Exit, Ebola: Infection Control & the Hospital Exit Room

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When the Democratic Republic of Congo was mired in a health emergency in May 2018, working to contain an outbreak of the deadly, highly contagious Ebola virus, all nations looked inward and asked: are we prepared?

When concerns crescendo about Ebola’s global reach with each new crisis, we vividly recall its frightening, first-time U.S. arrival in HKS’ headquarter city in October 2014, at Texas Health Presbyterian Hospital Dallas— a facility we designed and have been proud to continue working with for more than 50 years.

It was a difficult and stressful time for the hospital, its staff, patients, and the entire Dallas community. As a leading planner and designer of medical and healing facilities, the Ebola crisis in our own backyard presented an opportunity to critically reconsider infection control in our health client’s operations: the flow of staff, patients and visitors through the space, the donning and doffing of personal protection equipment—including secondary people watching—minimizing disruption of care and more.

Back in the 1980s, anterooms were thought to provide a safety zone in which putting on personal protection equipment (PPE), hand-washing and de-gowning could be properly executed. It also presumed additional protection by not allowing air from the room of the infectious patient to mix with the air of the “clean” zones of the hospital. Over time, these rooms were considered unnecessary as negative pressure in the room could prevent air from escaping, and hand-cleansing stations could be placed anywhere.

Enter Ebola. When the crisis first arose in 1976 in central Africa, infectious disease experts did not know how the virus was spread. Understanding how infectious pathogens propagate is critical to preventing deadly outbreaks. Once experts discovered that Ebola is transmitted through direct contact with infected bodily fluids versus airborne, the global medical community understood how to control transmission—and health facility design plays a part.

Ebola claims its victims quickly, and often—left untreated, people contracting Ebola usually die within a week, and the disease is fatal in 50-90% of cases. The highly viral and lethal nature of the disease caused hospitals to reconsider their infection control strategies, and possibly reintroduce the anteroom.

In a thorough review of the clinical process, workflows and infectious disease safety principles, we found there is not a need for a separate compartment prior to entering a room where a highly infectious patient is being treated.

The problem resides with the room exit. All the PPE, once used, is assumed contaminated. Further, when someone exits a room rapidly, air currents created through physical body movements can overcome the negative pressure pulling air back into the isolation room. In fact, this violates one critical general principle of contamination handling: never backtrack. Our exit room concept eliminates dangerous backtracking of contamination within a medical facility.