Design of Immersive Information Simulation of Negative Pressure Isolation Room for Covid-19 Infection Patients Using Virtual Reality

This research aims to provide knowledge about how to create and the need for air circulation in negative pressure isolation rooms. If practiced directly, it will require large costs because it requires costs for procuring space and equipment. By using virtual reality (VR) technology, this problem can be solved because VR can provide an immersive environment like being in the real world. VR users will be able to experience how the requirements and how to create a negative pressure isolation room are like how it feels in the real world. So this can provide information and training on how to make a negative pressure isolation room before making an actual isolation room. Activities using VR will reduce the risk of errors and training costs on how to make an isolation room even without the cost of equipment. The purpose of this research is to provide convenience for health educators and the government on how to make negative pressure isolation rooms and the need for air circulation. So, it is enough to use VR technology, so the information on how to use VR is enough to make the isolation room and its needs work without having to use the right tools. This research method is descriptive and quantitative which begins with a literature review followed by an analysis of the need for isolation rooms and VR immersive environments. The implementation and testing process results in VR technology being able to help understand negative pressure isolation rooms for health workers.


Introduction
Hospitals are a very important need for patients infected with the COVID-19 virus.The existence of a special COVID-19 hospital is currently only in a general hospital that is accommodated due to the limited number of hospital buildings so some are accommodated in unused buildings or athletes homestays which are used as special emergency hospitals for COVID-19.19 as at Wisma Atlet Senayan.The negative impact of the availability of public hospitals and emergency buildings used for COVID-19 patients is the problem of ventilation.Negative pressure isolation rooms are ideal for COVID-19 infection patients.However, due to the overwhelming demand for hospital beds, COVID-19 infection patients are placed in ordinary general patient rooms which will have an impact on the spread of the COVID-19 virus [1].
A negative pressure isolation room is an isolation room that has a lower air pressure than the air pressure outside the room.The negative air pressure room has the property to be able to withstand viruses or bacteria that exist or enter the room so that the virus or bacteria are locked and will not leave the room.The temperature in the negative pressure isolation room is conditioned around 24-26°C.Humidity for the Negative Class isolation room must reach a humidity of 30 -60% RH.If the humidity does not reach it is recommended to use a desiccant base dehumidifier unit to reduce high humidity [2].
Based on this background, this study aims to provide information about negative pressure isolation rooms using VR.So that the formulation of the problem is how to make a simulation room for a negative pressure isolation room using VR.The airflow for negative pressure isolation rooms according to the Technical Guidelines for Isolation Rooms, Directorate of Medical Support Services and Health Facilities in 2015 follows the pattern of airflow from the corridor to the anteroom then airflow from the anteroom to the isolation patient room then airflow from the isolation room to the toilet room.Figure 1 there is an anteroom, which is a room designed to provide an "air-lock" between infectious and non-infectious patients or general patients and other medical personnel on duty."Air-lock" is right next to the patient room.Air will flow from the "anteroom" to the isolation room.To visually explain how the negative pressure isolation room is designed and designed requires a visual understanding so that it is easily understood by the general public.This needs to be done to provide public knowledge on how to create a negative pressure isolation room to help ease the burden on the government and hospitals providing negative pressure isolation room facilities for patients infected with COVID-19.The simulation of designing an immersive negative pressure isolation room using virtual reality will make it easier for the community to independently or work together to make their own how to create a negative pressure isolation room for people affected by COVID-19 infection.Virtual reality is a technology created so that users can interact with the environment in cyberspace.Virtual reality can be used to simulate human activities to train humans before entering the real world.Meanwhile, immersion itself is a sensation that brings users into virtual reality technology by feeling like they are in a real, fictitious environment.

Negative Pressure Insulation Room
Based on the technical guidelines for isolation rooms from the Directorate of Medical Support Services and Health Facilities, Directorate General of Health Efforts, Ministry of Health in 2014, it is stated that there are requirements that must be met in creating a negative pressure isolation room.Several things that must be considered when creating a negative pressure isolation room are temperature and humidity.,air flow, air pressure, air ventilation, and air quality.Environment, routes of spread of infection, particulate contamination, and microbes.Likewise, the type of exhaust, anteroom space and ducting in the patient room must comply with the provisions.The ideal negative pressure isolation room consists of:

Toilet
Isolation room Anteroom Corridor • Corridor space as a circulation space for residents.
• Pressure monitor which functions to monitor air pressure so that it can help to see the stability of air pressure.• Ducting exhaust that serves to draw air from the room.
• Anteroom is a connecting room between the isolation room and the corridor.The purpose of the anteroom room is to air-lock so that the air from the infectious isolation room does not mix with the general non-infectious patient room or medical personnel.• The exhaust wall type is an air puller from the isolation patient room.
• Incoming air flows from the outside into the isolation room and inter room space.
If the air in the patient's room is recirculated, it is recommended that it pass through a HEPA filter before re-entering the circulation.The air entering the isolation room must go through a pre-filter to be filtered.This pre-filter process is important to filter the air to make it sterile so that the air around the room becomes sterile from viruses.After that, it enters the AC coil and enters the fan supply to circulate into the room.

