THE PLANNING OF A MODERN ISOLATION UNIT IN THE NETHERLANDS
Geneeskundige Hoofdinspectie van de Volksgezondheid, Afdeling Infectieziekten, Dokter Reijersstraat 8, Leidschendam, The Netherlands.
The Netherlands - just like a number of other European countries - do not have the possibility to isolate, to treat and to nurse adequately patients with or suspected of a highly communicable disease against which full protection by (e.g.) vaccination is not yet available. That is the reason why the big quarantine station "The Heyplaat" in Rotterdam is to be considered as obsolete: still valuable for smallpox but of no use for Lassa Fever or Marburg Virus Disease. That situation has led to setting up a working-group in 1975 for studying the question how to realize in the near future the isolation of patients with a very contagious disease in Holland. Such an isolation should not only protect (para-) medical personnel from infection by the patient but should also allow for optimum treatment and nursing.
After ample discussions the working-group advised the construction of a small isolation unit for 4 patients, situated in the centre of the country not far away from the National Institute of Public Health in Bilthoven. In a small country like Holland one unit in the centre is considered to be sufficient. There is a great chance that the unit will be built on the site of the Hospital "De Lichtenberg" in Amersfoort.
The development of the Trexler Plastic Bed Isolator by Vickers Ltd., appeared to be of crucial importance. It gave the impetus necessary to speed up the discussions about the requirements for the isolation-unit. The discussions in the working-group have not yet been concluded. We hope to arrive at a final digestion of the available information after studying the reports of two delegations of the working-group which have just returned from a visit to the United Kingdom and as well of the condensation of the knowledge gathered at this meeting in Antwerp. The perspective of the isolation-unit to be built seems to be a sound one. The general draught of it has already been drawn. Quite a few requirements, however, have still to be formulated. However immature our plans still may be, for those contemplating to have also modern facilities in their respective countries it may be worthwhile taking note of our endeavours in this respect. Therefore a brief outline of the unit we intend to have is given:
The isolation unit shall contain four patients at most. They will be treated in Plastic Bed Isolators in one ward where for extra security a lower air pressure than its surroundings should be maintained as well. The ward should have an exhaust-ventilator with a H.E.P.A. or "Absolute" filter. The entry to the ward will be through air-locks.
A separate room - connected with the ward - is intended for the convalescent who is considered not to be directly contagious any more but who is still regarded as a potential risk (e.g. semen still containing the pathogen).
Another small room that will also be connected with the ward will serve as laboratory where tests can be performed on pre-sterilized material of the patients.
The medical and paramedical personnel in the unit shall not be isolated.
The unit shall have a recreation room, bedrooms, bathrooms, toilets, etc., for the personnel.
An incinerator and an autoclave shall be installed between the ward and one of the adjacent rooms.
Although the unit will be connected to the hospital by means of a corridor, a small pantry outside the nursing area for preparing coffee, tea, etc., for patients and personnel is considered desirable.
A micro-wave oven (magnetron oven) should also be installed.
The unit should have a basement where the airconditioning equipment could be installed.
Ample technical facilities shall be made available for the patients' care, e.g. connection with the CCU, call and alarm system, mechanical ventilation, oxygen supply, air conditioning regulation, etc.
An ambulance-garage - part of the unit - shall be appropriate for loading and unloading of isolators and for disinfecting the ambulance. Annex to the garage there shall be washing and changing facilities for the ambulance personnel.
Provision shall be made for emergency current in case the main current fails.
The total area of the unit will probably be about 400 sq.metres, i.e. 100 sq.metres per patient.
The question of double-usage of the unit is still under consideration. Double-usage may hamper the rapid clearance of the unit in case a patient with or suspected of a highly communicable disease must be isolated. On the other hand, double-usage may be very important for the continuous training of (para-) medical personnel in the unit.
At the moment we have one Plastic Bed Isolator in the Harbour Hospital in Rotterdam and a Plastic Aircraft Transit Isolator at Schiphol Airport.