Setting up a sick room
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The text below is from a discussion thread Originally posted at Fluwikie
I have a room on top of the garage that has a separate entrance from the street. A flight of stairs from this entrance goes up to the landing where there is a bathroom (shower) immediately next to this bedroom. At the bottom of the stairs there is another door to the garage through which at the back you can exit to a small yard that is not part of the main garden. This whole setup is connected to the main house via a hallway and another door.
The reason why I explain all this is that I want to demonstrate how to design the space to create different levels of infection control, including a one-way system if someone is sick and a carer has to go in and out of the room and disinfect properly before returning to the main part of the house.
The carer goes in through the internal door from the main house, closes that door, and uses the hallway as changing area to put on whatever PPE needed. This may be some old clothes covered with apron, shower cap, gloves and mask. Also either disposable shoe covers or change into wellies (rubber boots).
For higher level of protection, I would use long-sleeve surgical gowns (these can be home-made) that tie at the back plus plastic apron. Use duct tape to seal the wrists of the gloves. Use two pairs of gloves if available.
It is important before entering the room to make sure that the other set of doors are closed ie at any point, there is at least one closed door between the patient area and the living quarters. If you don't have 2 sets of doors, use plastic sheets to create an additional barrier.
The room that I have is long and so it can be separated into two areas. The patient can sleep on a bed at the far end. This area is semi-partitioned with the use of plastic sheet/shower curtain. Behind this, next to the bed, you would need to put basins for disinfection and all the paraphernalia that one would normally need if someone is ill/bored.
The big challenge in this case is toilet facilities. Because the bathroom in this case is on the outside, I want to reserve that for cleaning/disinfection purposes. I tried to come up with different ideas to safely deal with waste, and the best so far is to get a chemical toilet from caravan companies. The neat(!) thing about this is that it has an enclosed compartment that receives waste. You can disconnect the lower portion as a fully enclosed container. If you put in disinfectant eg bleach ahead of time, then removing and disposing of that waste is not going to be hazardous.
The reason why it is better to partition the room, apart from the privacy issue, is that if the carer is to stay in for any length of time, any barrier would improve protection.
Any article/clothing from the room is to be disinfected with bleach. The easiest way for laundry is to get the biggest bucket you can find and fill it to half with diluted bleach. You can keep it just outside the room, in this case in the bathroom, so that the stuff goes straight in soon as you leave the room. That way, you are only handling contaminated laundry when still fully protected.
Before leaving the room, the carer should wash and disinfect the outer pair of gloves, remove and dispose of them, spray disinfectant on the inner gloves before opening the door. Once outside, close door immediately. Just outside the room, you can put a tray with a folded bath-towel or large cloth soaked with bleach. As the carer leaves, he should step on this and rub the bottom of the wellies vigorously. If using disposable shoe covers, step on the bleach, remove the covers and dispose of them.
Wash and disinfect remaining gloves. Take off apron and put immediately into wastebin, making sure that the bin closes completely. Take off gown and put into laundry bleach bucket. Wash and disinfect gloves again.
Now the carer is ready to leave. In this instance, he can exit through the garage door, making sure to touch only the door handles and nothing else. These can be disinfected later.
Walk through the garage and out the back. On the outside, prepare a shallow basin of bleach as footbath and plastic flip-flops (sandals). If wearing wellies, step into the basin and take off the wellies. Step out and put on flip-flops. Wash and disinfect gloves again. Take off glove, wash and disinfect hands.
Take off and dispose of mask and cap, taking care to not touch the outside of mask.
Wash and disinfect hands.
If you want to be extra careful, and if you live in a warm climate, consider getting a camping shower, which is just a bag filled with that you can hang up and use. You can shower right outside, change, before re-entering house from a different door.
If weather does not permit, then put on a big bathrobe to go in the house, making sure that you change your footwear again just as you enter. Go straight to the bathroom and shower completely.
