What is the appropriate level of isolation for a COVID-19 (Coronavirus Disease 2019) hospitalized patient?

Appropriate Isolation for COVID-19 Hospitalized Patients

COVID-19 hospitalized patients should be placed in a negative pressure isolation room with airborne precautions, including appropriate PPE consisting of N95 masks, goggles, face shield, double gloves, and protective gowns. 1, 2

Isolation Environment Requirements

• Negative pressure room: The ideal isolation environment for COVID-19 patients is a negative pressure room with a minimum pressure differential of 8 Pa between the room and corridor 3
• Air exchange rate: 8-12 air changes per hour should be maintained 3
• Alternative settings: If negative pressure rooms are unavailable, positive pressure systems and air conditioning must be turned off 1
• Dedicated pathways: Patients should be transferred through dedicated lobbies and elevators to minimize exposure risk 1

Personal Protective Equipment (PPE) Requirements

For Direct Patient Care:

• Tertiary protection (highest level) 1:
  • N95 mask (not surgical mask)
  • Goggles and face shield
  • Head cover (fluid-repellent cap)
  • Double layer of protective gowns (inner long-sleeved + outer waterproof)
  • Double layer of gloves (powder-free, covering sleeves)
  • Shoe covers

For Procedures:

• All aerosol-generating procedures require full tertiary protection 1, 4
• Non-aerosol procedures still require at minimum secondary protection (N95 mask, goggles, single gown, single gloves) 1

Patient Transfer Protocols

1. Within hospital:

   • Patient must wear a surgical mask or N95 mask during transfer 1
   • Cover patient with disposable operating sheet 1
   • Staff must wear proper PPE during transfer 1
   • Use dedicated pathways and elevators 1
   • Clean all surfaces after transfer 1

2. If intubated:

   • Use single-patient-use respiratory bag 1
   • Avoid using ventilator during transfer 1

Equipment and Environmental Considerations

• All equipment should be single-use when possible 1
• Equipment that directly contacts patient skin/mucosa must be single-use 1
• All surfaces should be disinfected with 2-3% hydrogen peroxide 1
• Carbon dioxide absorbers should be replaced between cases 1
• Respiratory circuits should be disinfected between cases 1

Isolation Duration Guidelines

• Patients should remain in isolation for at least 14 days from their first positive test 2
• Isolation may end earlier only if:
  • Symptoms have resolved for at least 3 days
  • Patient has normal temperature for >3 days without fever-reducing medications
  • Respiratory symptoms have significantly improved
  • Patient has obtained a negative RT-PCR test 2

Common Pitfalls and Caveats

• Underestimating transmission distance: Evidence suggests droplets can travel beyond the traditional 1-2 meter rule, with some studies showing travel up to 8 meters 4
• Ignoring non-respiratory transmission: Fecal-oral transmission has been documented in hospital settings 5
• Inadequate PPE during transfers: Ensure full PPE compliance even during brief patient transfers 1
• False negative test results: Maintain high index of suspicion and maximize safety procedures even with negative tests 1
• Prolonged viral shedding: Immunocompromised patients may require extended isolation due to prolonged viral shedding 2

By following these comprehensive isolation protocols, healthcare facilities can minimize the risk of COVID-19 transmission to healthcare workers and other patients while providing appropriate care for those infected.