EPHB Report No. 301-05f

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Transcript of EPHB Report No. 301-05f

  • In-Depth Report

    Expedient Methods for Surge Airborne Isolation within Healthcare Settings during Response to a Natural or Manmade Epidemic

    Kenneth R. Mead, Ph.D., P.E. Amy Feng, M.S. Duane Hammond, M.S., P.E. Stan Shulman, Ph.D.

    Division of Applied Research and Technology Engineering and Physical Hazards Branch EPHB Report No. 301-05f

    Veterans Administration Medical Center, Oklahoma City, Oklahoma Central Kansas Medical Center, Great Bend, Kansas St. Joseph Memorial Hospital, Larned, Kansas INTEGRIS Baptist Medical Center, Oklahoma City, Oklahoma

    April 2012

    DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Institute for Occupational Safety and Health

  • EPHB Report No. EPHB 301-05f

    Page i

    Research Locations: Veterans Administration Medical Center Oklahoma City, OK

    Central Kansas Medical Center Great Bend, KS

    St. Joseph Memorial Hospital Larned, KS

    Integris Baptist Medical Center Oklahoma City, OK

    NAICS Code: 622110 (General Medical and Surgical Hospitals)

    Research Period: July 2003May 2008

    Surveys Conducted By: Kenneth R. Mead, Ph.D., P.E. NIOSH, Cincinnati, OH

    Duane Hammond, M.S., P.E. NIOSH, Cincinnati, OH

    Adam Paberzs Formerly NIOSH, Cincinnati, OH

    Brian Adams Formerly NIOSH, Cincinnati, OH

    Facility Representatives Veterans Administration Medical Center Contacted Phil Comp, MD Director of Research

    Janey Wooley, RN Vice-chair of Nursing

    Beverly Stiles, RN Ward Nurse

    Central Kansas Medical Center (CKMC) Chris Thomas, CHE, MBA President/CEO

  • EPHB Report No. EPHB 301-05f

    Page ii

    Nancy Winkelman, RN, ICP Manager Infection Control, Employee Health, Patient Education, Workers Compensation Coordinator

    St. Joseph Memorial Hospital Previously identified CKMC Representatives plus

    Danielle Johnson, MA Hospital Administrator

    John Broderway Environmental Services Manager

    Integris Baptist Medical Center Harry J. Goett, CIH System Industrial Hygienist

    Barbara Morton, RN, BSN Clinical Director, 9-East

  • EPHB Report No. EPHB 301-05f

    Page iii

    Disclaimer

    Mention of any company or product does not constitute endorsement by NIOSH. In addition, citations to websites external to NIOSH do not constitute NIOSH endorsement of the sponsoring organizations or their programs or products. Furthermore, NIOSH is not responsible for the content of these websites. All Web addresses referenced in this document were accessible as of the publication date.

  • Page iv

    Table of Contents Disclaimer ........................................................................................ iii List of Tables .................................................................................... iv List of Figures ................................................................................. viii Chapter I .......................................................................................... 1

    Introduction and Literature Review .................................................... 1 History: Airborne Disease Transmission Theory ......................................... 1 The Development of Droplet Nuclei Theory ............................................... 4 Droplet Nuclei: From Theory to Human Contagion...................................... 8 The Evolution of Standardized Hospital Isolation Criteria ........................... 10 The CDC Weighs In .............................................................................. 11 OSHA Proposes Bloodborne Pathogens Regulation ................................... 12 CDC Isolation Precautions for Control of Tuberculosis ............................... 13 The Hospital Infection Control Practices Advisory Committee ..................... 15 Pathogens of Interest for Airborne Isolation ............................................ 16 Engineering Design Standards for Hospital Isolation ................................. 18 Potential Lessons from Industrial Contaminant Control Theory .................. 22 Summary of Background Issues and Recent Events ................................. 28 Problem Statement .............................................................................. 30 Purpose and Scope .............................................................................. 30

    Chapter II ....................................................................................... 31 Methods and Materials ................................................................... 31 Expedient Isolation Configuration Descriptions .................................. 32 Surrogate Aerosol Source GenerationProtocol Development ............. 36

    Testing Platform and Set-up Description ................................................. 36 Aerosol Generation Technique ............................................................... 38 Preliminary Work to Develop the Generation Protocol ............................... 40 Validation of the Generation Protocol ...................................................... 45 Validation Results ................................................................................ 46 Validation Conclusion ........................................................................... 50

    Field Equipment and Methodology ................................................... 50 Configuration Setup ............................................................................. 50 Experimental Procedure ........................................................................ 56 Patient Source Generation (Order of Operation) ....................................... 57

  • Page v

    Data Collection and Management ........................................................... 57

    Data Analysis ................................................................................ 58 Air Filter Sampling and Particle Counting .......................................... 60

    Chapter III ...................................................................................... 61 Results ......................................................................................... 61 Oklahoma City Department of Veterans Affairs Medical Center ............ 61

    Zone-within-Zone, Two-Patient Configuration .......................................... 62 Ventilated Headboard, One-Patient Configuration .................................... 67

    Central Kansas Medical Center, Great Bend, KS ................................. 71 Zone-within-Zone, Two-Patient Configuration .......................................... 72 Ventilated Headboard, One-Patient Configuration .................................... 78

    St Joseph Memorial Hospital, Larned, Kansas .................................... 83 Zone-within-Zone, Two-Patient Configuration .......................................... 83 Ventilated Headboard, One-Patient Configuration .................................... 89 Zone-within-Zone, Two-Patient Configuration .......................................... 92 Ventilated Headboard, One-Patient Configuration .................................... 99

    Summary of Physical Field Conditions ............................................ 104 Chapter IV .................................................................................... 106

    Analysis and Discussion ................................................................ 106 Aerosol Spectrometer Data ................................................................. 106 Zone-Within-Zone Configuration .......................................................... 109 Ventilated Headboard Configuration ..................................................... 113

    IH Sampling/Optical Particle Counting ............................................ 115 Impact of 0.03 Baseline Shift .............................................................. 117

    HEPA Fan Motor Impact Upon Room Temperature ........................... 118 Physical Parameters ..................................................................... 119

    Zone-Within-Zone Configuration .......................................................... 119 Ventilated Headboard Configuration ..................................................... 121

    Chapter V ..................................................................................... 123 Summary ................................................................................... 123

    Background ...................................................................................... 123 Research Methodology........................................................................ 123 Major Findings ................................................................................... 124 Implications ...................................................................................... 125

  • Page vi

    Limitations ........................................................................................ 126 Suggestions for Further Research ........................................................ 127 Bed Position ...................................................................................... 127 Worker position/worker movement ...................................................... 127 Comparison Temporary Negative Pressure Isolation ............................... 127 Combining Ventilated Headboard and Zone-Within-Zone Configurations ... 128 Protective Isolation ............................................................................ 128 Nonhospital Environments .................................................................. 128

    Conclusion ..............................................................