Emergency Preparedness

Kern Medical Bioterrorism Response Guide Section 2-C-1 – Smallpox

Isolation Recommendations Recommendations for smallpox isolation were developed to assist infection control practitioners in developing a rational approach to reducing the risk of transmission of this highly contagious virus to healthcare workers and the community. Isolation should be maintained until the local health officer informs healthcare facilities that isolation is no longer necessary. Room Placement Although patients with smallpox should be isolated in negative pressure rooms with adjoining anterooms these facilities may be limited or, in some hospitals, non-existent. Several options for isolating patients with smallpox are presented. Plan A or B is the best approach when only a limited number of cases are anticipated. If the outbreak escalates, plan C or D may have to be implemented to accommodate increasing numbers of patients. Plan A: - Negative Pressure Isolation Room Place the patient in a private room that has (1) monitored negative air pressure in relation to the exterior surrounding areas, (2) 6 -12 air changes per hour (ACH), and (3) appropriate venting of contaminated air to the outside. If 6 – 12 ACH cannot be achieved, place a HEPA filtration unit in the room. The windows and doors should remain closed and the patient should remain in the room. Plan B: – No Negative Pressure Room If no negative pressure room is available, place the patient in a private room. The room should be equipped with a HEPA filtration unit. The windows and doors should remain closed and the patient should remain in the room. Plan C: – Designated Nursing Unit As the number of smallpox patients requiring hospitalization and isolation increases, consider designating a wing of a nursing unit or, preferentially, an entire nursing unit. It may be necessary to create a barrier between the designated nursing unit (wing) and other areas of the hospital. Infection control practitioners should develop a plan consistent with the structure of the hospital and the ability to effectively isolate infected patients from non-infected patients. These barriers may include, but are not limited to, sealing off the existing ventilation system to prevent contaminated air from circulating to other areas of the hospital, closing all windows and doors, including fire doors, and limiting access to the unit to trained personnel.

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