This is just an example using my own house. Many elements can be varied but I think these considerations might be important:
1. Try to get a 2-door or 2 barrier setup
2. Contaminated laundry should be handled minimally and put into disinfectant asap.
3. Pay a lot of attention to disposal of body waste. The ideal situation is if you have ensuite facilities for the patient's sole use. No other disinfection/washing activities should go on here. If using bedpan or other open containers, make sure it always contains bleach even before use, cover as much as possible, even if only with a cloth, dispose asap wearing maximum protection.
4. If the area is quite near to the living areas of the rest of the family, consider putting in a powerful extractor fan which is always on. However, the direction of extraction in relation to where the carer is likely to spend most time inside the room is important. Make sure the airflow is from the carer/house to patient to extractor.
5. To increase the effectiveness of this one-way airflow, consider using draught-protectors under doors. These are just strips of rubber that allows air to go one-way only.
6. If there is no bathroom right next door that can be used for the carer's disinfection, put basins of soapy water and bleach right outside for disinfection. Put waste bin and laundry bucket here as well. This area should be frequently cleaned and disinfected and should be used either not at all or as little as possible by anyone else in the family. The carer should again put on a bathrobe that covers the body as much as possible before walking through the rest of the house to shower.
BTW one of the reasons why I wrote this thread is to show the number of items that you may want to get ahead of time, such as plastic sheets. These and duct tape are always going to be handy. But the extra buckets, basins, etc need to be counted up as well. Other details to think through include stuff like how you're going to get that water into and out of the laundry bucket if the bathroom is some ways off and the whole thing is too heavy to lug around the house.
You should also keep a list of important phone numbers near the phone. You might know your mom's number buy heart, but a 103 degree fever could make remembering it a challenge. I certainly wouldn't remember my doctor's!
For those who are unable to self-quarantine (essential services) and have to sleep in their own home, should an area be designated for their use (near exit/entrance) and isolated from the rest of the household? Something to consider: It might be a good idea to have two copies of 'tracking' info as mentioned immediately above, one in the isolation area and one outside so you can refer to it when not actually providing care. New info could be added right after you leave the isolation area. BTW I've decided to make two physical copies of all of my prep plans (including the ones on my computer) and keep them in two different places- this might be especially important for those who will try to self-medicate if they become ill- a glass of spilled juice could erase your recommended dosages, etc. I wouldn't want to have to trust someone's life to my memory, especially if I'm tired and worried.
To seal off a room: There is a
great zipper door unit at Home Depot which contractors use to seal off rooms in houses. It is probably 8 feet long and gets taped into the center of a sheet of plastic which you tape to a door frame and then you slit the plastic as you unzip the zipper. I bought several thinking that with 6mm. plastic sheeting it can create a barrier. A second one can make a changing chamber outside a sick room.
YOu need to wear goggles if you are within a close distance of someone shedding virus.
The best ones are the clear ones with unvented sides. Those with small vents are not a problem but if you want to be extra careful, especially if there is a risk of being splashed then tape over the vents.
Swim or ski goggles will also do the job. However, it's important to make sure that these do not affect the fit of the mask. A useful hint is that if your goggles are fogging up (on the outside), the mask is not working properly.
Bleach: for normal household bleach, which is approx 5%, use 1:100 (10ml in 1L of water) for general cleaning and disinfection. For body fluids, waste, and spillages, use 1:10 (10ml in 100 ml of water). Bleach needs to be made up each day, otherwise it degrades very quickly. Now that can add up to a lot of bleach over a few months. Instead of buying bottles, you can buy bleach tablets. These come in packets of 10 where each one makes 1L of bleach, which can then be diluted as above. I don't know if it's sold in the US but in the UK it costs only £1.00 for a packet. Remember that bleach is corrosive to hands but the fumes are quite toxic if you breathe a lot of it. Make sure there is plenty of ventilation.
The best alternative to bleach is Virkon. This is non-toxic, does not give out fumes, and not corrosive for surfaces so that you can use it for wood and metal.It is frequently used a-n-i-m-a-l-s. Just follow the dilution instructions on the package.
Citric acid is also useful and easy to obtain (from food product shops or people who sell chemicals to make bath-soap). It is safe to use on clothes etc and even on your body if you ever need decontamination. (You could also use Virkon at a pinch but do not use bleach.)
