How to Reduce COVID-19 Risk In Long-Term Care Facilities

From isolation rooms to personal protective equipment

By Dave Ruhland


For most U.S. states, at least one-third of COVID-19 related deaths took place in long-term care facilities such as nursing homes, adult care residences and other skilled nursing settings. Facility managers are working hard to stop the spread of this infectious disease. From requiring staff to wear personal protective equipment (PPE) to testing residents daily for COVID-19, administrators are exploring their options for mitigating the risk of this new virus strain from spreading to their high-risk residents. 

Given that COVID-19 is an aerosol respiratory disease that spreads through airborne particles, facility managers are also exploring ways to increase isolation room capacity or create isolation wings, as simply isolating infected individuals in their own rooms is not enough to control the spread of the virus. Isolation rooms are needed more than ever, not only to keep residents safe, but also to give family members and workers peace of mind that the facility is doing everything it possibly can to stop the spread of infection. Here are key considerations that long-term care administrators should know when creating effective isolation rooms and protecting residents and staff from COVID-19.

How Isolation Rooms Keep the Bad Germs In – Or Out

Traditionally, heating, ventilation and air conditioning (HVAC) recirculates air by cycling it back through a building for energy efficiency in heating and cooling expenses. When an infected patient coughs, sneezes, exhales or talks, particles are released into the air and can spread from person to person through the building ventilation. This could result in a loss of control over the virus and increased risk of spreading the infection. An isolation room is designed to exhaust air out of the building instead of recirculating back into the building, thus eliminating the spread of bacteria or the virus. Once the bacteria or virus is outside, the ultraviolet rays from the sun scrambles the DNA in the bacteria or virus and prevents it from reproducing. 

To be effective, it is critical to maintain a negative pressure differential inside an isolation room to ensure that the air pressure in the room is lower than the surrounding areas. This prevents viruses or bacteria in the room from migrating through open doors or other openings in the room. 

In many cases, isolation rooms are permanent rooms that were planned for when the facility was originally designed to accommodate these environmental scenarios, but there are steps that long-term care facilities can take to quickly and effectively convert existing rooms into working isolation rooms.

Converting an Existing Room to an Isolation Room

When converting an existing room in a long-term care facility into an effective isolation room, there are two key steps that can be done quickly – and with minimal structural changes to the environment. For buildings that have centralized heating and cooling, the first step is to disconnect the return air from recirculating back into the building. The second step is to have a HVAC professional add an exhaust fan, which creates airflow out of the room and ultimately negative pressure in the room. By blocking off return air flow to other rooms or hallways and fanning the exhaust directly out of the building, any air particles that contain COVID-19 or other respiratory diseases like tuberculosis, or even the flu, would be prevented from spreading throughout the building. Best practice is to HEPA-filter the exhaust air to capture particles and ensure they cannot re-enter the building.

From there, it is important to also increase the amount of air supplied to the areas surrounding the isolation room, or rooms, to ensure that plenty of fresh air is circulating, while the negative pressure in the room keeps the bad air particles from contaminating the clean air. Ideally, each room should be separately controlled versus an entire wing, as it provides a more effective way to control the virus from moving through the air. 

A final, and critical, step when converting an isolation room is to implement tools to monitor the air pressure 24/7. To ensure that the room is properly pressurized and keeping bad contaminants in – or out – a room pressure monitor, like a PresSura, can be installed to verify proper airflow and pressure both inside the room and outside, ensuring safety for patients and staff alike. 

Keeping Staff Safe with Proper Fitting PPE

Staff play a critical role in keeping patients safe. And taking proper steps to ensure they are safe is critical to maintaining the overall health at long-term care facilities. Personal protective equipment (PPE), like respirators and masks, can protect staff who are caring for residents’ in isolation rooms and in the general population, but the reality is that the efficacy of the PPE is only as good as the fit.  

With the temporary lift in OSHA’s annual respirator fit testing guidelines, hospitals, first responders and long-term care providers are currently only required to fit test new employees or anytime an employee must wear a new model or size of mask, which could leave healthcare workers at risk of infection. There are two ways to perform a respirator fit test – qualitative testing and quantitative testing. Qualitative testing, also known as the “smell test,” is a very subjective way to determine if a mask is sealed properly and fully protecting the individual wearing it as it relies on the wearer’s ability to detect fragrance and taste. Given that loss of smell and taste are known symptoms of COVID-19, relying on the smell test to determine a proper respirator fit could leave staff unprotected and ultimately expose residents to air borne infections that are escaping the mask.

Quantitative fit testing, like the PortaCount® Respirator Fit Testers, leverages technology and data to test all NIOSH-certified respirators and ensure that staff are wearing their PPE correctly to minimize health risks. As new staff join long-term care facilities or PPE from different sources is leveraged in facilities, it is critical to ensure that they are leveraging PPE properly and staying safe by conducting fit testing when masks from different manufacturers are put into use.

COVID-19 has been raising the question, “are we doing all we can to keep our healthcare workers and patients safe?” By creating proper isolation rooms and executing quantitative respiratory fit testing, long-term care facilities can show current residents, staff, and prospects that they are taking science-based prevention measures to maintain a healthy facility and mitigate the spread of air born infections like COVID-19. 

About the Author: Dave Ruhland is a Senior Global Product Manager of TSI Incorporated, an industry leader in particle measurements and precision instrumentation. Dave holds a degree in mechanical engineering and MBA from the University of Minnesota. With over 20 years of  experience at TSI with HVAC and critical environments such as isolation rooms, operating rooms, and chemical laboratories, Dave has extensive experience working with pressure differentials. TSI Incorporated is a leading provider of respirator fit testing instruments, room pressure monitors and controls, flow meters critical to the production and proper maintenance of ventilators, as well as filter testing equipment to ensure PPE is within the target range to filter out harmful particles. TSI has been in business more than 50 years with offices around the globe.

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