Diseases that need a negative pressure room are airborne infectious diseases that spread via small particles that remain suspended in air for hours and can travel beyond close contact, requiring airborne precautions beyond standard droplet precautions. The classic disease that always requires a negative pressure room, also called airborne infection isolation room, is tuberculosis, because Mycobacterium tuberculosis can stay airborne for long periods. Other diseases that require negative pressure include measles, which is extremely contagious airborne, chickenpox and disseminated herpes zoster caused by varicella-zoster virus, and smallpox if it were to reappear. During outbreaks, diseases like SARS, MERS, and novel influenza strains with airborne potential are placed in negative pressure rooms, especially during aerosol-generating procedures. COVID-19 is now recognized as airborne, and CDC guidelines recommend negative pressure for COVID patients during aerosol-generating procedures like intubation, bronchoscopy, CPR, and nebulizer treatments, though routine COVID care may use regular rooms with good ventilation and N95 masks. The purpose of negative pressure is to keep air pressure lower inside than outside, so air flows in, not out, and exhaust is HEPA filtered, preventing contaminated air from escaping to hallways and infecting others. Hospitals have 6 to 12 air changes per hour in these rooms with continuous pressure monitoring.
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