Inappropriate federal standards for air control in hospital intensive care units

Abstract

Since 1947, the federal government has set forth standards for the construction of hospi­ tals. These standards were created as part of the regulations for implementation of the Hill-Burton program, which provided federal funding for hospital construction. The most re­ cent standards apply to the construction of new hospitals and renovation of existing hospitals when Hill-Burton money is used.! Most states have adopted these standards in their entirety or in slightly modified versions even though little federal funding is available. Additionally, hospital architects frequently refer to the fed­ eral document in their hospital construction or renovation projects. This may present a prob­ lem when one examines the air pressure rec­ ommendation for intensive care units (ICU). The present Hill-Burton standards recom­ mend a positive air pressure relationship be­ tween an intensive care unit room and the ad­ jacent area. We believe that this may not be desirable when one considers the diverse pa­ tient population which is cared for in this set­ ting. Patients in the ICU with airborne com­ municable diseases requiring strict isolation (Staphylococcus aureus pneumonia) or respira­ tory isolation (tuberculosis) are preferably not placed in positive pressure rooms. Transmis