Immersive
Immersion is exemplified such as diving into water where the feeling of being in water arises, feeling the water touching the skin and the environment in the water can be felt [3].Virtual reality (VR) is the interaction of humans with a simulated environment created using computational technology involving primarily computer graphics and artificial intelligence [4].References in this study include an immersive environment created using virtual reality technology to handle basic assistance to hospital visitors who have had a heart attack [5][6][7][8].Figure 2 explains that the first stage of the research is a literature study as a step to find out the theories regarding the meaning and requirements for making a negative pressure isolation room.Followed by looking for information about the immersive environment of negative pressure isolation rooms for the needs of making a virtual reality.The next step is to analyze the need for a negative pressure isolation room in terms of room requirements, air circulation, and supporting accessories for the isolation room.The analysis then continued with the need for 3D modeling of the need for an isolation room equipped with supporting accessories for a negative pressure isolation room to create a truly immersive environment.The next stage is to create 3D modeling using open-source 3D modeling applications such as a blender.After collecting all the 3D modeling assets, it is continued with the editing process using Unity 3D software.After the VR design is complete, it is continued with implementation and testing whether the results of the design are as expected.

Standard Precautions
The results of the implementation of the study obtained the results of room data for negative pressure isolation rooms in Hospital Indonesia.According to the technical guidelines for the isolation room from the Ministry of Health of the Republic of Indonesia, the Directorate General of Health Efforts Ministry of Health 2014 [9].In addition to standard precautions, there is also something to be aware of, namely the type of vigilance transmission that occurs as a result of contact, through droplets, through the air, through common vehicles such as (food, drink, medicine, tools), and vectors such as (flies, mice, mosquitoes).For transmission through the air, the design of the room is made of air passing between the patient and health workers as shown below.Figure 3 explains that there is air circulation outside which limits the patient and staff health so that airborne transmission can be avoided.Air outlets can be with windows, grille air, or exhaust fans.

Negative Pressure Insulation Room Requirements Data
The requirements set by the Ministry of Health regarding negative pressure isolation rooms for patients require the isolation of droplet cores through the air.Patients should be placed in negative pressure isolation rooms to reduce airborne disease transmission, suitable for COVID-19 patients.Below in Table 1 is data on room requirements that must be met.
Table 1.One of the requirements used for negative pressure isolation rooms [9].

No One of the Requirements Used 1
Isolation patient inpatient room with individual room module/ isolation room between 15 m² -20 m² per room per bed 2 There is a roar that the anteroom must be large enough to be cleaned and disinfected There is no specific size for the anteroom space 3 To maintain airflow and pressure, there are no windows that can open to keep airtight 5 Make sure the exhaust runs by the duct system so that the exhaust below becomes a constant pressure the most negative among the other rooms 6 Install an alarm to monitor the exhaust fan and air supply in case of damage and not running according to the desired standard

Analysis of Negative Pressure Insulation Room Needs
Based on the results of the analysis of the technical guidelines for the isolation room from the Ministry of Health of the Republic of Indonesia, the area obtained is a room with an isolation floor plan of 18 m² with a room height of 2.8 meters with a floor plan as follows.Figure 4 is a floor plan of a negative pressure isolation room consisting of a patient room, toilet and vestibule which has an area of 18 square meters which is also explained in the following table.Table 2 explains the details of the negative pressure room which consists of the patient room, anteroom and toilet room.These rooms are planned with dimensions that comply with standards [9].The room is accompanied by a corridor for circulation of hospital staff, patients and visitors.The isolation room consists of a patient room with a size of 3×3 meters, an anteroom room with a size of 1.5×2 meters, and a patient toilet with a size of 1.5×2 meters.The following is the design result of the negative pressure isolation room using the Blender application.The design is based on the manual [9] which is included with the air circulation installation.Figure 5 describes a negative pressure room in the form of immersive 3D visuals viewed from above using VR.In the 3D visual, there is a separate ducting pipe between the special AC supply pipe and the ducting pipe for the exhaust.The room in the VR immersive 3D image consists of the patient's bedroom, toilet, and anteroom.According to the Ministry of Health of the Republic of Indonesia, the standard in a negative pressure isolation room is -2.5 Pascal.Before entering the negative pressure isolation room, you must pass through the anteroom first and there are two system airlock doors to avoid a large loss of air pressure.The negative pressure isolation room has a remote exhaust fan that adjusts the room's negative pressure to meet the standards.The isolation room has a grill which functions to sweep the room so that it is not contaminated by viruses and bacteria so that the air in the isolation room always remains sterile.The workings of air circulation in the isolation room starting from the exhaust fan will sweep the air clean to enter the grille and then the air is distributed through a HEPA filter with a cleaning efficiency of 99%.Then the air is redistributed through the grille after the HEPA filter meets UV light.UV rays function to kill viruses or bacteria that may still be present or not filtered by the HEPA filter.
The impact of this research by visualizing a negative pressure isolation room using VR is the feel of being in an actual room even though it is actually just a virtual room.Another impact is to provide a real room simulation using VR so that it can reduce errors when a real isolation room is to be built.Virtual reality technology can be used as an alternative to first get to know the introduction of a negative pressure room before creating a real negative pressure room.

Summary
This research can be summarized that a negative pressure room can be described visually using VR with immersive 3D modeling so that it can be used as information to simulate what a negative pressure room actually looks like before the actual room is created.So it has the effect of reducing errors when making the actual negative pressure isolation room.In the future, this VR technology can be improved by using artificial intelligence, namely by adding an air temperature environment that suits the needs of a negative pressure isolation room.

Figure 1 .
Figure 1.Airflow pattern for negative pressure isolation room.
Quantitative descriptive was chosen as the research method for Designing Immersive Simulation Information in Negative Pressure Isolation Rooms for Covid-19 Infection Patients Using Virtual Reality.The stages of the research are described in full in Figure 2 below.The tools and materials for designing this research were Blender software, Unity 3d, and computer hardware equipped with Google Cardboard.

Table 2 .
Types of isolation room sizes.