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Hospital preparedness in community measles outbreaks-challenges and recommendations for low-resource settings.

Shakoor S, Mir F, Zaidi AK, Zafar A - Emerg Health Threats J (2015)

Bottom Line: We have reviewed various strategies involved in containment of measles in healthcare facilities during community outbreaks.Ventilation methods need innovative customization for resource-poor settings followed by validation and post-implementation analysis for impact.Mandatory vaccination of all HCWs with two doses of measles-containing vaccine, appropriate post-exposure prophylaxis of immunocompromised inpatients, and stringent admission criteria for measles cases can contribute toward reduction of nosocomial and secondary transmission within facilities.

View Article: PubMed Central - PubMed

Affiliation: Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan.

ABSTRACT
We have reviewed various strategies involved in containment of measles in healthcare facilities during community outbreaks. The strategies that are more applicable to resource-poor settings, such as natural ventilation, mechanical ventilation with heating and air-conditioning systems allowing unidirectional air-flow, and protection of un-infected patients and healthcare workers (HCWs), have been examined. Ventilation methods need innovative customization for resource-poor settings followed by validation and post-implementation analysis for impact. Mandatory vaccination of all HCWs with two doses of measles-containing vaccine, appropriate post-exposure prophylaxis of immunocompromised inpatients, and stringent admission criteria for measles cases can contribute toward reduction of nosocomial and secondary transmission within facilities.

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Related in: MedlinePlus

Preferable plan for a naturally ventilated room in a facility without HVAC. Patient bed position in the middle (preferred) Windows at either bed end facilitate air transmission. Walls on outside (without the room) show cordoned-off area with no traffic. Cordoned area must facilitate air passage to maintain dilutional effect. An exhaust placed at point A (upward arrow) will create negative pressure producing a hybrid model.
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Figure 0003: Preferable plan for a naturally ventilated room in a facility without HVAC. Patient bed position in the middle (preferred) Windows at either bed end facilitate air transmission. Walls on outside (without the room) show cordoned-off area with no traffic. Cordoned area must facilitate air passage to maintain dilutional effect. An exhaust placed at point A (upward arrow) will create negative pressure producing a hybrid model.

Mentions: Natural ventilation has been proven as an effective method of removing airborne infectious agents (32, 33). Natural ventilation simply involves opening doors and windows to external ambient air. This alone can improve room ventilation to 28 ACH (32) which is more than twice the recommended ACH for airborne isolation rooms. This strategy has not been applied widely to hospitals. Natural ventilation can be integrated into hospital buildings without HVAC to achieve dilution of airborne contagion either at the design stage or changes can be made later as per requirement, though cost is much lower if it is part of initial planning. Filtration of air is not required, since contagion discharged into outer air is also naturally diluted; however, open windows designed to achieve dilution must face a cordoned-off area with no traffic to minimize contamination. The challenge is to achieve and maintain unidirectional airflow so that air moves from the patient room to the outside thus diluting the infectious particles in the environment. This may be achieved by combining the natural ventilation mode with exhaust fans (the hybrid model) so as to facilitate airflow direction from patient room to the outside. Negative pressure may also be achieved through this model (33, 34), although the recommendation of 2.5 Pa pressure differential has been made for mechanically ventilated closed spaces and will therefore not apply to naturally ventilated rooms. Whether same pressure differentials apply to naturally ventilated spaces is not known. Figure 3 shows a suggested plan for a naturally ventilated single room.


Hospital preparedness in community measles outbreaks-challenges and recommendations for low-resource settings.

Shakoor S, Mir F, Zaidi AK, Zafar A - Emerg Health Threats J (2015)

Preferable plan for a naturally ventilated room in a facility without HVAC. Patient bed position in the middle (preferred) Windows at either bed end facilitate air transmission. Walls on outside (without the room) show cordoned-off area with no traffic. Cordoned area must facilitate air passage to maintain dilutional effect. An exhaust placed at point A (upward arrow) will create negative pressure producing a hybrid model.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4400300&req=5

Figure 0003: Preferable plan for a naturally ventilated room in a facility without HVAC. Patient bed position in the middle (preferred) Windows at either bed end facilitate air transmission. Walls on outside (without the room) show cordoned-off area with no traffic. Cordoned area must facilitate air passage to maintain dilutional effect. An exhaust placed at point A (upward arrow) will create negative pressure producing a hybrid model.
Mentions: Natural ventilation has been proven as an effective method of removing airborne infectious agents (32, 33). Natural ventilation simply involves opening doors and windows to external ambient air. This alone can improve room ventilation to 28 ACH (32) which is more than twice the recommended ACH for airborne isolation rooms. This strategy has not been applied widely to hospitals. Natural ventilation can be integrated into hospital buildings without HVAC to achieve dilution of airborne contagion either at the design stage or changes can be made later as per requirement, though cost is much lower if it is part of initial planning. Filtration of air is not required, since contagion discharged into outer air is also naturally diluted; however, open windows designed to achieve dilution must face a cordoned-off area with no traffic to minimize contamination. The challenge is to achieve and maintain unidirectional airflow so that air moves from the patient room to the outside thus diluting the infectious particles in the environment. This may be achieved by combining the natural ventilation mode with exhaust fans (the hybrid model) so as to facilitate airflow direction from patient room to the outside. Negative pressure may also be achieved through this model (33, 34), although the recommendation of 2.5 Pa pressure differential has been made for mechanically ventilated closed spaces and will therefore not apply to naturally ventilated rooms. Whether same pressure differentials apply to naturally ventilated spaces is not known. Figure 3 shows a suggested plan for a naturally ventilated single room.

Bottom Line: We have reviewed various strategies involved in containment of measles in healthcare facilities during community outbreaks.Ventilation methods need innovative customization for resource-poor settings followed by validation and post-implementation analysis for impact.Mandatory vaccination of all HCWs with two doses of measles-containing vaccine, appropriate post-exposure prophylaxis of immunocompromised inpatients, and stringent admission criteria for measles cases can contribute toward reduction of nosocomial and secondary transmission within facilities.

View Article: PubMed Central - PubMed

Affiliation: Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan.

ABSTRACT
We have reviewed various strategies involved in containment of measles in healthcare facilities during community outbreaks. The strategies that are more applicable to resource-poor settings, such as natural ventilation, mechanical ventilation with heating and air-conditioning systems allowing unidirectional air-flow, and protection of un-infected patients and healthcare workers (HCWs), have been examined. Ventilation methods need innovative customization for resource-poor settings followed by validation and post-implementation analysis for impact. Mandatory vaccination of all HCWs with two doses of measles-containing vaccine, appropriate post-exposure prophylaxis of immunocompromised inpatients, and stringent admission criteria for measles cases can contribute toward reduction of nosocomial and secondary transmission within facilities.

Show MeSH
Related in: MedlinePlus