Public Health Guidance for Community-Level Preparedness and Response to
Severe Acute Respiratory Syndrome (SARS) Version 2

Supplement D: Community Containment Measures, Including Non-Hospital
Isolation and Quarantine

Appendix D3

Guidelines for Evaluating Homes and Facilities for Isolation and
Quarantine

### I. Isolation Facilities

####### 

#######  **A. Home isolation**

> Ideally, persons who meet the criteria for a confirmed or probable
> case of SARS-CoV disease or a SARS RUI (see MMWR 52(49):1202-1206
> \[[www.cdc.gov/mmwr/preview/mmwrhtml/mm5249a2.htm](http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5249a2.htm)\])
> and who do not require hospitalization for medical reasons should be
> isolated in their homes. The home environment is less disruptive to
> the patient's routine than isolation in a hospital or other community
> setting.
>
> Any home being considered as an isolation setting should be evaluated
> by the patient's physician, health department official, or other
> appropriate person to verify its suitability. The assessment should
> center on the following minimum standards for home isolation of a SARS
> patient:

[Infrastructure]{.underline}

-   Functioning telephone

-   Electricity

-   Heat source

-   Potable water

-   Bathroom with commode and sink

-   Waste and sewage disposal (septic tank, community sewage line)

[Accommodations]{.underline}

-   Ability to provide a separate bedroom for the SARS patient

-   Accessible bathroom in the residence; if multiple bathrooms are
    available, one bathroom designated for use by the SARS patient

> [Resources for patient care and support]{.underline}

-   Primary caregiver who will remain in the residence and who is not at
    high risk for complications from SARS-CoV disease

-   Meal preparation

-   Laundry

-   Banking

-   Essential shopping

-   Social diversion (e.g., television, radio, internet access, reading
    materials)

-   Masks, tissues, hand hygiene products

#######  **B. Isolation in a community-based facility**

> When persons requiring isolation cannot be accommodated either at home
> or in a healthcare facility, a community-based facility for isolation
> will be required. The availability of a community-based facility will
> be particularly important during a large outbreak.
>
> Much of the work in identifying and evaluating potential sites for
> isolation should be conducted in advance of an outbreak as part of
> preparedness planning. Each jurisdiction should assemble a team to
> identify appropriate locations and resources for community SARS
> isolation facilities, establish procedures for activating them, and
> coordinate activities related to patient management. The team should
> consider the use of both existing and temporary structures. Options
> for existing structures include community health centers, nursing
> homes, apartments, schools, dormitories, and hotels. Options for
> temporary structures include trailers, barracks, tents, and "bubble
> systems." Considerations include the following:
>
> [Basic infrastructure requirements]{.underline}

-   Meets all local code requirements for a public facility

-   Functioning telephone system

-   Electricity

-   Heating, ventilating, and air conditioning (HVAC)

-   Potable water

-   Bathroom with commode and sink

-   Waste and sewage disposal (septic tank, community sewage line)

-   Multiple rooms for housing ill patients

[Ventilation capacity]{.underline}

-   Preferably, rooms with individual ventilation systems (e.g., room or
    window fan coil units that do not recirculate to other parts of the
    building)

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-   Alternatively, facility with a non-recirculating ventilation system
    that permits redirection of the air flow from corridors and staff
    areas into patient rooms.

> [Access considerations]{.underline}

-   Proximity to hospital

-   Parking space

-   Ease of access for delivery of food and medical and other supplies

-   Handicap accessibility

[Space requirements]{.underline}

-   Administrative offices

-   Offices/areas for clinical staff

-   Holding area for contaminated waste and laundry

-   Laundry facilities (on- or off-site)

-   Meal preparation (on- or off-site)

[Social support resources]{.underline}

-   Television and radio

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-   Reading materials

> To determine priorities among available facilities, consider these
> features:

-   Separate rooms for patients or areas amenable to isolation of
    patients with minimal construction

-   Single pass (non-recirculatiing) ventilation for each room or
    isolation area

