NIOSH Ventilated Headboard Provides Solution to Patient Isolation During an Epidemic

Posted on by Kenneth R. Mead Ph.D., PE
Ventilated headboard

To protect healthcare workers, other patients, and visitors from exposure to airborne infectious diseases, patients in hospital settings sometimes need to be placed in airborne infection isolation rooms (AIIRs). AIIRs contain specific engineered features to isolate and more-quickly remove potentially infectious patient aerosols so that they do not infect others. Isolation rooms are expensive, costing about $30,000 more to construct than a typical patient room. As a result, not all facilities have isolation rooms or have enough isolation rooms to handle an epidemic/pandemic.

To address the need for multiple isolation rooms, the National Institute for Occupational Safety and Health (NIOSH) developed the Ventilated Headboard to isolate patients while protecting healthcare personnel from airborne infectious diseases. The ventilated headboard is inexpensive, easy to erect, safe, and scientifically proven.

The ventilated headboard consists of lightweight, sturdy, and adjustable aluminum framing with a retractable plastic canopy. The ventilated headboard is not a filtration system in itself, rather it is a special inlet system designed to provide a strategically improved air intake for a corresponding high-efficiency particulate air (HEPA) fan/filter unit.  Together, the ventilated headboard and HEPA system can provide multiple isolation units or “surge isolation capacity” in traditional patient rooms, triage stations, emergency medical shelters, or even as emergency/temporary support options for displaced population shelters.

  • The ventilated headboard provides near-instant capture of patient-generated aerosol.
  • Laboratory tests show the capture and removal of over 99% of airborne infectious-sized aerosol.
  • The retractable canopy allows for hands-on healthcare procedures while still offering protection to attending healthcare personnel.
  • The canopy allows low-velocity air currents to capture/remove contaminants without irritating the patient.
  • The canopy material (plastic sheeting) is held into place by removable retainer clips and can easily be replaced between patients.
  • In addition to the direct-capture capabilities of the ventilated headboard, the HEPA fan/filtration system provides continuous air cleaning to the surrounding room air.

NIOSH researchers have constructed and tested the Ventilated Headboard in two general configurations: (1) a wooden, do-it-yourself model constructed from supplies found at your local hardware store and (2) a lightweight aluminum model constructed using commercially available extruded aluminum framing and related fittings. The extruded aluminum model is likely the preferred variation for most healthcare environments.  For circumstances where large numbers of patients requiring isolation may require triage and/or treatment in non-traditional healthcare environments, detailed instructions for the wooden, do-it- yourself configuration of the Ventilated Headboard can be found here.

Multiple hood system

When the ventilated headboard is desired for use in an emergency medical shelter or similar environment, it may make sense to build a multi-cot (or bed) system served by a single, large HEPA/fan system as opposed to deploying multiple headboards, each driven by their own HEPA fan unit. Example instructions for a 5-cot ventilated headboard system designed using quick-connect ducting and fittings can be found here: Expedient Airborne Infection Isolation 5 Bed Demonstration Kit Assembly Instructions pdf icon[PDF – 1009 KB]. In addition, the multi-cot ventilated headboard approach can be augmented with a second layer of containment using a tent or canopy. In this case, the air removed by the ventilated headboard places the tent under negative pressure, thus providing a second layer of containment for more serious cases or ambulatory patient cases that may be less likely to remain prone in their bed. Example instructions for expedient airborne isolation tents can be found here: Expedient Airborne Isolation Tent Assembly Instructions pdf icon[PDF – 740 KB] and Expedient Airborne Isolation Tent Option 2 Constructed using a 10’ X 10’ “Pop-Up” Canopy pdf icon[PDF – 1.65 MB].

In the event of an epidemic, when surge airborne infection isolation is needed, the ventilated headboard can provide affordable, portable, effective, scientifically proven capture of patient aerosols to protect healthcare workers.

For more information see Engineering Controls To Reduce Airborne, Droplet and Contact Exposures During Epidemic/Pandemic Response and the video which demonstrates the ventilated headboard’s function and explains the  supporting research.

Kenneth R. Mead Ph.D., PE, is the Chief of the Engineering and Physical Hazards Branch in the NIOSH Division of Field Studies and Engineering. 

 

 

Posted on by Kenneth R. Mead Ph.D., PE

15 comments on “NIOSH Ventilated Headboard Provides Solution to Patient Isolation During an Epidemic”

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    For the five cot system, is dampering at each duct takeoff available to regulate airflow for each patient?

    Is fan noise control an issue for any of the ventilator configerations?

    Looks like a good practical solution!

    Thank you for your comment. Yes, each hood on the 5-cot system, has a butterfly valve to balance the airflow. This is identified as part “C” on the linked assembly schematic. Due to work at home restrictions, I do not have my field notes with me but my recollection was that the noise levels at the cot came in under 70 dBA.

