GB2314859A - Accommodation units providing an isolated environment - Google Patents

Abstract

An accommodation unit provides an isolated environment for an infected patient, or protects a patient from external contamination. This unit comprises a capsule (1) providing a living space, filter means (3,4) for providing filtered air into and/or out of the space; means (14,15) for allowing the entry and exit of apparatus and waste from the space, without disturbing the integrity of the space; and means (1) for enabling a patient to be manipulated or operated on by a person isolated from the patient. Preferably, there is also provided a mobile unit (28)(fig 3, not shown) for the transport of a patient, wherein cooperating means are provided on the accommodation unit and the mobile unit for linking the two to provide a passage for allowing the patient to move or be moved between the two without disturbing the integrity of the isolated environment, the mobile unit also providing an isolated environment.

Description

ACCOMMODATION UNITS PROVIDING AN ISOLATED ENVIRONMENT This invention relates to accommodation units providing an isolated environment. In particular, it relates to an accommodation unit providing an isolated environment in which a patient may temporarily or indeed semi-permanently reside and which enables either an infected patient to be isolated so as not to spread the infection to other persons, particularly in a hospital ward, or to provide an environment in which a patient is protected from external contamination, as is often required to protect post-operative patient from viral or bacterial contamination or for providing operating facilities in contaminated environments.

A particular problem has emerged in the last few years due to the emergence of strains of bacteria which are resistant to conventional antibiotics. Hospitals in particular are finding that wards are becoming contaminated by such bacteria which, by the fact that it cannot be successfully treated by conventional antibiotics, poses a great threat to both patients and staff. Up to now, when contamination with one of these organisms has been found, the only option has been to close down a hospital ward temporarily and to sterilise the ward before moving patients back into it. This can be very expensive and of course greatly inconvenient or dangerous for patients who have to wait longer for operations or who may have to be moved out of the ward during a critical post-operative recovery period.

Isolation wards are sometime available but these are expensive to maintain and may lie unoccupied for long periods of time, wasting space and resources in the hospital.

There is thus a need for an efficient method of isolating patients with particular illness, or for isolating healthy persons from external contamination.

According to the present invention there is provided an accommodation unit providing an isolated environment for an infected patient, or to protect a patient from external contamination, comprising a capsule providing a living space, filter means for providing filtered air into and/or out of the space; means for allowing the entry and exit of apparatus and waste from the space, without disturbing the integrity of the space; and means for enabling a patient to be manipulated or operated on by a person isolated from the patient.

Preferably, there is further provided a mobile unit for the transport of a patient, wherein cooperating means are provided on the accommodation unit and the mobile unit for linking the two to provide a passage for allowing the patient to move or be moved between the two without disturbing the integrity of the isolated environment, the mobile unit also providing an isolated environment.

The mobile unit may be provided with means for enabling the patients condition to be monitored, such as for enabling X-ray, ultra-sound, or other scanning apparatus to be mounted externally, to monitor the patient internal of the unit. The mobile unit may be used to transfer patients from one accommodation unit to another.

The mobile unit preferably also comprises means for enabling the patient to be manipulated. The manipulating means on the accommodation unit and/or mobile unit may comprise gloves, half suit or other body protection apparatus.

An accommodation unit, or a mobile unit, may be arranged or adapted for use as an isolated operating theatre, or be arranged for many other uses.

Embodiments of the invention will now be described, by way of example only, with reference to accompanying drawings, in which: Figure 1 shows a patient containment system according to the present invention; Figure 2 shows a cut-away view of the system, illustrating its interior; Figure 3 shows a mobile patient transferral unit for docking with the patient containment system; and Figure 4(a) and (b) illustrate a docking system between the patient containment system and a mobile unit.

Referring to Figure 1, there is shown schematically a patient containment system 1 for providing an isolated environment in which a patient may temporarily or more permanently reside. The containment system 1 provides a physical protective barrier between a controlled area inside it and the environment outside.

Essentially, it forms a capsule inside which the patient lives. The system shown in Figures 1 and 2 may be a mobile one mounted on casters so that the unit can be wheeled to a desired position in a hospital ward for example and then, after use, moved to a new location. In the embodiment shown, however, the unit does not possess casters or other movement means and is semi-permanently located in a desired position. This enables the unit to be larger (since it does not have to pass through doorways) and thus less restricting to a patient.

The unit is generally constructed of any material suitable to prevent the ingress or egress of undesired material, such as metal or plastics materials.

One or more windows 2 are also present to enable an occupant to be viewed and the occupant to view outside.

It is greatly preferable for as large a window area as possible to be provided so as to reduce claustrophobic effects to a patient inside the system as much as possible.

