Table 5.

Components of a protective environment

I. Patients: allogeneic hematopoeitic stem cell transplantation only

• Maintain in protective environment (PE) room except for required diagnostic or therapeutic procedures that cannot be performed in the room (eg, radiology, surgery)

• Respiratory protection (eg, N95 respirator) for the patient when leaving PE during periods of construction

II. Standard and Expanded Precautions

• Hand hygiene observed before and after patient contact

• Gown, gloves, mask not required for health care workers (HCWs) or visitors for routine entry into the room

• Use of gown, gloves, and mask by HCWs and visitors according to Standard Precautions and as indicated for suspected or proven infections for which transmission-based precautions are recommended

III. Engineering

• Central or point-of-use high-efficiency particulate air (HEPA) filters (99.97% efficiency) filters capable of removing particles 0.3 μm in diameter in supply (incoming) air

• Well-sealed rooms:

- Proper construction of windows, doors, and intake and exhaust ports

- Ceilings: smooth, free of fissures, open joints, crevices

- Walls sealed above and below the ceiling

- If leakage detected, locate source and make necessary repairs

• Ventilation to maintain ≥12 air changes/hour

• Directed air flow; air supply and exhaust grills located so that clean, filtered air enters from one side of the room, flows across the patient's bed, and exits on opposite side of the room

• Positive room air pressure in relation to the corridor; pressure differential of >2.5 Pa (0.01-inch water gauge)

• Air flow patterns monitored and recorded daily using visual methods (eg, flutter strips, smoke tubes) or a hand-held pressure gauge

• Self-closing door on all room exits

• Back-up ventilation equipment (eg, portable units for fans or filters) maintained for emergency provision of ventilation requirements for PE areas, with immediate steps taken to restore the fixed ventilation system

• For patients who require both a PE and an airborne infection isolation room (AIIR), use an anteroom to ensure proper air balance relationships and provide independent exhaust of contaminated air to the outside, or place a HEPA filter in the exhaust duct. If an anteroom is not available, place patient in an AIIR and use portable ventilation units, industrial-grade HEPA filters to enhance filtration of spores.

IV. Surfaces

• Daily wet-dusting of horizontal surfaces using cloths moistened with EPA-registered hospital disinfectant/detergent

• Avoid dusting methods that disperse dust

• No carpeting in patient rooms or hallways

• No upholstered furniture and furnishings

V. Other

• No flowers (fresh or dried) or potted plants in PE rooms or areas

• Vacuum cleaner equipped with HEPA filters when vacuum cleaning is necessary

Adapted from Centers for Disease Control and Prevention.¹¹