    If you are interested, there is a video created by the state of Tennessee showing the ventilated headboard being set-up for an emergency response exercise. In the video, it is being assembled for an alternate care site using emergency medical cots with 5 of the wooden DIY hoods plus medical cots being served by a single 2000cfm-rated fan (actual performance as shown, closer to 1400 cfm). If desired, augmenting each cot with pop-up tent with side walls gives you 5 negative pressure patient “rooms” with ~17 ACH and direct source control to capture patient-bed generated aerosol almost instantly. Of course scale can go up/down depending upon need, ducting and equipment (want actual 240-270 cfm/hood). Same setup can also serve hospital beds instead of cots.
    https://www.dropbox.com/s/xprymyn5ed38b2v/Expedient%20airborne%20infectious%20isolation%20unit.mov?dl=0

    Thank you for your question! The plastic canopy never fully closes the patient. That is one of the advantages of this approach over other techniques that require near-total enclosure in some form of tent or bubble. In the case of the ventilated headboard, the canopy simply extends to maximize the capture efficiency of the low-velocity air flow. The front of the canopy remains open, and is sufficiently sized to allow patient interaction with healthcare providers, other room occupants, televisions etc.

    Ken, if we wanted several thousand of these in preparation for the CA wildfire season, are you aware of manufacturers who are able/willing to provide a bid and produce the products by early or mid-summer?

    I will reach out to you offline as I’m not sure if you are interested in using the ventilated headboard to support Infectious Isolation at alternative care sites or if you are interested in using them to provide “protective isolation”. [The headboard can be configured to do either one, based on airflow direction.].

    Note that assembly of the wooden version is very simple. We tested it with high school students who were able to construct the ventilated headboards without any issues. For the extruded aluminum version, a vendor of similar products should be able to easily construct the ventilated headboards with the parts list and assembly instructions.

    The air velocity seems rather low to capture coughs and sneezes. In the video you talk about the easy capture of the viral particles and their low momentum due to their small size. I don’t think you were taking into account that the particles are inside a fast moving mass of air with significantly higher momentum than individual particle have.

    Hi Jay,

    Thank you for your question. The canopy extension is what allows the velocity to be so low and places the upper half of the patient’s torso within a unidirectional moving airflow. With the canopy extended and the patient laying flat or even with the head of the bed/cot elevated at an angle up to approx. 40 deg. The discharge from patients mouth will hit the canopy wall, disperse the cloud, and then follow the air currents (This was modeled in reference #2 listed at: https://www.cdc.gov/niosh/topics/healthcare/engcontrolsolutions/ventilated-headboard.html ). Admittedly, if the patient sat up vertically to the point that their head was at the face of the canopy and pointed outwards, the cough “cloud” would escape the controlling low-velocity airflow. However, if that occurred in a real or alternative patient room, the HEPA fan/filter system would still provide high ventilation rate room air cleaning, consistent or exceeding that which is currently provided in a traditional airborne infectious isolation room. If being used in a multi-cot shelter configuration and this became a concern, erecting a pop-up tent enclosure with wall kit around the cot area would create the negative pressure, high ventilation rate room air cleaning for the occasional “cough cloud escapes” while also providing the direct source control for the overwhelming majority of the patient’s time.

    Thanks again for a great question!

    Hello,

    Firstly I hope everyone is safe at home.
    This is one interesting article, i loved reading this
    Thank you.

    Thank you for your question. To my knowledge (which admittedly may be limited in regards to requirements outside of the United States), the World Health Organization (WHO) is not in the business of approving intervention designs such as the ventilated headboard. Note that the ventilated headboard itself is not the primary air-cleaning device. Instead, it is a strategically-designed “inlet” that provides improved barrier protection and controlled airflow direction for an exhaust system or air-cleaning device utilized by the facility. As you may be aware, the WHO’s Infection Prevention Guidance: Infection prevention and control during health care when COVID-19 is suspected, prescribes minimum protective guidance for healthcare workers around the world and under a wide range of available resources. In the cited guidance document, WHO recommends (1) patients should be placed in adequately ventilated single rooms, and (2) When aerosol-generating procedures (such as tracheal intubation, non-invasive ventilation, tracheotomy, cardiopulmonary resuscitation, manual ventilation before intubation, and bronchoscopy) are possible, to use “…an adequately ventilated room – that is, natural ventilation with air flow of at least 160 L/s per patient or in negative-pressure rooms with at least 12 air changes per hour and controlled direction of air flow when using mechanical ventilation”. For both room placement scenarios, we believe that the ventilated headboard in combination with a HEPA fan/filter unit or appropriately configured external exhaust fan can help provide that “adequately ventilated room” while also providing the “controlled direction of airflow”.

    When we responded offline to your question, the assembly instructions document was not available online. Now that it is posted to our website, we are posting this reply for the benefit of all blog readers.

    Thank you for your question. At this time, the extruded aluminum version of the ventilated headboard is commercially available and can be ordered preassembled or in a more-compressed kit that you assemble yourself. The parts list with assembly instructions are available here. Note that the instructions are very detailed, including multiple graphics and photos. NIOSH Beta-tested these instructions with several student interns and believes them to be sufficiently easy to follow. The extruded aluminum version of the ventilated headboard is designed around a common product line which has multiple vendors throughout the country. In addition, there are competing framing product suppliers who may also be able to adapt the design to accommodate their specific framing material. An internet search using keywords “extruded aluminum framing” will bring up several such manufacturers that should be able to assist you in such a pursuit. Adaptations that vary any internal or external dimensional measurements should be evaluated with caution and at minimum, qualitatively tested to confirm containment performance and patient acceptability.

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Page last reviewed: August 14, 2020
Page last updated: August 14, 2020