Filtering means 3, 4 are provided for the intake and outlet of air from the container. The filtration system in one embodiment is a high efficiency particulate air (HEPA) filtration system, of which many examples are known in the art. Air is taken in through filter 3 and extracted through filter 4. Such types of air filtration systems can supply very high quality filtered air into and out of the isolator, filtering out all particulate contamination to an efficiency level, if required, of up to 99.99995% of a particle size of 0.1 ssm. Note that for most types of viral or bacterial contamination it is not the actual virus or bacteria itself that tends to spread in the air, rather, the virus or bacteria attaches itself to particles in the air, such as dust particles, which are of course many times bigger than the virus or bacteria itself and thus, by preventing movement of these particles, contamination by the virus or bacteria is prevented.

Generally to protect an infected patient from contaminating the outside atmosphere the environment within the isolator is kept under a negative pressure.

This means that if the integrity of the system is broken, the tendency is for outside air to be drawn in, thus preventing airborne contamination migrating outwards. If the unit is used to provide protection from outside contamination, ie to provide a sterile environment such as an operating theatre, then a slight positive pressure is applied inside it. This acts to stop external viral or bacterial contamination from penetrating into the isolator. The air is supplied through the filters 3,4 by independent intake and extract fans (not shown) mounted on the roof. Selection of the parameters of these can be used to alter the environment within the unit, both to create the required negative or positive pressure and for patient comfort. The filter boxes 3 and 4 are mounted in the ceiling of the isolator and are mounted such that they can be changed safely when required without disturbing the integrity of the unit.

Inside the unit there is mounted a bed base 5 upon which a mattress 6 is placed and used (shown in Figure 1 and dashed lines in Figure 2). The bed base is connected to a plurality of hydraulic rams 7 which act to raise or lower the top and/or bottom of the bed to enable the bed to be moved between a variety of positions from lie flat to a sitting up position. The bed acts in the same way as a conventional hospital bed and the positioning of it is controlled by a control panel 8 which is preferably accessed, as shown in Figure 1, from both inside and outside the unit such that either the patient himself, or his carers, may alter the bed position.

Figure 2 is a partially cut-away view from the other side to Figure 1 and illustrates that a toilet 9 is provided at the head of the bed. The toilet may, alternatively, be provided in any other position in the unit. The toilet is of conventional chemical toilet type in which urine and excrement are collected into a cassette unit underneath the unit. Preferably, a warning light system is provided which illuminates a light when the cassette unit is full. A cupboard door is provided on the outside of the unit adjacent to the toilet and this door is opened by an orderly to empty the cassette unit of the toilet. This does not disturb the integrity of the environment within the unit. The toilet is mounted underneath a hingeable seat 8, 10 so that the patient may sit upon the seat 10 or, if he wishes to use the toilet, raise the seat and sit directly upon the toilet. A footwell 11 is provided adjacent the seat/toilet for the users feet. As shown, this is sloped away from the toilet for drainage and may include drainage holes.

One or more slidable screens 26 may be provided which provide a degree of screening for a patient using the toilet 9 for privacy. These screens slide up and down under the manual control of the patient.

Inside the unit there are also provided one or more rails 12 to which may be attached drips, bags or other medical or personal apparatus and also it is preferable to provide some cupboard and/or shelf space 13 for the patient's effects. Cupboards 14 may also be provided which open to the exterior of the unit and in which medical equipment may be stored.

Access of equipment and/or waste to and from the patient is provided through an air lock system 14 which has two doors, one opening into the isolated bed and the other opening out into the ward. Air lock systems in themselves are well known and maintain integrity, with the positive or negative pressure, provided both doors may not be opened at the same time. Thus, an interlocking system, as is known, is used to prevent both doors accidently being opened at the same time. To use the system, one door is opened, the product is placed within the compartment, that door is closed and the other door is opened.

A further entry/exit means 15 is provided for removing contaminated waste materials for example. This consists of a sealed internal door 16 (hidden in the figure) within the unit and which opens out to a flange 17 to which an elongate tube of flexible plastics material 15 is connected. The plastics tubing is in the form of lay flat tubing which lies in a generally flattened disposition. It is of considerable length and typically folded over itself in alternate opposite directions, in a multiple 'Z' configuration. One end of the tubing 15 is connected to circular flange 17 by an '0' ring 17a. The other end is sealed with a cable tie 18.

When waste materials are ready to be removed from the isolator, the sealed door 16 inside the isolator is opened. The waste material is pushed out through the doorway into the end of flanged section 17. The door 16 is then resealed and from outside the isolator the waste material is pulled into the tubing 15. The tubing 15 is then sealed using a cable tied behind the waste material, thereby sealing the waste material in its own envelope. A further cable tie is then placed behind the last cable tie, ie nearer to flange 17. The plastics tubing material 15 can then be cut between the two newly applied cable ties, releasing the waste material for incineration in its owned sealed envelope. Thus, no contamination has been allowed to enter or exit the isolator from or to the external atmosphere, and the waste products are sealed in their own protective envelope for disposal. The plastics tubing material is preferably of a substantial length so that many such cutting and tieing operations may be performed before the plastics material needs replacing.

