title: Impact of implementing an exclusively dedicated respiratory isolation room in a Brazilian tertiary emergency department.
abstract: BACKGROUND
  Occupational risk due to airborne disease challenges healthcare institutions. Environmental measures are effective but their cost-effectiveness is still debatable and most of the capacity planning is based on occupational rates. Better indices to plan and evaluate capacity are needed.
  
  
  OBJECTIVE
  To evaluate the impact of installing an exclusively dedicated respiratory isolation room (EDRIR) in a tertiary emergency department (ED) determined by a time-to-reach-facility method.
  
  
  METHODS
  A group of patients in need of respiratory isolation were first identified--group I (2004; 29 patients; 44.1±3.4 years) and the occupational rate and time intervals (arrival to diagnosis, diagnosis to respiratory isolation indication and indication to effective isolation) were determined and it was estimated that adding an EDRIR would have a significant impact over the time to isolation. After implementing the EDRIR, a second group of patients was gathered in the same period of the year--group II (2007; 50 patients; 43.4±1.8 years) and demographic and functional parameters were recorded to evaluate time to isolation. Cox proportional hazard models adjusted for age, gender and inhospital respiratory isolation room availability were obtained.
  
  
  RESULTS
  Implementing an EDRIR decreased the time from arrival to indication of respiratory isolation (27.5±9.3 × 3.7±2.0; p=0.0180) and from indication to effective respiratory isolation (13.3±3.0 × 2.94±1.06; p=0.003) but not the respiratory isolation duration and total hospital stay. The impact on crude isolation rates was very significant (8.9 × 75.4/100.000 patients; p<0.001). The HR for effective respiratory isolation was 26.8 (95% CI 7.42 to 96.9) p<0.001 greater for 2007.
  
  
  CONCLUSIONS
  Implementing an EDRIR in a tertiary ED significantly reduced the time to respiratory isolation.
authors: University Hospital of the Medical School of Ribeirão Preto, University of Sao Paulo, Sao Paulo, Brazil.
authors: Rômulo Rebouças
authors: RR
authors: Lobo
authors: Marcos Carvalho
authors: MC
authors: Borges
authors: Fábio Fernandes
authors: FF
authors: Neves
authors: Bento
authors: B
authors: Vidal de Moura Negrini
authors: Francisco Antonio
authors: FA
authors: Colleto
authors: José Luiz
authors: JL
authors: Romeo Boullosa
authors: Maria
authors: M
authors: Camila de Miranda Cardoso
authors: Antonio
authors: A
authors: Pazin-Filho
mesh_terms: D000328:Adult; D001938:Brazil; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000517:prevention & control; D010356:Patient Isolation / Q000379:methods*; D016016:Proportional Hazards Models; D012141:Respiratory Tract Infections / Q000517:prevention & control; D013997:Time Factors