ISSUE: The number of hospital airborne infection isolation (AII) rooms is limited. An outbreak of infectious disease will produce a demand for a large number of AII rooms. A multidisciplinary panel set out to provide hospitals with cost-effective options to create additional AII surge capacity rooms.

PROJECT: Baseline AII capacity was obtained from general medical/surgical hospitals in the state to determine isolation capacity. The result was an emergency room (ER) AII capacity of 2.2 rooms per 100,000 population (117 rooms) and a medical/surgical (M/S) room capacity of 11.5 (617 rooms). A panel of infection control practitioners (ICPs) set minimum AII standards for all hospitals (2 ER AII, 1 AII M/S room, 1 AII intensive care unit, 1 AII room with anteroom per 100 staffed beds, 2% of all staffed beds to be AII). Federal Health Resources and Services Administration (HRSA) funds were used to support the construction of additional AII rooms, resulting in ER AII ratio of 6.1 (328 rooms) and an M/S AII ratio of 14.1 (755 rooms). Another multidisciplinary panel of ICPs, hospital plant operation managers, architects, and mechanical engineers was convened to provide options to hospitals for increasing this ratio substantially without the significant cost of constructing individual AII rooms. Criteria were established for negative-pressure surge capacity (NPSC) rooms along with the protocol for the use of these rooms as isolation rooms.

RESULTS: Hospitals identified areas that could be engineered as NPSC rooms according to the criteria. This resulted in 558 additional rooms that can be used to care for 1116 cohorted patients. Combined with existing AII rooms, the total patient rooms available allow hospitals to care for a total of 2626 patients, twice the goal of 10% of staffed beds that was set by the panel. The panel developed schematics for three engineering options that hospitals can use to construct or renovate space into NPSC rooms. A metropolitan hospital added 56 NPSC rooms (112 patients) with federal HRSA funds. Funds are set aside for five additional NPSC demonstration projects so that there will be at least one hospital in each of the seven regions to serve as an isolation center.

LESSONS LEARNED: 1) Synergy results from a multidisciplinary approach to problem solving. 2) Hospitals are willing to invest in AII/NPSC rooms when given cost-effective options and guidance. 3) Despite significant enhancement of physical assets, basic infection control standards remain the cornerstone for minimizing the transmission of infectious disease.