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Establishing
Airborneinfectionisolationrooms(AIIR)
&ProtectiveEnvironments(PE)
(positive&negativepressureisolationroomsforhospitals&medical
facilities)

Lookforlinkstoprintablepdf
literatureinequipment
specificationssections,abovein
thiscolumn,&onsitemap.

Airborne infection isolation room (AIIR). Formerly, negative pressure isolation room, an AIIR is a singleoccupancy patientcare
roomusedtoisolatepersonswithasuspectedorconfirmedairborneinfectiousdisease.EnvironmentalfactorsarecontrolledinAIIRsto
minimize the transmission of infectious agents that are usually transmitted from person to person by droplet nuclei associated with
coughingoraerosolizationofcontaminatedfluids.AIIRsshouldprovidenegativepressureintheroom(sothatairflowsunderthedoor
gapintotheroom)andanairflowrateof612ACH(6ACHforexistingstructures,12ACHfornewconstructionorrenovation)and
direct exhaust of air from the room to the outside of the building or recirculation of air through a HEPA filter before returning to
circulation(MMWR200554[RR17]).
ProtectiveEnvironment(PE).Aspecializedpatientcarearea,usuallyinahospital,thathasapositiveairflowrelativetothecorridor
(i.e., air flows from the room to the outside adjacent space). The combination of highefficiency particulate air (HEPA) filtration, high
numbers (>12) of air changes per hour (ACH), and minimal leakage of air into the room creates an environment that can safely
accommodate patients with a severely compromised immune system (e.g., those who have received allogeneic hemopoietic stemcell
transplant [HSCT]) and decrease the risk of exposure to spores produced by environmental fungi. Other components include use of
scrubbable surfaces instead of materials such as upholstery or carpeting, cleaning to prevent dust accumulation, and prohibition of
freshflowersorpottedplants.

DifferentialRoomPressureMonitorbrochure

2007GuidelineforIsolationPrecautions:PreventingTransmissionof
InfectiousAgentsinHealthcareSettings,CDC,June2007

Table1:Engineeredspecificationsforpositiveandnegativepressureisolationrooms*

Pressuredifferentials
Airchangesperhour(ACH)
Filtrationefficiency
Roomairflowdirection
Cleantodirtyairflowinroom
Idealpressuredifferential

Positivepressureareas(e.g.,protective
environments[PE])
>+2.5Pa(0.01watergauge)
>12
Supply:99.97%@0.3mDOP
Return:nonerequired**
Outtotheadjacentarea
Awayfromthepatient(highriskpatient,
immunosuppressedpatient)
>+8Pa

Negativepressureareas(e.g.,airborne
infectionisolation[AII])
>2.5Pa(0.01watergauge)
>12(forrenovationornewconstruction)
Supply:90%(dustspottest)
Return:99.97%@0.3mDOP^
Intotheroom
Towardsthepatient(airbornedisease
patient)
>2.5Pa

*FromTable6,fulltextversion,"GuidelinesforEnvironmentalInfectionControlinHealthCareFacilities",U.S.DepartmentofHealthandHumanServices,
CentersforDiseaseControlandPrevention(CDC),Atlanta,GA30333,Published:2003.Seeoriginaldocumentatabovelink,forreferences.
PaistheabbreviationforPascal,ametricunitofmeasurementforpressurebasedonairvelocity250Paequals1.0inchwatergauge.
DOPistheabbreviationfordioctylphthalateparticlesof0.3mdiameter.
**IfthepatientrequiresbothPEandAII,returnairshouldbeHEPAfilteredorotherwiseexhaustedtotheoutside.
^HEPAfiltrationofexhaustairfromAIIroomsshouldnotberequired,providingthattheexhaustisproperlylocatedtopreventreentryintothebuilding.

Ventilationrequirementsforareasaffectingpatientcareinhospitalsandoutpatientfacilities
HospitalGradeHEPAAirCleanersforPositive&NegativePressureIsolationRooms
AchievingNegativePressureinHospitalIsolationRooms:Negative pressure is needed to control the direction of airflow between
selectedroomsinahealthcaresettingandtheiradjacentspacestopreventcontaminatedairfromescapingfromtheroomintoother
areas (Figure 1). Control of a room's differential airflow and total leakage area is critical to achieving and maintaining negative
pressure. Differential airflow, differential pressure, and leakage area are interrelated. This relation is illustrated (Figure 1) and is
expressedinanempiricalequation.

