Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-27T18:10:37.986Z Has data issue: false hasContentIssue false

Evaluation of a Room for Tuberculosis Patient Isolation Using Theatrical Fog

Published online by Cambridge University Press:  02 January 2015

Edward L. Gershey
Affiliation:
The Rockefeller University, New York City, New York
James Reiman
Affiliation:
Laboratory Safety Services Inc, Butler, New Jersey
William Wood
Affiliation:
Laboratory Safety Services Inc, Butler, New Jersey
Esmeralda Party*
Affiliation:
The Rockefeller University, New York City, New York
*
The Rockefeller University, 1230 York Ave, New York, NY 10021

Abstract

Objective:

To develop a method to evaluate directional airflow patterns, air dilution, and air mixing in facilities where tuberculosis patients are seen.

Design:

A tuberculosis patient isolation room was evaluated by analyzing pressure differential between the room and the corridor and by using theatrical fog to visualize room air movement and impact of dilution and exchange, as well as air capture and displacement. Tracer gas was compared to fog results and used to calculate air exchange rates.

Setting:

A small research hospital.

Results:

By adding theatrical fog to the patient room at several locations, we quickly learned that most of the air entering the room through the transom and around the door to the corridor was exhausted through the three exhaust vents. Little air appeared to move toward the exhaust fan.

For comparison and to confirm the room air exchange rate, tracer gas was distributed and sampled. The kinetics of decay were very similar whether the tracer gas and room air were mixed during sampling or not.

Conclusions:

The fog procedure allowed good visual confirmation of air mixing and airflow patterns and provided quantitative data for evaluating the efficacy of air capture and displacement or dilution and exchange

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1998

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Centers for Disease Control and Prevention, Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care facilities. MMWR 1994;43(RR-13):129.Google Scholar
2. National Institute for Occupational Safety and Health. Hazard evaluation technical assistance support. NIOSH Publication HETA 92-296-2243, Washington, DC: NIOSH. 08 1992.Google Scholar
3. Marier, RL, Nelson, T. A ventilation-filtration unit for respiratory isolation. Infect Control Hosp Epidemiol 1993;14:700705.Google Scholar
4. Nardell, EA, Keegan, J, Cheney, SA, Etkind, SC. Airborne infection: theoretical limits of protection achievable by building ventilation. Am Rev Respir Dis 1991;144:302306.Google Scholar
5. Sandberg, M. What is ventilation efficiency? Building Environment Report 1981;16:123135.Google Scholar
6. Decker, J. Evaluation of isolation rooms in health care settings using tracer gas analysis. Applied Occupational and Environmental Hygiene 1995;10:887891.Google Scholar
7. Riffat, SB, Cheong, KW. Measurement of ventilation and aerosol particles in buildings. International Journal of Energy Research 1993;17:4555.Google Scholar
8. Niemela, R, Lefevre, A, Muller, JP, Aubertin, G. Comparison of three tracer gases for determining ventilation effectiveness and capture efficiency. Ann Occup Hyg 1991;35:405417.Google Scholar
9. Skåret, E. Contaminant removal performance in terms of ventilation effectiveness. Environment International 1986;12:419427.Google Scholar
10. Breum, NO. Helbo, F. Laustsen, O. Dilution versus displacement ventilation—an intervention study. Ann Occup Hyg 1989;33:321329.Google Scholar
11. Party, E, Reiman, J, Gershey, EL. Certification of Biosafety Level 3 (BSL3) Facilities. Journal of the American Biological Safety Association 1996;1(1):2651.Google Scholar
12. American Conference of Governmental Industrial Hygienists. Industrial Ventilation: A Manual of Recommended Practice, 23rd ed. Cincinnati, OH: ACGIH; 1998:512.Google Scholar
13. American Society of Heating, Refrigeration and Air-Conditioning Engineers. Health facilities. In: 1991 Application Handbook. Atlanta, GA: American Society of Heating Refrigerating and Air-Conditioning Engineers, Inc; 1991: chapter 7.Google Scholar
14. Herman, HH Jr. Are theatrical fogs dangerous? Chemical Health & Safety 1995;2:1014.Google Scholar
15. National Sanitation Foundation. Standard 49 Class II (Laminar Flow) Biohazard Cabinetry. Ann Arbor, MI: NSF International; 1992.Google Scholar
16. Loudon, RG, Roberts, RM. Droplet expulsion from the respiratory tract. Am Rev Respir Dis 1967;95:435442.Google Scholar
17. Hinds, W, Macher, J, First, MW. Size distributions of aerosols produced from substitute materials by the Laskin cold DOP aerosol generator. Presented at the 16th Department of Energy Nuclear Air Cleaning Conference.Google Scholar
18. Yan, X, First, MW, Rudnick, SN. Characteristics of Laskin nozzle generating aerosols. In: Proceedings of the 21st Nuclear Air Cleaning Conference; Springfield, VA; 01 1991:116.Google Scholar
19. International Agency for Research on Cancer. Monographs on the evaluation of carcinogenic risks to humans. Overall evaluations of carcino-genicity: an updating of IARC Monographs volumes 1 to 42. Lyon, France: World Health Organization; 1987(suppl 7):62.Google Scholar
20. Committee on Architecture for Health. General hospital. Guidelines for Construction and Equipment of Hospital and Medical Facilities. Washington, DC: The American Institute of Architects Press; 1987. Chapter 7.Google Scholar
21. US Department of Health and Human Services. Guidelines for Construction and Equipment of Hospital and Medical Facilities. USDHSS HRSA 84-14500. Rockville, MD: Health Resources and Services Administration; 1984.Google Scholar
22. Wells, WF. Airborne Contagion and Air Hygiene. Cambridge, MA: Harvard University Press; 1955:105141.Google Scholar
23. Nyka, W. Studies on the infective particle in air-borne tuberculosis, I: observations in mice infected with a bovine strain of M tuberculosis . Am Rev Respir Dis 1962;85:3339.Google ScholarPubMed
24. Nicas, M. Modeling respirator penetration values with the beta distribution: an application to occupational tuberculosis transmission. Am Ind Hyg Assoc J 1994;55:515524.CrossRefGoogle ScholarPubMed