Fig. 2.

Flow chart of critical steps to prepare an ICU for the management of a bronchiolitis outbreak. The isolation area and instruments to be used in it should be prepared beforehand: images A and B show an isolation room (red circle) which is located at the end of an ICU and equipped with negative pressure ventilation, filter and personal protective equipment (blue square), as well as single door through which patients are admitted and discharged (red dual arrow) without entering other zones of the ICU (pictures from the “A. Béclère” Hospital, APHP-Paris Saclay University); image C shows a ventilator equipped with a HEPA filter on the expiratory limb (red arrow). A protocol for clinical management should then be prepared and shared between the wards concerned. Specific training and simulation should be performed, and this is particularly important for those neonatal ICUs that are versed only in managing neonates with different types of respiratory failure. Specific criteria for ICU admission/discharge and continuous communication between wards should be enforced to guarantee an optimised patient flow. Finally, containment to reduce the risk of cross-contamination should be enforced and ICU stay should be kept as short as possible. Abbreviations. ED: emergency department; HEPA: high-efficiency particulate absorption; ICU: intensive care unit.