(Formula1)

In the equation, AE is the leakage area in square inches [for instance, air gap under the isolation room entry door] DQ is the
differentialairflowrateincubicfeetperminute(CFM)[the difference between airflow exhausted from the negative pressure isolation
roomtoanadjoiningareathroughaHEPAfilter,and,supplyairenteringtheroomfromsourcessuchastheHVACsystemsupplyvent]
and DP is the differential pressure drop in inches of water gauge [the difference in pressure between the air in the adjoining area
where the HEPA filtered isolation room air is exhausted to, and, the air within the negative pressure isolation room]. This empirical
equation was used (Figure 1), which indicates that changing one parameter will influence one or both of the other parameters. For

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Usingairpuriferstocreatenegativepressure&positivepressureisolation
example, the control of differential pressure can frequently be improved by increasing the air tightness or seal of a room, HVAC
system, and ensuring continuous monitoring. In a room that is already substantially tight (e.g., with 10 square inches of leakage),
however, a small change in differential pressure will have a substantial affect on differential airflow. Similarly, a room with a more
substantial leakage area (e.g., 300 square inches of leakage) requires a higher differential airflow rate to achieve a pressure
differentialof0.01inchofwatergauge.Reducingtheleakageinaroomwith300squareinchesofleakagecanhelpachieveapressure
differential of 0.01 inch of water gauge (Figure 1). If the leakage area is reduced to approximately 40 square inches, a pressure
differentialof0.01inchofwatergaugecanbeachievedbyexhaustingapproximately100CFMmoreairfromtheroomthanissupplied
totheroom.
Room leakage can occur through cracks or spaces near doors, windows, ceiling, and utility connections. Steps should be taken to
minimize these leaks. Changes in the performance of the HVAC system will affect the pressure differential in a room and can
potentially cause a negativepressure room to become positivepressure. Therefore, each of these parameters requires close
monitoring to ensure that minor changes in the performance of the HVAC system do not adversely affect the entire system.
(DifferentialRoomPressureMonitorsforHospitalIsolationRooms)
Figure1:Empiricalrelationbetweendifferentialairflow,
differentialpressure,andleakageareas*

Table2:RequiredDifferentialAirflowvs.
NegativePressureIsolationRoomLeakageat
IsolationRoomDifferentialPressureof0.01
incheswc
Differential Differential
Leakage
Airflow
Pressure
AE

Section"AchievingNegativePressureinHospitalIsolationRooms"adaptedfrom"Guidelines
for Preventing the Transmission of Mycobacterium tuberculosis in HealthCare Settings,
2005" December 30, 2005 / 54(RR17)1141, US Centers for Disease Control and
Prevention.
OriginalsourcedocumentsforFormula1&Figure1:
HaydenIICS,FischbachTJ,JohnstonOE,HughesRT,JensenPA.Amodelfor
calculating leakage areas into negative pressure isolation rooms. Cincinnati, OH:
USDepartmentofHealthandHumanServices,CDC1996

AE

(Square (Square
Inches)
Feet)
17.70
0.12
39.82
0.28
64.00
0.44
89.61
0.62
116.34
0.81
144.00
1.00
172.47
1.20
201.63
1.40
231.42
1.61
261.78
1.82
292.66
2.03
324.03
2.25
355.84
2.47
388.07
2.69
420.69
2.92
453.69
3.15
487.04
3.38
520.72
3.62
554.73
3.85
589.04
4.09
946.61
6.57
1,325.40
9.20
1,720.81
11.95
2,129.97
14.79
2,550.95
17.71
2,982.31
20.71

DQ

DP

(CFM)

(Incheswc)

50.00
100.00
150.00
200.00
250.00
300.00
350.00
400.00
450.00
500.00
550.00
600.00
650.00
700.00
750.00
800.00
850.00
900.00
950.00
1,000.00
1,500.00
2,000.00
2,500.00
3,000.00
3,500.00
4,000.00

0.01
0.01
0.01
0.01
0.01
0.01
0.01
0.01
0.01
0.01
0.01
0.01
0.01
0.01
0.01
0.01
0.01
0.01
0.01
0.01
0.01
0.01
0.01
0.01
0.01
0.01

TABLE3:Airchangesperhour(ACH)andtimerequiredforremovalefficienciesof99%and99.9%ofairbornecontaminants*

**Table3fromTable1of"GuidelinesforPreventingtheTransmissionofMycobacteriumtuberculosisinHealthCareSettings,2005"December30,2005/
54(RR17)1141,USCentersforDiseaseControlandPrevention.
Furtherinformation:

1. GuidelineforIsolationPrecautions:PreventingTransmissionofInfectiousAgentsinHealthcareSettings,CDC,June2007
2. CDC|TB|TBGuidelinesInfectionControl&PreventionApril19,2012
3. OSHASafetyandHealthTopics,HealthcareFacilities
4. Guidelines&RecommendationsforVentilation,Construction,andRenovationofHospitals
5. GuidelinesforDesignandConstructionofHealthCareFacilities,TheFacilityGuidelinesInstitute
6. IsolationRooms&PressurizationControlpictorials,PennStateUniversityArchitecturalEngineeringIndoorEnvironmentCenter
WorldwideSupplierofAirPurifiers,AirCleaners,AirFilters,DustCollectors,&MistCollectorsshippingfromNorthAmerica.
Many,butnotallmodelsaredisplayed.AirPurifiersareavailablewithavarietyofelectricaloptionstomeetthepowerstandardsofmostcountries.

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