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Use of Adult Acute Assessment Treatment Room, Negative Air Flow and Negative Pressure Rooms - SHED

This document provides a summary of best practice in relation to use of the SHED Negative Air Flow Rooms (Adult Acute Assessment Treatment Room, Resus Cubicles 1 and 4) and Class N negative pressure rooms (Adult Cubicle 23, SSU Bed 1 & Children’s Area Cubicle 1, Resus Cubicle 3). The summary has been created to support staff during the Sunshine Hospital Emergency Department Redevelopment transition and early post-move period, and has been endorsed by the ED Leadership Team.

Overview

This QRG provides an overview of use of the SHED Negative Air Flow Rooms (Adult Acute Assessment Treatment Room, Resus Bays 1 and 4) and Class N negative pressure rooms (Adult Cubicle 23, SSU Bed 1 & Children’s Area Cubicle 1, Resus Cubicle 3).

Applicability

This QRG is applicable to all clinical and non-clinical staff within the SHED.

Responsibility

The SHED Nurse Unit Manager and Medical Directors are responsible for ensuring that all relevant staff are aware of this QRG and are appropriately trained and orientated in effective use of external AV access for the purposes outlined.

Guideline/Process Details

Using the Adult Acute Assessment Treatment Room

Purpose:

The three uses of the Adult Acute Assessment Treatment Room are:

Negative Air Flow Rooms:

  • Resuscitation Cubicle 1
  • Resuscitation Cubicle 4
  • Adult Acute Assessment Treatment Room

Negative Air Flow Functionality

Negative pressure rooms are designed to reduce the risk of staff being exposed to airborne pathogens.

Doors should be kept closed to maintain the negative pressure between the room and the corridor. Negative air flow rooms, in comparison to “negative pressure rooms’ do not have an ANTE Room or filtration for extracted air.

Priority 1 patients should not be managed in Negative Air Flow Rooms unless there is no safer alternative available and with agreement of the Senior ED doctor and Nurse in Charge.

Priority 1
Priority 2
·         Tuberculosis (TB)

·         Measles

·         Disseminated Chickenpox

·         Disseminated Shingles

·         COVID-19 Quarantine undergoing AGPs

·         COVID-19 Confirmed undergoing AGPs

·         COVID-19 Suspected (High Risk) undergoing AGPs

 

Class N Isolation Resus with ANTE Rooms:

Class N Rooms

  • Adult cubicle 23
  • Short Stay Unit – Bed 1
  • Children’s Cubicle 1
  • Resuscitation Cubicle 3

Class N Isolation with ANTE Rooms and should preferentially be used over the Negative Air Flow Rooms for patients of all infectious risk priorities.

Resuscitation Cubicle 3 should be the first preference for resuscitating patients with infectious risk, and the first preference for Priority 1 patients arriving by ambulance as it has a direct entrance for access from ambulances.

The Class N Isolation with ANTE Room (Adult Cubicle 23, SSU Bed 1, Children Cubicle 1 and Resus Cubicle 3) are the only rooms designed to manage priority 1 patients. This recommendation can be reviewed in consultation with Infection Prevention (or Infectious Diseases after hours) if the need arises.

Should the patient require resuscitation facilities, Resuscitation cubicles are to be used in preference. Resus Cubicle 3 preferentially over Resus Cubicles 1 and 4 as per the principle outlined above.

If patient requires NIV or Intubation – NIV machine and Ventilator along with circuits and ETCO2 monitoring equipment to be brought to the room.

Should rooms outside the Resuscitation area be used, they are staffed by Resuscitation staff unless patient not high acuity e.g. TB and can be staffed by SSU staff and another cubicle closed to maintain EBA ratios.

Equipment to remain in area at all times –

    • Airway boxes kept in ante room
    • CMAC to be stored in neg pressure room and blades stored in bottom draw of SSU Resus/Responder trolley

Children’s Resus trolley located in Children’s Cubicle 1. If adult patient ALL Equipment will need to be sourced and taken to room.

Adult Acute Treatment Room to be used predominantly as procedure room and plaster room as it contains plaster trap sink. All equipment will need to be decanted in event AGP is required for an infectious patient. All resuscitation equipment to be sourced and taken to room.

New Class N Isolation Rooms – Children’s Area Cubicle 1, Short Stay Unit Bed 1, Resus Cubicle 3

Negative Pressure on/off function:

All new Class N Isolation rooms are co-located with an anteroom. The Cubicle and anteroom have the function to turn the negative pressure off and use this as a standard room.  . Negative pressure gauges must be monitored and pressure documented once per shift by nursing staff when room in use. There is a touch pad on the outside wall of the anteroom to control this function see Figure 1.

Figure 1: Negative Pressure Function

Door interlock on/off function:

The interlock function should be turned on at the staff base when using the room as a negative pressure room. When the interlock is on you are unable to have both the ANTE Room and negative pressure room door open at the same time. The door interlock function should only be turned off when using it as standard room. Having it turned off will allow you to have both doors open at the same time. See Figure 2 for an example.

Figure 2: Door interlock function

Second Room Door:

The cat and kitten door from the Pod corridor directly into the Negative Pressure Room should be bolted shut when being used as a negative pressure room. Except when you require to transfer a patient in/out on a bed (Seen in Figure 3 below).

Figure 3: cat and kitten door

Intercom Phone in New Class N Negative Pressure Rooms:

New Class N negative pressure rooms have a video intercom located in the ANTE Room. This can be used to communicate with staff or with an ambulant visitor or patient inside the room. The phone is located on the wall to the right as you enter the room and a loudspeaker option is available – see Figure 4.

Figure 4: video intercom

Supporting Documentation

Document Governance

Title: Use of Negative Air Flow and Negative Pressure Rooms – SHED
Version: 2.0
Date Published: June, 2021
Date of scheduled review: 01/05/2022
Author:  Approver: 
Fiona Pazsa SHED Leadership Team
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