Expanded Precautions

• Hand hygiene observed before and after patient contact
• Gown, gloves, mask NOT required for HCWs or visitors for routine entry into the room
• Use of gown, gloves, mask by HCWs and visitors according to Standard Precautions and as indicated for suspected or proven infections for which Transmission-Based Precautions are recommended

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III. Engineering

• Central or point-of-use HEPA (99.97% efficiency) filters capable of removing particles 0.3 μm in diameter for supply (incoming) air
• Well-sealed rooms
  • Proper construction of windows, doors, and intake and exhaust ports
  • Ceilings: smooth, free of fissures, open joints, crevices
  • Walls sealed above and below the ceiling
  • If leakage detected, locate source and make necessary repairs
• Ventilation to maintain ≥12 ACH
• Directed air flow: air supply and exhaust grills located so that clean, filtered air enters from one side of the room, flows across the patient’s bed, exits on opposite side of the room
• Positive room air pressure in relation to the corridor
  • Pressure differential of >2.5 Pa [0.01” water gauge]
• Monitor and document results of air flow patterns daily using visual methods (e.g., flutter strips, smoke tubes) or a hand held pressure gauge
• Self-closing door on all room exits
• Maintain back-up ventilation equipment (e.g., portable units for fans or filters) for emergency provision of ventilation requirements for PE areas and take immediate steps to restore the fixed ventilation system
• For patients who require both a PE and Airborne Infection Isolation, use an anteroom to ensure proper air balance relationships and provide independent exhaust of contaminated air to the outside or place a HEPA filter in the exhaust duct. If an anteroom is not available, place patient in an AIIR and use portable ventilation units, industrial-grade HEPA filters to enhance filtration of spores.

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IV. Surfaces

• Daily wet-dusting of horizontal surfaces using cloths moistened with EPA-registered hospital disinfectant/detergent
• Avoid dusting methods that disperse dust
• No carpeting in patient rooms or hallways
• No upholstered furniture and furnishings

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V. Other

• No flowers (fresh or dried) or potted plants in PE rooms or areas
• Use vacuum cleaner equipped with HEPA filters when vacuum cleaning is necessary

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