title: Evaluation of rooms with negative pressure ventilation used for respiratory isolation in seven midwestern hospitals.
abstract: OBJECTIVE
  To determine the number and efficacy of respiratory isolation facilities in St. Louis hospitals and to assess the mechanisms in place for evaluating function of hospital ventilation systems.
  
  
  METHODS
  A prospective multi-hospital surveillance study using direct observation and a standardized questionnaire.
  
  
  METHODS
  Seven hospitals (including university-affiliated large teaching, private community, private teaching, and private nonteaching adult hospitals, and one pediatric teaching hospital) in St. Louis, Missouri.
  
  
  METHODS
  Actual direction of airflow in rooms designated for respiratory isolation was measured using smokesticks. Hospital demographic information, respiratory isolation policies, and frequency of ventilation tests were provided by infection control personnel.
  
  
  RESULTS
  One hundred twenty-one (3.4%) of 3,574 hospital rooms were designed to have negative pressure ventilation suitable for respiratory isolation. The percentage of isolation rooms in each institution ranged from 0.4% (92 of 486) to 93% (39 of 42). Only three (43%) of seven hospitals had intensive care respiratory isolation rooms, and none had isolation rooms in the emergency department. No hospital had tested routinely the efficacy of the negative pressure ventilation, and two (28%) of seven had tested airflow for the first time in the past year. We tested 115 (95%) of 121 isolation rooms. With the doors closed, 52 (45%) of 115 designated negative pressure rooms actually had positive airflow to the corridor. The number of negative pressure rooms and the presence or absence of anterooms did not predict correct direction of airflow. There was a significant difference among hospitals in the percentage of designated isolation rooms that had truly negative pressure (P < 0.0001). Hospital age, size, and type correlated with correct direction of airflow (P < 0.0001).
  
  
  CONCLUSIONS
  In the hospitals studied, only a small number of rooms were designated for respiratory isolation, and the performance of these was not tested routinely. High-risk areas including intensive care units and emergency rooms were not equipped to provide respiratory isolation. The direction of airflow in respiratory isolation rooms was not always correct and should be evaluated frequently.
authors.affiliation: Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110.
authors.forename: V J
authors.initials: VJ
authors.lastname: Fraser
authors.forename: K
authors.initials: K
authors.lastname: Johnson
authors.forename: J
authors.initials: J
authors.lastname: Primack
authors.forename: M
authors.initials: M
authors.lastname: Jones
authors.forename: G
authors.initials: G
authors.lastname: Medoff
authors.forename: W C
authors.initials: WC
authors.lastname: Dunagan
mesh_terms: D003428:Cross Infection / Q000517:prevention & control*; D005069:Evaluation Studies as Topic; D006276:Health Facility Size; D006761:Hospitals / Q000145:classification / Q000706:statistics & numerical data; D006801:Humans; D017053:Infection Control / Q000379:methods; D008923:Missouri; D010356:Patient Isolation; D010362:Patients' Rooms; D011446:Prospective Studies; D014376:Tuberculosis / Q000517:prevention & control*; D014691:Ventilation / Q000592:standards*