Implementing a Negative Pressure Isolation Space within a Skilled Nursing Facility to Control SARS-CoV-2 Transmission

Background Isolation space must be expanded during pandemics involving airborne transmission. Little to no work has been done to establish optimal design strategies and implementation plans to ease surge capacity and expand isolation capacity over long periods in congregate living facilities. The COVID-19 pandemic has an airborne transmission component and requires isolation, which is difficult to accomplish in skilled nursing facilities. Purpose In this study we designed, implemented, and validated an isolation space at a skilled nursing facility in Lancaster, PA. The overall goal was to minimize disease transmission between residents and staff within the facility. Basic Procedures We created an isolation space by modifying an existing HVAC system of the SNF. We measured pressure on-site and performed computational fluid dynamics and Lagrangian particle-based modeling to test containment and possible transmission extent given the isolation space is considered negative rather than individual rooms. Main Findings Pressure data shows the isolation space maintained an average hourly value of (standard deviation) -2.3 Pa (0.12 Pa) pressure differential between it and the external hallway connected to the rest of the facility. No transmission of SARS-CoV-2 between residents isolated to the space occurred, nor did any transmission to the staff or other residents occur. The isolation space was successfully implemented and, as of writing, continues to be operational through the pandemic. Highlights Negative pressure isolation space is an effective method to meet needed surge capacity during the COVID-19 pandemic and future pandemics Planning for how and where to rapidly create a negative pressure isolation space is needed in congregate living areas such as skilled nursing facilities This demonstration shows the feasibility of using low-cost and in-house systems to quickly create negative pressure within a skilled nursing facility hallway and to maintain these conditions, minimizing disease transmission between residents and staff