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The Design of Isolation Ward for Reducing Airborne Infection in Common Clinical Settings.

机译:常见临床环境中减少空气传播感染的隔离病房设计。

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摘要

The design of airborne infection isolation (AII) room has become one of the major research domains following the emergence of the global concern of acute respiratory diseases in this century. These include severe acute respiratory syndrome (SARS) in 2003, H5N1 avian influenza, and pandemic influenza H1N1 in 2009. All of which have claimed thousands of lives. Even with the current stringent design and practice guidelines, nosocomial infection of healthcare workers (HCWs) and inpatients continues to occur. This implies that there might be limitations in current isolation ward designs.;Many patients with severe respiratory infection require supportive therapy for respiratory failure. Common interventions involve supplemental oxygen to improve tissue oxygenation. In the worst scenario, mechanical ventilation via non-invasive positive pressure ventilation (NPPV) may be required. Since a large amount of aerosols is generated during these interventions, there is a great risk of spreading infectious aerosols from the respiratory tract of the patient to the surrounding environment.;According to recommendations from the Facility Guidelines Institute (FGI) of the American Institute of Architects (AIA), World Health Organization (WHO) and Center for Disease Control and Prevention (CDC), a common engineering approach to isolation room design is to maintain the air ventilation rate at a minimum of 12 air changes per hour (ACH) for mixing and dilution, and a negative pressure in the room to direct airflow inwards, instead of leaking outwards.;In collaborations with physicians in the Respiratory Division and the Intensive Care Unit (ICU) at the Chinese University of Hong Kong (CUHK), a series of experiments were carried out to verify the ventilation performance of an All room at the Princess Margaret Hospital (PMH). Experiments investigated the effects of ACH, the control of airflow direction, the air tightness of the automatic swing door and the application of positive pressure ventilation procedures, such as high flow rate oxygen masks, jet nebulizers and NPPV. These were extensively tested in two different isolation rooms of the Prince of Wales Hospital (PWH) and PMH, under common clinical circumstances and environmental conditions.;The experiments implemented a high-fidelity human patient simulator (HPS) which could be programmed with different lung breathing conditions and oxygen flow rate settings. The patient exhaled air dispersion distances and airflow patterns were captured in detail with a non-intrusive, laser light sheet, smoke particle scattering technique, designed for this thesis. Thin laser light sheets were generated by a high energy YAG laser with custom cylindrical optics. Smoke concentration in the patient exhaled air and leakage jets was estimated from the intensity of light scattered, which was then expressed as nonnalized particle concentration contours using computer programs developed for this study.;The study quantitatively revealed the distinctive patient exhaled airflow patterns and the extent of bioaerosol, generated directly from the patient source with the application of different oxygen delivery interventions for different patient lung conditions and oxygen flow rates. It was found that contamination was more critical during the administration of oxygen therapies, which is common in clinical circumstances. Source control is therefore the most efficient and effective approach to the reduction and even elimination of patient exhaled bioaerosol contaminants. Thus, when working in an isolation room environment, full preventive measure should be taken and it is essential to consider the location of mechanical vents and the patient exhaled airflow patterns. It has also been shown in experiment that applications of bacterial viral filter could be a solution to the problem.;The aerodynamic data in this thesis infonns architects and engineers on how to improve the hospital ward ventilation design so as to avoid aerosol and ventilation leakage. Ultimately, it is hoped that this work may play a role in preventing devastating nosocomial outbreaks in the future.
机译:随着本世纪全球对急性呼吸系统疾病的关注,空气传播隔离室的设计已成为主要研究领域之一。其中包括2003年的严重急性呼吸道综合症(SARS),2009年的H5N1禽流感和2009年的H1N1大流行性流感。所有这些都夺走了数千人的生命。即使采用当前严格的设计和实践指南,医护人员(HCW)和住院病人的医院感染仍在继续发生。这意味着当前隔离病房的设计可能会有局限性。许多严重呼吸道感染的患者需要支持治疗呼吸衰竭。常见的干预措施包括补充氧气以改善组织氧合。在最坏的情况下,可能需要通过无创正压通气(NPPV)进行机械通气。由于在这些干预过程中会产生大量的气溶胶,因此存在很大的风险将传染性气溶胶从患者的呼吸道传播到周围环境。;根据美国疾病预防与控制研究所设施指南研究所(FGI)的建议建筑师(AIA),世界卫生组织(WHO)和疾病控制与预防中心(CDC)的隔离室设计的常见工程方法是将空气流通率保持在每小时至少12换气量(ACH)混合和稀释,以及房间内的负压以使气流向内引导而不是向外泄漏;与香港中文大学(CUHK)呼吸科和重症监护室(ICU)的医生合作,进行了一系列实验,以验证玛格丽特公主医院(PMH)所有房间的通风性能。实验研究了ACH的影响,气流方向的控制,自动平开门的气密性以及正压通风程序的应用,例如高流量氧气面罩,喷射雾化器和NPPV。这些在普通的临床情况和环境条件下在威尔斯亲王医院(PWH)和PMH的两个不同的隔离室中进行了广泛的测试;该实验实现了可以用不同肺部进行编程的高保真人类患者模拟器(HPS)呼吸条件和氧气流速设置。针对该论文设计的非侵入性激光片烟颗粒散射技术详细记录了患者呼气的空气扩散距离和气流模式。薄激光片是由具有定制柱面光学器件的高能YAG激光器产生的。根据散发的光的强度估算患者呼出空气和泄漏喷口中的烟雾浓度,然后使用为该研究开发的计算机程序将其表示为未归纳的颗粒浓度等值线。该研究定量揭示了患者呼出气流的独特流型和程度直接从患者源中产生的生物气溶胶,适用于不同的患者肺部疾病和氧气流速的氧气输送干预措施。发现在氧气疗法的施用过程中污染更为关键,这在临床情况下很常见。因此,源头控制是减少甚至消除患者呼出的生物气溶胶污染物的最有效方法。因此,在隔离室环境中工作时,应采取全面的预防措施,并且必须考虑机械通风口的位置和患者呼出的气流模式。实验还表明,细菌病毒过滤器的应用可以解决该问题。本论文中的空气动力学数据向建筑师和工程师介绍了如何改进医院病房的通风设计,以避免气溶胶和通风泄漏。最终,希望这项工作可以在将来防止灾难性医院爆发中发挥作用。

著录项

  • 作者

    Chow, Ka Ming.;

  • 作者单位

    The Chinese University of Hong Kong (Hong Kong).;

  • 授予单位 The Chinese University of Hong Kong (Hong Kong).;
  • 学科 Health Sciences Occupational Health and Safety.;Engineering Mechanical.;Architecture.;Health Sciences Health Care Management.
  • 学位 Ph.D.
  • 年度 2011
  • 页码 181 p.
  • 总页数 181
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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