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Dear members,

I have two questions I would like to share with you:

1)some texts are recommending at least 1m distance between beds for TB hospitalization wards.
BUT: am I correct saying that BCG droplet is far too little (and to light) to be falling down in just 1m?

2)if, on the contrary, this recommendation should be taken as good for hospitalization wards, should we assume that the same distance (1m) is to be recommended as well between patients in the waiting areas?

Thank you very much

Thea Zuccotti

 
Edward Nardell, MD
Replied at 6:53 AM, 4 Nov 2009

Hi Thea,

M. tuberculosis droplet nuclei (not BCG which is the vaccine) are too
light to fall within a meter. Perhaps many larger respiratory droplets
(ie some respiratory viruses) do fall out within that space, so for
droplet-spread infections such recommendations have made sense since
Florence Nightingale proposed standard distances between beds in the
19th Century.

However, the distance droplets and droplet nuclei travel is only part of
the issue. Putting a meter between people LIMITS THE NUMBER OF PEOPLE IN
A GIVEN ROOM, which is the critical issue. The more people in one room,
the greater the chance that one or more is infectious and the greater
the number of those exposed. Five rooms with 2 persons each is much
better than one room with 10 people.

All of this applies to waiting rooms as well as any other setting. It is
harder to divide up waiting areas, but not impossible. Having a separate
"triage" waiting area for patients with cough, for example, makes sense.
Many smaller waiting areas (still not overcrowded) makes more sense than
one larger one.

I hope these concepts help.

Ed

S. Mehtar
Replied at 10:52 AM, 4 Nov 2009

At our hospital and other areas I work in we recommend 3.5m between the centre of two beds lying parallel to each other ( ref.NHS. Infection control in the built environment. NHS Estates).
This is adequate distance for droplets and some airborne particles- the latter may be suspended for longer if there is no ventilation.
Regards
Shaheen
Prof Shaheen Mehtar
MBBS, FRC Path (UK), FCPath (Micro) (SA), MD (Eng)
Chair IPC Africa Network
Head of Academic Unit for Infection Prevention and Control
Tygerberg Hospital & Stellenbosch Uni

Tariq Alexander Qaiser
Replied at 8:44 PM, 4 Nov 2009

Thea,
Let us talk about the center line of bed placement. The minimum recomended distance between beds for surgical wards is 2.4 m or 8 ft. Tb wards or other ID facilities require a larger distance. I prefer 3.65 m or 12 ft. This too on its own is not enough. The ward needs to be well ventilated and have upper room UVGI lamps installed.
Waiting areas should have a triage zone, a seperate well ventilated waiting area for patients with obvious symptoms. Other waiting areas should be broken up into smaller zones (more areas with less people in each) all waitiing areas should be airy, well ventilated, and have UVGI lamps istalled. Try to keep waiting out of corridors. Distance between patients is difficult to manage, but keep the density low.
Taq

Thea Zuccotti
Replied at 4:43 AM, 5 Nov 2009

Thank you for your comments,

the concept of “low density” is very clear to me, as well as all needed environmental measures to be set up. I’ll stay with those general recommendations without providing an easy-to-be-applied rule (as minimum 1m between patients in the waiting area) which could become a too strict advice.

Thank you for your contributions
Thea

PS. Ed, of course: TB droplet nuclei (!) sorry for the “lapsus”
PPS. Shaheen: is the “Infection control in the built environment. NHS Estates” available in pdf format?
Thank you.

Ifunanya Igbojekwe
Replied at 10:56 AM, 5 Nov 2009

Dear all,
Great comments. More like a refresher training for me. I just want to
include and also remind us of what Tariq taught us during the course
this year; due to the difficulty of ensuring that the hospital staff
adhere to the "low density" TB patients in the ward, he recommended
that it may be worth clipping the beds to the floor (and maybe walls
as the case may be) to make them immovable. That way you don't come
back after couple of months and find out that a 4 bed room has become
a 10 bed room (staff moved in more beds).
This approach i believe can be applied to waiting areas where
immovable chairs can be put or the chairs can be linked to one another
maintaining specified distance that can ensure PLANNED "low density".
Lets us also remember to give room for expansion and also not forget
to propagate proper cough etiquette in the waiting areas.

ifunanya

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