What is the recommended minimum distance and structural separation between an infectious disease ward and a non‑infectious ward in a hospital?

Proper Distance and Structural Separation Between Infectious and Non-Infectious Wards

Infectious and non-infectious wards should be structurally separated by distinct physical barriers with ideally separate buildings, or at minimum separate floors in the same building, with controlled access points and separate ventilation systems to prevent cross-contamination. 1

Structural Separation Requirements

Optimal Separation Hierarchy

The evidence provides a clear hierarchy for separating infectious from non-infectious areas:

• First choice: Separate buildings - This provides the most effective barrier against transmission of infectious agents 1
• Second choice: Separate floors within the same building with dedicated access routes 1
• Minimum acceptable: Clearly differentiated zones on the same floor with physical barriers and controlled traffic flow 1

Physical Distance Specifications

While specific metric distances are not universally mandated in guidelines, the evidence provides these practical parameters:

• 2 meters minimum separation for patient-to-patient distancing within common areas to minimize droplet transmission 1
• Clean utility rooms should be within 30 meters of patient care areas for operational efficiency 2
• Separate geographic entities with controlled access are required - through-traffic not intended for the infectious ward must be avoided 1

Essential Design Features for Separation

Ventilation and Air Handling

Infectious wards must have separate ventilation systems with 100% exhaust to the outside and negative pressure relative to adjacent areas. 1

• Negative pressure isolation rooms prevent aerosol escape to non-infectious areas 1, 3
• Air handling systems must be separately controlled and monitored 1
• The ratio of isolation rooms should be 1-2 per 10 beds in general ICUs, but may be 5-6 per 10 beds in specialized infectious disease units 1

Traffic Control and Access Points

Separate entrances, corridors, and elevators for infectious areas are essential to prevent cross-contamination. 1

• Designated entrances for staff working in infectious areas 1
• Anteroom spaces (minimum 3 m²) for donning/doffing personal protective equipment 1
• Hand hygiene checkpoints at transitions between zones 1
• Separate routes for clean supplies versus contaminated materials 2

Barrier Construction

Physical barriers between infectious and non-infectious areas must be impermeable to fungal spores and comply with fire codes. 1

• Barriers should seal off return air vents when rigid containment is used 1
• Monitor barrier integrity continuously during operation 1
• Visual barriers to prevent psychological distress to non-infectious patients from observing acute infectious cases 1

Compartmentalization Strategy

Zone Classification System

The evidence strongly supports a three-zone approach: 1

1. Clean Zone - Non-infectious patient areas with standard precautions
2. Transition Zone - Quarantine area for patients of unknown infectious status (14-day observation period) 1
3. Infectious Zone - Confirmed infectious cases with enhanced infection control measures

Staffing Segregation

Healthcare workers should be specifically designated to individual compartments with minimal movement between zones. 1

• When movement is necessary, proper hand hygiene at designated checkpoints is mandatory 1
• Staff working in infectious areas should have designated changing rooms and storage for protective equipment 1
• Separate staffing for COVID-19 positive, COVID-19 negative, and unknown status wards is recommended 1

Critical Operational Considerations

Patient Cohorting

Patients with confirmed infectious diseases should be cohorted together in a single unit or location, allowing the entire area to be treated as an isolation zone. 1

• This approach is more efficient than scattered isolation rooms during epidemic situations 1
• Units, wings, or entire campuses may need to be designated as infectious areas depending on outbreak scope 1

Utility Room Separation

Clean and dirty utility rooms must be completely separate with no shared access. 2

• Clean utility room (15 m²) for sterile supplies and equipment preparation 2
• Dirty utility room (25 m²) for contaminated materials, located separately 2
• This separation is fundamental to preventing cross-contamination 2

Common Pitfalls to Avoid

• Inadequate barrier integrity - Gaps or breaks in barrier joints must be immediately repaired 1
• Shared ventilation systems - Never allow infectious and non-infectious areas to share air handling without proper filtration 1
• Insufficient anteroom space - Minimum 3 m² is required for proper gowning procedures 1
• Lack of pressure monitoring - Negative pressure must be continuously monitored and maintained 1, 3
• Inadequate staff training - Healthcare workers must understand how isolation systems operate and be trained in proper zone transitions 3

Special Considerations for Airborne Pathogens

For diseases like tuberculosis or SARS requiring airborne precautions: 1, 3

• Functional negative airflow is optimal (not just physical separation) 1
• High air-change rates allow rapid removal of infectious aerosols 3
• Temporary anterooms for PPE donning must be established 1
• Industrial-grade portable HEPA filters (300-800 ft³/min filtration rates) should be used during construction or repairs 1