-   Feasibility of modifying existing infrastructure as needed to meet
    AIIR standards (see Supplement I)

-   Feasibility of controlling access to the facility and to each room

-   Availability of potable water, bathroom, and shower facilities

-   Facilities for patient evaluation, treatment, and monitoring

-   Capacity for providing basic needs to patients

-   Rooms and corridors that are amenable to disinfection

-   Facilities for accommodating staff

-   Facilities for collecting, disinfecting, and disposing of infectious
    waste

-   Facilities for collecting and laundering infectious linens and
    clothing

-   Ease of access for delivery of patients and supplies

-   Legal/property considerations

> Additional considerations include:

-   Staffing and administrative support

-   Training

-   Ventilation and other engineering controls

-   Ability to support appropriate infection control measures

-   Availability of food services and supplies

-   Ability to provide an environment that supports the social and
    psychological well-being of patients

-   Security and access control

-   Ability to support appropriate medical care, including emergency
    procedures

-   Access to communication systems that allow for dependable
    communication within and outside the facility

-   Ability to adequately monitor the health status of facility staff

### II. Quarantine Facilities

A.  **Home quarantine**

> A person's residence is generally the preferred setting for
> quarantine. As with isolation, home quarantine is often least
> disruptive to a person's routine. Because persons who have been
> exposed to SARS-CoV may need to stay in quarantine for as long as 10
> days, it is important to ensure that the home environment meets the
> ongoing physical, mental, and medical needs of the individual. An
> evaluation of the home for its suitability for quarantine should be
> performed, ideally before the person is placed in quarantine. This
> evaluation may be performed on site by a health official or designee.
> However, from a practical standpoint, it may be more convenient to
> evaluate the residence through the administration of a questionnaire
> to the individual and/or the caregiver. Points to be considered in the
> evaluation include:

-   Availability of/access to educational materials about SARS and
    quarantine

-   Basic utilities (water, electricity, garbage collection, and heating
    or air-conditioning as appropriate)

-   Basic supplies (clothing, food, hand-hygiene supplies, laundry
    services)

-   Mechanism for addressing special needs (e.g., filling prescriptions)

-   Mechanism for communication, including telephone (for monitoring by
    health staff, reporting of symptoms, gaining access to support
    services, and communicating with family)

-   Accessibility to healthcare workers or ambulance personnel

-   Access to food and food preparation

-   Access to supplies such as thermometers, fever logs, phone numbers
    for reporting symptoms or accessing services, and emergency numbers
    (these can be supplied by health authorities if necessary)

-   Access to mental health and other psychological support services

B.  **Quarantine in a community-based facility**

> Although the home is generally the preferred setting for quarantine,
> alternative sites for quarantine may be necessary in certain
> situations. For example, persons who do not have a home situation
> suitable for this purpose or those who require quarantine away from
> home (e.g., during travel) will need to be housed in an alternative
> location. Because persons who have been exposed to SARS-CoV may
> require quarantine for as long as 10 days, it is important to ensure
> that the environment is conducive to meeting the ongoing physical,
> mental, and medical needs of the individual. Ideally, one or more
> community-based facilities that could be used for quarantine should be
> identified and evaluated as part of SARS preparedness planning. The
> evaluation should be performed on site by a public health official or
> designee. Additional considerations, beyond those listed above for
> home quarantine, include:

-   Separate rooms and bathrooms for each contact

-   Delivery systems for food and other needs

-   Staff to monitor contacts at least daily for fever and respiratory
    symptoms

-   Transportation for medical evaluation for person who develop
    symptoms

-   Mechanisms for communication, including telephone (for monitoring by
    health staff, reporting of symptoms, gaining access to support
    services, and communicating with family)

-   Services for removal of waste. (Note: No special precautions for
    removal of waste are required as long as persons remain
    asymptomatic)

For more information, visit
[www.cdc.gov/ncidod/sars](http://www.cdc.gov/ncidod/sars/) or call the
CDC public response hotline\
at (888) 246-2675 (English), (888) 246-2857 (Español), or (866) 874-2646
(TTY)