Appendix D3: Guidelines for Evaluating Homes and Facilities for Isolation and Quarantine

Supplement D: Community Containment Measures, Including Non-Hospital Isolation and Quarantine

Public Health Guidance for Community-Level Preparedness and Response to Severe Acute Respiratory Syndrome (SARS) Version 2/3

I. Isolation Facilities

A. Home isolation

Ideally, persons who meet the criteria for a confirmed or probable case of SARS-CoV disease or a SARS RUI (see MMWR 52(49):1202-1206) and who do not require hospitalization for medical reasons should be isolated in their homes. The home environment is less disruptive to the patient’s routine than isolation in a hospital or other community setting.

Any home being considered as an isolation setting should be evaluated by the patient’s physician, health department official, or other appropriate person to verify its suitability. The assessment should center on the following minimum standards for home isolation of a SARS patient:

Infrastructure

Functioning telephone
Electricity
Heat source
Potable water
Bathroom with commode and sink
Waste and sewage disposal (septic tank, community sewage line)

Accommodations

Ability to provide a separate bedroom for the SARS patient
Accessible bathroom in the residence; if multiple bathrooms are available, one bathroom designated for use by the SARS patient

Resources for patient care and support

Primary caregiver who will remain in the residence and who is not at high risk for complications from SARS-CoV disease
Meal preparation
Laundry
Banking
Essential shopping
Social diversion (e.g., television, radio, internet access, reading materials)
Masks, tissues, hand hygiene products

B. Isolation in a community-based facility

When persons requiring isolation cannot be accommodated either at home or in a healthcare facility, a community-based facility for isolation will be required. The availability of a community-based facility will be particularly important during a large outbreak.

Much of the work in identifying and evaluating potential sites for isolation should be conducted in advance of an outbreak as part of preparedness planning. Each jurisdiction should assemble a team to identify appropriate locations and resources for community SARS isolation facilities, establish procedures for activating them, and coordinate activities related to patient management. The team should consider the use of both existing and temporary structures. Options for existing structures include community health centers, nursing homes, apartments, schools, dormitories, and hotels. Options for temporary structures include trailers, barracks, tents, and “bubble systems.” Considerations include the following:

Basic infrastructure requirements

Meets all local code requirements for a public facility
Functioning telephone system
Electricity
Heating, ventilating, and air conditioning (HVAC)
Potable water
Bathroom with commode and sink
Waste and sewage disposal (septic tank, community sewage line)
Multiple rooms for housing ill patients

Ventilation capacity

Preferably, rooms with individual ventilation systems (e.g., room or window fan coil units that do not recirculate to other parts of the building)
Alternatively, facility with a non-recirculating ventilation system that permits redirection of the air flow from corridors and staff areas into patient rooms.

Access considerations

Proximity to hospital
Parking space
Ease of access for delivery of food and medical and other supplies
Handicap accessibility

Space requirements

Administrative offices
Offices/areas for clinical staff
Holding area for contaminated waste and laundry
Laundry facilities (on- or off-site)
Meal preparation (on- or off-site)

Social support resources

Television and radio
Reading materials

To determine priorities among available facilities, consider these features:

Separate rooms for patients or areas amenable to isolation of patients with minimal construction
Single pass (non-recirculatiing) ventilation for each room or isolation area
Feasibility of modifying existing infrastructure as needed to meet AIIR standards (see Supplement I)
Feasibility of controlling access to the facility and to each room
Availability of potable water, bathroom, and shower facilities
Facilities for patient evaluation, treatment, and monitoring
Capacity for providing basic needs to patients
Rooms and corridors that are amenable to disinfection
Facilities for accommodating staff
Facilities for collecting, disinfecting, and disposing of infectious waste
Facilities for collecting and laundering infectious linens and clothing
Ease of access for delivery of patients and supplies
Legal/property considerations

Additional considerations include:

Staffing and administrative support
Training
Ventilation and other engineering controls
Ability to support appropriate infection control measures
Availability of food services and supplies
Ability to provide an environment that supports the social and psychological well-being of patients
Security and access control
Ability to support appropriate medical care, including emergency procedures
Access to communication systems that allow for dependable communication within and outside the facility
Ability to adequately monitor the health status of facility staff

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II. Quarantine Facilities

A. Home quarantine

A person’s residence is generally the preferred setting for quarantine. As with isolation, home quarantine is often least disruptive to a person’s routine. Because persons who have been exposed to SARS-CoV may need to stay in quarantine for as long as 10 days, it is important to ensure that the home environment meets the ongoing physical, mental, and medical needs of the individual. An evaluation of the home for its suitability for quarantine should be performed, ideally before the person is placed in quarantine. This evaluation may be performed on site by a health official or designee. However, from a practical standpoint, it may be more convenient to evaluate the residence through the administration of a questionnaire to the individual and/or the caregiver. Points to be considered in the evaluation include:

Availability of/access to educational materials about SARS and quarantine
Basic utilities (water, electricity, garbage collection, and heating or air-conditioning as appropriate)
Basic supplies (clothing, food, hand-hygiene supplies, laundry services)
Mechanism for addressing special needs (e.g., filling prescriptions)
Mechanism for communication, including telephone (for monitoring by health staff, reporting of symptoms, gaining access to support services, and communicating with family)
Accessibility to healthcare workers or ambulance personnel
Access to food and food preparation
Access to supplies such as thermometers, fever logs, phone numbers for reporting symptoms or accessing services, and emergency numbers (these can be supplied by health authorities if necessary)
Access to mental health and other psychological support services

B. Quarantine in a community-based facility

Although the home is generally the preferred setting for quarantine, alternative sites for quarantine may be necessary in certain situations. For example, persons who do not have a home situation suitable for this purpose or those who require quarantine away from home (e.g., during travel) will need to be housed in an alternative location. Because persons who have been exposed to SARS-CoV may require quarantine for as long as 10 days, it is important to ensure that the environment is conducive to meeting the ongoing physical, mental, and medical needs of the individual. Ideally, one or more community-based facilities that could be used for quarantine should be identified and evaluated as part of SARS preparedness planning. The evaluation should be performed on site by a public health official or designee. Additional considerations, beyond those listed above for home quarantine, include:

Separate rooms and bathrooms for each contact
Delivery systems for food and other needs
Staff to monitor contacts at least daily for fever and respiratory symptoms
Transportation for medical evaluation for person who develop symptoms
Mechanisms for communication, including telephone (for monitoring by health staff, reporting of symptoms, gaining access to support services, and communicating with family)
Services for removal of waste. (Note: No special precautions for removal of waste are required as long as persons remain asymptomatic)