Having said all that about disinfectants, it is important to remember good old soap and water is the first line. Washing with soap especially under running water removes a significant amount of any contamination. You should always do that before disinfecting.
Bedding: Make sure you
cover the mattress COMPLETELY with a plastic sheet. What you want is to make sure that the whole thing can be wiped clean every day. The normal mattress covers are useless because they do not go all the way round and often the surface cannot be wiped.
Also get waterproof covers for pillows and duvet covers.
Floors: Carpets are useless in this situation because they cannot be cleaned/disinfected thoroughly. The best thing to do is again to
cover it and tack it down with plastic sheet. (Are you counting the # of plastic sheets and roles of duct tape needed yet?) Make sure everything is secure ‘cause loose edges can cause serious accidents.
Curtains: Replace fabric curtains with wipe-clean (yes) plastic or blinds.
This might seem a lot of trouble but it is worth the effort because
anything that catches dirt and is difficult to disinfect will raise your hazard level and also add to your angst. Remember that this whole setup won't be used unless someone is suspected to have bird flu, in which case you will be so stressed out that mistakes will be very likely. So anything that you can do or plan ahead of time will reduce that and allow you to concentrate on helping the person to get well.
Going back to
toilets again. Depending on how your system is plumbed, (and if you are like me you don't know anything about it), it might be
better to assume that the system is contaminated if someone in the house is sick. If you live in an apartment so that your plumbing is connected to others' then just assume that it is contaminated. Again the
best thing to use is bleach. Remember in this instance you are not worried about the water in the tank but rather the stuff in the toilet bowl so make sure that you put some in there.
In addition,
to reduce splashing, always close the lid before flushing. During SARS when people were actually infected by such routes in HOng Kong, gentlemen were advised to use the facilities sitting down!
Some bathrooms or sometimes even kitchens have floor drains to remove any accidental spillage. A huge outbreak of SARS (300+ people infected, 35 died, most of them from one apartment tower block) was caused by waste back-flow or back-log in the system and when people turn on extractor fans to shower, tiny contaminated aerosols were sucked into the room air. The solution to that is again to
put a small amount of bleach into the drain, wait 5 minutes and then flush. Do this several times a day.
Ventilation: The gold standard for an isolation room is the negative pressure room. This is basically a room that has a very powerful extraction system (6 air change per hour minimum) directed away from the rest of the house and ducted outside at a point that is far away from adjacent buildings or windows. To achieve a proper negative pressure,
the air supply rate must be substantially less than the exhaust rate. Without the help of an engineer, this can be simplified to mean that the air supply inlet should be reasonably small eg under the door.
As I said before but is worth repeating, if you want to put in an extractor fan, you must make sure that you are creating the most direct and smoothest airflow that goes from door to carer to patient to extraction system. Mis-alignments can result in unexpected turbulent flow so that the point of maximum virus accumulation becomes unpredictable. The air is passed through a HEPA filter to the outside. There must of course be no other window or opening, so that air only enters through the doorway (under the door).
For most people this will not be possible.
The next best alternative is to have windows open. A small oscillating fan to create a gentle breeze is helpful. If you live in a really cold area so that you can't keep a window open then any small extraction system that you can put in will help.
Some stand-alone domestic air filter/purifiers have HEPA filters which theorectically can help reduce the virus load. In actual practice, however, many have filters that need changing or cleaning. It is possible to have significant virus deposit on these filters so that cleaning is probably more dangerous than not having the machine.
However I have found an air purifier by Sharp which claims that the machine can destroy viruses in the air including H5N1. It emits positive and negatively charged ions which supposedly attach to the coating of the virus and inactivates it. Sharp quotes a study by John Oxford's lab using a sample of H5N1. The other thing about this machine is that you are not passing the air through the machine so the amount of virus contamination on the filter would be a lot less. I don't know how well it works since there is no independent corroboration, but I have been using it for my study and the air quality is definitely a lot better than the other machines that I have tried.
http://www.noticias.info/asp/aspcomunic ... ?nid=72321