Access to the patient or other person within the unit is achieved by means of, for example, gloves or half suits 19. In the example shown, two half suits are used, one at either side for working on a patient lying on the bed and these are mounted upon ledges 20 above recesses 21 which allow access into each half suit from below. The construction of half suits is well known and they generally comprise an upper torso portion, arms and a head covering portion, the upper torso portion being sealably connected to the upper side of ledge 20 so that a person entering the suit from under recess 21 stands up to enter the suit and can then work upon the patient yet be isolated so that contamination cannot pass between him and the patient or vice versa. The suit may be made of material appropriate for providing a barrier against the particular containment in suit, whether it be viral or bacterial contamination, chemical contamination or even radiation contamination. Typically, the suit will be of plastics or rubber composition. Clearly, for medical uses, the suit, or at least its glove portions, should be as thin as possible so that intricate operations can be performed by the wearer. Alternatively or additionally, one or more glove port arms may be provided, operating in a similar manner to the half suits.

The bed assembly 5 is most preferably mounted upon rails 22 and can be slid back and forth along these rails. The rails are mounted on the sides of the unit as shown. At one end, the rails extend to a door 23 such that the bed can be slid out from this door when it is opened. The door is, of course, normally closed and sealed. In Figures 1 and 2 the door is shown open for clarity. The door is mounted within a bulk head peripheral seal 24 and, when open, the door moves up and is stored into a space 25 behind the bulk head. The operation of the door will be described further below.

As described, the main unit is provided with standard medical equipment such as drip stands, blood pressure monitors, thermometers, stethoscopes, etc.

Preferably, a plurality of standard connections are provided on the unit which enables more sophisticated equipment such as heart monitors to be connected to further improve patient monitoring and diagnostics.

Control panel 8 may be accessed both from inside or outside to monitor the environment and equipment within the unit. These may include controls for the bed position, for the adjustment of air flow, a communications system to enabling communication between a person inside the unit and person outside and may also include controls for, eg entertainment services such as radio and television and various alarms such as an 'assistance required' alarm or emergency panic alarms. It may also be used to provide patient controllable lighting.

It is most preferable to include a facility for obtaining emergency access to the patient, where he requires immediate life saving treatment for example.

This may be provided by an electronic panic system by which, when a button is pressed, one or more of the side or end panels of the unit are removable, eg by lifting out, to obtain immediate access. Whilst this will of course break the integrity of the unit and allow contamination to flow either inside or outside the unit, this will have to be balanced against the dangers to the patient if emergency treatment is not given.

In embodiments where the unit is portable, the shelf portions 21 may be hingeable upwards and the remainder of the apparatus made smaller so that the apparatus may be moved through doorways with the shelf hinged upwardly and then the hinge moved back to its horizontal portion when the unit is in situ.

The provision of an entry/exit doorway 23 enables the patient on a bed to be slid to a portable isolating unit such as that shown in Figure 3. This includes a cooperating doorway 27 which, by a mechanism described below, or an alternative mechanism, enables a patient to be slid, on a bed, between the main unit 1 and the portable unit 28 whilst both units 1 and 28 remain within an isolated, sterile, atmosphere. A pair of rails 29 are provided in the portable unit so that the bed can slide, when both doors 23 and 27 are open, from one unit to the other. The portable unit can then be sealed shut.

The portable unit includes casters or wheels 30 and is smaller than the main unit. The patient, on a bed, may be wheeled on the portable unit, which is in effect an isolated stretcher unit, to a diagnostic or monitoring machine, for example. Examples of these are X-ray machines, scanning machines of various sorts, or other types of apparatus. The unit is provided with its own intake and extract HEPA filter system (shown schematically at 31 although in practise both intake and extract systems will usually be required) for providing filtered air in and out and maintaining the isolated atmosphere at the desired negative or positive pressure and has a flexible, generally transparent, airtight cover 32. One or more pairs of glove port arms 32 may be mounted in a similar way to that of the half suits of the main unit so that external operators can insert their hands into the arms and thereby have their hands isolated from contamination within the unit yet still be able to work on the patient.

Underneath the patient, a flexible flap of material 33 is provided upon which the patient rests. This flap unit may be pulled out as shown to allow equipment, such as X-ray plates, to be placed right underneath the patient to allow him to be monitored, X-rayed or otherwise treated. The unit is provided with handles 35, brakes 36 and other apparatus as desired.

The mobile unit 28 may therefore be used as a mobile X-ray or other monitoring or diagnostic isolator.

It may alternatively be used for transferring patients between main units or between a main unit and a vehicle.

