HEALTHCARE DESIGN


of ‘outside views and using windows with low cills’. It also states that ‘internet access for the patient should be provided.’ Whether such references are enough to provoke a designer to properly respond to the design challenge of extended isolation is questioned. Is reference to windows and internet access enough and do these provisions make a difference to patients? The inadequacy of the response through guidance is further highlighted when one considers the guidance regarding area provision. The template schedule of accommodation in HBN 04:01: Adult in- patient facilities2


bedroom should be 19m2 an isolation bedroom should also be 19m2


suggests the size of a standard inpatient . It further states that the size of . Given the


unique nature of isolation, might one expect the size of the space to be different and possibly larger? The need for guidance to be refreshed to better recognise the unique challenges of a confined patient seems to be clear.


The author in an isolation bedroom.


neutropenia and the wait for neutrophils to return to safe levels creates an extended period – typically three to four weeks – where the patient is at risk of harmful infection as their immune function resets. During this time, it is critical that patients are protected against infection risks through air, water, people, food, and drink. A key feature of any isolation bedroom is the


mechanism to achieve a pressure differential to adjacent spaces and the provision of HEPA filtration to regulate the air quality within the room and eradicate potential airborne pathogens. The NHS provides design guidance on isolation bedrooms within Health Building Note (HBN) 04:01 Supplement 1: Special ventilated isolation facilities for patients in acute settings.1


The focus in the guidance


is maintaining safe air quality, and it states that a positive pressure differential of +5 Pa between bedroom and adjacent corridor must be achieved via the provision of an ‘airlock’ lobby arrangement. With the focus on technical engineering matters to maintain pressure differentials and ventilation rates, little is said in the guidance about countering the challenge faced by a confined occupant. The guidance does recognise the challenge in clause 4.19, where it says ‘…patients who are already vulnerable, but not necessarily severely physically incapacitated, may be confined to the room for sometimes several weeks and can experience long periods of boredom’. Clauses 4.20 and 4.25 in the HBN also make passing reference to the challenge with mention of the need for accommodation to be ‘stimulating and as comfortable as possible’ and also through the provision


What does current research literature say about these matters? The unique set of circumstances faced by confined patients – a combination of social isolation and arduous physical treatment – elevates their response to and decreases their tolerance of environmental factors such as noise, smell, and temperature, ultimately impacting their wellbeing. Useful research on these topics is provided by Hsu et al,3


environments. Also, Eusbio et al4


who has studied the impact of noise in patient provide useful research


findings about the impact of odour and the adequacy of ventilation systems in quickly releasing odour from within the patient room. Similarly, much has been written about the emotional


challenges of isolation. Documented accounts by Annibali et al5


describe the emotional experience of inpatients,


where extreme boredom, high anxiety, anger, despair, frustration, and even escape behaviour and suicide ideation are recorded. In some cases, this has resulted in symptoms of post-traumatic stress following discharge. Powerful quotations from participants in studies by Biagioli et al6


have also been recorded: “I was looking at the ceiling and counting the tiles. It’s


very bad to be confined in a room. You are sealed in there and you cannot move or talk with anyone. It was like being imprisoned with a strict sentence.” Similar research carried out by Coolbrandt et al7 and Digby et al8


refer to patient reported outcomes


and patients’ efforts to remain courageous throughout the process. Research exploring the difficulties faced by patients during isolation is extensive, therefore, but little is said about the design of the isolation room itself and how this may have impacted patient experience either positively or negatively.


With the focus on technical engineering matters to maintain pressure differentials and ventilation rates, little is said in the guidance about countering the challenge faced by a confined occupant.


46 Health Estate Journal September 2026


Introducing an auto-ethnographic aspect Combining my own patient and professional experience has prompted me to consider some questions which perhaps have not yet been posed in research. Questions which do not tend to be asked specifically about life within an isolation room include ‘what could the patient see, what could they do, or not do, in the room, how did sound travel within and into the room, how much connection with the outdoors did the room allow, could conditions within the room be controlled or adjusted’? These queries are relevant in almost any healthcare context but somehow have added significance in the context of strict confinement. There is clearly an opportunity to address a gap in the research context and to explore the need for new solutions and how these might be delivered. Going beyond a simple auto-ethnographic account of


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