title: Door-opening motion can potentially lead to a transient breakdown in negative-pressure isolation conditions: the importance of vorticity and buoyancy airflows.
abstract: A patient with severe chickenpox was admitted to a negative-pressure isolation room. He remained sedated, intubated and mechanically ventilated throughout his admission. He was managed only by nurses immune to chickenpox. A non-immune male nurse occasionally handed equipment through the doorway, without entering the room. Ten days later, he also developed chickenpox. Sequencing of viruses from the patient and nurse showed the same rare genotype, indicating nosocomial transmission. An experimental model demonstrated that, despite negative pressure, opening the door could have resulted in transport of infectious air out of the isolation room, leading to a breakdown in isolation conditions.
authors.affiliation: Division of Infection and Immunity, Centre for Virology, Royal Free and University College Medical Schools, London, UK. julian.tang@cuhk.edu.hk
authors.forename: J W
authors.initials: JW
authors.lastname: Tang
authors.forename: I
authors.initials: I
authors.lastname: Eames
authors.forename: Y
authors.initials: Y
authors.lastname: Li
authors.forename: Y A
authors.initials: YA
authors.lastname: Taha
authors.forename: P
authors.initials: P
authors.lastname: Wilson
authors.forename: G
authors.initials: G
authors.lastname: Bellingan
authors.forename: K N
authors.initials: KN
authors.lastname: Ward
authors.forename: J
authors.initials: J
authors.lastname: Breuer
mesh_terms: D000399:Air Pressure; D002644:Chickenpox / Q000635:transmission* / Q000821:virology; D004780:Environment, Controlled; D005838:Genotype; D014645:Herpesvirus 3, Human / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional; D008297:Male; D008875:Middle Aged; D010357:Patient Isolators; D017422:Sequence Analysis, DNA; D017385:Sequence Homology