Alternatively, units may be provided which form mobile operating theatres, cleansing environments (such as showering or bathing units) or for many other uses.

Figure 4 shows in more detail the docking mechanism between the standard 1 and mobile unit 28. The main unit l is shown at the left of each of Figures 4a and 4b and the mobile unit to the right. When the two units are moved relative to each other to a docking position, doors 23 and 27 are locked together, thus providing separate sealed environments within the two units. Each door has a respective door seal 41, 42 mounted peripherally on its front and facing outwards. Locking of the doors 23 and 27 brings the units together such that the seals substantially contact as shown. The respective doors sit within respective flange seals 24 and 43.

Around the peripheral edge of each respective door is also provided a respective inflatable seal 44, 45. These are normally inflated to provide a seal around the periphery of each door. They may be inflated from small air compressors or pressurised cylinders located within the system for example. When the two units are placed in a mating position, internal door seals 41 and 42 are abutted. The two respective external flanges are clamped together by means of clamp bolt 46 and an additional clamp bolt 47 also forces the two respective doors together.

These bolts may be actuated manually or by motors for example. Once the doors are clamped together, then the inflatable seals 44 and 45 are collapsed, as shown in Figure 4b. This is done by opening valves, enabling the air within them to escape. Air may also be applied down through the two flanges by a supply 48 which serves to purge the flange seal assembly 24, 43 to remove any debris or contamination and provide a better seal. At this stage, seals 41 and 42 are compressed by means of the clamping force of bolt 47 and doors 23 and 27 are substantially clamped together as a single assembly. This combined door assembly can then be moved out of the way of the entry/ exit port and is moved generally horizontally into the "static" unit 1 and upward into gap 25 within the bulk head (Figure 2). This may be achieved by a pneumatic system, by mechanical linkages or by other means. The respective flanges of the doorways are then sealed together by virtue of seals 24 and 43 and a through path is created between units 1 and 28. It should be noted that the only parts of the respective assemblies which would have been contaminated are the external faces of doors 23 and 27 and parts of seals 41 and 42. In the method described, these faces are clamped together so that this contamination cannot escape into the isolated environments.

When patient transfer has been made then the reverse process to that shown in Figures 4a and 4b is done to seal the two units again. That is, the combined door assembly is moved downwards and then into the required position in the doorway, the inflatable seals are reinflated to provide sealing between the bottom of the flanges and the top of the doors and then the doors and the flanges are released through the reverse operation of clamp bolts 46 and 47. The two units may then be moved away from each other and their isolated environments have not been disturbed.

Claims (12)

1. Isolation apparatus, comprising an accommodation unit providing an isolated environment for an infected patient, or to protect a patient from external contamination, comprising a capsule providing a living space, filter means for providing filtered air into and/or out of the space; means for allowing the entry and exit of apparatus and waste from the space, without disturbing the integrity of the space; and means for enabling a patient to be manipulated or operated on by a person isolated from the patient.

2. Isolation apparatus as claimed in Claim 1, and further comprising a mobile unit for the transport of a patient, wherein cooperating means are provided on the accommodation unit and the mobile unit for linking the two to provide a through-passage for allowing the patient to move or be moved between the two without disturbing the integrity of the isolated environment, the mobile unit also providing an isolated environment.

3. Isolation apparatus as claimed in Claim 2, wherein the mobile unit comprises means for enabling the condition of a patient within the unit to be monitored.

4. Isolation apparatus as claimed in Claim 2 or Claim 3, wherein the mobile unit includes means for enabling a patient to be manipulated or operated on by a person or persons isolated from the patient.

5. Isolation apparatus as claimed in any preceding claim, wherein the manipulation means comprises one or more half suits and/or glove port arms.

6. Isolation apparatus as claimed in Claim 5, wherein one or more half suits are mounted on a shelf above an external recess enabling access to each suit.

7. Isolation apparatus as claimed in Claim 2, wherein respective doors are provided on the accommodation unit and mobile unit, the doors having means for cooperatively opening to enable patient transfer between the units.

8. Isolation apparatus as claimed in Claim 7, including means for clamping the doors together and removing them as a single assembly to a stowage position in one of the units to enable patient transfer between the units.

9. Isolation apparatus as claimed in Claim 8, wherein peripheral sealing means are provided which, when the doors are clamped together, prevent contamination on the respective adjacent surfaces of the doors from spreading.

10. Isolation apparatus as claimed in any of Claims 7 to 9, including inflatable sealing means which are inflated to seal the doorways and deflated to allow opening of the doors.

11. Isolation apparatus as claimed in Claim 2, wherein the portable unit comprises a flap means movable under the patient.

12. Isolation apparatus substantially as hereinbefore described, with reference to, and as illustrated by, any one of the accompanying drawings.